Cutaneous Manifestation of Systemic Disease

Question 1

What are the cutaneous features of diabetes?

Answer 1

1. Flexural candidiasis

2. Acanthosis nigricans

Question 2

What is the key cutaneous feature of coeliac disease?

Answer 2

Dermatitis herpetiformis - itchy blisters on elbows/shoulders

Question 3

What are the cutaneous features of IBD?

Answer 3

1. Erythema nodosum

2. Pyoderma gangrenosum

Question 4

What are the cutaneous features of SLE?

Answer 4

1. Facial butterfly rash
2. Photosensitivity
3. Diffuse alopecia

Question 5

What is the key cutaneous feature of systemic sclerosis?

Answer 5

Scleroderma

Question 6

What is the key cutaneous feature of sarcoidosis?

Answer 6

Lupus pernio

Question 7

What is this a presentation of?

Chronic sarcoid plaques on nose, ears, lips, and cheeks +/- permanent scarring.

Answer 7

Lupus pernio - sarcoidosis

Question 8

What is this a presentation of?
Target lesions where the centre is paler, 2cm in size and raised, initially on back of hands/feet before spreading to torso. Mild pruritus.

Answer 8

Erythema multiforme

Question 9

What is the cause of erythema multiforme?

Answer 9

Hypersensitivity reaction (commonly triggered by infections)

Question 10

What are the causes of the hypersensitivity reaction which causes erythema multiforme?

Answer 10

1. HSV (most common)
2. Idiopathic
3. Mycoplasma, streptococcus
4. Drugs
5. Connective tissue disease
6. Sarcoidosis
7. Malignancy

Question 11

What is this a presentation of?

‘Bull’s eye’ papule.

Answer 11

Erythema migrans (Lyme disease)

Question 12

What is the key skin feature of Lyme disease (diagnostic)?

Answer 12

Erythema migrans

Question 13

What causes erythema migrans and how is it treated?

Answer 13

1. Lyme disease

2. Doxycycline

Question 14

What is erythema nodosum?

Answer 14

Inflammation of the subcutaneous fat

Question 15

What is this a presentation of?

Tender, erythematous, nodular lesions over shins. Usually resolves in 6 weeks, heals without scarring.

Answer 15

Erythema nodosum

Question 16

What are the causes of erythema nodosum?

Answer 16

1. Streptococcus, TB
2. Sarcoidosis, IBD
3. Malignancy/lymphoma
4. Penicillin, COCP
5. Pregnancy

Question 17

What is this a presentation of?

Non-blanching vague pink-blue mottling.

Answer 17

Livedo reticularis

Question 18

What is the cause of continuous livedo reticularis?

Answer 18

Physiological (normal), disappears when warm.

Question 19

What are the causes of discontinuous livedo reticularis?

Answer 19

1. Connective tissue disease
2. Vasculitis
3. Hyperviscosity states

Question 20

What is this a presentation of?
40-50 years old, pustules become ulcers that progressively grow. Lower limbs, initially small red papule that becomes a deep, red, necrotic ulcer.

Answer 20

Pyoderma gangrenosum

Question 21

What are the causes of pyoderma gangrenosum?

Answer 21

1. Idiopathic in 50%
2. IBD/RA/SLE
3. Myeloproliferative disorders/leukaemia/lymphomas

Question 22

How is pyoderma gangrenosum treated?

Answer 22

PO steroids

Question 23

What is this a presentation of?

Dry, dark patches of skin appearing in armpits/neck/groin.

Answer 23

Acanthosis nigricans

Question 24

What are the causes of acanthosis nigricans?

Answer 24

1. Obesity, insulin resistance

2. Think malignancy (gastric adenocarcinoma in the thin and young)

Question 25

What is this a presentation of?
Heliotrope eyelids (red/purple), Gottron's papules.

Answer 25

Dermatomyositis

Question 26

What conditions is dermatomyositis associated with?

Answer 26

Breast, ovary, lung, prostate, and colorectal cancer.