Mnemonics Flashcards
Acquired diffuse PPK
EF PLC SPRAINED
Eczema
Fungal infections
Psoriasis
Lichen planus
Climactericum keratoderma
SLE, DME
PRP
Reiter’s
Acanthosis nigricans
Infection (syphilis, scabies)
Neoplasms (MF, Sezary, Bazex)
Endocrine (hypothyroid)
Drugs (nibs)
Acquired focal or punctate PPK (including drugs list)
CLAW DRIP
Callosities
LP/LE
Arsenic
Warts
Drug*
Reiters
Infection
Porokeratosis/psoriasis
Drug - FLIC BT
Flu vax
Lithium
Iodine
Calcium channel blockers
BRAF inhibitors
TNF inhibitors
Behcet’s systemic manifestations
Eye CARVNG
Eye: ocular in 90% pts. M>F. Painful, may lead to blindness. Retinal vasculitis, posterior uveitis (most characteristic eye finding), anterior uveitis, secondary glaucoma, cataracts, conjunctivitis, keratitis, scleritis, vitreous haemorrhage, optic neuritis
Cardiopulmonary: coronary arteritis, valvular disease, myocarditis, recurrent ventricular arrhythmias, pulmonary artery aneurysms
Arthritis: ~50% pts. In ~80% pts the duration is <2/12. Mono or polyarthritic and nonerosive. Knees, wrists, ankles
Renal: GN
Vascular: aneurysmal or occlusive arterial disease, s/f or DVT
Neurologic: usually later in disease. A/W poor prognosis. Acute meningo-encephalitis, CN palsies, brainstem lesions which can induce swallowing difficulties, laughter and crying; pyramidal or extrapyramidal signs
GI: abdo pain, haemorrhage, ulcerations
Behcet’s diagnostic criteria
O PEGS
MAJOR: Aphthous idiopathic oral ulceration recurring at least 3 times in 12/12
and 2 of minor
MINOR:
- Pathergy test interpreted at 24 - 48hrs
- Eye lesions: anterior or posterior uveitis, cells in vitreous by slit lamp examination or retinal vasculitis
- Recurrent genital ulceration
- Skin lesions: EN like lesions, papulopustular lesions or pseudofolliculitis, or characteristic acneiform nodules
Drug causes DRESS
Drug causes - DRESS
Dapsone (and other sulphas), minocycline, bactrim (and other sulphonamides), vanc, amoxicillin, piptaz
Retrovirals - abacavir, nevirapine
Epileptics - lamotrigine, aromatic anticonvulsants (phenobarbital, phenytoin, carbamazepine)
So Sore - allopurinol, NSAIDs
Frusemide, Omeprazole
SJS/TEN drug causes
ASS CLAAPPPN T
Allopurinol
Sulfa ABx (sulfamethoxazole, sulfadiazine)
Sulfasalazine
Carbamazepine
Lamotrigine
Antibiotics (other: aminopenicillins, quinolones, cephalosporins, tetracyclines)
Antiretrovirals (nevirapine)
Phenytoin
Phenobarbital
Paracetamol
NSAIDs
Terbinafine
Complications of SCARs, erythroderma
THEINET - complications of SCARS in general
Thermoregulatory
Haemodynamic
Electrolytes
Infection
Nutrition
Ectropion
Thromboembolism
SCORTEN - prognostic indicator in SJS TEN
TAMEBUG:1 point each
Tachycardia >120bpm
Age >40
Malignancy
Epidermal detachment - BSA day 1 >10%
Bicarb <20mmol/L
Urea >10mmol/L
Glucose >14mmol/L
0-1: 3.2% mortality
2: 12.1% mortality
3: 35.8% mortality
4: 58.3% mortality
>5: 90% mortality
Acquired ichthyosis
> Drugs: retinoids, allopurinol, statins, cholestyramine, clofazamine, lithium
Renal disease and liver disease, Refsum disease (genoderm, weakness or numbness in hands and feet, lack enzyme for fitanic acid)
Infections (HIV, leprosy, LGV – chlamydia, syphilis, HTLV1)
Neoplasm (lymphomas - Hodgkins, NHL, MF, KS, breast, lung, GVHD, gastric adeno), >Nutrition (essential fatty acid deficiency, vitamin A deficiency, haemochromatosis, marasmus and wasting diseases)
Endocrine (hypothyroid, hypoparathyroid, hypopituitarism), Eczema
Sarcoid
Solar damage
SLE, Sjogren’s
Drug causes acquired ichthyosis
CRACKL
Clofazamine, cholestyramine, cimetidine
Retinoids
Allopurinol, antipsychotics
Chol lowering agents - statins, nicotinic acid
Kava, tyrosine Kinase inhibs
Lithium, lasix and other diuretics
Ichthyoses - autosomal dominant inheritance
ADVERBS
Autosomal
Dominant
Vulgaris (IV)
Erythrokeratoderma variabilis
Reticular ichthyosiform erythroderma (confetti)
BIE
Siemens, IH
Ichthyoses - autosomal recessive inheritance
ARLICH
Autosomal
Recessive
Lamellar
Ichthyosis
CIE
Harlequin ichthyosis
Rare: bathing suit ichthyosis, self-healing collodion, ichthyosis prematurity syndrome
Ichthyoses - syndromic
N SIReNS
Netherton’s
Sjogren Larsson
IBIDS
Refsum
Neutral lipid storage disease
Sulfatase deficiency
Erythema nodosum - associations
BEDREST:
Behcet,
Estrogens,
Drugs (OCP, sulphonamides, penicillin, bromides, TNFi, BRAFi),
Recent infection (strep, yersinia),
Enteropathy (Crohn’s, UC),
Sarcoid (eg Lofgren),
Tuberculosis
And haem malignancy
Drug causes / triggers psoriasis
BLASTIN
Beta blockers
Lithium
Antimalarials, acei
Steroid withdrawal
Terbinafine, TNFi
Interferon, Infliximab
NSAIDs
Also: PD1, dupilumab
Erythroderma drugs of concern
BERNS A
Biotics
Epileptics
Retrovirals
NSAIDs
Sulphurs
Allopurinol
Erythroderma -
Common causes
Less common causes
PEDLI
GOLF PINS
Psoriasis
Eczema: atopic, allergic contact, id reaction, stasis, CAD, seborrhoeic
Drug: exanthematous, DRESS, SJS/TEN
Lymphoma
Idiopathic
Gvhd
Ofuji - papuloerythroderma of
Lupus, LP
Fungus - dermatophyte
PRP, paraneoplastic, pemphigus, pemphigoid
Infection/infestation, ichthyoses
Netherton’s, neoplastic (mastocytosis, LCH)
Sarcoidosis
LP variants
I HAVE A LEAN FLAG
Inverse
Hypertrophic
Actinic
Vesiculobullous
Erosive
Linear
Exanthematous
Annular
Palms/soles
Follicular
LPP
Atrophic
Guttate
Drug causes lichen planus / lichenoid drug eruption
ABCD LGPTQ TT
ACEi
Beta blockers
Calcium channel blockers
Diuretics - frusemide, spiro, thiazides
Lithium
Gold
PD1i, Penicillamine
Tetracyclines, TNF
Quinidine, quinine
Hanifin and Rajka diagnostic criteria AD
CHIP BAKES DRIP
Chronicity
Hx of atopy, personal or Fhx
Involvement face and flexures
Pruritus
Blanching - delayed, due to cholinergics
Anterior subcapsular cataract
Keratoconus
E - IgE raised
Skin test - immediate type 1
Dennie Morgan lines
Recurrent skin infections
Ichthyosis vulgaris over palmar crease
Pallor on face
DDx intertriginous dermatoses
BIGGLE SPINNED
Babboon - SDRIFE
Infection - candidiasis, tinea, erythrasma
Granular parakeratosis
Genetic - HHD, Darier
LCH
EMPD
Seb derm
Psoriasis, inverse
Intertrigo
Nutritional - Zn deficiency
Necrolytic migratory erythema
Extra - cutaneous Crohn’s
Dermatitis, allergic contact
Types of Malassezia
F GROS
Furfur
Globosa
Restricta
Obtusa
Sloofiae
Acute rheumatic fever - JONES criteria
Jones criteria: (major) 2 major OR 1 major and 2 minor PLUS evidence GAS infection (culture, rising ASOT or anti-Dnase B)
