Cutaneous Manifestations of Systemic Disease Flashcards
jaundice
liver disease
scleral yellowing
diffuse yellowness of the skin
gynecomastia
liver disease
arises because of relatively higher levels of circulating estrogen
usually the liver clears the estrogen but when the liver is damaged that doesn’t happen
Kaput Medusa
liver disease
increased portal pressure and results in engorged periorbital veins
spider angiomas
liver disease
can happen de novo, ut in liver disease, patients have high levels of estrogen which leads to broken blood vessels with podlike extensions
in patients with severe disease, this spreads throughout the body
lichen planus
liver disease
viral hepatitis serology because of association
prototypical skin lesion is purple, puritic, polygona, papules, placques
can have oral mucosal lesions in some cases
some reticulations is common, sometimes can be the sole manifestation
overgrowth of nail plate, typical
hemochromatosis
liver disease
patients develop hyperpigmentation from disease causing increased melanin deposits
autosomal dominant
diabetes, arthritis, iron overload (primary process)
Kayser-Fleisher Ring
Wilson’s Disease (liver disease)
autosomal recessive, copper metabolism defect
cryoglobulinemia
Hep C (liver disease)
variety of causes - acquired condition of autoantibodies
these cause vasculitis, which has many different manifestations
ischemic changes in severe cases
puritis
renal disease
itching of the skin, no primary lesions - lesions here are self-inflicted from scratching
theory is that kidney filters out itch-causing agents, so when they fail this happens
dialysis will improve itch
calciphylaxis
renal disease
end result of derangement in calcium and phosphate metabolism
from calcium that has precipitated out
patients have pain, get septic and die quickly without proper management
uremic frost
renal disease
result of urea and uric acid precipitating once the sweat dries on top of the skin
cyanosis
pulmonary disease
blue lips and reddish-blue hands, especially tips of fingers
clubbing
pulmonary disease
long-standing pulmonary disease
Schamroth’s windis is missing in clubbing
can be idiopathic or familial
lupus pernio
sarcoidosis (pulmonary disease)
sarcoidal involvement of the skin around the nose
priminent papular placque
harbinger that a patient has sarcoidosis
need biopsy to prove
Lofgren’s Syndrome
sarcoidosis (pulmonary disease)
associated with hilar adenopathy that is subclinical and bilateral
peniculitis - inflammation of subcutaneous fat
typically involving anterior and peritubular areas of the leg
not sarcoidosis involving the skin
good prognosis
causes of erythema nodosum
Behcet disease
Estrogens
Drugs
Recent infection (pneumococcus)
Enteropathies (IBD)
Sarcoid
Tuberculosis
lupus valgaris
cutaneous TB (pulmonary disease)
dissemination of TB onto the skin from the lungs
can be reactivation or reinfection
erythema induratum
pulmonary disease
nodular vasculitis - reactive panniculitis from past or present TB infection
typically posterior calf or side
indication of tuberculosis in the lungs
scrofuloderma
lung disease
direct extension of TB lymphadenitis
biopsy for diagnosis
Osler’s nodes
cardiovascular disease
sign of dissemination of bacterial lesions in cardiac valves into the skin
painful, palpable red lesions usually on fingers/toes
they are caused by immune complexes
Janeway’s Lesions
cardiovascular disease
non-painful, macular lesions, usually onpalms/soles
they are caused by septic emboli, more common in Staph aureus endocarditis
splinter hemorrhages
endocarditis (cardiovascular disease)
small clots in the vessels of the nail plate
