Cutaneous Systemic Dz Flashcards
Oval, violaceous patch that expands slowly
Proceeds to a red advancing border with yellow brown central area
Soon ulcerates and has a woody duration
Associated with DM and on the anterior Tib/fib
Necrobiosis lipoidica
Tx: Topical & Intralesional steroids
—Stops inflammation, but promotes atrophy
Systemic oral steroids
3-5 week course may stop the disease (existing lesions will remain)
Pentoxifylline 400mg tid
—Shown significant results in 1 month
A pt presents with a RING of small red flesh colored papules
That start out flesh colored and turn to red
MC to the lateral dorsal side of the hands and feet
Think?
Grannuloma Annulare
Strong association with HIV, DM
No treatment necessary, cosmetically can use topical steroids and occlusion
If Disseminated; PUVA + Dapsone
A pt presents with Velvety hyperpigmented plaques
Think
Acanthosis Nigrans
MC 2/2 obesity and in the axilla
Any pt with DM or Cushings
Treat underlying cause
+ ammonium lactate to soften
Or tretinoin cream to thicken
What is the most common manifestation of xanthomas
Xanthalsma
Lipid deposits around the eyes
A pt presents with 1-4 mm yellow deposites with a red halo
On the extensior surfaces
(Arms, leg, back)
Think
Eruptive xanthomas
Sign of high triGs
A pt presents with slow evolving paupules/ tumors
(lipid deposits) MC to the knees, elbows, extensors, AND palms That are painless
Think
Tuberous Xanthomas
Sign of high TriGs and/or Billiary cirrhosis
A pt presents with smooth deep deposits/ lesions that are attached to tendons
MC to the Achilles
Think
Tendonous xanthomas
What is the treatment for any xanthomas
Treat underlying lipidemia
Cosmetically: trichloroacetic acid
This is a VASCULAR cancer, 2/2 HPV 8
MC in older men, on the hands feet and LE
And is the most common tumor in AIDS pts
“Raised, oval, elongated, RUST colored infiltrates: that DECRESAED with pressure and then return to size. Progress to ulcers
Kaposi’s Sarcosis
The decrease with pressure helps DDx this from lichen planus
If on the Trunk suspect AIDS
Dx with Bx
(Blood vessel w neoplastic epithelium)
Tx with nitrogen creo or excision
Or intralsional chemo
(Vinblastine)
What is Vinblastine
Intralesional chemo treatment for Kaposi’s sarcoma
Pt presents with moist, warm, smooth skin, with hyperhydrosis
(Sweating), thin hair, with a bronze tint to the skin, clubbing of the fingers and nails, with concave nails, and an ORANGE PEEL appearance on the pretibial surfaces
Think
Hyperthyroioism
Think orange peel look is called pretibial myxedema
A pt presents with swollen, cool, waxy, pale dry skin with increased wrinkles,
Eyelid puffiness, with a YELLOWING tint to the skin
(Carotemia), + alopecia of the lateral eyebrows
+vitiligo
Think
Hypothyroidism
A pt presents with immune mediated hyper keratosis
+koebner phenomomen
Is a red flat papule that coalesces into oval plaques
“Thick adherent silvery scales”
+auspitz sign
MC to the extensor surfaces
+pitting/ oil spots on the nails
Think
Psoriasis
(Chronic plaque psoriasis)
Tends to worsen with stress and triggers
Tx with a group I/II topical steroid
(Avoid tachyphylaxis with steroid holiday)
+/- salicylic acid to remove scales
Topical D3 analogs/ Topical V. D3
Steroids plus D3 is the best combination
What is the treatment for psoriasis of the scalp
Karatinolytics to the scalp with foams or gels
If psoriasis covers more that 5 % of the body what is the treatment approach
Biologics: methotrexate, cyclosporine
A pt presents with a recent viral URI and two weeks later has psoriasis like lesions, with sudden scaling papules on the trunk/ extremities
That SPARES the Palmer and soles
“Tear drop” scattered or diffuse pattern that are RED and tiny with a thick white scale
Think
Guttate Psoriasis
Tx with throat culture
UVB 1st line tx and emollients
A pt presents with deep creamy yellow pustules mc tot he middle of the palm or foot that turn into dry crusts and DO NOT RUPUTRE
Think
Pustular psoriasis
Tx with Group I steroid
(Clobetasol)
+occlusion and PUVA
DO NOT GIVE PO STEROIDS
Encourage smoking cessation
What is the general variant of pustular psoriasis
Lakes of pus that can be fatal
A pt presetns with scales that are macerated and dispersed in the flexural or intertriginous areas that are smooth rep plaques
Thin k
Psoriasis inversis
DDX with candida
A pt presents with fine white or yellow greasy flakes, +/- inflamed base, pruritus and red papules
2.2 increased sebum production
Around hormonal periods
Or dry winters
On the scalp/ margins, eyebrows, or Nasolabial folds
Think
Seborrheric dermatitis
Treat with frequent wasting with antiseborrheic shampoos
Ketoconazole
( shampoo or cream)
or selenium sulfide
Can use baby shampoo on eye lids
Topical steroids to reduce inflammation
-use weak steroids and avoid overuse
When would you use oral anti fungals for seborrheic dermatitis
If moderate to severe
Itraconazole 200mg/day x 1 week, then 200mg once every 2 weeks until remission
Pattern of distribution for Seborrheic dermatitis in an infant
Vertex of the scalp
“Cradle Cap”
Severe seborrheic dermatitis is one of the most common cutaneous manifestations of….
AIDS pts
A pt presents with a salamon colored Harald patch in an Xmas tree distribution,
+fine wrinkled tissue like scales
Very pruritic
Pt thinks they have wringworm
Think
Pityriasis Rosea
Treat with reassurance as most do not require treatment
GrouP V (weak) steroids and Anithistamines as necessary for itch
Natural sunlight
If severe: Predinsone, UVB x 22 weeks
Or Oral acyclovir for 1 week
CONSIDER SYPHILLIS INFECTION
What are the 5 ps of lichen planus
5 “P’s” Pruritic Planar (flat topped) Polygonal Purple Papules/plaques (Persistent – 6th “P”)
