Dermatology, hair and nails Flashcards
Most common clinical manifestation of SLE
And most common people with SLE
85% of cases present with skin lesions 90% of patients have joint involvement 85% of cases are in females 1:250 black women are diagnosed 1:1000 white women are diagnosed
Systemic features of SLE
fever, anorexia, malaise, weight loss
Mnemonic for lupus symptoms
SOAP BRAIN MD
S=serositis O=oral ulcers A=arthritis P=photosensitivity, pulmonary fibrosis B=blood cells R=renal, Raynauds A=ANA I=immunologic (anti-Sm, anti-dsDNA) N=neuropsych M=malar rash D=discoid rash
Treatments for SLE
Based upon intensity of the disease
Start with NSAIDs and hydrochloroqine
If does not improve add
Low-dose steroids.
AcuteCutaneousLE:
Butterfly malar rash +/- forehead, chin and V-neck, spares NL folds → sun-exposed areas
- Widespread morbilliform or exanthematous eruption of extensor arms and wrists sparing the knuckles
- Severely acute can simulate toxic epidermal necrolysis
- Lasts hours, days, weeks. NO scarring involved unless 2° bacterial infection
SubacuteCutaneousLE:
erythematous macules/plaques on sun-exposed areas more so upper extremities, trunk, shoulders
- Less transient that ACLE, heal with more pigment change
DiscoidLE:
induration, greater hyper/hypopigmentation, atrophic dermal scarring, follicular plugging, and adherent scale, scarring alopecia
- Classic red-purple macules, papules, small plaques that evolve into discoid erythematous plaques covered by prominent adherent scale that extends into orifices of dilated hair follicles
- “Carpet tack” sign = keratotic spikes beneath adherent scale
Raynaud’s disease: dermatologic manifestations
- Paroxysmal bilateral finger pallor and cyanosis followed by rubor
- Precipitated by cold or emotional stress, relieved by warmth
- Primary form (Raynaud disease, idiopathic) is benign
- Secondary form (rheumatic disease, especially scleroderma) for can lead to ulceration and gangrene of digits
What is scleroderma?
Meaning; hardening of the skin of the hands.
A chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases
What and who does scleroderma effect?
Hardening and tightening of the skin and connective tissues
- Can effect skin, vessels, internal organs, gi tract
Affects more women then men and most commonly between the ages of 30 and 50
What are the limited symptoms of scleroderma
CREST syndrome: Cutaneous calcification, Raynaud’s, Esophageal dysfunction, Sclerodactyly, Telangiectasia
Hands, feet, face, trunk, mucous membrane
What causes Livedo reticularis?
Thought to be caused by a spasm of the blood vessels or abnormality of the circulation near the surface of the skin.
Can just be a result of being chilled or an indication of a serious vascular condition, endocrine disorder, or rheumatologic condition.
Primary and secondary Livedo reticularis:
- Idiopathic LR: disappears after warming, a physiologic phenomenon
- Secondary LR: starburst or lightning-like pattern, net-like but with open meshes, often confined to lower extremities and butt. Signifies systemic disease.
What is Erythema nodosum?
An inflammatory disorder. It involves tender, red nodules under the skin.
most common on the shins. It may also occur on other areas of the body such as buttocks, calves, ankles, thighs, and arms.
The lesions begin as flat, firm, hot, red, painful lumps that are about an inch across. Within a few days, they may become purplish in color. Over several weeks, the lumps fade to a brownish, flat patch.
Behcet’s Syndrome
Unknown etiology: but vascular
S/sx: oral apthous ulcers, genital ulcers, papulopustules, erythema nodosum-like lesions, uveitis, and arthropathy.
Pyoderma gangrenosum
Eti: unknown but thought to be autoimmune
Associated with: IBD, RA, crohn’s
- Acute: Painful, boggy, blue-red hemorrhagic ulcers with undetermined borders and purulent necrotic bases, either de novo or post-trauma +/- “phenomenon of pathergy” (needle stick, insect bite, biopsy, other minimal trauma triggers lesion)
- Chronic: slow progression over larger areas of the body with granulation and hyperkeratosis, less painful
