cutaneous signs of systemic disease

Question 1

Diabetic dermopathy

Answer 1

Common (30%) in long standing diabetes Lower legs, possibly trauma related

Question 2

Acanthosis nigricans

Answer 2

Common in type 2 DM

Marker for insulin resistance

Velvety hyperpigmented thick skin

Intertriginous (inguinal, axillary folds)

Flexures (elbows, neck)

Not usually extensor surfaces or face

with/out skin tags

NOT ALWAYS due to diabetes–> AN1 (familial), AN2 (malignancy, esp gastric and lung), AN3 (related to obesisty, insulin resistance, and endocrinopathy)

Question 3

Diabetes mellitus common associations

Answer 3

Tinea, Candidiasis, Cellulitis, MRSA infections

Neuropathic ulcers

Vascular disease: Peripheral arterial disease (ischemia), Various gangrene

Question 4

hyperthyroidism

Answer 4

fine, velvety, smooth skin

Warm and moist due to increased sweating

Hyperpigmentation–localized or generalized

Pruritus

Hair: fine, thin hair, mild diffuse alopecia

Nails: onycholysis

Question 5

Hypothyroidism

Answer 5

Dry, rough, coarse skin, cold and pale skin

Yellow discoloration from carotenemia

thick scale on feet (keratoderma)

generalized boggy and edematous skin (myxedema)

Hair dull, coarse, brittle, slow growing

Alopecia of lateral third of eyebrows

Nails: thin, brittle, slow growing

Question 6

hyperthyroidism with graves disease

Answer 6

Pretibial myxedema:

cutaneous infiltration of skin of shins with mucin

Peau d’orange

Can occur during Grave’s

Question 7

Addisons disease

Answer 7

Addison’s disease: 1’ adrenocortical insufficiency

usually autoimmune in 80%

Difficult to diagnose/delay diagnosis

Skin: hyperpigmentation, loss of ambisexual hair, fibrosis and calcification of cartilage in ear

Question 8

cushings disease

Answer 8

overproduction of cortisol by adrenal gland

typical cushings disease: striae

Question 9

lupus erythematousus

Answer 9

multisystem disorder

Cutaneous lupus has subsets

80% of SLE have skin problems, some only have skin problems

Question 10

SLE skin findings

Answer 10

Malar erythema (butterfly)

discoid (chronic thick) lesions

oral ulcers

Photosensitivity

Female, young, black

Question 11

ACLE (acute cutaneous LE)

Answer 11

resolves quickly without scarring

generalized or photodistributed

usually brought on by the sun

Question 12

Chronic cutaneous lupus erythematosus

Answer 12

Discoid lupus

Common form of CCLE

15-30% of SLE pts have these lesions

only 5% of those with CCLE develop systemic SLE

Female-male (craters in the face)

Usually in the face ears, scalp and arms

Mucosal involvement

Atrophic thin scarring (telangiectasia, follicular scales)

LEaves scars

Question 13

SCLE: subacute cutaneous lupus erythematosus

Answer 13

usually positive ARA criteria of SLE

photosensitive but not on face

Scaly patches

The SSA/B Ab can cross the placenta to neonate

Question 14

Dermatomyositis

Answer 14

skin and muscles

Skin: heliotrope rash (eyes)

Photosensitive (poikiloderma)

Gottrons papules knuckles

Positive ANA

Elevated CRP/ESR

Muscle: proximal muscle weakness

Elevated CK. aldolase

Abnormal EMG of muscles, myositis on biopsy

Question 15

Dermatomyositis

Answer 15

Associated cancer in adults: GU, ovarian, colon most common, also breast, lung, pancreatic and lymphoma, always consider ovarian in women with DM

DM may overlap with other CT diseases

Interstitial lung disease may be fatal

Question 16

Sarcoidosis

Answer 16

Multisystem risk of disease

Non-caseating granulomas

Cutaneous disease in sarcoidosis: most common at the onset of the disease (if present should look for disease)

Skin can be specific with granulomas on pathology

usually asymptomatic,

usually of no prognostic significance

Question 17

Cutaneous sarcoidosis looks

Answer 17

brown-red papules and plaques are characteristics

Lesions can be small papules of larger plaques

A great pretender and can look like a lot of stuff

Periorbital granulomatous papules

Diascopy (press some glass)–brown red color

Question 18

Lofgren’s syndrome

Answer 18

hilar adenopathy, erythema nodosum, fever, iritsi, arthritis

Spring; better prognosis (usually resolves itself)

Question 19

IBD pyoderma gangrenosum

Answer 19

A sterile, rapid ulceration of the skin caused by neutrophilic infiltration

Characteristic undetermined

Dusky border

Associated with IBD but also many others

Question 20

dermatitis herpetiformis

Answer 20

consequence of gluten sensitivity

much less common than prevalence of celiac disease

Bowel disease can be asymptomatic

Dermatitis herpetiformis is riduculously pruritic

porphyria