Dermatologic Manifestations Of Systemic Diseases Flashcards
Disseminated Gonorrhea
Gram (-) diplococci
- produces hemorrhagic painful pustules that are common in feet and hands
“Clap” hands to make painful hemorrhagic pustules
Other symptoms:
- tenosynovits
- arthralgia
- fever/Chills
Secondary syphilis
Caused Treponema pallidum
- gram (-) spirochete
Produces condyloma lata rash
- papular syphilids in genitals
Also alopecia with moth eaten hair and oral mucosa patches
- *Labs to measure
- **Non-treponemal test (RPR/VDRL)
- **treponema test (FTA-ABS)
Treatment = single dose of IM penicillin G
- **watch for jarish-herxheimer reaction after penicillin injection (occurs in 70%)
- casued by endotoxins released by palladium species upon death
- treatment = ibuprofen prophylaxis. Meptazinol and management of shock if it occurs
Hepatitis C cutaneous manifestations
Telangiectasias
Mixed cyroglobulinemia
Porphyria cutaneous Garda
Lichen planus (especially in oral mucosa)
Cutaneous pruritus
Necrolysis acral erythema
Three forms of SLE
1) acute cutaneous lupus
- most common*
- produces malar rash
2) subacute cutaneous lupus
- NO systemic lupus
3) chronic cutaneous lupus
- discoid lupus symptoms
All show anti-dsDNA, anti-smith antibodies
- some show anti-histone also if drug induced
Possible systemic symptoms
- weight loss
- arthralgia/myalgia
- photosensitivity
- renal disease
- hematologic disorders
- seizures and psychosis
What are the most serious complications in infantile SLE?
3rd degree heart block
Thrombocytopenia
Hepatic disease
caused by Anti-Ro antibody in mothers blood
Common drugs that can produce drug-induced lupus
Hydralazine, INH, procainamide, etanercept, minocycline, penicillin, phenytoin, quinidine
Dermatomyosittis
Caused by ANA, ANti-Jo, ANti-mi2 antibodies
Produces proximal muscle weakness as #1 symptoms
- patient usually complains of standing up from sitting down
Shows heliotrope rash with gottron papules and nail fold telangiectasias
need to screen for malignancy and refractory myositis
Treatment = corticosteroids
Kawasaki disease
Childhood induced illness caused by autoantibodies
Need 5/6 criteria to diagnose
- 1) fever present for at least 5 days and spikes by day 5
- 2) conjunctivitis (bilateral usually)
- 3) strawberry tongue
- 4) lymphadenopathy (unilateral on cervical)
Complications = cardiac aneurysms and myocarditis
- also most common cause of acquired heart disease in children*****
Treatment = IVIG and aspirin
Raynaud syndrome
Primary = More common in younger women and eating disorder patients
Secondary = SLE/RA/scleroderma/sjogren causes
Treatment = CCBs or Botox
- or just keep them out of cold
Most common drugs associated with SJS/TEN
Sulfonamide, carbamazepine, lamotrigine, phenytoin, allopurinol, barbiturates
What ***SJS/TEN = perforin and Granzymes activities from NK cells induce this disorder
Drug induced hypersensitivity syndrome (DIHS)
OR
Drug rash with eosinophilia and systemic symptoms (DRESS)
Triad = fever, skin eruption with facial edema and internal organ involvement
- most common organ = liver***
Takes 2-6 weeks after first exposure
Takes 1 day within reexposure episodes
Systemic symptoms:
- eosinophilia***
- hepatitis***
- Interstitial nephritis
- ARDS
Most common drugs implicated
- phenytoin
- phenobarbital
- carbamazepine
- sulfa drugs
Treatment:
- get rid of drug
- antihistamines and topical steroids
- order labs to ensure its just drug induced
What are common paraneoplastic dermatological causes
1) acanthosis nigricans
- associated with gastric adenocarinoma, and lung cancers
2) necrolysis migratory erythema
- periofricial flexural and acral eruption rash
- looks similar to zinc deficiency but has normal zinc
- caused by glucagonoma’s usually
3) erythema curtain repens
- lung cancer causes this
4) acrokeratosis Paraneoplastica (Bazex syndrome)
- upper digestive tract malignancies
5) carcinoid syndrome
- head/neck flushing and sweating/wheezing and abdominal pain
- causes pellagra-like symptoms also due to increased serotonin production
- common in fore and mid gut tumors
- labs show elevated 5-HIAA level
Sign of leasar trelat
60% caused by gastric adenocarinoma
- also SCC of lung and lymphoma and Breast
Sudden saturation of multiple pruritic keratosis
Sweet syndrome
75% are due to systemic infections and autoimmune infections
10% = malignancy via leukemia
Acquired ichthyosis
Fish scale like hardened skin
- highly tied to Hodgkins and non-Hodgkin cancers
