Skin and Systematic Disease Flashcards
What is Curth’s postulates?
- Chance occurrence or associated event?
- Concurrent onset
- Parallel course
- Uniform site or type of neoplasm
- Statistical association
- Genetic linkage
In what skin conditions is there an underlying cancer in most/all cases?
- Carcinoid Syndrome
- Paraneoplastic pemphigus
- Erythema Gyratum Repens
- Acquired hypertrichosis
- Leser Trelat
- Bazex Syndrome
- Ectopic ACTH
- Pagets Disease
What skin conditions are strongly associated with cancer?
- Acanthosis Nigricans
- Dermatomyositis
What skin conditions may be associated with malignancy?
- Bullous pemphgoid
- Sweets Syndrome
- Pyoderma gangrenosum
- Acquired ichthyosis
- Acquired angioedema
- Primary systemic amyloid
- Cryoglobulinaemia
Give examples of genetic tumour syndromes.
- Muir-Torre
- Peutz-Jeghers
- Neurofibromatosis
- MEN syndromes
- Xeroderma pigmentosum
- Howel-Evans
How does carcinoid syndrome present?
- Episodic flushing, lasts mins -hours
- No sweating
- Facial telangiectasia
What malignancies is carcinoid syndrome associated with?
- GI carcinoid = liver mets
- Bronchial, ovarian = can occur with no liver mets
How does paraneoplastic pemphigus present?
Erosive stomatitis, rash
What malignancies is paraneoplastic pemphigus associated with?
- Non-hodgkins lymphoma
- Castlemans’ disease (produced the autoantibody)
How does erythema gyratum repens present?
Concentric erythematous lesions
What malignancies is erythema gyratum repens associated with?
Variable sites & types of malignancy
How does acquired hypertrichosis lanuginoas present?
Acute onset of lanugo hairs at face & body
What malignancies if acquired hypertrichosis associated with?
- Colorectal
- Lung
- Breast
- Usually advanced
How does Leser-trelat present?
Eruptive seborrhoeic keratoses
What malignancies is Leser-trelat associated with?
GI adenocarcinomas
How does Bazex Syndrome present?
- Hyperkeratosis of extremities
- Resembles psoriasis, non-specific fx on skin biopsy
What malignancies is Bazex syndrome associated with?
- SCC of bronchials, oropharynx and GIT
- Gastric, colon and biliary adenocarcinomas
How does ectopic ACTH syndrome present?
Tumour production of ACTH leads to generalised hyperpigmentation
Why does tumour production of ACTH lead to hyperpigmentation?
ACTH release (including MSH) leads to the release of melanin from melanocytes
How does Paget’s disease present?
Eczematous plaque at nipple / areola
What malignancies is Paget’s disease associated with?
Extension of underlying ductal adenocarcinoma
How does extra-mammary paget’s present?
Primary intraepithelial adenocarcinoma (>75%)
What malignancies is extra-mammary Paget’s associated with?
Secondary to underlying visceral tumour: bladder, colon
When is there a concern in acanthosis nigricans?
- Older patient, rapid onset
- Other skin signs
- Involves lips
- Weight loss
What malignancy is acanthosis nigricans associated with?
Gastric adenocarcinoma
How does dermatomysoitis present?
Inflammatory myopathy + rash
- Periorbital heliotrope rash
- Gottrons papules: red maculo-papular lesions over bony prominences
- Shawl sign
- Photosensitive poikiloderma
- Scalp erythema
How can Peutz-Jeghers present?
- Melanosis
- Colon hamartomas
What malignancies is Peutz-Jeghers associated with?
Colon cancer
How can Muir-Torre present?
- Sebaceous tumours
- Keratoacanthomas,
What malignancies is Muir-Torre associated with?
- GI
- Breast
- Genitourinary
How can neurofibromatosis present?
- Café au lait
- Ax freckles
- Neurofibromas
What malignancies is neurofibromatosis associated with?
- Nerve sheath
- Phaeochromocytoma
- Carcinoid
How can MEN syndromes present?
- Angiofibromas
- Neuromas
- Lichen or macular amyloid (MEN2),
What malignancies are MEN syndromes associated with?
- Endocrine
- Ps
How can xeroderma pigmentosum present?
Inability to repair sun damage
What malignancies is xeroderma pigmentosum associated with?
- Sarcoma
- Leukaemia
- GI
- Lung
How can Howel-Evans present?
Palmoplantar keratoderma
What malignancies is Howel-Evans associated with?
-Oesophageal
Give examples of genetic conditions which can have a skin manifestation?
- Hereditary haemorrhagic telangiectasia
- Ehlers danlos (collagen)
- Pseudo xanthoma elasticum (elastic)
- Blue rubber bleb naevus
What risk is there with genetic conditions that affect collagen or elastin?
GI haemorrhage
Give examples of inflammatory/autoimmune conditions which can have skin manifestations?
- Malignant atrophic paupulosis (degos disease)
- Erythema nodosum
- Pyoderma gangrenosum
What is there risk of in malignant atrophic papulosis?
GI haemorrhage
What is there a risk of in pyoderma gangrenosum?
IBD
What skin signs are associated with diabetes?
- Acanthosis nigricans
- Acral erythema
- Carotenemia
- Diabetic bullae
- Diabetic dermopathy
- Disseminated granuloma annulare
- Eruptive xanthomas
- Necrobiosis lipoidica
- Rubeosis
- Scleredema
Give examples of skin conditions which are associated with autoimmune disease.
- Cutaneous lupus
- Cutaneous vasculitis
- Alopecia
- Vitiligo
What are the different types of cutaneous lupus?
- Acute
- Subacute
- Chronic (Discoid, Hypertrophic)
- Mucosal
- Lupus profundus
- Drug induced
- Neonatal
What are the different types of cutaneous vasculitis?
- Small vessel vasculitis
- Leucocytoclastic vasculitis
What can be seen on direct immunofluorescence of cutaneous vasculitis?
IgA deposition
What can cause cutaneous vasculitis?
- Post infective
- Drug induced
- Idiopathic
Give examples of types of alopecia.
- Alopecia areata
- Scarring alopecia
- Androgenic alopecia
What are the 2 subtypes of hair loss in alopecia?
- Totalis
- Universalis
What is alopecia?
T-lymphocyte, cytokine rejection of hair
What is vitiligo?
Destruction of melanocytes
What is vitiligo associated with?
Other autoimmune conditions
What patterns of vitiligo are there?
- Segmental
- Generalised
How are systemic skin manifestations treated?
Treatment is symptomatic & that of the underlying disease
