Clinical Dermatology Flashcards
Compare the skin lesions seen in Dermatomyositis and Lupus
Dermatomyositis:
- Involves the knuckles (Gottron’s papules)
- More epidermal atrophy
- Heliotrope Rash
- Shawl sign
- Very itchy
Lupus:
- Spares the knuckles
- Malar rash sparing the nasolabial folds
- Discoid lesions are scarred, depressed plaques with a hypopigmented center
- Scarring alopecia
Dermatomyositis
What may be associated with increased risk of malignancy?
P155/p140 (TIF-y)
What are Gottron’s papules?
Violaceous erythema overlaying the knuckles
May also be on elbows or tendons
Seen in dermatomyositis
What is a heliotrope rash?
Violaceous rash around eyes (upper lid common)
Seen in dermatomyositis
What is a shawl sign?
Lavender erythema in a shawl pattern on back, may be surrounded by flagellate erythema
Seen in dermatomyositis
Describe the Malar rash of Lupus
Comes across bridge of nose and both cheeks, sparing the nasolabial folds
Can be somewhat scaly
Transient
Most highly associated with SLE
Someone with a malar rash sees you in the office. They should NOT leave without doing a…
Urinalysis
Worried about underlying kidney disease in lupus
Describe the lesions in Discoid lupus
Scarring depressed plaques
Hyperpigmented rim and hypopigmented center
Commonly located on head, neck, ears
causes SCARRING ALOPECIA on the scalp (hair will NOT grow back in that area)
A patient comes in whose skin demonstrates tenting. You are worried about what disease?
Scleroderma = systemic sclerosis
Symptoms of CREST Syndrome
Calcinosis Cutis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias
CREST Syndrome is associated with what antibody?
Anti-centromere antibody
What is Lichen Sclerosis? What does it look like and where might it appear?
White-atrophic appearing plaques
Cigarette paper scale, most commonly in female genital area
Sarcoidosis
- Histology
- Serology
- Skin path
Non caseating granulomas, often in areas of scars or trauma
Elevated serum ACE
Erythema nodosum (ill-defined tender plaques on ant legs)
Necrobiosis Lipoidica
Appearance and cause
Yellow-pink atrophic plaques on pretibia
Caused by diabetes, even if well controlled
Pyoderma Gangrenosum
Cause
Autoinflammatory disease causing ulcers in the skin
Very painful
NOT infected
Associated with underlying systemic disease (Crohn’s, arthritis, heme disorders)
Pyoderma Gangrenosum
Appearance
Often appears infected with yellow necrotic debris in center
Overlaying ledge of blue/gray skin
Calciphylaxis
- Cause
- Appearance
Retiform (stellate) shape due to relation to blood supply
Calcium deposition in the vessels, causes ischemia in tissues perfused by that vessel
High mortality, often associated with end stage renal disease
Purpura
How do you know a lesion is purpura?
It doesn’t blanch with pressure!
Purpura
Palpable vs Non-palpable
What does it tell you?
Palpable – think inflammation, often due to vasculitis
Non-palpable– vasculopathy, thromboembolic cause
Leukocytoclastic Vasculitis
Caused by…
Type III HSR (immune complex)
PMN infiltrate around superficial vessels, leaks blood into skin
Assoc with infection, connective tissue disease, meds
Leukocytoclastic Vasculitis
Appearance
Small pruritic papules
Venous Stasis Dermatitis
Appearance
Chronic edema and leaking of blood into skin causes orange-brown color (hemosiderin deposition)
Bilateral
Acutely, may cause inflammation from skin stretching and weep fluid
Venous ulcers are commonly seen where?
Ankle (side, near the malleolus)
AV malformation
Locations, what is it?
Commonly on face
Congenital vascular anomaly that may flare up in puberty
Coxsackie Virus
Where are the lesions seen?
Hand-foot-mouth disease
Vesicles on plams and soles
Parvovirus B19
Appearance of skin
Slapped cheeks virus
Reticulated lacy erythematous eruption on extremities
Parvovirus B19
Fetal infection could cause…
Anemia
Hydrops fetalis
Death
Urticaria = Wheals
Appearance
Pruritic edematous non-scaly plaques
Transient
Orange skin appearance
Urticaria = Wheals
Cause
Allergy Autoimmune Drugs Infection Idiopathic
Urticaria Pigmentosa
What is seen in histology? Gross?
Red-brown papules
MAST CELL disease with tons of mast cells in the dermis
Allergic Contact Dermatitis
Describe the lesion pattern. What might be the cause?
“Outside-in” pattern
Cause by….ABX (topical), topical cleansers, nickel, plants
Morbilliform Rash
Caused by….
Drug or a virus
Starts 7-10 days after initiation of the drug
Morbilliform Rash
Location and Appearance
Common in skin folds and on torso
Many pink papules coalescing
DRESS Syndrome
What is it? How is it different than morbilliform?
Drug
Reaction
Eosinophilia
Systemic Symptoms
Morbilliform rash doesn’t make people feel sick. DRESS Syndrome causes peripheral eosinophilia and systemic symptoms
DRESS Syndrome
Treatment
Stop the offending drug and avoid it from that point forward
DRESS Syndrome
Common culprits
Anticonvulsants
Allopurinol
ABC
Sulfonamides
Erythema Multiforme
Cause
Appearance
Targetoid lesions
Most commonly caused by infection (HSV)
Steven Johnsons Syndrome
Cause
Location
Cause: drug
Atypical target lesions often in trunk and face
Severe mucus membrane involvement
Less than 10% detachment
TEN
Cause
Lesions
How much of body involved?
Cause: drug
Lesions are painful and epidermolytic
Over 30% of skin involved
SPF stands for…? What does it refer to?
Sunlight Protection factor
Refers to amount of protection against UVA-B light
