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Year 3 - Dermatology > Skin and Systemic Disease > Flashcards

Skin and Systemic Disease Flashcards

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Dermatology Board Prep 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
Q

Name some skin changes that can indicate internal malignancy, but can be caused by other diseases.

A 
Erythema annulare
Sweet's Syndrome
- juicy, raw lesions
Sister Mary Joseph Nodule
- intrabdominal malignancy (tumour protrusion through umbilicus)
26
Q

What kinds of nutritional deficiencies can cause skin changes?

A

Vitamin B
Zinc
Vitamin C

27
Q

Describe the skin changes seen in vitamin B deficiency.

A

B6 - Dermatitis
B12 - Angular chelitis
B3 - Pellagra (dementia, dermatitis and diarrhoea)

28
Q

Describe the skin changes seen in zinc deficiency.

A

Acrodermatitis enteropathica

  • inherited/acquired
  • pustules, bullae, scarring, redness, scaling
  • acral and perioral distribution
29
Q

How can a zinc deficiency be inherited?

A

Mutation in SLC39A - encodes an intestinal zinc transporter

30
Q

What are the acquired forms of zinc deficiency?

A 
Infants
- when there is low zinc in breast milk
Adults 
- alcoholism 
- malabsorption
- poor diet
- IBD
- bowel surgery
31
Q

What is the differential diagnoses for acrodermatitis enteropathica?

A

Zinc deficiency
Nutritional deficiencies
Necrolytic migratory erythema

32
Q

Describe the clinical features (including skin changes) seen in vitamin C deficiency.

A 
Easy bruising 
Spiral curly hairs 
Patchy hyperpigmentation at base of hair follicles 
Dry skin
Dry hair
Non-healing wounds
Inflamed gums
33
Q

What conditions can cause erythema nodosum?

A 
Strep infection
Pregnancy/oral contraceptive
Sarcoidosis 
Drug induced
Bacterial/viral infection
Others
34
Q

Describe the skin changes in erythema nodosum.

A

Painful - can’t even be touched by a bed sheet
Bruise-like lesions
Most commonly on the shins
Warm

35
Q

What is erythema nododusm?

A

Inflammation of the subcutaneous fat - a panniculitis

36
Q

What conditions cause pyoderma gangernosum?

A

Inflammatory bowel disease
Rheumatoid arthritis
Myeloma
Others

37
Q

Describe the skin changes in pyoderma gangrenosum.

A

Purple raised edge
Central area of ulceration
Most common on the shins

38
Q

Which diseases can affects the hair and nails?

A 
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

Year 3 - Dermatology (6 decks)

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