Skin and Systemic Disease Flashcards
What can changes in the skin be markers of?
Endocrine disease Internal malignancy Nutritional deficiency Systemic infection Systemic inflammatory disease
What endocrine conditions can cause skin changes?
Thyroid
Diabetes
Cushing/steroid excess
Sex hormone
What skin changes can occur in Thyroid disease?
Dry skin - hypothyroidism
Thyroid dermopathy - Grave’s disease
Thyroid acropachy - Grave’s disease
What skin changes can occur in a Diabetic?
Necrobiosis lipoidica Diabetic dermopathy Sclerodema (not scleroderma) Leg ulcers Granuloma anulare
Describe the skin appearance of necrobiosis lipoidica.
Waxy appearance (shiny) Yellow discolouration Often on the shins Occasionally ulcerates and scars Symmetrical Palpable - depressed or elevated
Describe the skin appearance of Diabetic dermopathy.
Non-specific rash Lots of inflammatory papules and patches Some ulceration Itchy Post inflammatory changes is it has been there for a while
Describe the skin appearance of sclerodema.
Infiltrated, spongy sensation in the skin - hard to push finger in Warm Inflamed Common over the shoulders and upper back Less elastic and soft
Name some causes of diabetic ulcers.
Pressure ulcers
Arterial ulcers
Diabetic neuropathy
Venous ulcers
Describe the appearance of Granuloma Annulare.
Thick, palpable infiltrate in the skin
Circular lesions
Back of hands or top of feet are common
When is Granuloma Annulare associated with diabetes?
Sudden onset and widespread
What skin changes can occur in steroid excess?
- i.e. Cushing’s disease, exogenous cause
Acne
Striae
Erythema
Gynaecomastia - stretched breast tissue
What skin changes can occur in steroid insufficiency?
- i.e. Addison’s disease
Hyperpigmentation
- often on mucosal surfaces or on areas of thicker skin
Acanthosis nigracans
- another pigmenting condition
What non-dermatological clinical signs are associated with Cushing’s disease?
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
What skin changes can an excess of sex hormones cause?
Testosterone - acne - hirsutism (abnormal hair growth in male patent sites in a female) Progesterone - acne - dermatitis
What syndrome cause excess testosterone?
PCOS
Testicular tumours
Testosterone drug therapy
What syndrome cause excess progesterone?
Progesterone only pill
Congenital adrenal hyperplasia
What skin changes specifically indicate an internal malignancy?
Necrolytic migratory erythema
Erythema gyratum repens
Acanthosis nigricans
Describe the skin changes seen in necrolytic migratory erythema.
Inflammatory appearance of the skin
Moves about
Erythematous
Scaly plaques on acral, intertirginous and periorificial areas
Which internal malignancy is necrolytic migratory erythema associated with?
Islet cell tumour of the pancreas
- glucagon association
What are the non-dermatological clinical features of an islet cell tumour of the pancreas?
Hyperglycaemia
Diarrhoea
Weight loss
Glossitis
Describe the skin changes seen in erythema gyratum repens.
Reddened concentric bands whorled woodgrain pattern
Which internal malignancy is erythema gyratum repens associated with?
Strong association with lung cancer
Some association with breast, cervical and GI cancers
Describe the skin changes seen in acanthosis nigricans.
Smooth
Velvet like
Hyperkeratotic plaque
Found in intertriginous areas (groin, axilla, neck)
Name and describe the three recognised types of acanthosis nigricans.
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
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)
What kinds of nutritional deficiencies can cause skin changes?
Vitamin B
Zinc
Vitamin C
Describe the skin changes seen in vitamin B deficiency.
B6 - Dermatitis
B12 - Angular chelitis
B3 - Pellagra (dementia, dermatitis and diarrhoea)
Describe the skin changes seen in zinc deficiency.
Acrodermatitis enteropathica
- inherited/acquired
- pustules, bullae, scarring, redness, scaling
- acral and perioral distribution
How can a zinc deficiency be inherited?
Mutation in SLC39A - encodes an intestinal zinc transporter
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
What is the differential diagnoses for acrodermatitis enteropathica?
Zinc deficiency
Nutritional deficiencies
Necrolytic migratory erythema
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
What conditions can cause erythema nodosum?
Strep infection Pregnancy/oral contraceptive Sarcoidosis Drug induced Bacterial/viral infection Others
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
What is erythema nododusm?
Inflammation of the subcutaneous fat - a panniculitis
What conditions cause pyoderma gangernosum?
Inflammatory bowel disease
Rheumatoid arthritis
Myeloma
Others
Describe the skin changes in pyoderma gangrenosum.
Purple raised edge
Central area of ulceration
Most common on the shins
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