J - joints. Migratory polyarthritis. Commonly ankles, knees, elbows, wrists
O - heart. Carditis
N - nodules. Subcutaneous nodules. <2% pts. Over joints (elbows, knees, ankles, knuckles). Firm, round, mobile . 0.5-2cm in size. Nodules only present when severe carditis is present
E - erythema marginatum
S - Sydenham chorea. Jerky, uncoordinated movements esp affecting hands, feet, tongue, face. ‘Milkmaid’s grip’
(Minor)
Fever, arthralgias, abnormal lab findings (elevated ESR, CRP, prolonged PR on ECG)
Borrelia features
SHANE
Skin - ECM, ACA, sclerodermoid plaques
Heart - AV block, myocarditis, pericarditis
Arthritis, arthralgias
Neuro - meningitis, peripheral neuropathies, Bell’s palsy, headaches
Eyes - conjunctivitis, keratitis, episcleritis, iritis
Prognostic scoring / mortality estimator for TEN
SCORTEN - TAMEBUG
TAMEBUG:1 point each
Tachycardia >120bpm
Age >40
Malignancy
Epidermal detachment - BSA day 1 >10%
Bicarb <20mmol/L
Urea >10mmol/L
Glucose >14mmol/L
Causes AGEP
BADFACE
Bactrim
Abx
Diltiazem
Frusemide
Allopurinol
Antimalarials
Cimetidine
Epileptics
Acneiform drug eruption
PIMPLE J CATS
○ Prednisolone
○ Isoniazid/Iodides
○ MEKi (trametinib)
○ Progestins
○ Lithium
○ EGFR inhibs (cetuximab / antiepileptics
○ JAKs
○ CsA
○ AZA
Testosterone, tacro, sirolimus
Triggers for CSVV
Drug triggers
Triggers for CSVV: MANIC: medication, autoimmune, NSAID, infection, cancer
Medication triggers for CSVV 10-15% cases: PAIN MEH OR MEAN HIP
Beta lactams, GCSF
Penicillin, penicillamine, propylthiouracil, PPI (omeprazole)
Allopurinol, Abx (quinolones, sulfonamides, cefalosporin)
Interferon, infliximab
NSAIDs
MTx, minocycline, macrolides
Epileptics (gabapentin, lamotrigine)
Hypertensives (thiazide, hydralazine)
Sweets associations (including drugs)
MINT DROPS
Malignancy - haematological (10-20%) - AML, myelodysplasia; solid organ
Infection - viral URTI, CMV, HBV, HCV, HIV; bacteria (Yersinia, Strep), Mycobacteria (M TB, M leprae), fungi (sporotrichosis, coccidiomycosis)
Neutrophilic - other (Behcet’s PG)
Thyroid disease , Autoimmune (SLE, RA, DM, relapsing polychondritis, Sjogren)
Drugs - Abx (mino, bactrim), antihypertensive, antineoplastics, G-CSF, contraceptives, immsupp (AZA), NSAIDs, retinoids
**Drug causes of Sweets - think Allens lollies
All-lans (antis) ATRA, Abx (bactrim, mino, quinolones), some are fruit flavoured (frusemide), some are gummy lollies (G-CSF), then you get tooth ache (need NSAID) and need to check (checkpoint inhibitors) for cavities (abacavir), sugar high makes you mad (imatinib) as (AZA) a hatter (hydralazine) interferes with your day/function (IFNa), need to take NSAIDs for your toothache
Sweet AF GANCHINIs
ATRA
Frusemide
G-CSF
Abx (mino, bactrim), abacavir
NSAIDs
Checkpoint inhibitors, contraceptives
Hydralazine
Imatinib
Neoplastics (ipilimumab, pembrolizumab, vemurafenib)
Immunosuppressants (AZA)
RA
Organ / bOwel - IBD (UC, Crohn’s)
Pregnancy
SLE, sarcoid
Subtypes/variants of PG
PPE- Pyodermatitis pyostomatitis (w IBD), Peristomal, Extracutaneous to the PUBS - Pustular, Ulcerative, Bullous, Superficial
Behcet’s Diagnostic Criteria
O PEGS
Diagnostic criteria - 1990 international study group - O PEGS
MAJOR: Aphthous idiopathic oral ulceration recurring at least 3 times in 12/12
and 2 of minor
MINOR:
- Pathergy test interpreted at 24 - 48hrs
- Eye lesions: anterior or posterior uveitis, cells in vitreous by slit lamp examination or retinal vasculitis
- Recurrent genital ulceration
- Skin lesions: EN like lesions, papulopustular lesions or pseudofolliculitis, or characteristic acneiform nodules
Bullous pemphigoid - drug causes
Drug induced:
SPACED PING:
Sulfas, Spironolactone
Penicillin, penicillamine, potassium iodide
ACE-I,
Diuretics - frusemide, spiro
Psoralens, PD1i, PPI (Laura in clinic 27/7)
Inhibitors - TNFi, checkpoint inhibitors (PD1i (nivolumab, pembrolizumab, cemiplimab), CTLA-4i (ipilimumab)
NSAIDs - ibuprofen, top diclofenac
Gliptins (dipeptidyl peptidase 4 inhibitor)
?Gold
Bullous pemphigoid - clinical variants
Clinical variants of BP - GLUED VANT:
Generalised, gestational
Lichen planus pemphigoides, localised (Brunsting Perry –> also variant of MMP not BP, stump, umbilical, peristomal, pretibial)
Urticarial
Erythrodermic, eczematous
Dyshidrosiform
Vesicular, vegetative, localised vulval
Acral (childhood)
Pemphigoid nodularis (Johannes long case, think about in prurigo nodularis, do Bx with DIF as part of workup)
TEN like
EBA - associations
Associations of EBA: CHADS
EBA about you. Think about finance CHADS
Crohn’s (> UC)
Haem malignancy
Arthritis / RA, AICTD
Drugs, diabetes
SLE
LABD - drug causes
VP CANS: Vancomycin
P: penicillins, phenytoin
C: cephalosporins, captopril
A: ACEi, ARB, amiodarone
N: NSAIDs (diclofenac, naproxen, oxaprozin, piroxicam)
S: sulphonamides
Less common - phenytoin, sulphonamides
Lithium, phenytoin, frusemide, atorvastatin
Drug induced LABD usually remits within 2-6/52 of cessation, but some cases have persisted for months
DDx acneiform eruption
DDx for acneiform eruption: ACNE PHAD
Acne agminata; acneiform follicular mucinosis
Chloracne; cosmetics
Naevus comedonicus
Elastosis, favre racouchot (rac coo show)
Perioral dermatitis; folliculotropic MF
Halogenoderma
Apert syndrome
Drugs
DDx facial plaques
GIRLS FAT
GF and GA
Infection - TB, leprosy, tinea
Rosacea
Lymphocytoma cutis, CTCL/CBCL, Jessner’s, LE tumid / discoid
Sweets, Sarcoid
Follicular mucinosis
Amyloid
tumours - BCC, Bowens
HS associations
ADIOS PAPI
Arthritis, up to 50% pts
Diabetes, up to 30% pts. 3x increased risk
IBD. 2x increased risk Crohn’s, 1.5x increased risk UC
Obesity, ~75% pts
Smoking, Scc (more common in men. Anal/gluteal area)
PCOS, ~10% pts, 3x increased risk
Anxiety or depression (JAAD Jan 2022. Higher depression in paeds and adults), Acne tetrad
Pyoderma gangrenosum
Insulin resistance or metabolic syndrome
Hyperhidrosis - causes of secondary hyperhidrosis
Then drug causes secondary hyperhidrosis
Causes secondary hyperhidrosis: DENIM
Drugs: SWEAT
Endocrine: hyperthyroidism, diabetes, menopause, phaeochromocytoma, carcinoid syndrome. POEMS
Neurological: Parkinson’s, stroke, spinal surgery, psychiatric disorders. Frey syndrome
Infection: HIV, malaria, TB
Malignancies: leukaemia, lymphoma, Menopause
Drug causes secondary hyperhidrosis: SWEAT
SSRI and other antidepressants, Stimulants (amphetamines, caffeine)
Wee wee - sildenafil
