Skin and Systemic Disease

Question 1

what are some dermatological manifestations of diabetes

Answer 1

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

Question 2

what is necrobiosis lipoidica

Answer 2

brown/red/yellow raised shiny patch usually above tibia

with telangeictasia

Question 3

what is diabetic dermopathy

Answer 3

atrophic hyperpigmented lesions on lower legs

Question 4

what is granuloma annulare

Answer 4

pink raised annular lesions - usually on knuckles

Question 5

what proportion of people with diabetes develop necrobiosis lipoidica

Answer 5

<1% of diabetics

Question 6

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

Answer 6

Females, 3:1

Question 7

what are some dermatological manifestations of thyroid dysfunction

Answer 7

pretibial myxedema (hyperthyroidism)
dry skin (hypothyroidism)

Question 8

what is pretibial myxedema

Answer 8

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

Question 9

what are some dermatological manifestations of SLE

Answer 9

acute malar rash in a butterfly distribution

Question 10

what are some cutaneous manifestations of systemic cancers

Answer 10

acanthosis nigricans 
acquired ichthosis
pyoderma gangrenosum 
dermatomyositis 
dermatitis herpetiformis 
generalised pruitis

Question 11

what is acanthosis nigricans

Answer 11

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

Question 12

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

Answer 12

insulin resistance and metabolic syndromes as well as GI malignancy

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

Question 13

what kinds of cancers is acanthosis nigricans associated with

Answer 13

GI cancers - specifically gastric carcinomas

Question 14

what is acquired ichthyosis

Answer 14

dry rough skin with scaling

Question 15

what cancer is particularly associated with acquired ichythosis

Answer 15

Hodgkins lymphoma

Question 16

what is pyoderma gangrenosum

Answer 16

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

Question 17

what systemic diseases is pyoderma gangrenosum associated with

Answer 17

RA
crohns 
diverticulitis 
chronic active hepatitis 
behcets diseae 
malignancy

Question 18

what malignancies is pyoderma gangrenosum associated with

Answer 18

haemotological maligancies

Question 19

how do you treat pyoderma gangrenosum

Answer 19

find/treat underlying disease

topical/oral steroids may be helpful + emmolients

ciclosporin may be used as final option

Question 20

what is dermatomyositis

Answer 20

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

Question 21

what causes dermatomyositis

Answer 21

autoantibodies to striated muscle

Question 22

what are some symptoms of dermatomyositis

Answer 22

skin changes

progressive proximal muscle weakness

Question 23

what indicates a good prognosis for dermatomyositis

Answer 23

calcinosis

Question 24

what proportion of patients with dermatomyositis have an underlying malignancy

Answer 24

30%

Question 25

what are some biochemical markers for dermatomyositis

Answer 25

elevated Creatine phosphokinase

Question 26

what test detects muscular abnormalities for suspected dermatomyositis

Answer 26

electromyography | muscular biopsy

Question 27

what is shown on muscle biopsy in dermatomyositis

Answer 27

inflammation/destruction

Question 28

what is the treatment for dermatomyositis

Answer 28

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

Question 29

what is dermatitis herpetiformis

Answer 29

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

Question 30

what is dermatitis herpetiformis associated with

Answer 30

coeliacs

Question 31

how do you diagnose dermatitis herpetiformis

Answer 31

immunoflourescent skin biopsy

Question 32

whats the treatment for dermatitis herpetiformis

Answer 32

dapsone (Antibiotic) | treat coeliacs

Question 33

what are the differentials for generalised pruitis

Answer 33

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

Question 34

what is erythema gyratum repens

Answer 34

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

Question 35

what is acquired hypertrichosis lanuginosa

Answer 35

malignant down - excessive/widespread growth of laguno hair

Question 36

what is necrolytic migratory erythema + what is it seen in

Answer 36

crusting edge that moves | anaemia/WL/diabetes/Stomatitis

Question 37

what does necrolytic migratory erythema indicate

Answer 37

glucagon secreting tumour

Question 38

what is bazex syndrome

Answer 38

papulosquamous eruption on finger, toes, ears nose

Question 39

what causes bazex syndrome

Answer 39

URT tumours

Question 40

what is acute febrile neutrophillic dermatosis

Answer 40

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

Question 41

what is associated with neutrophillic dermatosis

Answer 41

myeloproliferative disorders

Question 42

what is pachydermoperiostasis

Answer 42

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

Question 43

what causes pachydermoperiostasis

Answer 43

autosomal dominant disease or due to systemic disease

Question 44

what is erythema nodosum

Answer 44

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

Question 45

what is the demographics of a typical patient with erythema nodosum

Answer 45

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

Question 46

what is erythema nodosum associated with

Answer 46

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

Question 47

how do you treat erythema nodosum

Answer 47

rest NSAIDS prednisolone if refractory

Question 48

what's the prognosis for erythema nodosum

Answer 48

usually resolves in around 6 weeks

Question 49

what are some skin manifestations for cutaneous small vessel vasculitis

Answer 49

palpable purpura <1cm

Question 50

what is polyarteritis nodosa

Answer 50

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

Question 51

what happens if polyarteritis nodosa is left untreated

Answer 51

chronic oragn failure and death - usually from CKD

Question 52

what is the treatment for polyarteritis nodosa

Answer 52

systemic steroids and cyclophosphamides (chemo) low dose steroids only if disease is purely cutaneous

Question 53

what is the mechanism of non allergic drug eruptions

Answer 53

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

Question 54

what is the mechanism of allergic drug eruptions

Answer 54

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

Question 55

what is the most serious form of an allergic drug eruptions

Answer 55

toxic epidermal necrolysis

Question 56

what causes toxic epidermal necrolysis

Answer 56

barbiturates, anticonvulsants, antibiotics

Question 57

what drugs commonly cause rashes

Answer 57

``` penicillins/sulphonamides anticonvulsants NSAIDS Thiazides Allopurinol Gold + penicillinamine ```

Question 58

whats the treatment for toxic epidermal necrolysis

Answer 58

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

Question 59

what is toxic erythema

Answer 59

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

Question 60

what is erythema multiforme

Answer 60

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

Question 61

what is the age distribution of erythema multiforme

Answer 61

<20 years olf in 50% of patients

Question 62

what causes erythema multiforme

Answer 62

infection (HSV, mycoplasma) | drugs - penicillin, sulphonamide, phenytoin, allopurinol

Question 63

what are some differentials for erythema multiforme

Answer 63

non-EM eruption secondary syphilis urticarial

Question 64

what does a true target lesion have

Answer 64

at least 3 colours in it

Question 65

what is steven johnsons syndrome

Answer 65

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

Question 66

what causes steven-johnson syndrome

Answer 66

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