Rashes Associated With Systemic Disease And Pregnancy Flashcards
Erythema nodosum presentation
Red lumps on shins (and sometimes thighs and forearms)
Type of panic unlit is (inflammatory disorder affecting subcutaneous fat)
Symptoms of underlying disease eg.sore throat
Red lumps hot and painful and fade through colour changes of bruise
Fever, joint pain, feeling unwell
Age range for most cases of erythema nodosum
20-45
Erythema nodosum causes
Infection (viral, bacterial, TB)
Sarcoidosis
Pregnancy
Combined contraceptive pill
Drugs (sulphonamides, salicylates, NSAIDs, bromides and gold salts)
IBD
Idiopathic
What tests should be done in erythema nodosum?
Throat swab
Sputum or gastric washing if TB suspected
FBC, ESR, CRP
ASO titre (streptococcal infection test)
Chest X-ray (looking for TB/sarcoidosis)
What is cutaneous vasculitis?
Group of disorders in which there are inflamed blood vessels in skin
Skin presentation in small vessel vasculitis
Palpable purpura
Skin presentation in medium vessel vasculitis
Nodules and livedo reticularis
Skin presentation capillaritis
Pigmented purpura
Petechiae resolving with haemosiderin deposition
3 types of cutaneous vasculitis
Capillaritis
Small vessel vasculitis
Medium vessel vasculitis
Cutaneous vasculitis causes
Infection (viral, bacteria, mycobacteria)
Connective tissue disease
Malignant
Drugs (antibiotics)
Idiopathic (IgA vasculitis)
Pyoderma gangrenosum presentation
rapidly enlarging, very painful ulcer
normally has purulent base
ragged, purple, undermined edge
Pyoderma gangrenosum causes
IBD
myeloproliferative disease
RA
drugs
MGUS
idiopathic
How is pyoderma gangrenosum diagnosed?
clinical picture
swabs to rule out infection
biopsy to rule out other causes of ulcers
What is necrobiosis lipoidica?
granulomatous skin disorder which can affect the shin of insulin-dependent diabetics
can sometimes occur in non-diabetic patients
cause unknown
Necrobiosis lipoidica clinical picture
tender yellowish/brown patches develop slowly on lower legs over several months
round, oval or an irregular shape
centre of patch becomes shiny, pale, thinned, with telangiectasia
minor injury to patch can cause ulceration
slow to heal
What does granuloma annulare look like?
smooth skin-coloured plaques
thickened
ring-shaped or annular
affects children, teenagers or young adults
What can localised granuloma annulare be associated with?
autoimmune thyroiditis
Who does localised granuloma annulare most commonly affect and what is the clinical picture?
children
one or more skin coloured bumps occur in rings in skin over joints (particularly knuckles, ankles and elbows)
Who does generalised granuloma annulare most commonly affect and what is the clinical picture?
adults
widespread skin coloured, pinkish or slightly mauve coloured patches
disseminated type is composed of small papules
What is erythema multiforme?
hypersensitivity reaction usually triggered by infections (most commonly HSV)
How does erythema multiforme present?
target-like lesions
may be mucous membrane involvement
acute and self-limiting
divided into major and minor forms
Erythema multiforme causes
viral infection
parapoxvirus, herpes varicella zoster, adenovirus, hepatitis, HIV, cytomegalovirus, viral vaccine
drugs: barbiturates, NSAIDs, penicillin, sulphonamides, phenothiazines, anticonvulsants
What is a xanthoma?
skin lesion caused by accumulation of fat in macrophages immune cells in the skin and rarely in the layer of fat under the skin
What can cause xanthoma?
(can be indicative of lipid metabolism disorders)
primary biliary cirrhosis
idiopathic
familial hyperlipidaemia
acquired hyperlipidaemia (diabetes, cholestasis, hypothyroidism, chronic renal failure)
Where does xanthelasma palpebrarum occur?
symmetrically on upper and lower eyelids
most common type of xanthoma
Where do tuberous xanthomas occur, what do they look like and what can they be associated with?
firm, painless, red-yellow nodules
develop around pressure areas (eg. knees, elbows, heels and buttocks)
usually associated with hypercholesterolaemia
Where do tendinous xanthomas occur, what do they look like and what are they associated with?
slowly enlarging subcutaneous nodules related to a tendon or ligament
associated with severe hypercholesterolaemia and elevated LDL levels
What skin changed can occur during pregnancy?
stretch marks (striae)
skin tags
changes in hair growth
acne breakouts
spider veins and varicose veins
darkening of areas of skin (melasma)
darkening of moles and freckles
Describe pruritic urticated papules and plaques of pregnancy
3rd trimester
primiparous
does not recur in future pregnancies
spares umbilicus
resolves after delivery
no risk to newborn
What is PUPPP?
pruritic urticated papules and plaques of pregnancy
PUPPP treatment
topical steroids
antihistamines
Describe pemphigoid gestationis
does not spare umbilicus
abrupt onset of urticarial plaques and blisters
2nd trimester (mostly)
recurs in future
takes weeks-months to resolve post partum
histologically similar to bullous pemphigoid (C3, IgG)
Pemphigoid gestationis treatment
oral steroids
Describe intrahepatic cholestasis of pregnancy
frank jaundice
pruritis (palms and soles - excoriations, nodular prurigo)
2nd or 3rd trimester
resolves on delivery
risk of premature labour
How is intrahepatic cholestasis of pregnancy treated?
Ursodeoxycholic acid (helps lower bile salt levels)