Endocrine drugs - sulphonylureas, insulin
Anti-Parkinson’s, antipsychotic, antidepressant, ACEi, antiemetics
Tramadol, opioids
Criteria for primary hyperhidrosis
Sweaty Sam Smith WAS FAB
Sweat = exces sweating
Six monthsn
Secondary causes - none
Was fab
- Weekly episodes at least
- ADLs impaired
- Sleeping - stops during sleep
- FHx
- Age onset <25
Bilat and symmetric
Nonspecific cutaneous findings of SLE
(SPAM N RAV)
Nonspecific cutaneous findings of SLE - SPAM N RAV
S: Sweets like neutrophilic dermatosis
P: palmar erythema
A: alopecia, diffuse non-scarring
M: mucinosis, papular and nodular; papulonodular mucinosis of Gold
N: nailfold telangiectasias and erythema
R: Raynauds
A: Antiphospholipid syndrome signs
V: vasculitis
Causes / precipitating factors for lupus
(MUSIC)
Causes/precipitating factors for lupus: MUSIC
Medications
UVR
Stress, silica, solvents
Infections (EBV)
Cigarettes
Drug causes ACLE
(PIMP BEATS HO)
Drug induced
a/w anti-histone Ab (up to 95% cases), anti-dsDNA usually neg
Usually ANA +ve
Key features: MSK (arthritis, arthralgia, myalgia), serositis (pleuritis, pericarditis). Cutaneous involvement less common
PIMP BEATS HO
P: PPI, psychotics
I: isoniazid
M: methyldopa, minocycline
P: procainamide, penicillamine
B: beta blockers
E: epileptics - valproate, phenytoin
A: allopurinol
T: TNF
S: sulphonamides
H: hydralazine
O: OCP
Cutaneous signs antiphospholipid antibody syndrome
Cutaneous signs in APLA syndrome - LA DULA
L: livedo reticularis
A: acrocyanosis
D: Degos like lesions
U: ulcerations
L: livedoid vasculopathy
A: atrophie blanche like lesions
SLE EULAR / ACR 2019 Diagnostic criteria
SLE EULAR/ACR 2019 Diagnostic criteria - Clinical - MONARCHS - like butterfly
MSK - joint involvement
Oral/cutaneous - nonscarring alopecia, oral ulcers, SCLE/DLE/ACLE.
Neuropsychiatric - delirium, psychosis, seizure
ANA positive
Renal - proteinuria, renal Bx showing lupus nephritis
Constitutional - fever
Haematologic - leukopaenia, thrombocytopaenia, AI haemolysis
Serosal - pleural or pericardial effusion, acute pericarditis
Immunology -
Antiphospholipid antibodies, complement (low C3 and/or C4) or SLE specific Ab (anti-sm, anti-dsDNA)
Drug causes SCLE
(SPACE TTTT) PATCH
SPACE TTTT
S: statins
P: PPI
A: ACEi
C: calcium channel blockers
E: epileptics
T: terbinafine
T: TNFa
T: thiazides
T: taxanes
Patch - Tom’s one
PPI
ACEi, antiepileptics
Twrbinafine, TNF, griseo
Calcium channel
Hctz
Drug induced Dermatomyositis
(DERMATO M)
- Drug induced DM: DERMATO-M
○ DM - stat: statins
○ Epileptics - phenytoin
○ Reflux - PPI
○ MSAIDs - NSAIDs
○ Anti-TNF
○ Terbinafine
○ O - hydrOxyurea
Mine - penicillamine
Cutaneous features of SSc
SSc: TURNIP: Telangiectasias, Ulcers, Raynaud’s, Nailfold capillaries, I - calcinosis, Pruritus, Pigmentary changes
DDx sclerodermoid skin changes
Sclerodermoid skin changes: SCLEROGAMES
Scleroderma, scleredema, scleromyxoedema
Carcinoid, CTD mixed
Lichen sclerosus, morphoea, lipodermatosclerosis, lupus profundus & other panniculitides
Eosinophilic fasciitis
Radiotherapy, nephrogenic systemic fibrosis
Occupational: PVC, silicone, solvents (trichlorethylene in dry cleaning), epoxy resins, pesticides, bleomycin
GVHD
Amyloid, acrodermatitis chronica atrophicans (Lyme disease),
Ageing syndromes (progeria, acrogeria)
Metabolic (PCT, nephrogenic systemic fibrosis), Morphoea, Medications (bleomycin, docetaxel, vit K)
Endocrine: myxoedema, POEMs, diabetic cheiroarthropathy
Stiff skin syndrome
Treatments for calcinosis
IWARP - ivig, warfarin, abatacept, ritux, probenecid
ACR/EULAR Dx criteria for SSc
ACR/EULAR Dx criteria for SSc - Fingers CAPUT
Fingers 3 -
– thickening prox to MCP
– puffy / sclerodactyly
– raynauds
Capillaries
Antibodies
Pulmonary disease - PAH, ILD
Ulcers, digital OR pitted scars
Telangiectasias
Scleromyxoedema - variants
Variants: DANC
-Discrete papular lichen myxoedematosus (clin: not hands, can be anywhere else. Limbs and trunk, symmetrical)
-Acral persistent papular mucinosis (clin: dorsal hands. F>M. Ivory to skin coloured papules)
-Nodular lichen myxoedematosus (clin: deep nodules, mm to cm. indurated)
-Cutaneous (papular) mucinosis of infancy (clin: classic upper arms, torso, head and neck)
Drug triggers for PCT
BEGS for Alcoholic Drinks
Barbiturates
Estrogen; Ergot
Griseofulvin
Sulfonamides
Alcohol/Anticonvulsants
Dapsone
PCT cutaneous features
PCT cutaneous features: SHAVEMO
Sclerodermoid changes
Hyperpigmentation, Hypertrichosis
Alopecia
Vesicles and bullae
Erosions
Milia
Onycholysis
Acute porphyrias - triggers for acute attacks
SHOE BAGS
Sulphur drugs
Hormones: late luteal cycle, pregnancy, IVF, HRT
OCP
Epileptics - carbamazepine, valproate and EtOH
Barbiturates
Antimalarials, amphetamines
Griseofulvin
Sedatives
Acanthosis nigricans - associations
FOAMED DS
Familial - hereditary benign AN. Progresses until puberty then stabilises or regresses
Obesity
AI - lupus, Sjogren, SSc, hashimoto thyroiditis
Malignancy
Endocrine - hypothyroid, cushing’s , addison’s, hyperandrogenism, acromegaly
Diabetes
Drugs
Syndromes - HAIR AN (hyperandrogenism, insulin resistance, acanthosis nigricans), leprechaunism, Crouzon
Acanthosis nigricans - drug causes
Drugs - COPING
Corticosteroids
OCP
Protease inhibitors
Insulin
Nicotinic acid lotion
GH
Acquired ichthyosis - causes inc drugs
Acquired ichthyoses - DRINNESSS:
Drugs: retinoids, allopurinol, statins, cholestyramine, clofazamine, lithium
CRACKLSS
Cholestyramine; Retinoids; Allopurinol; Clofazamine; Kava; Lithium; Statins; Spiro (diuretics)
Wake up in the morning. Wash off retinoid. Put on clofes clofazamine. Go downstairs and say allo (purinol),. Etc]
Big smile on your face - lithium
Have cholestserol lowering with breakfast -
Renal disease, Refsum disease (genoderm, weakness or numbness in hands and feet, lack enzyme for fitanic acid)
Infections (HIV, leprosy, LGV – chlamydia)
Neoplasm (lymphomas, MF, KS),
Nutrition (essential fatty acid deficiency, vitamin A deficiency, haemochromatosis, marasmus and wasting diseases)
Endocrine (hypothyroid, hypoparathyroid, hypopituitarism), Eczema
Sarcoid
Solar damage
SLE, Sjogren’s
Inherited ichthyoses, AD
Ichthyoses Inheritance - autosomal dominant: ADVERBS
ADVERBS:
Autosomal
Dominant
Vulgaris (IV)
Erythrokeratoderma variabilis
Reticular ichthyosiform erythroderma (confetti)
BIE
Siemens, IH
Inherited ichthyoses, AR
Ichthyoses Inheritance - autosomal recessive: ARLICH
