Derm manifestations of metabolic diseases

Question 1

Necrobiosis lipoidica diabeticorum

Answer 1

3-1 F-M, anterior shin, dorsum of foot, well circumscribed oval, violateous to red plaques, advancing red border with yellow brown central area, may be waxy, ulceration common especially after trauma

Question 2

Diabetic dermopathy

Answer 2

one of most common skin probs with DM, anterior shins, round to oval, flat topped, red scaly papules, may ulcerate, may precede DM by many years

Question 3

Diabetic bullosis-non scarring

Answer 3

forms on tips and dorsal aspect of fingers and toes, erythematous periphery, non hemorrhagic, heals spontaneously

Question 4

diabetic bullosis-scarring

Answer 4

occasionally hemorrhagic, inflammatory base present

Question 5

Pigmented purpura

Answer 5

DM, may occur with DM dermopathy, deposition of RBCs, petechiae coalesce to form spots, orange or brown pigmentation, “cayanne pepper spots”

Question 6

granuloma annulare

Answer 6

DM, in up to 1/3 of DM its, on backs of hands and fingers, dorsal and lateral aspect of feet, ankles and legs, in disseminated form may be body wide

Question 7

granuloma annulare description

Answer 7

distinctive skin eruption, ring of firm well defined small pink to red papules, histologically similar to necrobiosis lipoidica and rheumatoid nodules

Question 8

Xanthoma eruptivum

Answer 8

DM, firm, contender yellow papule arising on an erythematous base, on knees, elbows, back, butt, trunk and heel, associated with hyperlipidemia, hyperglycemia and glycosuria

Question 9

Acute gout

Answer 9

most commonly 1st MPJ, erythema, increased soft tissue temp, localized edema, intense pain with hypersensitivity

Question 10

acute gout dx and tx

Answer 10

gold standard: joint aspirate with findings of negative birefringent crystals
tx: NSAIDs (indomethacin), oral steroids

Question 11

chronic gout

Answer 11

multiple attacks to one joint can cause precipitation of crystals causing tophi and joint destruction

Question 12

hypothyroidism

Answer 12

cold skin d/t cutaneous vasoconstriction, xerosis-absence of skin sweating, change in skin texture-skin atrophy and wrinkling, pale mottled skin yellow discoloration, keratoderma of feet (scaling and thick fissuring of heels), dry brittle hair, toenails thick, brittle, ridged, slow grow

Question 13

hypothyroidism causes

Answer 13

graves, multi nodular goiter, thyroid adenoma, excessive thyroid hormone administration

Question 14

hyperthyroidism

Answer 14

warm skin (vasodilation), moist and soft, pink or red skin (esp. elbows, palms and soles), smooth, hyperhydrosis, hyperpigmentation of face and lower legs, hypo pigmentation of face, knees, elbows, hands and feet

Question 15

Derm findings of thyroid disease not related to thyroid hormone levels

Answer 15

pretibial myxedema-sharply circumscribed plaque nodules, on anterior lower legs-bilat but not symmetrical, produced by large deposits of acid mucopolysaccharides, may get massively swollen feet

Question 16

Xanthomatoisis

Answer 16

hyperlipidemia, lipid deposition in skin, flat yellow plaques, papules or nodules

Question 17

What GI disorders are linked to skin disorders?

Answer 17

UC, Irritable bowel syndrome and crowns-cause pyoderma gangrenous and erythema nodosum

Question 18

pyoderma gangrenosum

Answer 18

ulcerative skin disorder of unknown cause, linked to IBD and RA, more common in F 20-50 yo, starts as small pustule that ulcerates, ulcer spreads and has violaceous border, often joint pain

Question 19

erythema nodosum

Answer 19

nodular erythematous eruption of unknown etiology, linked to IBD, bacterial and fungal infix, sarcoidosis, F 18-34, starts with flu like sx, self limiting, red tender nodules, start firm and become fluctuant, does not ulcerate, on anterior shins, aching and swelling legs

Question 20

Scurvy

Answer 20

lack of V C-alcoholism, unbalanced diet, chronic illness or GI disease, onset about 2 mo after V C depletion, petechial hemorrhages, small ecchymosis early, large echhy later, follicular hyperkeratosis on LE (has red hemorrhagic halo)