Managing skin disorders in systemic disease tutorial questions

Question 1

SBAQ-1

Answer 1

She has a photodistributive rash in keeping with SLE

We’d be looking for a FBC, renal profile, urinalysis to look for renal involement eg haematuria or proteinuria, also look at this because the kidneys have to be very damaged to show up abnormal results of U and E.

Lipid panel would do if saw xanthomas

Question 2

SBAQ-2

This is an anular (ring-like) or semi-anular plaque

Answer 2

Anular rash in neonate suggests neonatal lupus. We would be very worried about the heart as that is the main organ affected in this condition.

Question 3

SBAQ-3

Answer 3

Photodistributive rash on upper back-shawl sign

Dermatomyositis (DM) is a long-term inflammatory disorder which affects skin and the muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity.

Anti-p115 is associated with malignancy in adults. Anti-MDA5 antibodies are asssociated with digital ischemias and interstsitial lung disease, but not DM mellitus.

Question 4

SBAQ-4

Answer 4

Corscrew hairs and PP are indicative of scurvy.

Casal’s necklace-red rash around neck (think vitamin B so begins with C)

Question 5

SBAQ-5

Answer 5

Question 6

SBAQ-6

Answer 6

Don’t need a rash for drugs to be responsible eg bradykinins cause itching without a rash and these are produced when ACE inhibitors are given.

Opioids can also cause itching without a rash.

Question 7

SBAQ-7

Answer 7

Biopsy alone cannot say they have DRESS, need several criteria.

Question 8

SBAQ-8

Answer 8

upper-sarcoiditis

lower-lupus of subcutaneous fat

Question 9

SBAQ-9

Answer 9

Note-clubbing can also occur in people with Crohn’s disease

Question 10

SBAQ-10

Answer 10

dermatitis herpetiformis is associated with coeliac disease. Rarely see blisters as they are scratched so quickly. Due to gluten intolerance.

All others are associated with IBD

Question 11

SBAQ-11

Answer 11

Question 12

SBAQ-12

Answer 12

Any rash check for HIV as it is so heterogenous in presentation.

Question 13

SBAQ-13

Answer 13

Cutis gyrata verticis-thickening of the skin on the scalp

Perforating disorder: Where collagen perforates through epidermis-resulting in purple bit appearance.

Question 14

SBAQ-14

Answer 14

A-expensive, get false pos and neg findings and also potentially harm patient with radiation and may find harmles things eg some patients have autoantibodies that have no effect.

C-wrong, features are clinical and histopathologist interprets biopsy on basis of what you tell them eg amyloidosis is very hard to see unless you ask histopathologist is this a possibility

Question 15

SBAQ-15

Answer 15

People who had stem cell transplant are often immunosuppressed so they often need antibiotics so it is not trivial to remove their drugs.

If accompanied with diarrhoea suggests GI involvement.