ARLICH:
Autosomal
Recessive
Lamellar
Ichthyosis
CIE
Harlequin ichthyosis
Netherton - features
BARE ASS Spank
Bamboo hair
Atopic derm
REcessive
igE
Anaphylactic food allergy
Seb derm
Serine protease
SPINK 5
Conradi Hunerman Happle
CHH EBP
SAD FACE X
Conradi Hunerman Happle - features - CHH EBP
Transient blaschkoid ichthyosiform erythroderma at birth, resolves by 1yo with linear and follicular atrophoderma
Cataracts, CNS malformations, congenital cardiac defects, congenital renal
Hyper and hypopigmentation
Hyperkeratosis at birth, replaced by follicular atrophoderma, dilated follicular openings, ice pick like scars. Most pronounced forearms, dorsal hands
– Conrad the honey man, ice pick scars and atrophoderma like honeycomb
E - EBP gene
Bones/skeletal - limb shortening, stippled epiphyses (chondrodysplasia punctata on XR)
Patchy alopecia, nail dystrophy
SAD FACE X
Short stature
Asymmetrical limbs or cataracts
Dysmorphic facies - frontal bossing, macrocephaly
Follicular atrophoderma replacing blaschkoid hyperkeratosis
Alopecia
Chondrodysplasia punctata
Erythroderma at birth
XLD, EBP gene
Collodion baby causes
Clint Eastwood - CLNT SHNS
CIE
LI
Netherton’s
Trithothiodystrophy
Sjogren Larsson
Harlequin ichthyosis
Neutral lipid storage
Self healing
PPK - diffuse acquired
- FEPLC (common) - EFPLC ( ef PLC – presbytarian ladies college ) SPRAINED (uncommon)
○ Fungal - tinea
§ Beware unilateral hand rash
○ Eczema
§ Hyperkeratotic hand eczema
§ Irritant > allergic
○ Psoriasis
§ Examine other sites
○ Lichen planus
§ Examine other sites
○ Climactericum (keratoderma climactericum) - Haxthausen disease
§ Epi: women >45yrs. Obese perimenopausal women
§ Assoc: obesity, cold dry climates, backless shoes (sandals)
§ Clinical: hyperkeratosis begins over pressure points on heels. Formation of fissures makes walking painful. Feet esp pressure areas. Worse in winter- SPRAINED
○ SLE/DM
○ PRP
§ Yellow sandal. Perifollicular papules. Orange-red colour. Splinter haemorrhages
○ Reiter’s
§ Keratoderma blenorrhagicum
§ Circinate balanitis/vulvitis. Psoriasiform rash. Arthritis, urethritis, conjunctivitis
○ Acanthosis nigricans
§ Pachydermatoglyphy (yellow rugose appearance - tripe palms). Acanthosis palmaris
§ Associations: adenocarcinomas, lymphoma, leukaemia
○ Infection (scabies, syphilis)
○ Neoplasia (MF/Sezary, Bazex)
§ Bazex - acrokeratosis paraneoplastica. SCC upper aerodigestive tract. Scale fingertips, nailfolds, nose, ears. SCC upper resp tract or GI tract (oral cavity, pharynx, larynx, oesophagus), SCC thymus, vulva, adenocarcinoma of uterus
○ Endocrine
§ Hypothyroidism. Improves or resolves with thyroid replacement therapy
Drugs (vemurafenib, trametinib, imatinib)
- SPRAINED
DDx palmar / plantar pits
DDx for palmar pits / plantar pits: CD GAP PPD
Cowden’s
Darier’s
Gorlin’s
Acropigmentation of Kitamura, reticulate / Acrokeratosis verruciformis of Hopf
Punctate PPKs - BAFS (Buschke Fischer Brauer, Acrokeratoelastoidosis, Focal acral hyperkeratosis, Spiny keratoderma)
Pitted keratolysis
Punctate porokeratosis
Dupuytren’s contracture
DDx acral keratoses
Acral keratoses DDx:
Arsenic
Acrokeratosis verruciformis of Hopf
Cowden/PTEN
Darier
Rothmund Thomson syndrome
Acquired focal / punctate PPK
Causes acquired focal/punctate PPK: CLAW DRIPS
Callosities
LP/LE
Arsenic
Warts
Drug - FLIC BT
Reiters
Infection
Porokeratosis, Psoriasis
Drug causes acquired focal/punctate PPK - FLIC B T
* Lizzo with her fresh claws feeling suspiciously good as hell with all of her drugs
* Flu vax – pro flu vax
* Lithium – pro mental health
* Iodine – colour of her dress
* Calcium channel blockers – she’s on all the radio channels
* BRAF inhibitors
TNF inhibitors
Multiple CALM
Multiple Café au Lait macules - TNF BLAME
Tuberous sclerosis
Neurofibromatosis, Noonans
Fanconi anaemia, Familial
Blooms
LEOPARD (Noonan with multiple lentigines), Legius
Ataxia telangiectasia
McCune Albright, Maffucci syndrome
Endocrine neoplasia, multiple - MEN 1, MEN 2B
Noonan: CALM, pigmented naevi. Lymphoedema. Coarse woolly hair. Craniofacial changes. Webbed neck. Cryptorchidism
Fanconi: CALM,diffuse hypomelanosis of scalp hair, vitiligo, strabismus, bone marrow failure, short stature
Blooms
Blooms: photosensitivity. CALM
PC BLOOMS
Photosensitivity, poikiloderma
Café au lait macule
Butterfly erythema
Low fertility
Opportunistic infection / immunodeficiency
Oshkenazi Jews (but perhaps not per bolognia)
Malignancy - lymphoma, leukaemia - lymphoproliferative and GI
Short stature, syndactyly
LEOPARD syndrome
LEOPARD: (Noonan syndrome with multiple lentigines),
Lentigines,
Electrocardiographic conduction defects,
Ocular hypertelorism,
Pulmonary stenosis,
Abnormalities of the genitalia,
Retardation of growth,
Deafness
NF diagnostic criteria
NF Diagnostic criteria: NF SCORE
2 or more:
Criteria met by 97% by 8yo, 100% by 20yo
Neurofibromas: 2 or more, or one plexiform NF
Freckling in axillary or inguinal, Crowe’s sign (I’m like a bird)
Skeletal: osseous lesion such as sphenoid wing dysplasia (I’m like a bird) or thinning of long bone cortex (she’s really skinny) +/- pseudarthrosis (abnormal bowing, can progress to segment of bone loss, simulating appearance of a joint. Usually apparent shortly after birth, rarely diagnosed after age 2)
Café au lait macules: 6 or more >5mm in prepubertal, >15mm post pubertal (she’s super calm on stage)
Optic glioma (has glee in her eyes)
Relative: first degree with NF1 by these criteria (dedicating the show to her audience)
Eye: 2 or more Lisch nodules (iris hamartomas) (her friend Leisha Keys is there woo-ing her on)
NF malignancies
NF - malignancies. BORE3D JOGN
Breast
Optic glioma
Rhabdomyosarcoma
Endo x3:
-Phaeochromocytoma
-Somatostatinoma
-Parathyroid adenoma
Duodenal carcinoid
JMML
Other CNS - astrocytoma, brainstem glioma
GIST, glomus
NST - MPNST
TS diagnostic criteria - major and minor
PASH: major features
Periungual/subungual fibromas; at least 2 (Koenen tumours)
Angiofibromas; at least 3 OR fibrous cephalic plaque
Shagreen patch
Hypopigmented macules; at least 3
CORNER: major extracutaneous features
Cardiac rhabdomyomas
Ocular retinal hamartomas
Renal bilat angiomyolipomas
Neuro: subependymal nodules, SEGA (subependymal giant cell astrocytoma)
Extra brain stuff: cortical dysplasias – cortical tubers, cerebral white matter radial migration lines
Respiratory: pulmonary LALM
