Cutaneous Signs of Systemic Disease

Question 1

Acanthosis nigricans clinical presentation

Answer 1

Hyperpigmented velvety plaques on posterior neck fold and axillae, with or without acrochordons (skin tags)

Question 2

Acanthosis nigricans associated systemic disease

Answer 2

Diabetes, sign of insulin resistance

Question 3

Acanthosis nigricans malignancies

Answer 3

Unusual locations or sudden onset, tripe palms, associated with gastric adenocarcinoma

Question 4

Acanthosis nigricans histology

Answer 4

Hyperkeratosis, papillomatosis of spinous layer, hyper pigmentation of basal layer

Question 5

Sign of Leser-Trelat associated disorders

Answer 5

Malignant acanthosis nigricans

Question 6

Sign of Leser-Trelat histology

Answer 6

Same as seborrheic keratosis, string sign

Question 7

Sign of Leser-Trelat histology

Answer 7

Same as seborrheic keratosis, string sign, horn cysts

Question 8

Dermatitis herpetiformis clinical characteristics

Answer 8

Extremely itchy papules/vesicles, can be erosions from scratching so much, found on elbows, knees, back, buttocks

Question 9

Dermatitis herpetiformis diagnosis

Answer 9

Biopsy and direct immunofluorescence necessary

Question 10

Dermatitis herpetiformis age of onset

Answer 10

Young adulthood

Question 11

Dermatitis herpetiformis age of onset

Answer 11

Young adulthood

Question 12

Dermatitis herpetiformis histology

Answer 12

IgA found in dermal papillae, neutrophils recruited, subepidermal cleft filled with neutrophils

Question 13

Dermatitis herpetiformis DIF

Answer 13

Granular deposits of IgA in the dermal papillae

Question 14

Dermatitis herpetiformis treatment

Answer 14

Gluten-free diet, immunosuppression

Question 15

Dermatitis herpetiformis increased risk

Answer 15

Hypothyroidism or intestinal lymphoma

Question 16

Vitiligo clinical characteristics

Answer 16

Depigmented macules and patches, favors areas of trauma

Question 17

Vitiligo cause

Answer 17

Autoimmune attack on melanocytes

Question 18

Vitiligo increased risk

Answer 18

Increased risk of other autoimmune disorders

Question 19

Vitiligo histology

Answer 19

Melanocytes lost, but no inflammation seen

Question 20

Vitiligo treatment

Answer 20

Can heal on its own, or use topical anti-inflammatories, phototherapy, cosmetic camouflage

Question 21

Systemic lupus erythematosus cause

Answer 21

Chronic inflammatory disease, autoimmune disorder

Question 22

Systemic lupus erythematosus clinical characteristics

Answer 22

Pleural effusions, heart problems, lupus nephritis, arthritis, Raynaud’s phenomenon, butterfly rash

Question 23

Systemic lupus erythematosus epidemiology

Answer 23

Most common in women, African American, Hispanic, and Asian populations, and young adulthood

Question 24

Systemic lupus erythematosus histology

Answer 24

Dyskeratinized cells, lymphocytes around vessels, follicles, increased mucin within the dermis

Question 25

Subacute cutaneous lupus erythematosus clinical characteristics

Answer 25

Scaly erythematous plaques that are annular/polycyclic and psoriasiform, favors photodistribution and flares with sun exposure

Question 26

Subacute cutaneous lupus systemic involvement

Answer 26

Arthralgias, rare arthritis, Sjogren syndrome with dry mouth and eyes, possible presentation of systemic disease

Question 27

Discoid lupus erythematosus clinical characteristics

Answer 27

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

Question 28

Dermatomyositis clinical characteristics

Answer 28

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

Question 29

Dermatomyositis definition

Answer 29

Autoimmune inflammatory myopathy with characteristic skin finding

Question 30

Dermatomyositis associated symptoms

Answer 30

Calcinosis cutis (calcification of skin in children), proximal muscle weakness, muscle fatigue, muscle tenderness, fever, malaise, possible involvement of lungs and heart

Question 31

Dermatomyositis and malignancy

Answer 31

In adults, dermatomyositis can be associated with malignancy, typically ovarian, breast, melanoma, colon, non-Hodgkins lymphoma, or nasopharyngeal (especially in Asian populations)

Question 32

Erythema nodosum clinical characteristics

Answer 32

Acute, tender, nodular eruption, typically on shins, inflammation in the fat (panniculitis), bilateral

Question 33

Erythema nodosum cause

Answer 33

Hypersensitivity reaction

Question 34

Erythema nodosum prognosis

Answer 34

Usually self-limited and will heal in weeks, rarely is chronic or recurrent

Question 35

Erythema nodosum histology

Answer 35

Widened septae, inflammation deep into subcutis, septal panniculitis, loose granulomas, septal fibrosis

Question 36

Erythema nodosum associations

Answer 36

Infections (such as strep, yersinia, salmonella, EBV, bartonella, etc), medications (oral contraceptives, sulfa antibiotics), pregnancy, systemic disease (sarcoidosis, IBD, Bechet disease)

Question 37

Erythema nodosum treatment

Answer 37

Rest, ice, elevation, NSAIDs, treatment of underlying problem if indicated

Question 38

The "other" erythemas

Answer 38

Erythema marginatum rheumatic fever, erythema multiforme (HSV), erythema ab igne (chronic heat), erythema migrans (Lyme disease)

Question 39

Pyoderma gangrenosum clinical characteristics

Answer 39

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

Question 40

Pyoderma gangrenosum cause

Answer 40

Uncommon neutrophilic disease process, typically in patients with systemic disease

Question 41

Pyoderma gangrenosum histology

Answer 41

Ulceration evident, inflammation is increased underneath, if no ulcer is evident there is tunneling inflammation present

Question 42

Pyoderma gangrenosum associated diseases

Answer 42

IBD, arthritis, HIV, malignancy, leukemia, drug reactions

Question 43

Pyoderma gangrenosum classifications

Answer 43

Para-inflammatory (IBD triggered), paraneoplastic (malignancies), hematologic (anomaly in blood production), drug-induced (look for new Rx), idiopathic (no known cause)

Question 44

Cutaneous T-cell lymphoma clinical characteristics

Answer 44

Chronic, non-responsive erythematous scaly plaques on the trunk or sun-protected areas, may progress to mushroom-like tumors

Question 45

Cutaneous T-cell lymphoma cause

Answer 45

Proliferation of abnormal lymphocytes

Question 46

Cutaneous T-cell lymphoma histology

Answer 46

Atypical epidermotropic lymphoid infiltrate, no spongiosis, hyper chromatic, large, atypical lymphocytes, these collect into microabsecesses in the epidermis