can happen randomly as well
eruptive xanthoma
cardiovascular disease
lipid metabolism disorder, can happen anywhere
xanthomas
cardiovascular disease
tendinous xanthomas, nothing morthan cholesterol or lipid deposition in the skin
can be palmar, tendinous, or tuberous
xanthelasma
cardiovascular disease/billiary cirrhosis
yellowish bumps around eyelids
normal lipids, cholesterol from skin cells
usually, not lipid metabolism disorder but can be associated with high LDL or cholesterol
cholesterol emboli
cardiovascular disease
can happen spontaneously
claudication symptoms of the lower extremities
cholesterol emboli can cuase dots in the feet
usually resolves spontaneously
can also happen after an angioplasty
stasis dermatitis
venous disease (cardiovascular disease)
poor venous blood flow, inability of the veins to squeeze blood back to the heart
leakage of RBCs back into the skin
with enough inflammation, can get skin breakdown and ulceration
brown discoloration because of extravasation of RBCs into the skin - permanent discoloration
moon facies
adrenal/pituitary disease
caused by increase in relative amounts of cortisol - often due to pituitary tumors
also exogenous corticosteroids
buffalo hump
adrenal/pituitary disease
lipodystrophy changes where fat normally distributes
striae
adrenal/pituitary disease
happens in overweight or pregnant individuals
acanthosis nigricans
adrenal/pituitary disease
diabetes mellitus
insulin insensitivity from hypercortisolism
velvety appearance, due to high levels of insulin
hirsutism
pituitary/adrenal disease
women with male pattern of excess hair growth
can be triggered by increase in cortisol
hypercortisolism and hyperandrogenism from adrenal
acne
pituitary/adrenal disease
hypercortisolism and hyperadnrogenism from adrenal
often accompanied with puberty
diabetic ulcer
diabetes mellitus
poorly controlled diabetes, peripheral neuropathy
trauma and then skin breakdown
can lead to osteomyelitis and bone infection
need to be debrided
diabetic dermopathy
rare, skin becomes more fragile
fine blisters on lower legs
slight trauma may play a role
insulin lipodystrophy
diabetes mellitus
for patients that get multiple insulin injections, can get atrophy of skin
necrobiosis lipoidica
diabetes mellitus
granulomatous skin disorder
typical appearance is orangish yellow scales
almost as if you can see through the top of the skin
idiopathic, by far more common in diabetes
biopsy dependent
granuloma annulare
diabetes mellitus
can occur anywhere on the body
annular appearance with heaped up border
know that this is a common granulomatous skin disorder
necrolytic migratory erythema
(glucagonoma) diabetes mellitus
excessive glucagon production and high blood sugars
non-specific dermatosis usually around groin and mouth
requires diagnosis of islet cell tumors
Grave’s Disease
anautoimmune disease
most commonly affects the thyroid, frequently causing it to enlarge to twice its size or more (goiter), become overactive, with related hyperthyroid symptoms
exophthalmos
Grave’s Disease
hypertrophy of subcutaneous tissues and bony structures
can lead to proptosis (inability to move eyes)
pretibial myxedema
Grave’s Disease
autoantibodies stimulate thyroid production and leads to plaques
more severe forms can lead to hypertrophy and thickening of skin
goiter
hypothyroidism
in patients who can’t produce enough thyroid hormone, and the gland keeps growing to attempt to do so
thin hair
hypothyroidism
if left untreated
generalized myxedema
hypothyroidism
coarse facial features, edema, ptosis
comatose, bradycardic, hypotensive - medical emergency!