________________________________________
Minor: CHAFER OR CAFÉ HR
Confetti like skin lesions
Hamartomas, non renal
Achromic retinal patch
Fibromas, intraoral >2
Dental Enamel pits >3
Renal cysts, multiple
TS organ involvement
Organ involvement: TS COMPLEX
Teeth
Skin
Cardiovascular
Ocular
Mental (neurological)
Pulmonary
Le kidneys
Endocrine
Xray (skeletal)
Goltz syndrome / focal dermal hypoplasia
GOLTZ
Golden blobs of fat - from dermal atrophy with fat herniation
Osteopathia striata
Linear hyper and hypopigmentation
Teeth/hair/nails
Z - limbZ (syndactyly, ectrodactyly) and eyeZ (colobomas, microphthalmia, anophthalmia)
Epidermal naevi - types
Types of epidermal naevi: VBCASE
Verrucous, Becker, Comedonal, Apocrine 9rare), Sebaceous, Eccrine (rare)f
Epidermal naevi syndromes - types
Types of epidermal naevi syndrome: VB CASE
Verrucous: CHILD, type 2 segmental Cowden, FGFR3 ENS
Becker naevus syndrome
Comedo naevus syndrome
Angora hair naevus syndrome
Sebaceous:
Extra: Proteus, CLOVE
Associations of ENS: skeletal, optic, neurological
Proteus syndrome
PROTEUS syndrome. AKT1
Progressive overgrowth, Palmoplantar connective tissue naevi
R - shape of the back, hunched over. Disproportionate overgrowth and focal atrophy of upper arm muscles and neck, leading to hunched over look. Respiratory - lung cysts
Orthopaedic and soft tissue overgrowth. Disproportionate, asymmetric
Thromboembolism
Epidermal naevi, Lipomas
U - Vascular and lymphatic malformations
Spleen, thymus overgrowth
SOLAMEN syndrome
Segmental Overgrowth, Lipomatosis, Arteriovenous Malformation, Epidermal Naevus
Autosomal dominant mosaicism disorders
DN PHaB LAB: Do Not enter the PHaB LAB
Darier’s
NF
Porokeratosis
Hailey Hailey
Benign lesions
Legius
Angiofibromas
BCC
Linear inflammatory disorders
Linear inflammatory disorders: VBPLS
Vitiligo
Blaschkitis
Psoriasis
Lichen planus
Striatus, lichen
Cowdens - major and minor criteria
Cowdens/PHTS Major Criteria: TO PLANT MacBETH
Oral papillomas / cobblestoning
Penile freckling
Lhermitte duclos - dysplastic cerebellar gnagliocytoma
Acral keratoses on dorsal hands, punctate keratoses of palms
Neuromas mucocutaneous
Tricholemmomas
Macrocephaly
Breast Ca
Endometrial Ca
Thyroid cancer - follicular. It would be a folly to miss it
Hamartomas of GI
Cowden’s Minor Criteria: GRAVL
GI malignancy - CRC
Rcc
ASD
Vascular anomalies
Lipomas, testicular lipoma
Cowden’s malignancies
Cowden’s Malignancies - BLT REG - get a BLT on the regular
Breast
Lhermitte Duclos
Thyroid, follicular
Renal cell carcinoma
Endometrial
GI hamartomas/polyposis
Cowdens features
MILK FLOAT
Mucocutaneous neuromas
Invasife. Melanomas
Lipomas
K - cognition, cancer, cerebellar disease
Fibromas
Lentigines of glans penis
Oral papillomas
Acral keratoses
Tricholemmomas
PLANT MOM
Penile freckling
Lipomas
Acral keratoses
Neuromas, mucosal
Tricholemmomas
Macrocephaly
Oral papillomas
Melanomas
GI polyps and skin signs (no mnemonic)
GI polyps and skin signs:
Gardner
Peutz Jegher
Muir Torre
PTEN hamartoma tumour syndrome - Cowden
Juvenile polyposis syndromes can be a/w HHT
Vitiligo associations
Vitiligo associations: TADA CARL!
Thyroid disease
Anaemia, pernicious
Diabetes
Addison disease
Coeliac disease
Atopic dermatitis
Rheumatoid arthritis
Lupus erythematosus
DDx hypopigmentation
DDx for hypopigmentation: VIC GETS NIP
V: vitiligo
I: infection – leprosy, onchocerciasis, syphilis, pit versi, leishmaniasis
C: chemical leukoderma – drugs (imatinib)
G: genetic eg piebaldism, TS, pigmentary dilution list CAPN M GOH
E: eating – nutrition: Kwashiorkor, copper, selenium
T: tinea versicolour
S: syphilis, scleroderma
N: naevus depigmentosus
I: idiopathic guttate hypomelanosis
P: post inflammatory, MF
DDx pigmentary dilution
Pigmentary dilution: CAPN M GOH (Captain Michelle Goh)
Chediak Higashi
Apert syndrome
Phenylketonuria
Nutritional - copper, selenium deficiency
Menke’s
Griscelli
Oculocutaneous albinism
Hermansky Pudlak
DDx diffuse hyperpigmentation
NED PLANKS
Neoplasms - melanoma, ACTH producing
Endocrine - Addison’s, cushing’s phaeochromocytoma, carcinoid, hyperthyroidism, pregnancy
Drugs
PIH, PCT
Liver disease - haemochromatosis, Wilson’s
Anaemias - Fanconi, haemolytic, IDA
Nutritional deficiencies - pellagra, vit b12, kwashiorkor
Kidney failure
SSc, other CTD
DDx linear hyperpigmentation
Causes of linear hyperpigmentation - FFILL X COMB
Flagellate
Focal dermal hypoplasia (Goltz)
Incontinentia pigmenti
Linear lichen planus
Linear naevoid hypermelanosis
X linked reticulate
Conradi hunerman happle
Morphoea - linear atrophoderma of Moulin
Blaschkitis
DDx blaschkoid linear hyperpigmentation
Blaschkiod linear hyperpigmentation - Conrad FLEXI at Moulin Rouge
Conradi Hunerman Happle
Focal dermal dysplasia AKA Goltz syndrome
Linear and whorled naevoid hypermelanosis
Epidermal naevus
X linked reticulate pigmentary disorder
Incontinentia pigmenti
Moulin - linear atrophoderma of Moulin
DDx reticulated hyperpigmentation
Reticulate hyperpigmentation: DEEP DANC DIP X. Reticulate, fishing net, in the ocean. Deep danc dark dip, x marks the spot
Dyskeratosis congenita
Erythema ab igne
EBS with mottled pigmentation
Prurigo pigmentosa
Dowling Degos disease
Amyloid, macular
Naegeli Franceschetti Jadassohn syndrome
CARP
Drugs: diltiazem, 5FU, bleo
Incontinentia pigmenti
PIH
X linked reticulate pigmentary disorder
Dowling Degos disease
Dowling Degos Disease: DDD
Dirty pits - acquired reticulated hyperpigmentation flexural sites
Dents in the face - pitted facial scars. Comedones, HS like features
Don’t care - no other associations. Develops over time - acquired.
Drug causes - telogen effluvium
ABCD ROME
ACEi, AntiTNF (JAAD R/V 06/23)
Beta blockers
Anti Coagulants - enoxaparin, Chemotherapy/Targeted therapy (anagen effluvium. Scalp cooling)
Anti Depressants
Retinoids
OCP/hormones
Minoxidil (telogen release)
Anti Epileptics - lamotrigine
Tacrolimus
Vaccines - zoster
Most don’t have evidence to suggest cause and effect. All kinds of alopecia
DDx causes onycholysis
Causes of onycholysis: IPEELD
Infection: Candida, dermatophytes, HPV
Psoriasis
Environmental: irritants, water, trauma, UV photoonycholysis
Endocrine: hyperthyroidism
Lesions: SCC, subungual exostosis
Drugs: tetracyclines, taxanes, psoralens, PDT
Causes gingival hyperplasia
Causes of gingival hyperplasia - GINGIVA
Geno - Cowden
Infiltrate - leukaemia cutis
Nutritional - vit D def, vit C def
Geno - TS
Iatrogenic - drugs.
