Skin and Systemic Disease Flashcards

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1
Q

what are some dermatological manifestations of diabetes

A
Necrobiosis lipoidica
rubeosis 
diabetic dermopathy
granuloma annulare
vitiligo 
acanthosis nigricans 
lipodystrophy
vascular changes 
xanthomata 
yellow skin
dry and wet gangrene
candidiasis 
necrotising fasciitis 
foot ulcers
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2
Q

what is necrobiosis lipoidica

A

brown/red/yellow raised shiny patch usually above tibia

with telangeictasia

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3
Q

what is diabetic dermopathy

A

atrophic hyperpigmented lesions on lower legs

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4
Q

what is granuloma annulare

A

pink raised annular lesions - usually on knuckles

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5
Q

what proportion of people with diabetes develop necrobiosis lipoidica

A

<1% of diabetics

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6
Q

what sex is more likely to get necrobiosis lipoidica and by how much

A

Females, 3:1

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7
Q

what are some dermatological manifestations of thyroid dysfunction

A
pretibial myxedema (hyperthyroidism)
dry skin (hypothyroidism)
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8
Q

what is pretibial myxedema

A

pink/flesh coloured mucoid plaques seen on lower shins, marked exophthalmos may also be seen

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9
Q

what are some dermatological manifestations of SLE

A

acute malar rash in a butterfly distribution

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10
Q

what are some cutaneous manifestations of systemic cancers

A
acanthosis nigricans 
acquired ichthosis
pyoderma gangrenosum 
dermatomyositis 
dermatitis herpetiformis 
generalised pruitis
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11
Q

what is acanthosis nigricans

A

velvety thickened hyperpigmented papillomatous ‘dirty’ looking skin - usually in flexors

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12
Q

in what conditions is acanthosis nigricans seen and when would you be suspicious of malignancy

A

insulin resistance and metabolic syndromes as well as GI malignancy

hyperacute onset + severe symptoms, usually on mucous membranes and palms

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13
Q

what kinds of cancers is acanthosis nigricans associated with

A

GI cancers - specifically gastric carcinomas

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14
Q

what is acquired ichthyosis

A

dry rough skin with scaling

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15
Q

what cancer is particularly associated with acquired ichythosis

A

Hodgkins lymphoma

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16
Q

what is pyoderma gangrenosum

A

ulcerative skin disease causing an acute onset painful pustule/nodule arising after minor trauma

presents with a rapidly enlarging ragged border and a necrotic center

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17
Q

what systemic diseases is pyoderma gangrenosum associated with

A
RA
crohns 
diverticulitis 
chronic active hepatitis 
behcets diseae 
malignancy
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18
Q

what malignancies is pyoderma gangrenosum associated with

A

haemotological maligancies

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19
Q

how do you treat pyoderma gangrenosum

A

find/treat underlying disease

topical/oral steroids may be helpful + emmolients

ciclosporin may be used as final option

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20
Q

what is dermatomyositis

A

subset of polymyosistis with distincitive skin change where it changes to a lilac discolouration around eyes, malar erythema, some also get slightly atrophic lilac papules over the knuckles, streaks of erythema over extensor tendons, ragged cuticles + periungal telangiectasia

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21
Q

what causes dermatomyositis

A

autoantibodies to striated muscle

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22
Q

what are some symptoms of dermatomyositis

A

skin changes

progressive proximal muscle weakness

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23
Q

what indicates a good prognosis for dermatomyositis

A

calcinosis

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24
Q

what proportion of patients with dermatomyositis have an underlying malignancy

A

30%

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25
Q

what are some biochemical markers for dermatomyositis

A

elevated Creatine phosphokinase

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26
Q

what test detects muscular abnormalities for suspected dermatomyositis

A

electromyography

muscular biopsy

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27
Q

what is shown on muscle biopsy in dermatomyositis

A

inflammation/destruction

28
Q

what is the treatment for dermatomyositis

A

high dose systemic steroids
needed for several years
immunosuppressive agents (azathioprine) used to rpevent seteroids
treat until there is a biochemical improvement

29
Q

what is dermatitis herpetiformis

A

chronic recurrent intensely pruritic eruptions occurring symmetrically on extensor surfaces of trunk and extremities - typically grouped vesicles

30
Q

what is dermatitis herpetiformis associated with

A

coeliacs

31
Q

how do you diagnose dermatitis herpetiformis

A

immunoflourescent skin biopsy

32
Q

whats the treatment for dermatitis herpetiformis

A

dapsone (Antibiotic)

treat coeliacs

33
Q

what are the differentials for generalised pruitis

A

metabolic - thyroid, renal failure
malignancy - lymphoma. leukaemia, myeloma most common
drugs = alcohol, aspirin, codeine, morphine
haematological - polycythamiea RV, ID
hepatic disease - obstructive jaundice, cholestasis
pregnancy
dry skin

