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2A week 8 - blisters, puritus etc. > rashes associated with systemic disease and pregnancy > Flashcards

rashes associated with systemic disease and pregnancy Flashcards

1
Q

what is erythema nodosum

A

skin condition where red lumps form on the shins (and also thighs and forearms); lumps are usually tender and symmetrical - a type of panniculitis affecting subcutaneous fat (hypersenitivity response or response to underlying inflammatory diseases)

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2
Q

6 causes of erythema nodosum

A
  1. infection
  2. sarcoidosis
  3. pregnancy/CCP
  4. drugs (sulphonamides, saliclyates, NSAIDs etc.)
  5. IBD
  6. idiopathic
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3
Q

Mgx for erythema nodosum

A
  1. treat underlying cause;
  2. rest and elevation;
  3. NSAIDs
  4. support stockings
  5. potassium iodide
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4
Q

how might erythema nodosum change over time (appearance)

A

initially appear bright red (hot and painful) -> become purple and fade like a bruise

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5
Q

5 investigations for presentation w erythema nodosum

A
  1. throat swab (check for strep A);
  2. sputum/ gastric washings (suspected TB);
  3. CRP, ESR, FBC;
  4. ASO titre (anti-streptococcal titre);
  5. CXR (Tb/sarcoidosis);
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6
Q

what kind of blood vessels are involved in cutaneous vasculitis

A

small/medium vessels

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7
Q

what conditions are characterised by petechiae resolving without haemosidering deposition (2)

A

cappillaritis, pigmented purpura

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8
Q

how do small vessel vasculitises present generally

A

palpable purpura - no blanching

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9
Q

key characteristic of purpura

A

no blanching

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10
Q

where are small vessel vasculitises likely to be found

A

‘dependent’ area e.g. shins

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11
Q

typical presentation of medium vessel vasculitis

A

nodules, livido reticularis (APPL)

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12
Q

5 causes for cutaneous vasculitis (+ examples)

A
  1. infection;
  2. CTD (SLE, RA, Sjogren’s);
  3. malignancy (multiple myeloma, lymphoma);
  4. drugs (penicillins, anti TNF-a);
  5. idiopathic (IgA vasculitis);
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13
Q

who typically presents with IgA vasculitis (Henoch-Schönlein purpura)

A

young boys (3-10yro), presents on extensor surface

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14
Q

what investigatiosn should be done for cutenous vasculitis presentations (4)

A
  1. skin biopsy;
  2. bloods - FBC, LFT, U&Es
  3. screen for underlying cause - ANCA, Hep B/C, HIV, CXR, RhF, anti-CCP
  4. urinalyis (check renal function - can be done as a dipstick by bedside so fast)
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15
Q

what is pyoderma gangrenosum

A

a rapidly enlarging very painful ulcer

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16
Q

presentation of pyoderm gangrenosum

A

ragged, purple, rolled/underminded edge

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17
Q

6 causes for pyoderma gangrenosum

A
  1. IBD;
  2. myeloproliferative disease;
  3. RA;
  4. drugs;
  5. monocolonal gammopathy;
  6. idiopathic
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18
Q

investigations for pyoderma gangrenosum (4)

A
  1. swabs
  2. biopsy (rule out other causes)
  3. Hx of systemic disease
  4. steroid response
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19
Q

what is an important ddx for pyoderma gangrenosum

A

SCC

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20
Q

what is necrobiosis lipoidica

A

a granulomatous skin disorder which affects the shin of insulin dependent diabetics (don’t always hv to be diabetic)

21
Q

necrobiosis lipoidica presentation

A

yellow-brown pattern; round/oval or irregular shape; doesn’t heal well; telangectasia - centre of patch becomes thin, pale and shiny so bvs seen; not painful

22
Q

what is granuloma annulare (localised)

A

smooth skin coloured plaques that are thickened and have a ring/annular shape, usually central sparing is seen; usually localised espepcially over the joints

23
Q

who is affected by granuloma annulare usually

A

children, teenagers, young adults

24
Q

what might generalised granuloma annulare signify

A

autoimmune (HIV, diabetes, lymphoma etc.) or thyroiditis

25
Q

how does generalised granuloma annulare present

A

widespread skin-coloured pink/mauve coloured patches; if disseminated then small papules are seen

