Skin and Systemic Disease Flashcards

1
Q

What can changes in the skin be markers of?

A
Endocrine disease
Internal malignancy
Nutritional deficiency
Systemic infection
Systemic inflammatory disease
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2
Q

What endocrine conditions can cause skin changes?

A

Thyroid
Diabetes
Cushing/steroid excess
Sex hormone

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3
Q

What skin changes can occur in Thyroid disease?

A

Dry skin - hypothyroidism
Thyroid dermopathy - Grave’s disease
Thyroid acropachy - Grave’s disease

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4
Q

What skin changes can occur in a Diabetic?

A
Necrobiosis lipoidica
Diabetic dermopathy 
Sclerodema (not scleroderma)
Leg ulcers
Granuloma anulare
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5
Q

Describe the skin appearance of necrobiosis lipoidica.

A
Waxy appearance (shiny)
Yellow discolouration 
Often on the shins 
Occasionally ulcerates and scars 
Symmetrical 
Palpable - depressed or elevated
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6
Q

Describe the skin appearance of Diabetic dermopathy.

A
Non-specific rash
Lots of inflammatory papules and patches
Some ulceration
Itchy
Post inflammatory changes is it has been there for a while
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7
Q

Describe the skin appearance of sclerodema.

A
Infiltrated, spongy sensation in the skin
- hard to push finger in
Warm
Inflamed 
Common over the shoulders and upper back
Less elastic and soft
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8
Q

Name some causes of diabetic ulcers.

A

Pressure ulcers
Arterial ulcers
Diabetic neuropathy
Venous ulcers

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9
Q

Describe the appearance of Granuloma Annulare.

A

Thick, palpable infiltrate in the skin
Circular lesions
Back of hands or top of feet are common

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10
Q

When is Granuloma Annulare associated with diabetes?

A

Sudden onset and widespread

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11
Q

What skin changes can occur in steroid excess?

- i.e. Cushing’s disease, exogenous cause

A

Acne
Striae
Erythema
Gynaecomastia - stretched breast tissue

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12
Q

What skin changes can occur in steroid insufficiency?

- i.e. Addison’s disease

A

Hyperpigmentation
- often on mucosal surfaces or on areas of thicker skin
Acanthosis nigracans
- another pigmenting condition

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13
Q

What non-dermatological clinical signs are associated with Cushing’s disease?

A

Increased central adiposity
Moon face
Buffalo hump
Global skin atrophy, epidermal and dermal components
Striae on abdomen, arms and thighs
Purpura with minor trauma - reduced connective tissue

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14
Q

What skin changes can an excess of sex hormones cause?

A
Testosterone 
- acne
- hirsutism (abnormal hair growth in male patent sites in a female)
Progesterone 
- acne 
- dermatitis
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15
Q

What syndrome cause excess testosterone?

A

PCOS
Testicular tumours
Testosterone drug therapy

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16
Q

What syndrome cause excess progesterone?

A

Progesterone only pill

Congenital adrenal hyperplasia

17
Q

What skin changes specifically indicate an internal malignancy?

A

Necrolytic migratory erythema
Erythema gyratum repens
Acanthosis nigricans

18
Q

Describe the skin changes seen in necrolytic migratory erythema.

A

Inflammatory appearance of the skin
Moves about
Erythematous
Scaly plaques on acral, intertirginous and periorificial areas

19
Q

Which internal malignancy is necrolytic migratory erythema associated with?

A

Islet cell tumour of the pancreas

- glucagon association

20
Q

What are the non-dermatological clinical features of an islet cell tumour of the pancreas?

A

Hyperglycaemia
Diarrhoea
Weight loss
Glossitis

21
Q

Describe the skin changes seen in erythema gyratum repens.

A

Reddened concentric bands whorled woodgrain pattern

22
Q

Which internal malignancy is erythema gyratum repens associated with?

A

Strong association with lung cancer

Some association with breast, cervical and GI cancers

23
Q

Describe the skin changes seen in acanthosis nigricans.

A

Smooth
Velvet like
Hyperkeratotic plaque
Found in intertriginous areas (groin, axilla, neck)

24
Q

Name and describe the three recognised types of acanthosis nigricans.

A

Type 1
- associated with malignancy adenocarcinoma, especially of the GI tract
- sudden onset and extensive
Type 2
- familial type, autosomal dominant
- very rare, appears at birth and has no associated to malignancy
Type 3
- associated with obesity and insulin resistance
- most common type

25
Name some skin changes that can indicate internal malignancy, but can be caused by other diseases.
``` Erythema annulare Sweet's Syndrome - juicy, raw lesions Sister Mary Joseph Nodule - intrabdominal malignancy (tumour protrusion through umbilicus) ```
26
What kinds of nutritional deficiencies can cause skin changes?
Vitamin B Zinc Vitamin C
27
Describe the skin changes seen in vitamin B deficiency.
B6 - Dermatitis B12 - Angular chelitis B3 - Pellagra (dementia, dermatitis and diarrhoea)
28
Describe the skin changes seen in zinc deficiency.
Acrodermatitis enteropathica - inherited/acquired - pustules, bullae, scarring, redness, scaling - acral and perioral distribution
29
How can a zinc deficiency be inherited?
Mutation in SLC39A - encodes an intestinal zinc transporter
30
What are the acquired forms of zinc deficiency?
``` Infants - when there is low zinc in breast milk Adults - alcoholism - malabsorption - poor diet - IBD - bowel surgery ```
31
What is the differential diagnoses for acrodermatitis enteropathica?
Zinc deficiency Nutritional deficiencies Necrolytic migratory erythema
32
Describe the clinical features (including skin changes) seen in vitamin C deficiency.
``` Easy bruising Spiral curly hairs Patchy hyperpigmentation at base of hair follicles Dry skin Dry hair Non-healing wounds Inflamed gums ```
33
What conditions can cause erythema nodosum?
``` Strep infection Pregnancy/oral contraceptive Sarcoidosis Drug induced Bacterial/viral infection Others ```
34
Describe the skin changes in erythema nodosum.
Painful - can't even be touched by a bed sheet Bruise-like lesions Most commonly on the shins Warm
35
What is erythema nododusm?
Inflammation of the subcutaneous fat - a panniculitis
36
What conditions cause pyoderma gangernosum?
Inflammatory bowel disease Rheumatoid arthritis Myeloma Others
37
Describe the skin changes in pyoderma gangrenosum.
Purple raised edge Central area of ulceration Most common on the shins
38
Which diseases can affects the hair and nails?
``` Alopecia areata - autoimmune mediated hair loss in distinctive circular patches Hair thinning - B12/iron deficiency - lupus - hypothyroidism Androgen excess - male pattern balding outside the normal age range Nail fold telangectasia - nail clubbing ```