Skin and Systemic Disease Flashcards
what are some dermatological manifestations of diabetes
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
what is necrobiosis lipoidica
brown/red/yellow raised shiny patch usually above tibia
with telangeictasia
what is diabetic dermopathy
atrophic hyperpigmented lesions on lower legs
what is granuloma annulare
pink raised annular lesions - usually on knuckles
what proportion of people with diabetes develop necrobiosis lipoidica
<1% of diabetics
what sex is more likely to get necrobiosis lipoidica and by how much
Females, 3:1
what are some dermatological manifestations of thyroid dysfunction
pretibial myxedema (hyperthyroidism) dry skin (hypothyroidism)
what is pretibial myxedema
pink/flesh coloured mucoid plaques seen on lower shins, marked exophthalmos may also be seen
what are some dermatological manifestations of SLE
acute malar rash in a butterfly distribution
what are some cutaneous manifestations of systemic cancers
acanthosis nigricans acquired ichthosis pyoderma gangrenosum dermatomyositis dermatitis herpetiformis generalised pruitis
what is acanthosis nigricans
velvety thickened hyperpigmented papillomatous ‘dirty’ looking skin - usually in flexors
in what conditions is acanthosis nigricans seen and when would you be suspicious of malignancy
insulin resistance and metabolic syndromes as well as GI malignancy
hyperacute onset + severe symptoms, usually on mucous membranes and palms
what kinds of cancers is acanthosis nigricans associated with
GI cancers - specifically gastric carcinomas
what is acquired ichthyosis
dry rough skin with scaling
what cancer is particularly associated with acquired ichythosis
Hodgkins lymphoma
what is pyoderma gangrenosum
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
what systemic diseases is pyoderma gangrenosum associated with
RA crohns diverticulitis chronic active hepatitis behcets diseae malignancy
what malignancies is pyoderma gangrenosum associated with
haemotological maligancies
how do you treat pyoderma gangrenosum
find/treat underlying disease
topical/oral steroids may be helpful + emmolients
ciclosporin may be used as final option
what is dermatomyositis
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
what causes dermatomyositis
autoantibodies to striated muscle
what are some symptoms of dermatomyositis
skin changes
progressive proximal muscle weakness
what indicates a good prognosis for dermatomyositis
calcinosis
what proportion of patients with dermatomyositis have an underlying malignancy
30%
what are some biochemical markers for dermatomyositis
elevated Creatine phosphokinase
what test detects muscular abnormalities for suspected dermatomyositis
electromyography
muscular biopsy
what is shown on muscle biopsy in dermatomyositis
inflammation/destruction
what is the treatment for dermatomyositis
high dose systemic steroids
needed for several years
immunosuppressive agents (azathioprine) used to rpevent seteroids
treat until there is a biochemical improvement
what is dermatitis herpetiformis
chronic recurrent intensely pruritic eruptions occurring symmetrically on extensor surfaces of trunk and extremities - typically grouped vesicles
what is dermatitis herpetiformis associated with
coeliacs
how do you diagnose dermatitis herpetiformis
immunoflourescent skin biopsy
whats the treatment for dermatitis herpetiformis
dapsone (Antibiotic)
treat coeliacs
what are the differentials for generalised pruitis
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
what is erythema gyratum repens
shifting wave of erythema covering the skins surface looking like the grain of wood
what is acquired hypertrichosis lanuginosa
malignant down - excessive/widespread growth of laguno hair
what is necrolytic migratory erythema + what is it seen in
crusting edge that moves
anaemia/WL/diabetes/Stomatitis
what does necrolytic migratory erythema indicate
glucagon secreting tumour
what is bazex syndrome
papulosquamous eruption on finger, toes, ears nose
what causes bazex syndrome
URT tumours
what is acute febrile neutrophillic dermatosis
red odematous plaque presenting with a classic triad of increased ESR, fever and raised neutrophils
what is associated with neutrophillic dermatosis
myeloproliferative disorders
what is pachydermoperiostasis
coarsening/thickening of the skin seen with severe clubbing occuring on face/fingers commonly
what causes pachydermoperiostasis
autosomal dominant disease or due to systemic disease
what is erythema nodosum
immunological inflammation of subcutaneous fat presenting as tender bruise like nodules on the lower legs with associated fever, malaise and lethargy
what is the demographics of a typical patient with erythema nodosum
F>M 3:1, 15-30 years old
what is erythema nodosum associated with
infection - TB
drugs - OCP, sulfonamides
disease - IBD, sarcoid, behets
how do you treat erythema nodosum
rest
NSAIDS
prednisolone if refractory
what’s the prognosis for erythema nodosum
usually resolves in around 6 weeks
what are some skin manifestations for cutaneous small vessel vasculitis
palpable purpura <1cm
what is polyarteritis nodosa
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
what happens if polyarteritis nodosa is left untreated
chronic oragn failure and death - usually from CKD
what is the treatment for polyarteritis nodosa
systemic steroids and cyclophosphamides (chemo)
low dose steroids only if disease is purely cutaneous
what is the mechanism of non allergic drug eruptions
intrinsic pharmacological mechanisms (disclolouration + amiodarone)
predictable
may be exacerbation of existing skin disease
idiosyncratic
what is the mechanism of allergic drug eruptions
unpredictable eruptions commonly occuring on 2nd exposure, most commonly morbilliform rashes with a central distribution
what is the most serious form of an allergic drug eruptions
toxic epidermal necrolysis
what causes toxic epidermal necrolysis
barbiturates, anticonvulsants, antibiotics
what drugs commonly cause rashes
penicillins/sulphonamides anticonvulsants NSAIDS Thiazides Allopurinol Gold + penicillinamine
whats the treatment for toxic epidermal necrolysis
stop drugs consider measures to decrease drug in system symptomatic oral steroids controversial avoid drug in future label medical records
what is toxic erythema
most common drug related rash
marbiform erythematous macules
most often occurs 7-14 dats after into of drug
what is erythema multiforme
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
what is the age distribution of erythema multiforme
<20 years olf in 50% of patients
what causes erythema multiforme
infection (HSV, mycoplasma)
drugs - penicillin, sulphonamide, phenytoin, allopurinol
what are some differentials for erythema multiforme
non-EM eruption
secondary syphilis
urticarial
what does a true target lesion have
at least 3 colours in it
what is steven johnsons syndrome
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
what causes steven-johnson syndrome
infections - mycoplasma + HSV
idiopathic
Drugs - NSAIDS, sulphonamides, penicillin, anti-convulsants, allopurinol
