Dermatologic manifestations in patients w/ systemic disease Flashcards
What are the cutaneous findings in Behçet’s disease?
Orogenital aphthous ulcers, pustular vasculitis, and pathergy
What systemic manifestations are seen in Behçet’s disease?
A/w pericarditis, coronary arteritis, valve disease, CNS vasculitis, and ocular disease (e.g. vasculitis, uveitis [panuveitis > posterior uveitis > anterior uveitis], vitritis, retinitis)
What are the cutaneous findings of Birt-Hogg-Dubé syndrome?
Fibrofolliculomas, trichodiscomas, perifollicular fibromas, and acrochordons; lesions most commonly affect head/neck; lesions tend to present in 30s–40s
What are the genetics of Birt-Hogg-Dubé syndrome?
Folliculin (FLCN) mutations (involved in mTOR signaling)
What are the associations seen in Birt-Hogg-Dubé syndrome?
- Pulmonary cysts (most common; up to 90%) lead to spontaneous pneumothorax (30%)
- Multiple renal carcinomas (15%, most commonly chromophobe renal carcinoma and oncocytoma)
- Medullary thyroid cancers
- +/- colon cancer
Cutaneous findings of Cardio-facio-cutaneous syndrome?
Coarse facies (long and broad), generalized ichthyosis- like scaling, keratosis pilaris, CALMs, nevi, and sparse curly hair
Genetics of Cardio-facio-cutaneous syndrome?
AD; RASopathy, mutations in BRAF (most commonly) and other MAPK mutations
Assocations of Cardio-facio-cutaneous syndrome?
- A/w mental retardation, pulmonic stenosis, atrial septal defect, hypertrophic cardiomyopathy, and short stature
- All RASopathies (CFC, NF1, Noonan, Costello syndromes, and LEOPARD) affect RAS/MAPK pathway and have similar clinical presentations → often need genetic tests to distinguish
Cutaneous findings in Carney complex (LAMB/NAME syndromes)?
LAMB = Lentigines, Atrial (and cutaneous) Myxomas, Blue nevi (classically epithelioid blue nevi)
NAME = Nevi, Atrial (and cutaneous) Myxomas, Ephelides
Genetics of Carney complex (LAMB/NAME syndromes)?
AD, mutations in PRKAR1A gene (subunit of protein kinase A)
Associations seen in Carney complex (LAMB/NAME syndromes)?
A/w variety of endocrine neoplasms;
most commonly affected = adrenal gland; p/w
primary pigmented nodular adrenocortical disease →
Cushing’s
Other endocrine abnormalities: pituitary adenomas and testicular cancer (Sertoli type)
A/w psammomatous melanotic schwannoma
What are the cutaneous findings in Carvajal syndrome?
Striate epidermolytic palmoplantar keratoderma; wooly scalp hair
Genetics of Carvajal syndrome?
AR, desmoplakin mutations
Associations seen in Carvajal syndrome?
A/w dilated left ventricular cardiomyopathy
* Mnemonic: “CarvajaL = Linear/striate PPK + Left ventricular cardiomyopathy”
Cutaneous findings of Churg-Strauss syndrome (allergic granulomatous angiitis)?
Skin involvement in 60%; LCV, urticaria, livedo reticularis, subcutaneous nodules, PNGD (palisaded neutrophilic granulomatous dermatitis), and extravascular granulomas
Associations of Churg-Strauss syndrome (allergic granulomatous angiitis)?
Most commonly a/w allergic rhinitis, severe asthma, peripheral eosinophilia of ≥10%, sinusitis, transient pulmonary infiltrates, and mononeuritis multiplex
- Increased serum IgE levels
- Most common causes of mortality: myocarditis and coronary arteritis
- ANCAs detectable in 50%; p-ANCA (anti-MPO) ≫ c-ANCA (PR-3)
- ANCAs less frequently positive compared with Wegener’s (50% vs ~100%)
- May be a/w leukotriene inhibitors (montelukast and zafirlukast)
Cutaneous findings of Costello syndrome?
Lax skin on hands and feet, coarse facies, low-set ears, deep palmoplantar creases, periorificial papillomas, acanthosis nigricans, and curly hair
Genetics of Costello syndrome?
AD, one of the RASopathies; mutations in HRAS (85%) > KRAS (10%–15%)
Associations with Costello syndrome?
- A/w mental and growth retardation, pulmonic stenosis, hypertrophic cardiomyopathy, and arrhythmias
- Increased risk of rhabdomyosarcoma and transitional cell (bladder) CA
- All RASopathies (CFC, NF1, Noonan, Costello syndromes, and LEOPARD) have similar clinical presentations –> need genetic tests to distinguish
Cutaneous findings of cutis laxa?
Loose, pendulous skin of face (esp. periocular and cheeks leading to “bloodhound facies”), neck, axillae, and thighs; skin lacks elastic recoil (vs EDS)
Genetics of cutis laxa?
Multiple forms:
- AR: most common and most severe; Fibulin-5 (FBLN5)
- AD: benign course; Elastin (ELN) > FBLN5 - XLR: ATP7A (copper transporter)
Associations of cutis laxa?
Occipital horn syndrome is the current name for XLR cutis laxa, (which was also formerly called Ehlers-Danlos type IX); OHS a mild variant of Menkes kinky hair syndrome
- AR cutis laxa is most frequently a/w internal organ dysfunction and death:
Pulmonary: bronchiectasis, emphysema leading to right-sided heart failure
Cardiac: aortic dilation/rupture; right-sided heart failure
GI: diverticulae
Associations with dermatomyositis?
A/w ECG changes and pericarditis
- Cardiac involvement = poor prognostic sign; a/w
anti-SRP autoantibodies
- Pulmonary fibrosis a/w antisynthetase syndrome (Jo-1, PL7, and PL-12; autoantibodies target tRNA synthetase)
Cutaneous findings in Ehler-Danlos syndrome (classic form)?
Skin hyperelasticity, “cigarette paper” and “fish mouth” scars, ecchymoses, Gorlin sign, and molluscoid pseudotumors