Cutaneous manifestations systemic disease

Question 1

What can changes in skin be a sign of?

Answer 1

Endocrine disease
Internal malignancy 
Nutritional deficiency 
Systemic infection
Systemic inflammatory disease

Question 2

What skin changes are seen in hypothyroidism?

Answer 2

Dry skin

Question 3

What skin changes are seen in Graves disease

Answer 3

Thyroid dermopathy

Thyroid acropachy

Question 4

What skin changes are seen in diabetes?

Answer 4

Necrobiosis lipoidica

ulcers

Scleroderma (skin thickening)

granuloma annulare: delayed hypersensitivity reaction against dermis

Question 5

What skin changes in Cushing’s/steroid excess?

Answer 5

Striae

Gynaecomastia

Skin atrophy

Central adiposity

Question 6

What skin changes in Addison’s?

Answer 6

Hyperpigmentation

Acanthosis nigrans

Question 7

What skin changes in internal malignancies?

Answer 7

Necrolytic migratory erythema

Erythema gyratum repens

Acanthosis nigrans

Erythema annulare

Sweet’s syndrome

Sister Mary Joseph nodule

Question 8

What is necrolytic migratory erythema?

Answer 8

Erythematous scaly plaques on acral, genital areas, flexures

Associated with islet cell tumour of pancreas (glucagonoma)

May be associated with hyperglycaemia, diarrhoea, weight loss, glossitis

Question 9

What is erythema gyratum repens?

Answer 9

Reddened concentric bands with whorled woodgrain patters

Associated with lung cancer (also breast, GI, cervical)

May be itch and eosinophillia

Question 10

What is acanthosis nigrans?

Answer 10

Smooth, velvet, hyperkeratoic pigmented plaques in groin, axilla, neck

Type 1 = adenocarcinoma e.g. of GI tract (gastric)

Type 2 = familial, AD, no malignancy

Type 3 = obesity and insulin resistance

Question 11

What symptoms from B6 deficiency? (pyroxidone)

Answer 11

Dermatitis

Question 12

What symptoms from B12 deficiency?

Answer 12

Angular chelitis, subacute combined degeneration of cord, psychiatric, anaemia…

Question 13

What symptoms from B3 deficiency? (niacin)

Answer 13

Pellagra: dementia, diarrhoea, dermatitis

Question 14

What symptoms from zinc deficiency?

Answer 14

Acrodermatitis enteropathica: pustules, bullae, scaling, in groin and perioral

Question 15

What are causes of zinc deficiency?

Answer 15

Infants getting breast fed - no zinc

Adults getting TPN without zinc, alcoholism, IBD, bowel surgery

Question 16

What are symptoms of vitamin C deficiency (scurvy)

Answer 16

Punctuate purpura and bruising, corkscrew curly hairs, dry skin, non-healing wounds, inflamed gums

Question 17

What is erythema nodosum?

Answer 17

Red nodules on anterior shins due to inflammation of SC fat

Question 18

What are causes of erythema nodosum?

Answer 18

Strep throat 
pregnancy
Sarcoidosis
IBD
Drugs e.g. sulfonamide, NSAIDs, OCP, amoxicillin

Question 19

What is pyoderma gangrenosum?

Answer 19

Rapidly enlarging full thickness painful ulcer

Question 20

What conditions are associated with pyoderma gangrenosum?

Answer 20

IBD
RA
myeloma
leukaemia

Question 21

What skin changes in coeliac

Answer 21

Dermatitis herpetiformus