Vasculitis - GPA
Acromegaly
Drugs - CsA, phenytoin, nifedipine/calcium channel blockers
+ pregnancy
Drugs causing gingival hyperplasia:
Calcium channel blockers
CsA
Dilantin (phenytoin)
Clinical features of LEPROMATOUS leprosy
SMILE with your EYES and jazz hands SMILES G CORP(glove and stocking). V shaped smile – Virchow cells on path
Saddle nose
Madarosis
Ichthyosis
Leonine facies
Earlobe infiltration
Scrotum - testicular atrophy, orchitis, infertility
Glove and stocking anaesthesia
Claw hand - median nerve and ulnar nerve
Ocular – lagopthalmos, corneal and conjunctival anaesthesia
Radial nerve - wrist drop
Pope hand - ulnar nerve
Clinical features TUBERCULOID leprosy
SHAG:
Scaly plaques;
Hypopigmented;
Anaesthesia and Alopecia;
Granulomas but no organisms
If you had to shag someone with leprosy, you would want tuberculoid
Anaesthetic patches. Few well hypopigmented patches and plaques
Thickening of nerves
Alopecia in patches
Path – granulomatous. No organisms
Treatment of rickettsial infections
If suspect –> begin empiric Rx
1: doxycycline 100mg PO/IV BD. Until >3 days after defervescence, min course 5-7 days
OR chloramphenicol 500mg IV QID if pregnant and non-life threatening
OR rifampin 300mg PO BD for non-life threatening ehrlichiosis or granulocytic anaplasmosis
OR azithromycin 500mg PO OD for scrub typhus in pregnant women #1
DARC- get bitten by ticks in the dark
Tinea capitis - endothrix organisms
Endothrix: non-fluorescent arthroconidia within the hair shaft. Presentation variable - from ‘black dots’ and patchy alopecia, to kerion
T tonsurans - ‘black dot’ tinea capitis, due to hair breakage near scalp - having a night in because you have a sore throat/consils
T violaceum - violent sudanese film
T soudanense - watching international Sudanese film
T gourvilli - having gourmet food
T yaoundei – sitting at in yao undei’s
T rubrum – red wine
Schoenlenii
Watch TV inside (endothrix) with the lights off (don’t fluoresce), so get your red (wine)
Tinea capitis - ectothrix - organisms
Ectothrix: arthroconidia are formed from fragmented hyphae outside the hairshaft. Leads to cuticle destruction. May or may not be fluorescent via Wood’s lamp.
M canis*
M audouinii* - dry, scaly patches ‘grey patch’ tinea capitis – like houdini makes the hair disappear
M distortum* - distorts the hair
M ferrugineum* - furry animals
M gypseum - gypsy with clumped hair, gypsum rock grey
T rubrum (rarely)
Verrucosum, Mentagrophytes
Micro Cats and dogs fight and growl
Yellow-green fluorescence in FACD
EBV associated conditions
EBV associated conditions: SLEIGH CLM
Severe mosquito bite allergy
Lipschutz ulcer
Extranodal NK/T cell lymphoma
Infectious mononucleosis
Gianotti Crosti
HV LPD
Chronic active EBV infection
Lymphomatoid granulosis
Mucocutaneous ulceration
Conditions caused by / associated with HTLV1
Conditions caused by HTLV1 - SPASTIC
Seb derm
Paraperesis - myelopathy / tropical spastic paraparesis
Adult T cell leukaemia/lymphoma
Strongyloides, scabies
Tinea
Infective dermatitis; ichthyosis
Corneal opacities, HTLV1 associated uveitis
Leishmaniasis - old and new world infections. Which cause visceral, cutaneous, diffuse, mucocutaneous
Old world: DAMIT - at war again Midle East Afrida India
Donovani –> visceral
Aethiopica
Major*
Infantum –> visceral
Tropica*
New world: B MAC - big mac, central america/texas
Braziliensis –> mucocutaneous
Mexicana –> cutaneous
Amazonesis
Infantum Chagasi –> visceral
Visceral - DIC. donovani, infantum, chagasi Visceral involvement, have DIC they are so unwell
Cutaneous - TMM. Tropica, Major, Mexicana Too much mouth
Diffuse - AA. Amazon and Aethiopica. Big diffuse countries
Mucocutaneous - BP. Braziliensis, Peruviana Think BP , can affect mucous membranes
Xeroderma pigmentosum - features
LIMP ON
Lentigines - by age 2
Internal malignancy - brain, lung, oral cavity, GIT, kidney, haem
Gynae tumours - per a 2023 Nature article
Leukaemia, CNS, thyroid, gynae
Malignancy - skin cancers
Photosensitivity (290-340), poikiloderma
Ocular issues - photophobia, keratitis, corneal opacities
Neurological issues (except XP variant) - mental retardation, hyporeflexia, deafness, seizures
Neuro abnormalities more common in groups A and D
In ~20-30% pts
Rothnmund Thomson features
SCORPAD
Short stature, SCC acral
Cataracts
Osteosarcoma of long bone
Radial ray defects
Poikiloderma, Photosensitivity
Acral keratoses, Alopecia
Dental issues
Drugs causing photosensitivity
Drugs causing photosensitivity: TAN GARP SPF
Thiazides, Tetracyclines
Antimalarials
NSAIDS
Griseofulvin
Amiodarone
Retinoids
Psoralens
Sulfonamides, sulphonylureas
Phenothiazines
Fluoroquinolones
Voriconazole - and increased risk SCC
Vemurafenib
PPIs
VV TAN GARP SPF
Bruising in kids - when is bruising concerning for abuse. Screening tool
TEN-4-FACES-P: mnemonic for suspicious bruising in children <4yo
TEN4: in child <4yo, and any region for infant <4 months
Torso
Ear
Neck
FACES-P:
Frenulum
Auricular area, angle of jaw
Cheek
Eyelid
Sclera
Patterned bruising
Lofgren and Heerfordt syndromes
○ Lofgren: LEAF: lymphadenopathy (hilar), EN, arthritis, fever
○ Heerfordt: PUFF: parotid gland enlargement, uveitis, fever, facial/cranial nerve palsy
AKA uveoparotid fever
Sarcoid variants
Variants: HUMANS PELVIS
Hypopigmented, Ulcerative, Maculopapular/mucosal, Angiolupoid/annular/atrophic/alopecia, Nodular/nail, Subcutaneous
Papular/plaque/psoriasiform/palmoplantar, EN/erythrodermic, Lupus pernio/lichenoid, Verrucous, Ichthyotic, Scar, tattoo
Drug causes sarcoid
BRIT is so sarcastic
BRAF and checkpoint
Retrovirals
IFN, IL-1, implants
TNFi
Drug causes granulomatous dermatitis
Granulomatous drug causes: SATAN
Statins
Antihypertensive - amlodipine, ACEI
TNFs
Allopurinol
NSAIDs
Causes of secondary anetoderma
ANITA
AI: DLE SLE, APLS, Graves
Nfection: VZV, HIV, folliculitis, leprosy TB, syphilis, molluscum
Inflammation: JXG, LP, acne, mastocytosis
Tumours: JXG, involuted IH, pilomatricoma, DF, DFSP, MF
A - penicillAmine
Ulcerating panniculitis
NICE PLANT
Neutrophilic - a/w RA, subcutaneous sweets
Infective - EI
Calciphylaxis, Cytophagic histiocytic panniculitis
Enzymatic - pancreatic, alpha 1 antitrypsin
Pan
Lymphoma
Alpha 1 antitrypsin
NLD
Trauma, factitial
Panniculitis - septal, NO vasculitis
GRENS
Granuloma annulare, deep
Rheumatoid nodules
Erythema nodosum
NLD
Scleroderma, morphoea
Panniculitis - septal, WITH vasculitis
PLS
PAN
LCV
Superficial thrombophlebitis
Panniculitis - lobular, WITH vasculitis
EE
Erythema induratum of Bazin, Whitfield
Erythema nodosum leprosum
Panniculitis - lobular, NO vasculitis
