Skin and Systemic Disease

Question 1

What are the skin changes seen in thyroid diseases

Answer 1

Hypothyroidism - Dry skin.
Hyperthyroidism/Graves - Pretibial myxoedema (puffy swollen legs) and thyroid acropachy.

Question 2

What are potential skin changes seen in diabetes mellitus?

Answer 2

• Necrobiosis lipoidica,
• Diabetic dermopathy,
• Scleredema,
• Leg ulcers,
• Granuloma annulare

Question 3

What does the following image show

Answer 3

Necrobiosis Lipoidica. Often occurs on the shins, it appears as a waxy, yellow discolouration. It can offten ulcerate and scar

Question 4

What does the following image show?

Answer 4

Diabetic dermopathy. Inflammatory papules which heals with hyperpigmentation

Question 5

What does the following image show?

Answer 5

Scleredema. Makes it very difficult to pinch the skin

Question 6

What does the following image show?

Answer 6

Granuloma annulare. Single patch not for concern but concerning if there are multiple

Question 7

What are the skin changes seen with steroid excess (cushing’s disease)

Answer 7

• Acne,
• Striae,
• Erythema,
• Gynaecomastia
• Non dermatological presentation - increased central obesity, moon faces and buffalo hump

Question 8

What are the skin changes seen with steroid insufficiency (Addison’s disease)

Answer 8

Hyperpigmentation
Acanthosis nigracans

Question 9

What are the skin changes seen with testosterone excess and what conditions may cause this?

Answer 9

It can cause acne and hirsutism. This can be seen in PCOS, testicular tumours, testosterone drug therapy

Question 10

What skin changes can be seen with progesterone excess and what conditions may cause this?

Answer 10

Acne and dermatitis. It can be seen with OCP use or in congenital adrenal hyperplasia

Question 11

What skin changes can be seen with internal malignancies

Answer 11

• Necrolytic migratory erythema,
• Erythema gyratum repens,
• Acanthosis nigricans,
• Erythema annulare,
• Sweet syndrome (inflammatory plaques associated with haematological)
• Sister Mary Joseph nodule (umbilical tumour suggesting GU malignancy)

Question 12

What does the following image show?

Answer 12

Necrolytic migratory erythema. It causes erythematous scaly plaques which are associated with islet cell tumour of the pancreas

Question 13

What does the following image show?

Answer 13

Erythema gyratum repens. It has reddened concentric bands whorled woodgrain pattern. It has severe pruritus and peripheral eosinophilia. Strong association with lung cancer and less strong association with breast, cervical and GI ca.

Question 14

What are the 3 types of acanthosis nigricans?

Answer 14

Type 1 - associated with malignancy. Especially adenocarcinoma of GI tract.
Type 2 - Familial type which is autosomal dominant.
Type 3 - Associated with obesity and insulin resistance.
It is a smooth, velvet like hyperkeratotic plaque’s in skin folds (usually darker in colour)

Question 15

What are the dermatological appearence of vitamin B6, B12 and B3 deficiency

Answer 15

B6 - Dermatitis,
B12 - Angular chelitis,
B3 - Pellagra which is associated with 3 D’s: dementia, dermatitis and diarrhoea (and death)

Question 16

What is the dermatological appearence of zinc deficiencies

Answer 16

Pustules, bullae and scalling

Question 17

What are the different causes of a zinc deficiency?

Answer 17

• Inherited: Mutations in SLC39A which encodes for intestinal zinc transporter.
• Nutritional deficiency (in children it can occur if milk has low levels of zinc. In adults in occurs with diseases that affect absorption eg, alcoholism, IBD)

Question 18

What is the dermatological presentation of a vitamin C deficiency?

Answer 18

• Punctate purpura/bruising,
• Corkscrew spiral curly hairs,
• Patchy hyperpigmentation,
• Dry skin,
• Dry hair,
• Non healing wounds,
• Inflamed gums

Question 19

What does the following image show and what are some causes

Answer 19

Erythema nodosum. It can be caused by a streptococcal infection, pregnancy/OCP, sarcoidosis, drug induced, bacterial/viral infections

Question 20

What does the following image show and what are some causes?

Answer 20

Pyoderma Grangrenosum. It can be caused by inflammatory bowel diseases, rheumatoid arthritis, and myeloma

Question 21

What are some nail and hair diseases

Answer 21

• Alopecia areata hair loss (autoimmune)
• Hair thinning which can be caused by B12, iron deficiency, lupus or hypothyroidism.
• Male pattern balding with androgen excess,
• Nail clubbing,
• Nail fold telangectasia

Question 22

What does the following show?

Answer 22

Dermatitis herpetiformis.
They are itchy, vesicular lesions on extensor surfaces. Diagnosis via skin biopsy

Question 23

What are the skin disorders associated with SLE?

Answer 23

Photosensitive butterfly rash, discoid lupus, alopecia, livedo reticularis

Question 24

Describe features of the following

Answer 24

Keratoacanthoma - dome shapped erythematous lesions which appear over a period of a couple of days and grow rapidly. Normally contain a central pit of keratin

Question 25

Describe features of the following

Answer 25

Pyogenic granuloma - overgrowth of blood vessels which presents as red nodual, normally following trauma