34
Q

what is erythema gyratum repens

A

shifting wave of erythema covering the skins surface looking like the grain of wood

35
Q

what is acquired hypertrichosis lanuginosa

A

malignant down - excessive/widespread growth of laguno hair

36
Q

what is necrolytic migratory erythema + what is it seen in

A

crusting edge that moves

anaemia/WL/diabetes/Stomatitis

37
Q

what does necrolytic migratory erythema indicate

A

glucagon secreting tumour

38
Q

what is bazex syndrome

A

papulosquamous eruption on finger, toes, ears nose

39
Q

what causes bazex syndrome

A

URT tumours

40
Q

what is acute febrile neutrophillic dermatosis

A

red odematous plaque presenting with a classic triad of increased ESR, fever and raised neutrophils

41
Q

what is associated with neutrophillic dermatosis

A

myeloproliferative disorders

42
Q

what is pachydermoperiostasis

A

coarsening/thickening of the skin seen with severe clubbing occuring on face/fingers commonly

43
Q

what causes pachydermoperiostasis

A

autosomal dominant disease or due to systemic disease

44
Q

what is erythema nodosum

A

immunological inflammation of subcutaneous fat presenting as tender bruise like nodules on the lower legs with associated fever, malaise and lethargy

45
Q

what is the demographics of a typical patient with erythema nodosum

A

F>M 3:1, 15-30 years old

46
Q

what is erythema nodosum associated with

A

infection - TB
drugs - OCP, sulfonamides
disease - IBD, sarcoid, behets

47
Q

how do you treat erythema nodosum

A

rest
NSAIDS
prednisolone if refractory

48
Q

what’s the prognosis for erythema nodosum

A

usually resolves in around 6 weeks

49
Q

what are some skin manifestations for cutaneous small vessel vasculitis

A

palpable purpura <1cm

50
Q

what is polyarteritis nodosa

A

necrosing vasculitis of large arteries caused by immune complexes, causing tender subcutaneous nodules along lines of arteries, ulcerations/stellate patches of purpura covering the skin, splinter haemorrhages and net like vascular patterns

51
Q

what happens if polyarteritis nodosa is left untreated

A

chronic oragn failure and death - usually from CKD

52
Q

what is the treatment for polyarteritis nodosa

A

systemic steroids and cyclophosphamides (chemo)

low dose steroids only if disease is purely cutaneous

53
Q

what is the mechanism of non allergic drug eruptions

A

intrinsic pharmacological mechanisms (disclolouration + amiodarone)
predictable
may be exacerbation of existing skin disease
idiosyncratic

54
Q

what is the mechanism of allergic drug eruptions

A

unpredictable eruptions commonly occuring on 2nd exposure, most commonly morbilliform rashes with a central distribution

55
Q

what is the most serious form of an allergic drug eruptions

A

toxic epidermal necrolysis

56
Q

what causes toxic epidermal necrolysis

A

barbiturates, anticonvulsants, antibiotics

57
Q

what drugs commonly cause rashes

A
penicillins/sulphonamides
anticonvulsants
NSAIDS
Thiazides
Allopurinol
Gold + penicillinamine
58
Q

whats the treatment for toxic epidermal necrolysis

A
stop drugs 
consider measures to decrease drug in system
symptomatic 
oral steroids controversial
avoid drug in future
label medical records
59
Q

what is toxic erythema

A

most common drug related rash
marbiform erythematous macules
most often occurs 7-14 dats after into of drug

60
Q

what is erythema multiforme

A

rreaction pattern of blood vessels in skin with secondary epidermal changes = classically red and a bullseye

lesions occur over a 10 days and are often symmetrically extensor skin mostly

61
Q

what is the age distribution of erythema multiforme

A

<20 years olf in 50% of patients

62
Q

what causes erythema multiforme

A

infection (HSV, mycoplasma)

drugs - penicillin, sulphonamide, phenytoin, allopurinol

63
Q

what are some differentials for erythema multiforme

A

non-EM eruption
secondary syphilis
urticarial

64
Q

what does a true target lesion have

A

at least 3 colours in it

65
Q

what is steven johnsons syndrome

A

severe drug eruptions associated with a prodrome of URTIs and fevers, followed by symmetrical red macular eruption with blistering, ALWAYS involving the oral mucosa

less severe than TEN

66
Q

what causes steven-johnson syndrome

A

infections - mycoplasma + HSV
idiopathic
Drugs - NSAIDS, sulphonamides, penicillin, anti-convulsants, allopurinol