PANNICULITIS
Pancreatic
Alpha 1 antitrypsin
Newborn - subcutaneous fat necrosis
Neonatal sclerema
Infiltrates - lymphoma, infectious, gout, factitious
CTD - lupus, DM, eosinophilic fasciitis, cold, crystals - gout, cholesterol, calcium
Unknown - Weber Christian
LDS, lipoatrophy, lipodystrophy
Insect bite reaction and other eosinophilic - Well’s, parasite, hypereosinophilic
Trauma
Injected or induced - factitial
Sweets, post steroid, sarcoid
Erythema nodosum - associations
BEDREST:
Behcet,
Estrogens, pregnancy
Drugs (OCP, sulphonamides, penicillin, bromides, TNFi, BRAFi),
Recent infection (strep, yersinia),
Enteropathy (Crohn’s > UC),
Sarcoid (eg Lofgren) 10-20% cases in some series,
Tuberculosis
And haem malignancy
Erythema nodosum - drug causes
Drug causes of EN - P BITES
Penicillin
Bromides, BRAF
Iodides
TNFs
Estrogen
Sulphonamides/sulpha
IH - PHACES
PHACES - large facial haemangioma with extracutaneous manifestations
Posterior fossa malformation
Haemangioma - large head and neck
Arterial anomalies
Cardiac anomalies
Eye and endocrine anomalies
Sternal defects, supraumbilical raphe (longitudinal ridge, seam)
PHACES = acronym for major criteria
IH - LUMBAR
LUMBAR
Lower body haemangioma and Lipomas or other skin anomalies (eg skin tags)
Urogenital anomalies and Ulceration of the haemangioma
Myelopathy (spinal dysraphism)
Bony deformities
Anorectal malformations and Arterial anomalies
Renal anomalies
Causes lymphoedema
Secondary/acquired: –> MT VISOR - THIN VISOR
Trauma, Thrombosis
HS / Heart failure
IBD (Crohn’s)
Malignancy/Neoplasia, Nephrotic syndrome, liver impairment (resulting in hypoalbuminaemia)
Venous insufficiency (chronic)
Infection - recurrent cellulitis, filariasis (Wuchereria bancrofti), podoconiosis (exposure to volcanic soils, eastern Africa Gordon - from absorption of silica within volcanic soils. Google - noninfectious, from barefoot exposure to irritant red clay volcanic soil. Endemic nonfilarial elephantiasis)
Surgical LN dissection
Obesity, morbid
Radiation
Causes of livedo
Causes of livedo: LIVEDO
Lopathy / vasculopathy: Sneddon syndrome, livedoid vasculopathy, LTA
Infection: meningococcal, hep C (cryos), SBE, syphilis, Mycoplasma (cold agglutinins)
Vasculitis: PAN, cryoglobulinaemic. AICTD associated vasculitis - rheumatoid, SLE
Embolic: cholesterol, thrombotic, septic
Disorders of connective tissue: lupus, DM, scleroderma, Sjogren’s. Due to vasospasm a/w AICTD
O: blood. Increased blood components (Polycythaemia, thrombocythaemia), abnormal proteins (paraprotein, cryoglobulins, cryofibrinogen), hypercoagulability (APLS, protein C and S deficiencies, antithrombin III, factor V leiden, homocysteinuria)
Causes of flushing
Causes of flushing: TRAMPED
Thyrotoxicosis
Rosacea
Alcohol
Menopause, mastocytosis, malignancy (pancreatic, renal)
Physiological
Endocrine tumours - phaeochromocytoma, medullary thyroid cancer, carcinoid
Drugs
Drug causes flushing
Drug causes of flushing: NACHOES- GP
* Nitrates (glyceryl trinitrate), Nicotinic acid
* ACE inhibitors, Antidepressants
* Calcium channel blockers (diltiazem), Cyclosporin, Cancer drugs (tamoxifen)
* Hydralazine
* Opiates
* Ethanol, fumaric acid Esters
* Sildenafil
* Gold
Prostaglandins
Red man syndrome list:
- Vancomycin
Rifampicin
Facial papules
BASKET CASE
Syndromic:
BCC - Gorlin’s
Angiofibromas - TS
Sebaceous neoplasms - Muir Torre
KAs - Ferguson Smith, Gryzbowski
Epidermoid cysts - Gardner, Gorlin
Trichoepitheliomas - Brooke Spiegler
Trichilemmomas - Cowden’s
Trichodiscomas/fibrofolliculomas - Birt Hogg Dube
Non syndromic:
Cysts
Acne, acne agminata, rosacea, POD, demodex folliculitis
Sarcoid, syringomas
Eruptive milia
Syringomas - associations
Associations of syringomas: DAMPED HAIR
Downs
Asians
Marfans
Pregnancy
Ehlers Danlos
Diabetes
Hair - scarring alopecia (?)
Think of that pt of Claire’s who had down syndrome
Mastocytosis - triggers
DR MASTO +/- CHEF
D: dextromethorphan (cough suppressant - Robitussin), dextran (in some IV solutions)
R: radiocontrast (iodine based)
M: NSAIDs, aspirin
A: anticholinergics (scopolamine), +/- aspirin, alcohol. ACD handout - antibiotics (vanc, polymyxin B, amphotericin)
S: suxamethonium, other systemic anaesthetics (lidocaine [but local injections are safe], thiopental, succinylcholine, isoflurane, enflurane, metocurine). ACD handout - local anaesthetics like procaine
T: tasty things - spicy foods, alcohol, hot beverages
O: opioids
+/- CHEF (cold, heat, exercise, friction)
Bee and wasp stings
Mastocytosis - WHO criteria for Dx systemic masto
MAST C: WHO criteria for diagnosis of systemic mastocytosis
Mast cells - multifocal infiltrates. >/=15
Activating cKIT variant
Spindled or atypical mast cells >25% in bone marrow or extracutaneous tissues
Tryptase >20
CD2/25 expressed in extracutaneous mast cells
DDx blueberry muffin baby
Blueberry muffin DDx - Ha Ha Ha, Look The Little NICU Child Rash
Haematopoiesis, extramedullary
Haemangiomas
Haemolytic anaemias - congenital spherocytosis, Rhesus disease
LCH
Twin twin transfusion syndrome
Neuroblastoma
CMV
Rubella
CsA interactions - drugs which inhibit CYP450 (thereby increasing level of CsA)
GECKO - inhibit CYPP450. Thereby increasing level of CsA
Drugs which inhibit CYP450 –
JAKi
Grapefruit juice
Erythromycin - macrolides
Calcium channel blockers - verapamil, diltiazem. Ciprofloxacin - fluoroquinolones
Ketoconazole - triazoles
OCP (Mims)
Protease inhibitors
Antidepressants SSRI
Updated 16.3.24 bsaed on MIMs/Wolverton
CsA interactions - drugs which induce CYP450 (thereby decreasing level of CsA)
Ridges - reduced serum level of CsA
Drugs which induce CYP450 - RIDGES
St John (St John’s wort) standing on top of a ridge, has TB and isn’t well (rifampicin, isoniazid), brought up his deck chair (dexamethasone) which attracted lightning he got zapped and hat a fit (epileptics – carbamazepine, phenytoin), and a grizzly bear (griseofulvin) came out and ate him up
CsA side effects
SE of CsA: SIR HASN’T GB
SCCs
Infection
Renal, hypertension
Hypertrichosis, hyperlipidaemia, hyperuricaemia, hyperkalaemia, hyPOmagnesaemia
Acne
Sebaceous hyperplasia
Neuro - paraesthesias, headaches
Tremors
Gum hyperplasia, GI (nausea, diarrhoea)
Breast lumps, benign adenomas
MTx drug interactions
SLANT
Sulpha drugs eg TMP, sulphamethox, dapsone - folate antagonists. Increase myelosuppression
Loop diuretics - inc MTx levels
Acitretin, alcohol - nc risk liver impairment - (Wolverton thinks laspirin lower risk)
NSAIDs - probenecid. Increase level
Tetracyclines - Wolverton thinks low risk inc level
HCQ - contraindications then AEs
