Hyperpigmentation Flashcards

1
Q

Causes of Generalised Hyperpigmentation

A
  1. Iron overload in chronic transfusion (e.g. Thalasaemia)
  2. Bile pigment accumulation
  3. Photosensitity (Exposed area, Drugs, Porphyria)
  4. Raised ACTH level
    Addison’s disease, Congenital Adrenal Hyperplasia (Pigments concentrated at mucosa, nipple, umbilicus, genitalia, joint creases and area of friction)
  5. Chronic renal failure (look for growth failure, pallor, rickets, hypertension and AV fistulas)
  6. Racial
  7. General patchy pigmentation (Fanconi anaemia, Porphyria, Liver disease)
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2
Q

Photosensitivity causes

A
  1. Skin disease (Photosensitive Dermatitis, Xeroderma Pigmentosa, Albinism and Hypopituitarism)
  2. Circulating photosensitizer (Porphyria, Drug - Sulphonamide, tetracycline, Thiazides etc)
  3. Systemic disease (SLE, Addison’s disease - often first presented with severe sunburn after outing)
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3
Q

Local pigmentation causes

A
  1. Mongolian Spot - Benign
  2. Neurodermatosis - NF and TS
  3. 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
  4. Pigmented Navi - Freckle
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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
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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

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6
Q

Steps in clinical examination of Hyperpigmentation

A
  1. Note the dark complexion
  2. Check if parents same colour (Racial)
  3. Note the distribution of pigment
  4. Note if any facial features (Cooley’s face; Pallor; Jaundice; Cafe au lait)
  5. Examinatin of hands and UL (Liver palm; Nail dystrophy, AV fistual; Drip site and Radial defect -Fanconi Anaemia)
  6. Abdominal examination (Only sun exposed area - photosensitivity e.g. SLE; Addisons - Mucosa, nipple, skin crease and genitalia)
  7. Measure BP
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