Skin and Systemic Disease Flashcards
Presentation of carcinoid syndrome
Episodic flushing mins - hours
No sweating
Facial telagiectasia
What is paraneoplastic pemphigus?
Blistering skin condition caused by weakness in certain areas of the skin
Presentation of paraneoplastic pemphigus
Blisters
Erosive stomatitis
Rash
Very dry and painful mouth
What causes carcinoid syndrome?
GI carcinoid
Bronchial carcinoid
Ovarian carcinoid
What can cause paraneoplastic pemphigus?
Non hodgkins lymphoma
Castlemans disease
What is erythema gyratum repens?
Concentric erythematous lesions
What is acquired hypertrichosis lanuginose?
Acute onset of lanugo hairs at face and body
Who normally have lanugo hairs?
Neonates
Causes of acquired hypertrichosis lanuginose
Severe eating disorders
Colorectal cancer >
Lung cancer >
Breast cancer
What is bazex syndrome?
Hyperkeratosis of extremities
Resembles psoriasis
Non specific diagnosis on skin biopsy
Causes of bzex syndrome
SCC; bronchial, oropharyngeal, GI
Gastric, colon, biliary tumours, adenocarcinomas
What is ectopic ACTH syndrome?
Tumour production of ACTH leads to generalised hyperpigmentation
Why does ectopic ACTH syndrome lead to hyperpigmentation?
ACTH -> increased MSH -> Release of melanin from melanocytes
Pathology of pagets disease
Extension of underlying ductal adenocarcinoma
Presentation of Pagets disease
Eczematous plaque at nipple / areola
Causes of extra mammary pagets
Primary intraepithelial adenocarcinoma (>75%)
Secondary to underlying visceral tumour
- bladder
- colon
What skin conditions are strongly associated with cancer?
Acanthosis nigricans
Dermatomyositis
How is acanthosis nigricans related to cancer?
Can preceed malignancy (particularly a gastric adenocarcinoma)
Concerns arise with acanthosis nigricans if;
Older patient Rapid onset Other skin signs Involves lips Weight loss
What is dermatomyositis?
Inflammatory myopathy + rash
Presentation of dermatomyositis
Periorbital heliotrope rash Gottrons papules - red maculo popular lesions over bony prominences Shawl sign Photosensitive poilkiloderma Scalp erythema
Skin conditions that may be associated with malignancy
Bullous pemphgoid Sweets syndrome Pyoderma gangrenosum Acquired ichthyosis Acquired angioedema Primary systemic amyloid Cryoglobulinaemia
Presentation of sweets syndrome
Juicy nodules which tend to be in upper back, upper limbs and neck
3 examples of genetic tumour syndromes
MEN syndromes
Xeroderma pigmentosum
Peutz-Jeghers
What is xeroderma pigmentosum?
Inability to repair sun damage
Diabetes skin signs
Acanthosis nigricans Acral erythema Carotenemia Diabetic bullae Diabetic dermopathy Disseminated granuloma annulare Eruptive xanthomas Necrobiosis lipoidica Rubeosis Scleroderma
What is alopecia?
Patchy loss of hair
What is the medical condition of alopecia called?
Alopecia areata
Pathology of alopecia
T lymphocyte, cytokine rejection of hair
- totalis
- universalis
Differential diagnosis of alopecia areata
Scarring alopecia
Androgenic alopecia
What is scarring alopecia?
Attack of the follicles
Leading to fibrosis
Hair will never grow back
What is vitiligo?
Segmental patches of different coloured skin
What type of condition is alopecia?
Autoimmune
Presentation of alopecia areata
Localised, well demarcated patches of hair loss
At edge of hair loss, may be small broken “exclamation mark” hairs
What % of people regrow their hair in alopecia areata?
50% by 1 year
80 - 90% eventually
Treatment options of alopecia
Hair regrowth naturally Topical or intralesional corticosteriods Topical minoxidil Phototherapy Dithranol Contact immunotherapy Wigs
What is bullous pemphigoid?
Autoimmune condition causing sub epidermal blistering of the skin
Pathology of bullous pemphigoid
Secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230
Diagnosis of bullous pemphigoid
Immunofluroescence
- IgG and C3 at the dermoepidermal junction
Management of bullous pemphigoid
Oral corticoids MAINSTAY
Topical corticosteriods
Immunosuppressants
Antibiotics
What is dermatitis herpetiformis?
Autoimmune blistering skin disorder
What condition is dermatitis herpetiformis associated with?
Coeliac disease
Pathology of dermatitis herpetiformis
IgA deposition in the dermis
Presentation of dermatitis herpetiformis
Itchy, vesicular skin lesions on the EXTENSOR surfaces (elbows, knees, buttocks)
Diagnosis of dermatitis herpetiformis
Skin biopsy
- direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
Management of dermatitis herpetiformis
Gluten free diet
Dapsone
Presentation of lichen planus
Itchy, popular rash most common on palms, soles, genitalia and flexor surfaces of the arms
Rash often polyglonal in shape - white lines pattern on the surface
Koebener phenomenon may be seen (new skin lesions appearing at the site of trauma)
Oral involvement in 50%
- white lace pattern on buccal mucosa
Nails
- thinning of nail plate
- longitudinal ridging
Causes of lichenoid drug eruptions
Gold
Quinine
Thiazides
Management of lichen planus
Topical steroids mainstay of treatment
Benzydamine mouthwash if oral
Extensive may require oral steroids or immunosuppression
What skin manifestations can be associated with SLE?
Photosensitive “butterfly rash”
Discoid lupus
Alopecia
Livedo reticularis (net like rash)
What is vitiligo?
Autoimmune condition which results in loss of melanocytes and consequent depigmentation of the skin
When do symptoms of vitiligo typically develop?
20 - 30 y/o
Where tends to be most affected in vitiligo?
Peripheries
What may precipitate new lesions in vitiligo and what is this called?
Trauma - koebner phenomenon
Assosiated conditions of vitligo
T1DM Addisons Autoimmune thyroid disease Pernicious anaemia Alopecia areata
Management of vitiligo
Suncream on affected areas Camoflague make up Topical steroids may reverse changes if applied early Topical tacrolimus maybe Phototherapy maybe
First line treatment for hyperhidrosis
Aluminium chloride