Justin Bieber - PRG HLM
Pregnancy, Psoriasis
Retinopathy / maculopathy
G6PD
Haem - severe blood dyscrasia
Liver - severe hepatic disease
Myasthenia gravis, severe neurological disease
OH classy girl now
OHCNG
Ocular -
- Reversible: blurred vision, halos, photophobia, retinal pigment
- Irreversible: bulls eye maculopathy
- MO:
○ Reversible: DIPLO, not as famous. Diplopia, Halo (blonde hair), Photophobia and blurred vision (desn’t wear galsses)
○ Irreversible: Pit Bull. Bulls eye maculopathy Mr worldwide -central scotoma. Always wearing glasses - bad night vision
Haem - agranulocytosis, pancytopaenia
Neuro - rare irritability, headache, vertigo, tinnitus, psychosis
GI: N/V/D
Cutaneous - psoriasis, drug rash, pigmentation, achromotrichia
Sirolimus - AEs
AH BLOW UP
A: acne
H: hypertension, hyperlipidaemia
B: bone marrow suppression
L: lung consolidation
O: peripheral oedema
W: wound healing issues
U: ulcers
P: proteinuria
DDx painful skin nodules
BLEND AN EGG
Blue rubber bleb
Leiomyoma
Eccrine spiradenoma
Neuroma
Dermatofibroma
Angiolipoma
Neurilemmoma
Endometriosis
Granular cell tumours
Glomus tumour
Intracellular organisms
Intracellular organisms: HIS GIRL PENELOPE
- Histoplasmosis
- Granuloma inguinale (aka donovanosis) - klebsiella granulomatosis, Donovan bodies (BT: said to look like safety pins)
- Ehrlichioses
- Rhinoscleroma - klebsiella rhinoscleromatosis, Russel bodies, mikulicz cell, Rickettsial (Rickettsiae, Ehrlichiosis, Coxiella burnetti)
- Leishmaniasis
- Penicillium marneffei
Rickettisiae, Ehrlichioses
Q fever (Coxiella burnetti)
Cryptococcosis
Koebnerising conditions
PELVIS
Psoriasis, perforating dermatoses
EM
LP, LS, lichen nitidus
Vitiligo
Infections - warts
Sweet’s
DDx leonine facies
CLAMPS x2-3
- Carcinoid, CAD, cutis verticis gyrata
○ Cowdens
- Leishmaniasis, lepromatous leprosy, lipoid proteinosis, leukaemia cutis
- Acromegaly, amyloidosis, alopecia mucinosis, atopic derm (airborne)
- Multi centric reticulohistiocytosis, MF, mastocytosis
- Pachydermoperiostosis, progressive nodular histiocytosis, phymatous rosacea
Sarcoid, scleromyxoedema, syphilis
DDx follicular papules
K FLIPS
- Keratosis pilaris
- Follicular mucinosis, follicular MF
- Lichen spinulosus, lichen scrofuloderma, lichen nitidus, lichen planopilaris
- Inflammatory - eczema, psoriasis, ichthyosis
- PRP, phrynoderma
- Sarcoid, syphilis
BRAF inhibitors - can cause keratotic if you don’t use MEKi you get the cutaneous effects a lot more - inc scc
DDx dermal
GIVEN + LP
Granulomatous
Infiltrates
Vascular
Erythemas
Neoplastic
Lichen planus
Skin associations Down syndrome
Skin associations Down syndrome – FAT FACES PALMS
Folliculitis
Alopecia areata
Tinea
Fissured tongue
Anetoderma
Cutis laxa; milia like calcinosis
Elastosis perforans serpiginosa; eczema
Syringomas; seb derm
Psoriasis/PRP; palmar crease
Ageing; acrocyanosis
Lichen nitidus; livedoid plaques
Melanoma
Suppurativa, hidradenitis
Medication causes of pemphigus
Medication causes pemphigus: CRAPT
Captopril and ACEi, Cephalosporins
Rifampicin, XRT
Amoxil, Alliums, INFa
Penicillamine, Psoralens, Propranolol, Piroxicam
Thiols
DDx itchy papules
SIGNALLED
Scabies
Infiltrates; Insect bite reaction
Grovers
Neurodermatoses, Nodular prurigo
Another - urticaria
Lichen planus; Lichenoid drug
Lichenoides chronica, pityriasis
Eczema, papular
DH; Darier’s; Drug
IgG4 related disease - associated skin disorders
FKAR, this is such a fucker
Faciale, granuloma
Kimura disease
Angiolymphoid hyperplasia with eosinophilia
Rosai Dorfman disease
DDx for retiform purpura
PC ADVICE
Platelet related: HIT, PNH, TTP
Coagulopathy: livedoid vasculopathy, malignant atrophic papulosis/Degos, Sneddon syndrome, DADA2
Antiphospholipid Ab syndrome. Protein C, S deficiency
Drug: warfarin, levamisole cocaine, hydroxyurea, heparin
Vasculitis: ANCA, PAN, AICTD associated
Infection: fungal (Mucor, Aspergillus) ecthyma gangrenosum (Pseudomonas), lucio phenom, rickettsial, disseminated strongyloidiasis
Calciphylaxis
Cold precipitable: cryoglob, cryofibrin, cold agglut
Embolic: cholesterol, oxalate crystal, septic, atrial myxoma
Keratoacanthoma types
Solitary - CMGS
Multiple - CMGF
Solitary - CMGS
Classic - SCC variant
Mucosal
Giant
Subungual (erodes bone and does not resolve compared w other types
Multiple - CMGF
Centrifugum marginatum
Muir Torre associated
Gryzbowski - ectropion, PN like, pruritic
Ferguson Smith - childhood onset
Features of Chediak Higashi
Features of Chediak Higashi - HIGASH
HLH
Immunodeficiencies
Giant melanosomes on biopsy
Anormal neutrophils
Silver hair
Hypopigmentation
DDx telangiectasias
SUGAR PATCH V
Spider naevi
Unilateral naevoid telangiectasia
Generalised essential telangiectasia, Benign essential telangiectasia; GVHD
Ataxia telangiectasia; Angioma serpiginosum
Radiotherapy; Rosacea
Poikiloderma ddx - XP, RTS, DKC, GVHD, MF, Bloom
Atrophy from steroids
TMEP
CREST; CTDs (DM, DLE, CREST, angiolupoid sarcoid); Carcinoid
HHT, CM AVM2
Varicose veins; Vascular malformations (CMTC, IH-MAG)
DDx bad eczema baby
Reasons why bad eczema baby not improving?
DDx - bad eczema baby
Wiskott Aldrich
IPEX
Netherton
Omenn syndrome
SCID
Reason for bad eczema baby not responding
- Food allergy
- Ichthyosis
- Immunodeficiency
Non compliance
Drug causes hypertrichosis
Drug causes hypertrichosis: M SPACE
Minoxidil, Mmf
Steroids, Streptomycin
Phenytoin, Psoralens
Acetazolamide
CsA
EGFR inhibitors
Cutaneous features of Birt Hogg Dube
Hog at the disco gets turned into a FAT MAC - Cutaneous features of BHD
Fibrofolliculoma
Angiofibroma
Trichodiscoma
Melanoma
Acrochordon
Connective tissue naevi
Path DDx - small blue cell tumours
LEMONS
Lymphoma
Ewing sarcoma
Merkel cell carcinoma / melanoma
Oat cell carcinoma of lung
Neuroblastoma
Small cell endocrine carcinoma
Gorlin’s diagnostic criteria
Diagnostic criteria Gorlin’s. 1 major + genetics OR 2 major OR 1 major + 2 minor
Major: BC PROM
BCCs <20yo or multiple
Calcification of falx cerebri
Palmar or plantar pitting
Relative, first degree
OKCs <20yo
Medulloblastoma
Minor: MC FLOOR
Macrocephaly
Cleft lip/palate
Fibroma, ovarian or cardiac
Lymphomesenteric cysts
Ocular: strabismus, hypertelorism, congenital cataracts, glaucoma, coloboma
Other skeletal: vertebral anomalies, kyphoscoliosis etc
Rib abnormalities
Cockayne - my new one
Cockayne = COCAINE
Cachectic, dwarf appearance
Ocular - salt and pepper retina, optic atrophy
Cataracts
Aged appearance, Mickey Mouse like
Irrationally large hands and feet, long limbs
Neuro - SNHL, demyelination of CNS and PNS, progressive
Erythema without pigment change
