Cutaneous signs of systemic disease Flashcards
What are cutaenous manifestations of Diabetes?
- Flexural candidiasis
- Necrobiosis lipodica
- Acanthosis nicrigans
- Granuloma annulare
- Folliculitis
What is the following?
Necrobiosis lipodica - area of spreading erythema over the shin which becomes yellowish and atrophic in the centra and may ulcerate
What would you ask about if you saw someone with the following skin lesion?
Diabetes - specifically management
What is the following?
Granuloma annulare - chronic, non-infectious inflammatory condion approx. 1cm ring-shaped lesion, often on the back of hands
What would you ask about if you saw somoene with the following?
Diabetes
What is the following?
Acanthosis nigricans
What would you ask about if you saw the following?
Diabetes
What is the following?
Dermatitis herpatiformis - very itchy/burning blisters on elbows, scalp, shoulders and ankles
What would you want to investigate for if you saw the following?
Coeliac disease - Anti-endomysial antibody, Anti-TTG, Endoscopy, Biopsy
What is the following?
Erythema nodosum - tender ill-defined subcutaneous nodules e.g. on shins
What might cause the following (lesions are painful/tender)?
- Strep infection
- Sarcoidosis
- TB
- Drugs
- IBD
- Chlamydia infection
Who does the following most commonly occur in?
Young adults, esp. females
What can the following be associated with symptomatically?
- Arthralgia
- Malaise
- Fever
What is the following?
Pyoderma gangrenosum - rapidly growing, very painful recurring nodulo-pustular ulcers, with tender red/blue overhanging necrotic edges. It is often preceded by tender pustules
What can cause the following?
- Inflammatory bowel disease
- Rheumatoid arthritis
- Myeloma, monoclonal gammopathy, leukaemia, lymphoma
- Liver disease (e.g. primary biliary cirrhosis)
- Idiopathic (>20% in some series).
What associated symptoms may be present with the following?
- Pyrexia
- Malaise
What would you find if you biopsied the following lesion?
Intense neutrophilic infiltrate and occasional vasculitis
What are cutaneous manifestions of IBD?
- Erythema nodosum
- Pyoderma gangrenosum
What can cause the following?
- Diabetes - insulin resistance - early life
- Malignancy - esp. GI tumours - later life
What is the following?
Chronic discoid lupus erythematosus - Inflamed sclay plaques + Scarring + atrophy with telangiectasia often localised to head and neck. Hypopigmentation is common
What are the cutaneous manifestations of SLE?
- Chronic discoid lupus
- Chillblain
- Subacute cutaneous LE
- Acute SLE
- Vasculitis
- Alopecia
- Oral ulcers
- Palmar erythema
- Periungal erythema
- Raynaud’s phenomenon
What can trigger the following?
UV exposure
What is the following?
Malar rash
What might cause the following?
- SLE
- Infective endocarditis
- Mitral stenosis
What is the following?
Alopecia
What medical conditions are associated with pruritis?
- Iron deficiency anaemia
- Internal malignancy
- Diabetes Mellitus
- Chronic kidney disease
- Chronic liver disease
- Thyroid disease
- HIV infection
- Polycythaemia rubra vera
What is thought to be the mechanism of the experience of itching?
Low level stimulation of unmyelinated C-fibres in the skin is associated with the sensation of itch (high stimulation produces pain). Histamine, tachykinins (e.g. substance P) and cytokines (e.g. interleukin-2) may also play a role peripherally in the skin.
What is the following?
Erythema multiforme - type of hypersensitivity reaction triggered most often by herpes simplex. clinically the lesions can be erythematous, polycyclic, annular or show concentric rings (‘target lesions’). The rash tends to be symmetrical and commonly affects the limbs, especially the hands and feet where palms and soles may be involved.
What could cause the following?
- Herpes simplex virus
- Other viral infections - e.g. Epstein–Barr virus (EBV)
- Drugs - e.g. sulphonamide, anticonvulsants
- Mycoplasma infection
- Autoimmune rheumatic disease - e.g. SLE, polyarteritis nodosa
- HIV infection
- Wegener’s granulomatosis
- Carcinoma, lymphoma.
What is the following?
Erythema multiforme - mucosal involvement around the mouth - this can lead to necrotic ulcers of the mouth and genitalia, and a conjunctivitis
What is meant by the minor form of erythema multiforme?
Erythematous well-defined round lesions appear on extensor surfaces of peripheries, palms, and soles and evolve at different stages into pathognomonic target lesions.
What are features of major erythema multiforme?
Features of minor with associated systemic upset and severe mucosal involvement
How long does erythema multiforme take to heal?
Up to 4 weeks
How would you manage erythema multiforme?
- No treatment required
- Consider steroids - provides relief but does not accelerate healing
- Treat cause
- Consider Aciclovir prophylaxis - if recurrent
What are cutaneous features of sarcoidosis?
- Hypopigmented patches
- Erythema nodosum
- Yellow-brown firm (periorbital) papules
- Scarring alopecia
- Firm subcutaneous nodules
- Lupus pernio
What is the following?
Lupus pernio - Chronic sarcoid plaques on nose, ears, lips, and cheeks +/- permanent scarring
What is the following?
Calcinosis
What syndrome is the following seen in?
Limited cutaneous systemic sclerosis - CREST syndrome
What is the following?
Telangiectasia
What rheumatological syndrome is the following seen in?
CREST syndrome
What is the following?
Livedo reticularis - Non-blanching vague pink-blue mottling caused by capillary dilatation and stasis in skin venules, like diamond shaped holes in a net, most often on the legs
What can cause the following?
- Vaculitis
- Cholesterol emboli
- Hyperviscosity states
What are cutaneous features of neurofibromatosis type 1?
- Café-au-lait spots
- Axillary freckling
- Lisch nodules
- Neurofibrommas
What are cutaneous features of tuberous sclerosis?
- Adenoma sebaceum
- Periungual fibroma
- Shagreen patches
- Ash-leaf hypopigmentation
- Forehead plaque
- Café-au-lait patches
What is the following?
Adenoma sebeceum - reddish papules/fibromas around the nose
What is the following?
Periungal fibroma - nodules arising from the nail bed
What is the following?
Shagreen patches - firm, flesh-coloured plaques on the trunk
What is the following?
Ash-Leaf hypopigmentation - pale macules best seen with UV light
What is the following?
Cafe-au-lait spots - brown macules, >2.5 cm in diameter and more than five lesions
What are causes of the following?
- Neurofibromatosis type 1
- Tuberous sclerosis
What are paraneoplastic skin phenomena?
- Leser-trelat sign
- Acanthosis nigricans
- Dermatomyositis
- Paraneoplastic pemhigus
- Acquired ichthyosis
- Hypertrichosis lanuginosa
- Tripe palms
What is the following?
Leser-trelat sign - sudden eruption of mutliple seborrheic keratoses seen rarely in association with GI adneocarcinomas and GU cancers
What cancers is Leser-Trelat sign most commonly associated with?
- GI adenocarcinomas
- GU cancers
What cancers is acanthosis nigricans most commonly associated with?
- Gastric cancer
- Lymphoma
What is the following?
Dermatomyocyitis
What cancers is the following associated with?
- Breast
- Ovary
- Lung
- Prostate
- Colorectal
What cancers is paraneoplastic pemphigus seen in?
Lymphreticular malignancy
What is the following?
Acquired Ichthyosis - dry scaly skin seen in lymphoproliferative disorders
What is the following?
Tripe palms - Ridged velvety lesions on the palms, often in association with acanthosis nigricans
What cancers is the following associated with?
- GI adenocarcinoma
- Lung cancer
