Dermatologic Manifestations Of Rheumatologic Conditions

Question 1

What is vasculitis?

Answer 1

Inflammation and necrosis of blood vessels

Question 2

What are the characteristics of small vessel vasculitis?

Answer 2

Most common
Majority of cases follow an acute infection or exposure to a new drug
Hallmark is palpable purpura
Predominate on the ankles and lower legs
Lesions resolve within 3-4 weeks with residual post inflammatory hyperpigmentation

Question 3

How to diagnose small vessel vasculitis?

Answer 3

Detailed history and physical exam
Skin biopsy
Labs: cbc, UA

Question 4

What is the treatment for small vessel vasculitis?

Answer 4

Non aggressive in patients that are clinically well
Rest, elevation of legs
NSAIDs, colchicine, dapsone, Systemic corticosteroids for more serious cases

Question 5

What are the characteristics of Henoch Schonlein Purpura (HSP)?

Answer 5

Affects male children between 4-8
Present with abdominal pain
Arthralgias progressing to arthritis with periarticular swelling around knees and ankles
Caused by viral infection or strep pharyngitis

Question 6

What are the characteristics of urticarial vasculitis?

Answer 6

Lesions last longer than 24 hours and are fixed

Lesions are painful rather than pruritic

Question 7

What is Erythema elevatum Diutinum (EED)?

Answer 7

Chronic fibrosing leukocytoclastic vasculitis
Multiple orange yellow papules and plaques over joints ( elbows, knees, hands and feet)
Most commonly asymptomatic

Question 8

What is psoriasis ?

Answer 8

Common chronic and recurrent inflammatory disease of the skin
Characterized by well circumscribed, erythematous, dry’ scaling plaques of various sizes
Present with Auspitz sign
Increased risk of cardiovascular disease

Question 9

What are the types of psoriasis ?

Answer 9

Seborrheic like
Inverse- in folds and flexor surfaces
Napkin- diaper are in infants
Psoriatic arthritis- involves hands, pencil in cups
Guttats- lesions size of water drops, respond well to UVB light treatment
Generalized pustular
Erythrodermic- head to toe

Question 10

What is the treatment for psoriasis ?

Answer 10

Corticosteroids (topical)
Methotrexate
Diet

Question 11

What is erythema nodosum?

Answer 11

Crops of bilateral deep tender nodules, pretibial
Affects young adult women
Most common non specific cutaneous finding in sarcoidosis

Question 12

What is Lofgrens syndrome?

Answer 12

Erythema nodosum with fever, arthralgias, hilar adenopathy and fatigue

Question 13

What are the types of lupus erythematous?

Answer 13

Discoid/ chronic cutaneous
Subacute cutaneous
Systemic
Cutaneous findings are common in all forms

Question 14

What are the characteristics of discoid lupus?

Answer 14

Primarily cutaneous
Commonly localized above the neck
Rarely ANA positive
Rarely progresses to systemic lupus
Heals with scarring, atrophy and pigment changes
Most common morbidities are scarring, rare squamous cell carcinoma

Question 15

What are the characteristics of subacute cutaneous lupus?

Answer 15

Affects caucasians females between 15-40 years old
Cutaneous disease with some internal involvement
80% ANA positive
Anti-Ro/SSA antibodies present

Question 16

What are the treatment for discoid and subacute lupus?

Answer 16

Sunscreen
Antimalarials: hydroxychloroquine is the gold standard
Dapsone
Topical steroids

Question 17

What are the characteristics of systemic lupus?

Answer 17

Malar rash in 80%
Multiple system involvement
ANA positive in 99%
Can be drug induced - anti histone antibodies present
Need 4 or more criteria for diagnosis
Most common cause of death is renal and CNS

Question 18

What are the diagnosis criteria of systemic lupus?

Answer 18

Discoid rash Renal disorder
Oral ulcers Arthritis
Photosensitivity Serositis
ANA positive Hematologic
Malar rash
Immunologic
Neurologic

Question 19

What is the treatment for systemic lupus?

Answer 19

All previous as with discoid
Retinoids
Systemic steroids

Question 20

What are the types of scleroderma?

Answer 20

Cutaneous type that can be morphea or linear

Systemic type with crest syndrome or progressive Systemic sclerosis

Question 21

What are the characteristics of the morphea?

Answer 21

Localized
Rose or violaceous macules initially
Becomes smooth, hard, somewhat depressed yellowish white or ivory colored lesions
Common on the trunk

Question 22

What are the characteristics of the linear scleroderma?

Answer 22

Often begins during first decade
Lesions follow lines of blaschko
Prasagittal lesion on the frontal scalp extends down the forehead
En coup de sabre

Question 23

What are the characteristics of crest syndrome?

Answer 23

Calcinosis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangiectasis
Presence of anti centromeres antibodies very specific

Question 24

What are the characteristics of progressive systemic sclerosis ?

Answer 24

Raynaud phenomenin is often the first manifestation
Thickening of dermal collagen
Digital pitting scars of fingertips
Most ofetn anti Scl-70 /anti topoisomerase 1 present

Question 25

What is the treatment for scleroderma?

Answer 25

Morphea- intralesional steroids
Raynauds- vasodilating drugs,CCBs( nifedipine,diltiazem); avoid cold exposure,do not smoke
No approved therapy for progressive systemic sclerosis

Question 26

What are the signs of dermatomyositis ?

Answer 26

Heliotrope rash
Gottrons papules
Shawl sign

Question 27

How to diagnose dermatomyositis ?

Answer 27

Elevated creatinine kinase 
EMG changes
Muscle biopsy
Positive anti Jo 1
Anti Mi2

Question 28

How to treat dermatomyositis ?

Answer 28

Prednisone
Immunosuppressive/ steroids sparing agents
Physical therapy

Question 29

What are the IBD cutaneous manifestations ?

Answer 29

Polyarteritis nodosa
Pellagra
Pyoderma gangrenosum- more common in UC, treated with steroids and immunosuppressive therapy