Cutaneous Manifestations of Systemic Disease Flashcards
What is the difference between a dermal and epidermal rash?
Epidermal - wet/weepy/flaky/dry, this is the majority of rashes
Dermal - skin feels smooth but elevated, due to granulomas or proteins or vasculitis under the skin
What are the 4 types of epidermal rash?
Eczema - flaky, scaly, dry skin
Psoriasis - thickened skin, flaky, red
Lichenoid - purplish rash, lymphocytes eating skin
Vesiculobullous - blistering
The latter two can be autoimmune
What are the 2 types of dermal rash?
Vasculopathic - urticaria, vasculitis
Granulomatous - brown/purple colour, raised
What are the skin manifestations of Cushings?
Stria, acne, bruising
What are the skin manifestations of Addisons?
Hyperpigmentation (in buccal mucosa and palmar crease)
What are the skin manifestations of hypothyroidism?
Periorbital oedema, loss of outer third of eyebrow, dryness
What are the skin manifestations of hyperthyroid?
Acropachy, fat infiltration around eye, pretibial myxoedema
What is porphyria?
- Skin sensitivity
- Hirsutism
- Blood filled blisters and scarring
- Milia
These are due to build up of porphyrins in the skin.
It is usually a sign of liver disease as the enzyme that breaks this compound down is produced in the liver.
Why do you get milia?
Severe blistering from porphyria that has ripped through the sweat glands, causing formation of hard keratin white cysts
What are the skin manifestations of hyperlipidemia?
Xanthelasma Tendon xanthomas Eruptive xanthomas (high triglycerides)
What are the skin manifestations of diabetes?
Acanthosis nigricans - due to IGF
Necrobiosis lipoidica - granulamotous skin infiltration
What conditions cause pyoderma gangrenosum?
Leukemia, myeloma, IBD, vasculitis
pustular, sterile necrotic blue black
What is Sweets syndrome?
Red rashers when systemically unwell, marker of haematological malignancy
What is cutaneous T cell lymphoma?
Lymphoma presenting as patchy plaques (looks like psoriasis) - can be used for staging.
Treat with phototherapy but this doesn’t alter prognosis just appearance, as the cancer is pushed back into the body
What is the name of a rash due to a virus?
Exanthem
What conditions cause morbilliform rashes?
Measles/rubella
What conditions causes vesicular rashes?
Chickenpox/shingles
What are the skin manifestations of syphillis?
- Primary painless chancre
- Copper brown rash on palms/soles and snail track ulcer
- Gummata
What are the skin manifestations of Lyme disease?
Borellia spp.
- Ring rash ‘erythema migrans’
- Severe neuro/joint/cardio problems
What rashes are associated with IBD?
Erythema nodosum
Pyoderma gangrenosum
What is pathergy?
Exaggerated skin injury from a minor trauma
What are the skin manifestations of sarcoidosis?
Granulomatous inflammation
Lupus pernia - facial rash
What are the skin manifestations of SLE?
Malar, photosensitive rash
Discoid rash
Nail fold changes
Livedo reticularis
What are the skin manifestations of RA?
Nodules
Nailfold infarcts
Vasculitic leg ulcers
What are the skin manifestations of systemic sclerosis?
Skin thinking and claw hands ‘sclerodactly’
Raynauds
Telangectasia
Nailfold changes
What are some paraneoplastic skin manifestations?
Acanthosis nigricans
Dermatomyositis
What are the skin manifestations of scurvy?
Ruptured haemorrhages around the skin follicles and corkscrew hairs
Bleeding gums
What is pellagra?
Dermatitis, diarrhoea and dementia, due to vitamin B3 deficiency
Patients have very bad photosensitive rashes
What is pseudoxanthoma elasticum?
Mutation of elastin fibres causing skin that looks like a plucked chicken
Angiod streaks in the back of the eyes
Arterial aneurysms
What are the skin manifestations of neurofibromatosis type 1?
Cafe au lait spots
Neurofibromas
Lisch nodules
What are the skin manifestations of neurofibromatosis type 2?
Cafe au lait spots
Schwannomas
Juvenile cataracts
How is pyoderma gangrenosum treated?
Give steroids
In which disease do you see blue-red nodular lesions on the nose and hands?
Sarcoidosis - this is a description of lupus pernio
In which disease do you see ash-leaf hypopigmentation?
Tuberous sclerosis
What do you get in vitamin B1 deficiency?
Beriberi - neuropathy and cardiomyopathy
What do you get in vitamin B6 deficiency?
Neuropathy and eruptions of dermatitis
In which condition do you get bleeding gums, easy bruising and frank purpura?
Scurvy from vitamin C deficiency