vertiligo
hypothyroidism
destruction of melanocytes
very commonly associated with endocrine disorders
alopecia areata
hypothyroidism
discrete form of nonscarring hair loss
get it in the head and arms
associated with thyroid disease
cutaneous Crohn’s Disease
GI disease
rare, disseminate to the skin
requires biopsy
pyosomatitis vegetans
GI disease
reactive process in patients with Chron’s or Ulcerative colitis
micropustules and vesicles
skin breakdown and ulceration of lips and oral mucosa
pyoderma gangrenosum
GI disease
in association with Chron’s and ulcerative colitis
start off as a little pimple and then expands over days or months
needs to be treated medically, not with surgery
ulceration with very heaped up border
sometimes a lot more subtly - Dx of exclusion
causes of pyoderma gangrenosum
Chron’s ulcerative colitis
Hep C
Rheumatoid arthritis
Hematologic malignancy (dorsal hands/wrists)
idiopathic
dermatitis herpetiformis
celiac disease (GI disease)
most people with celiac don’t have this, but most patients with this have celiac
acrodermatitis enteropathica
zinc deficiency
can be seen in kids and adults
if supplemented, goes away in a few days
scurvy
vitamin C deficiency
gingival bleeding, perifollicular hemorrhage and corckscrew hairs
pellagra
niacin deficiency
diarrhea, dermatitis, dementia, death
usually in alcoholics
circular distribution
Bitot’s spots
vitamin A deficiency
debris of conjunctival tissue
phrynoderma
vitamin A deficiency
toad’s skin
plugging of follicles around elbows and thighs
Cowden syndrome
autosomal dominant
PTEN gene
breast, endometrial, thyroid, kidney, colorectal cancers
facial trichilemmomas
Hereditary non-polyposis colorectal cancer (Lynch syndrome)
autosomal dominant
DNA mismatch repair defects
colorectal, endometrial, ovarian, gastric, urinary tract
sebaceous adenoma/carcinoma
Paget’s disease
mammary lesions - breast cancer
extra-mammary lesions - underlying geritourinary cancer
different from the bone
Sweet’s syndrome
acute febril neutrophilic dermatosis
typically seen in setting of fever, neutrophilia, acute leukemia, URI, G-CSF, or idiotpathic
high fever and development of edematous papules and plaques
sign of Leser-Trelat
GI malignancy
more likely to be GI cancer if develops quickly over a short time
acquired ichthyosis, keratoderma
Hodgkin disease
commonly seen, not associated with anything underlying
may be seen in a patient with Hodgkin’s disease
erythema gyratum repens
lung, esophageal cancer
wood grain appearance in the skin with diffuse plaques
lung and esophageal cancer suggested
What are the skin findings of liver disease?
jaundice
hynecomastia
dilated abdominal wll veins (Kaput Medusa)
spide rangiomas
lichen planus
hemochromatosis
Wilson’s disease
cryoglobulinemia
What are the skin findings of reneal disease?
puritis
calciphylaxis
uremic frost
What are the skin findings of pulmonary disease?
cyanosis
clubbing
yellow nails
sarcoidosis findings (lupus pernio and Lofgren’s syndrome)
TB findings (lupus vulgaris, erythema induratum, scrofuloderma)
What are skin findings of sarcoidosis?
lupus pernio
Logren’s syndrome (erythema nodosum and hilar adenopathy)
What are skin findings of tuberculosis?
lupus vulgaris (cutaneous dissemination of TB)
erythema induratum (cutaneous reaction to TB)
scrofuloderma
What are skin findings of cardiovascular/peripheral vascular disease?
endocarditis findings
xanthomas
xanthelasma
cholesterol emboli
stasis dermatitis
What are skin findings of endocarditis?
Janeway lesions (non-tender)
Osler nodes (tender)
splinter hemorrhages
What are skin findings of adrenal/pituitary disorder?
moon facies
buffalo hump
striae
acanthosis nigricans
hirsutism
acne
What are skin findings of diabetes mellitus?
acanthosis nigricans
diabetic ulcer
diabetic dermopathy
insulin lipodystrophy
necrobiosis lipoidica
granuloma annulare
necrolytic migratory erythema (glucagonoma)
What are the skin findings of thyroid disease?
1) Grave’s Disease - exophthalmos, peritibial myxedema
2) hypothyroidism - goiter, brittle/thin hair, generalized myxedema
3) skin diseases - vitiligo, alopecia areata
What are skin findings associated with gastrointestinal disease?
cutaneous Chron’s disease
pyostomatitis vegetans
pyoderma gangrenosum
dermatitis herpetiformis
What are skin findings associated with nutritional disease?
acrodermatitis enteropathica (zinc deficiency)
scurvy (ascorbic acid deficiency)
pellagra (niacin deficiency)
phyrnoderma (vitamin A deficiency)
What are skin findings associated with cancer, cancer syndromes, and paraneoplastic diseases?
Cowden’s
Lynch/Muir-Torre syndrome
Paget’s disease
Sweet’s syndrome
Sign of Leser-Trelat (erputive sseborrheic keratoses
acquired ichthyosis/keratoderma
erythema gyratum repens
cutaneous metastases of hematologic and solid organ malignancies
