Hyperpigmentation Flashcards
1
Q
Causes of Generalised Hyperpigmentation
A
- Iron overload in chronic transfusion (e.g. Thalasaemia)
- Bile pigment accumulation
- Photosensitity (Exposed area, Drugs, Porphyria)
- Raised ACTH level
Addison’s disease, Congenital Adrenal Hyperplasia (Pigments concentrated at mucosa, nipple, umbilicus, genitalia, joint creases and area of friction) - Chronic renal failure (look for growth failure, pallor, rickets, hypertension and AV fistulas)
- Racial
- General patchy pigmentation (Fanconi anaemia, Porphyria, Liver disease)
2
Q
Photosensitivity causes
A
- Skin disease (Photosensitive Dermatitis, Xeroderma Pigmentosa, Albinism and Hypopituitarism)
- Circulating photosensitizer (Porphyria, Drug - Sulphonamide, tetracycline, Thiazides etc)
- Systemic disease (SLE, Addison’s disease - often first presented with severe sunburn after outing)
3
Q
Local pigmentation causes
A
- Mongolian Spot - Benign
- Neurodermatosis - NF and TS
- Syndromes
McCune Albright Sx - Unilateral pigment and precocious puberty + cystic bone lesion
Peutz Jegher Sx - Pallor + pigment at lip/ Palmer surface of digit + intestinal polyposis, AD
Xeroderma Pigmentosa
Urticaria Pigmentosa - Pigmented Navi - Freckle
4
Q
Neurofibromatosis Type 1 Diagnostic Criteria
A
Chrom 17 Criteria: A. >2 of the following: > 6 significant cafe au lait spots (>5mm prepubertal and 15mm in adults) >2 Neurofibroma Axillary / Inguinal freckle >2 Iris Harmatoma Optic Glioma B. FH present C. XR bone show distinct cortical lesion
5
Q
Neurofibromatosis Type II Diagnostic Criteria
A
Chrom 22
Either bilateral Acoustic Neuroma
OR: 1st degree relative with Type II disease and either unilateral acoustic neuroma
OR: Neurofibroma / Glioma/ Schwannoma/ Meningioma/ Subcapsular Lenticular opacity
6
Q
Steps in clinical examination of Hyperpigmentation
A
- Note the dark complexion
- Check if parents same colour (Racial)
- Note the distribution of pigment
- Note if any facial features (Cooley’s face; Pallor; Jaundice; Cafe au lait)
- Examinatin of hands and UL (Liver palm; Nail dystrophy, AV fistual; Drip site and Radial defect -Fanconi Anaemia)
- Abdominal examination (Only sun exposed area - photosensitivity e.g. SLE; Addisons - Mucosa, nipple, skin crease and genitalia)
- Measure BP