26
Q

what presents with target-like lesions

A

erythema multiforma

27
Q

what is erythema multiforma

A

a hypersensitivity reaction usually triggered by infections (esp HSV); can be split into erythema multiforma major and minor

28
Q

apart from the skin what else is involved in erythema multiforma major

A

mucous membrane

29
Q

erythema multiforma prognosis

A

usually acute and self limiting

30
Q

what is Toxic epidermal necrolysis (TEN)

A

a rare, life-threatening skin condition - most severe form of SJS, 30% of the body surface area is involved where the top epidermal layer peels off (Nikolsky sign) leaving body open for infection

31
Q

what is steven-johnson-syndrome

A

a rare condition arising from ‘over-reaction’ of the immune system to a trigger such as a mild infection or a medicine, leading to blistering and peeling of the skin and surfaces of the eyes, mouth and throat

32
Q

2 major causes of erythema multiforma

A
  1. viral infection e.g. parapoxvirus, herpes varicella, HIV, hepaitis etc.;
  2. drugs e.g. NSAIDs, penecillins, anticonvulsants, sulphonamides
33
Q

what are xanthomas

A

skin lesions caused by accumulation of fat in the macrophages in the skin (may be in the fat layer under the skin but this is rare)

34
Q

5 causes for xanthomas

A
  1. lipid metabolism disorder;
  2. idiopathic;
  3. familial hyperlipidaemia;
  4. acquired hyperlipidaemia (diabetes, hypothyroidism, cholestasis etc.);
  5. primary biliary cirrhosis
35
Q

what are ther most common type of xanthoma

A

xanthelasma palpebrum - arise symmetrially on upper and lower eyelids, not necessarily associated with with hyperlipidaemia

36
Q

what are tuberous xanthomas and where are they usually found

A

firm, painless, red-yellow nodules that develop around pressure areas (knees, elbows, heels etc.); usually associated w hypercholesterolaemia

37
Q

what are tendinous xanthomas

A

slowly enlarging subcutaneous nodules related to a tendon/ligament; associated w severe hypercholesterolaemia and high LDL levels

38
Q

what drugs can cause high triglyceride levels

A

retinoids

39
Q

risk factors for eruptive xanthoma

A

diabetes; high triglycerides

40
Q

7 common skin changes during pregnancy

A
  1. stretch marks;
  2. skin tags;
  3. changes in hair growth;
  4. acne breakouts;
  5. spider veins/varicose veins;
  6. darkening of areas of the skin;
  7. darkening of moles and freckles
41
Q

what is melasma

A

a common skin condition of adults in which brown or greyish patches of pigmentation (colour) develop, usually on the face

42
Q

what are pyogenic granulomas

A

benign vascular tumor that arises in tissues such as the skin and mucous membranes - typicallly in pregnancy, if in non-pregnant pts then query melanoma

43
Q

what is puritic urticated papules and plaques of pregnancy (PUPPP)

A

a patch of itchy, hive-like bumps that form in the stretch marks on your belly and spread to other parts of your body when you’re pregnant; generally occurs in 3rd trimester and resolved after delivery with no risk to newborn

44
Q

PUPPP presentation and treatement

A

hive-like bumps that spare the umbilicus; treat with topical steroids and antihistamine

45
Q

what is pemphigoid gestationis

A

abrupt onset of urticarial plaques and blisters, generally in the 2nd trimester and takes weeks to resolve post-partum

46
Q

pemphigoid gestationis treatment

A

oral steroids

47
Q

pemphigoid gestationis presentation

A

inflammatory skin lesions (blisters and plaques) and severe pruritus with umbilical involvment

48
Q

what is intrahepatic cholestasis of pregnancy

A

a condition involving your liver which results in reduced bile salt clearance, usually presents in 2nd/3rd trimester and resolved on delivery

49
Q

intrahepatic cholestasis of pregnancy presentation and treatment

A

generalised puritis that is most intense on palms and soles; treat with ursodeoxycholic acid

2A week 8 - blisters, puritus etc. (6 decks)

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