secondary skin changes Flashcards
what is Acanthosis nigricans + where are they
symmetrical brown, velvet plaques // neck, axilla, groin
causes Acanthosis nigricans
T2DM // GI cancer // obesity // PCOS // acromegaly // cushings // hypothyroid
what meds can cause Acanthosis nigricans
COCP + nicotinic acid
pathology Acanthosis nigricans
insulin resistance –> raised insulin –> raised IGFR1 –> stimulation of keratinocytes
hisrutism vs hypertrichosis
hirsutism = androgen hair growth in women // hypertrichosis = excessive hair growth (not androgen dependent, men or women)
causes hisrutism
PCOS // congenital adrenal hyperplasia // androgen therapy // adrenal tumour // obesity
meds that cause hisrutism
phenytoin, steroids
assessment hisrutism
ferriman-Gallwey score
mx hisrutism
lose weight // COCP co-cyprindol (VTE risk)
mx facial hisrutism and contraindication
topical eflornithine - not in pregnancy or breastfeeding
causes hypertrichosis
anorexia // PCT // congenital // drugs eg ciclosporin
what is erythema nodosum
inflammation of subcut fat
symptoms + duration erythema nodosum
tender, red, nodular legions - usually on shins, no scars, last 6 weeks
causes of erythema nodosum
infectio (strep, TB) // sarcoid, IBD, Behcet’s // cancer // meds (penicillin, COCP) // pregnancy
symptoms + cause pretibial myoexedma
symmetrical, red, shiny orange peel - Graves disease
symptoms pyoderma gangrenosum
initiall small + red –> large, purple, necrotic ulcers
cause pyoderma gangrenosum
idiopathy // IBD, connective tissue, myeloproliferative
what is Necrobiosis lipoidica diabeticorum + what is it assoc with
shiny, painless red or yellow areas - diabetes
rash + skin changes SLP
butterfly phorosensitive rash (spares nasolavial fold) // discoid // alopecia // livedo reticularis
what is purpura
bleeding from small blood vessels –> non-blancing rash (petichea are small pupura)
underlying cause pupura
low platelets
children cause pupura
meningococcal // ALL // bleeding disorder // ITP // HSP
cause pellagra
nicotinic acid (b3) deficiency
RF pellegra
isoniazid, alcoholics
symptoms pellagra
dermatitis (brown scaly rash around sun areas) // diarrhoea // dementia + depression
symptoms zinc deficiency
acrodermatitis (red, crust lesion around mouth + anus + distal limbs) // alopecia // short // hypogonad // cognitive impairment // eating clay or soil
what is acrodermatitis enteropathica
recessive disease - defect in zinc absorption
when does polymorphic eruption of pregnancy usually occur
last trimester
symptoms polymorphic eruption of pregnancy + which area is spared
intense itch, pruitic rash, starts in abdomen, periumbilicus spared
mx polymorphic eruption of pregnancy
emollients –> mild topical steroids –> oral steroids
most common skin presentation in pregnancy
topic eruption
symptoms atopic eruption
eczema like, itchy, red rash
symptoms pemphigoid gestationas
itchy, blistering lesions in peri-umbilicus, trunk, back, buttocks, arms
when does pemphigoid gestationas develop
2-3rd trimester
mx pemphigoid gestationas
oral steroids
important, systemic causes of itch (5)
liver disease // iron deficiency anaemia // polycythaemia // CKD // lymphoma
symptoms and cause urticaria
allergy –> pale, pink, raised skin (hives, wheals), itchy
mx urticaria
1) non-drowsy antihistamines 2) prednisolone
drugs causes of urticaria
aspirin, penicillin, NSAIDs, opiates
sedating histamines examples
chlorpheniramine
SE sedating histamines
antimusciranic eg dry mouth, urinary retention
examples non-sedating antihistamines
loratidine, certirizine
what is erythroderma
any rash taht covers 95% of the skin
causes erythroderma
eczema, psoriasis, drugs eg cold, leaukeamia, idiopathic
what is erythroermic psoriasis
progresison to exfoliative phase with plaques over most of body - mild systemic upset
what is acute degeneration erythroermic psoriasis
usually caused by steroid withdrawal –> admission
what type of reaction is erythema multiforme
hypersensitivity
causes erythema multiforme
virus (HSV), bacteria, drugs, SLE, sarcoidosis, malignancy
what drugs can cause erythema multiforme
penicillin, sulphonamides, carbamazepine, NSAUDs, COCP
most common cause erythema multiforme
HSV
symptoms erythema multiforme
target lesions, start on hands –> torso, upper limb more common, not normally very itchy
what is erythema multiforme major
severe form - mucosal involvement
what drugs cause stevens-johnson
penicillin, sulphonamides, AEDs (lamotrigene, carbamezepine, phenytoin), allopurinol, NSAIDs, oral pill
symptoms stevens-johnson
maculopapular, target lesions, nikolsy +ive, mucosal involvement, fever, arthralgia
mx stevens-johnson
supportive
drugs causing toxic epidermal necrolysis (TEN)
penicillin, sulphonamides, carbamezepine, phenytoin), allopurinol, NSAIDs
symptoms TEN
systemically unewell, +ive nikolsy, looks like a burn
mx TEN
stop drugs // Iv Ig // immunosupression eg ciclosporin or cyclophosphamide // plasmapheresis
what is erythema ab igne
exposure to infrared radiaiotn
symptoms erythema ab igne
red sipder webs with hyperpigmentation + telangiectasia - elderly women who sits next to open fire
drugs causing photosensitivity
amiodarone!! // tetracycline, sulphonamide, cipro // NSAIDs // SUR // thiazide
