Cutaneous Signs of Systemic Disease Flashcards
Acanthosis nigricans clinical presentation
Hyperpigmented velvety plaques on posterior neck fold and axillae, with or without acrochordons (skin tags)
Acanthosis nigricans associated systemic disease
Diabetes, sign of insulin resistance
Acanthosis nigricans malignancies
Unusual locations or sudden onset, tripe palms, associated with gastric adenocarcinoma
Acanthosis nigricans histology
Hyperkeratosis, papillomatosis of spinous layer, hyper pigmentation of basal layer
Sign of Leser-Trelat associated disorders
Malignant acanthosis nigricans
Sign of Leser-Trelat histology
Same as seborrheic keratosis, string sign
Sign of Leser-Trelat histology
Same as seborrheic keratosis, string sign, horn cysts
Dermatitis herpetiformis clinical characteristics
Extremely itchy papules/vesicles, can be erosions from scratching so much, found on elbows, knees, back, buttocks
Dermatitis herpetiformis diagnosis
Biopsy and direct immunofluorescence necessary
Dermatitis herpetiformis age of onset
Young adulthood
Dermatitis herpetiformis age of onset
Young adulthood
Dermatitis herpetiformis histology
IgA found in dermal papillae, neutrophils recruited, subepidermal cleft filled with neutrophils
Dermatitis herpetiformis DIF
Granular deposits of IgA in the dermal papillae
Dermatitis herpetiformis treatment
Gluten-free diet, immunosuppression
Dermatitis herpetiformis increased risk
Hypothyroidism or intestinal lymphoma
Vitiligo clinical characteristics
Depigmented macules and patches, favors areas of trauma
Vitiligo cause
Autoimmune attack on melanocytes
Vitiligo increased risk
Increased risk of other autoimmune disorders
Vitiligo histology
Melanocytes lost, but no inflammation seen
Vitiligo treatment
Can heal on its own, or use topical anti-inflammatories, phototherapy, cosmetic camouflage
Systemic lupus erythematosus cause
Chronic inflammatory disease, autoimmune disorder
Systemic lupus erythematosus clinical characteristics
Pleural effusions, heart problems, lupus nephritis, arthritis, Raynaud’s phenomenon, butterfly rash
Systemic lupus erythematosus epidemiology
Most common in women, African American, Hispanic, and Asian populations, and young adulthood
Systemic lupus erythematosus histology
Dyskeratinized cells, lymphocytes around vessels, follicles, increased mucin within the dermis
Subacute cutaneous lupus erythematosus clinical characteristics
Scaly erythematous plaques that are annular/polycyclic and psoriasiform, favors photodistribution and flares with sun exposure
Subacute cutaneous lupus systemic involvement
Arthralgias, rare arthritis, Sjogren syndrome with dry mouth and eyes, possible presentation of systemic disease
Discoid lupus erythematosus clinical characteristics
Chronic form of cutaneous lupus, erythematous to violaceous scaly plaques, follicular plugging, hypo/hyperpigmentations, with or without scarring or atrophy, might occur with systemic lupus
Dermatomyositis clinical characteristics
Heliotrope (flower) rash on the eyelids, posterior neck, top of shoulders/chest/back (shawl sign), Gottrons papules on hands/elbows, erythamatous to dusky iliac patch-plaques with minimal scale
Dermatomyositis definition
Autoimmune inflammatory myopathy with characteristic skin finding
Dermatomyositis associated symptoms
Calcinosis cutis (calcification of skin in children), proximal muscle weakness, muscle fatigue, muscle tenderness, fever, malaise, possible involvement of lungs and heart
Dermatomyositis and malignancy
In adults, dermatomyositis can be associated with malignancy, typically ovarian, breast, melanoma, colon, non-Hodgkins lymphoma, or nasopharyngeal (especially in Asian populations)
Erythema nodosum clinical characteristics
Acute, tender, nodular eruption, typically on shins, inflammation in the fat (panniculitis), bilateral
Erythema nodosum cause
Hypersensitivity reaction
Erythema nodosum prognosis
Usually self-limited and will heal in weeks, rarely is chronic or recurrent
Erythema nodosum histology
Widened septae, inflammation deep into subcutis, septal panniculitis, loose granulomas, septal fibrosis
Erythema nodosum associations
Infections (such as strep, yersinia, salmonella, EBV, bartonella, etc), medications (oral contraceptives, sulfa antibiotics), pregnancy, systemic disease (sarcoidosis, IBD, Bechet disease)
Erythema nodosum treatment
Rest, ice, elevation, NSAIDs, treatment of underlying problem if indicated
The “other” erythemas
Erythema marginatum rheumatic fever, erythema multiforme (HSV), erythema ab igne (chronic heat), erythema migrans (Lyme disease)
Pyoderma gangrenosum clinical characteristics
Scarring, painful deep ulcers with “gun metal” rolled borders (necrotic), ulceration will have surrounding erythema, base is covered with granulation tissue and may extend to fat or muscle
Pyoderma gangrenosum cause
Uncommon neutrophilic disease process, typically in patients with systemic disease
Pyoderma gangrenosum histology
Ulceration evident, inflammation is increased underneath, if no ulcer is evident there is tunneling inflammation present
Pyoderma gangrenosum associated diseases
IBD, arthritis, HIV, malignancy, leukemia, drug reactions
Pyoderma gangrenosum classifications
Para-inflammatory (IBD triggered), paraneoplastic (malignancies), hematologic (anomaly in blood production), drug-induced (look for new Rx), idiopathic (no known cause)
Cutaneous T-cell lymphoma clinical characteristics
Chronic, non-responsive erythematous scaly plaques on the trunk or sun-protected areas, may progress to mushroom-like tumors
Cutaneous T-cell lymphoma cause
Proliferation of abnormal lymphocytes
Cutaneous T-cell lymphoma histology
Atypical epidermotropic lymphoid infiltrate, no spongiosis, hyper chromatic, large, atypical lymphocytes, these collect into microabsecesses in the epidermis
