Dermatology of Systemic Disease

Question 1

What is SOAP BRAIN MD?

Answer 1

Lupus symptoms:

Serositis – Pleurisy, pericarditis
Oral ulcers
Arthritis
Photosensitivity
Blood disorders
Renal involvement
Antinuclear antibodies
Immunologic phenomena
Neurologic disorder
Malar rash
Discoid rash

Question 2

What is the dermatological presentation of acute cutaneous lupus?

Answer 2

Malar rash
Bullous rash
Photosensitivity
Maculopapular rash
Mucosal involvement
Diffuse hair loss

Question 3

What is the management of acute cutaneous lupus?

Answer 3

Blood tests
Urine dipmab
skin biopsy
MDT

Tx = systemic steroids, hydroxychloroquine or rituximab

Question 4

What is subacute SLE?

Answer 4

Multiple well demarcated annular patches with scales, erythema and are polycyclic on the upper arm and back

Question 5

What is discoid lupus?

Answer 5

Crusty/ Scaly erythmatous discoid lesions with erosions

Treat with steroids/ hydroxychloroquine

Question 6

Is lupus photosensitive?

Answer 6

Yes

Question 7

What is this?

Answer 7

Scleroderma (CREST)

Question 8

What are the parts of CREST?

Answer 8

Calcinosis, Raynaud’s phenomenon, Oesophageal dysmotility, Sclerodactyly, and Telangiectasia

Question 9

What Ix do you do for CREST?

Answer 9

ENA: Anti centromere, Anti Scl 70

OGD and pH manometry

Question 10

What is the treatment of CREST?

Answer 10

Reynaulds: stop smoking, stay warm, diltiazem

Calcinosis: curettage and cautery

Methotrexate

Iloprost

Question 11

What is this?

Answer 11

Morphoea

Question 12

What kind of rash does morphoea present with?

Answer 12

Red bordered well demarcated hairless rash with thickened skin and an ivory centre.

Question 13

What are the types of morphoea?

Answer 13

Pansclerotic

Linear (like you’ve been hit with a sword and muscle atrophy)

Atrophic/ guttate

subcutaneous

Question 14

What is the treatment of morphoea?

Answer 14

Steroids, retinoids, Vit D analogues

Phototherapy

Methotrexate, hydroxychloroquine

Question 15

What does dermatomyositis present with?

Answer 15

A heliotropic rash on the eyelids (erythmatous and oedematous)

Gottrons papules (erythmatous scaly rash on the knuckles)

Question 16

What are the other features of dermatomyositis?

Answer 16

Poikoloderma

Ragged cuticles

Mega capillaries

Photosensitivity

Muscle weakness

Reynaulds

calcinosis

Question 17

Which antibody is linked to antisynthetase syndrome ( a type of dermatomyositis)?

Answer 17

Anti Jo 1

Mechanics hands, fever, myositis, reynaulds, arthritis, ILD

Question 18

What investigations do you do for dermatomyositis?

Answer 18

ANA

ENA

Anti Mi2 and Anti Jo 1

CK

adolase

AST/ALT/ LDH

Skin biopsy

EMG

MRI

Muscle biopsy

Question 19

What is the treatment of myositis?

Answer 19

MDT care

Sun protection

oral prednisolone/ methotrexate/ azathioprine

IVIG

mycophenolate

Question 20

What are oedema blisters?

Answer 20

Occur in acute exacerbation of odema creating conditions

Sterile fluid

Resolves spontaneoulsy when cause is treated

Question 21

What are the bullae like in bullous pemphigoid?

Answer 21

Pruritic

Prodromic oedema and erythematous rash

Requires skin biopsy and antibody test on bloods

Question 22

What does pemphigus vulgaris look like?

Answer 22

Erosions - bullae pop as they are thin walled and superficial

Appear in oro-nasal area and genitals

Question 23

Which antibodies do you test in pemphigus vulgaris?

Answer 23

Anti desmoglein 1 and 3

skin biopsy

Question 24

Which rash is linked to coeliac diseases?

Answer 24

Dermatitis herpetiformis

Question 25

What type of rash is dermatitis herpetiformis?

Answer 25

polymorphic rash with macules, papules, patches and vesicles that are erythmatous occuring over the extensors and buttocks V. itchy

Question 26

What are the Ix for dermatitis herpetiformis?

Answer 26

Skin bx Coeliac screen OGDS (duodenal biopsy)

Question 27

What is the management of dermatitis herpetiformis?

Answer 27

Gluten free diet Oral prednisolone Dapsone

Question 28

Which rashes may occur in sarcoidosis?

Answer 28

Erythmatous scaly nodules on nose = lupus pernio Large plaques over body Darier Roussey Disease Scar sarcoidosis Erythema nodosoum Calcinosis cutis if high calcium Pruritis

Question 29

What are the investigations of sarcoidosis?

Answer 29

Vitaamin D ACE Quantiferon Tb assay typical bloods CXR Skin biopsy spirometry

Question 30

What is the management of sarcoidosis?

Answer 30

Oral pred/ methotrexate/ azathioprine Tetracycline Hydroxychloroquine Can resolve spontaneously

Question 31

What can vasculitis rashes look like?

Answer 31

Small Vessel: Purpuric, Macules Urticarial with purpura, Haemorrhagic vesicles, Haemosiderin deposition Medium Vessel: Livedo reticularis, retiform purpura, ulcers, gangrene

Question 32

What are the causes of small vessel vasculitis?

Answer 32

Idiopathic Infection Drugs Inflammatory Malignancy

Question 33

How does HSP present?

Answer 33

Child with post strep who mayve had medications Purpuric rash and abdo pain + haematuria In adults: purpuric rash, haematuria and arthralgia

Question 34

What are the investigations for HSP?

Answer 34

Anti-streptolysin O Titre IgA Skin biopsy- IgA Renal (ESKD)

Question 35

What is the vasculitis screen?

Answer 35

Coagulation and FBC ANA/ENA RF, antidsDNA, ANCA, C3, C4 Anti Strep O, HBV/HCV and cryglobulins Ig/ serum electrophoresis urine dip CXR

Question 36

What is the treatment of vasculitis?

Answer 36

Presnisolone Dapsone Colchicine Methotrexate Moniter U+Es and urinalysis on drugs