Skin and Systemic Disease Flashcards
What is Curth’s postulates?
Are a well-known set of clinical criteria to help evaluate the relationship between underlying malignancy and a specific dermatological condition
What are some skin signs of GI disease?
GI genetic:
- Hereditary haemorrhagic telangiectasia
- Blur rubber bleb naevus
- Sign of GI haemorrhage
GI inflammatory/autoimmune:
- Erythema nodosum
- Pyoderma gangrenosum
- IBD
Vitamin deficiency:
- Scurvy/beriberi
What are some skin signs of GI genetic diseases?
- Hereditary haemorrhagic telangiectasia
- Blur rubber bleb naevus
- Sign of GI haemorrhage
What is blur rubber bleb naevus a sign of?
- Sign of GI haemorrhage
What are some skin signs of GI inflammatory/autoimmune disease?
- Erythema nodosum
- Pyoderma gangrenosum
- IBD
What is pyoderma gangrenosum a sign of?
IBD
What is a skin sign of vitamin deficiency?
- Scurvy/beriberi
What are some skin signs of diabetes?
- Acanthosis nigricans
- Diabetic bullae
- Diabetic dermopathy
- Eruptive xanthomas
- Necrobiosis lipiodica
What is a skin sign of hyperthroidism?
Thyroid acropachy
What is a skin sign of hypothyroidism?
- Pre-tibial myxoedema
What are some examples of autoimmune diseases than have skin signs?
Cutaneous lupus
Vasculitic rashes
Alopecia
Vitiligo
What are some skin presentations of cutaneous lupus?
- Butterfly rash
- Plaques with clear margins
- Photosensitivity
- Negative antibodies
What is the most common kind of vasculitic rashes?
- Small vessel vasculitis (commonest)
What is the full name of alopecia?
- alopecia areata
What is the pathology of alopecia?
- T lymphocyte, cytokine rejection of hair
- Totalis
- Universalis
What are the different kinds of alopecia?
Alopecia totalis (entire scalp)
Alopecia universalis (all body hair)
What is vitiligo?
Disease that causes the loss of skin color in blotches
What is the pathology of vitiligo?
Destruction of melanocytes
Some skin conditions have stronger associations with underlying malignancy, what are some examples of underlying malignancy with skin signs?
- Carcinoid syndrome
- Ectopic ACTH
- Pagets disease
- Paraneoplastic pemphigus
- Acquired hypertrichosis
- Erythema gyratum repens
- Bazex syndrome
- Leser trelat
What is the clinical presentation of carcinoid syndrome?
- Episodic flushing, lasting minutes to hours
- No sweating, until menopause
- Facial telangiectasia (distorted blood vessels)
What is telangiectasia?
Distorted blood vessels
What is carcinoid syndrome?
Paraneoplastic syndrome comprising the signs and symptoms that occur secondary to carcinoid tumors
What is a paraneoplastic syndrome?
A syndrome (a set of signs and symptoms) that is the consequence of cancer in the body specifically due to the production of chemical signalling molecules (such as hormones or cytokines) by tumor cells or by an immune response against the tumor
What is a syndrome?
Set of symptoms and signs
What is ectopic ACTH syndrome?
Caused by nonpituitary tumors that secrete either adrenocorticotropic hormone (ACTH) and/or corticotropin-releasing hormone (CRH) and cause bilateral adrenal hyperplasia
Explain the pathogenesis of ectopic ACTH syndrome?
- Tumour production of ACTH leads to generalised hyperpigmentation
- ACTH -> increased MSH -> release of melanin from melanocytes
What are the different kinds of Paget’s disease?
Paget’s disease
Extra-mammary paget’s disease
What is the clinical presentation of Paget’s disease?
- Eczematous plaque (nipple/areola)
- Extension of underlying ductal
What is the clinical presentation of extra-mammary paget’s disease?
- Usually axilla or ano-genital areas
- Intraepithelial adenoca in ¾ of cases
What is acquired hypertrichosis lanuginose?
- Acute onset of lanugo hairs at face and body
Describe the lesions due to erythema gyratum repens?
Concentric erythematous lesions
What is erythema gyratum repens associated with?
- Associated with lung cancer > oesophageal, breast
- Very rarely with mycobacterial infection, pregnancy
What is bazex syndrome?
- Symmetrical hyperkeratosis of extremities
- Acrokeratosis neoplastica
- Resembled psoriasis
What malignancy is Bazex syndrome most commonly associated with?
- Squamous cell carcinoma
- Bronchial, oropharyngeal, gastric, colon, biliary adenocarcinomas
What is Leser-trelat?
- Eruptive seborrheic keratosis
What malignancy is Leser-trelat associated with?
- GI adenocarcinomas
What are some skin conditions associated with cancer?
- Acanthosis nigricans
- Dermatomyositis
How is acanthosis nigricans associated with cancer?
- Can preceed malignancy (gastric adenocarcinoma)
What malignancy does acanthosis nigricans often preceed?
Gastric adenocarcinoma
When should you be concerned about a patient with acanthosis nigricans?
- Can preceed malignancy (gastric adenocarcinoma)
- Concern if
- Older patient, rapid onset
- Involves lips
- Weight loss
What is dermatomyositis?
- Inflammatory myopathy and rash
- Periorbital heliotrope rash
- Gottrons papules
- Red maculo-papular lesions over bony prominances
- Shawl sign
- Photosensitive
- Associated with ovarian, breast, lung carcinoma
What is the clinical presentation of dermatomyositis?
- Inflammatory myopathy and rash
- Periorbital heliotrope rash
- Gottrons papules
- Red maculo-papular lesions over bony prominances
- Shawl sign
- Photosensitive
- Associated with ovarian, breast, lung carcinoma
What malignancy is dermatomyositis often associated with?
- Associated with ovarian, breast, lung carcinoma
Describe the lesions due to dermatomyositis?
- Periorbital heliotrope rash
- Gottrons papules
- Red maculo-papular lesions over bony prominances
What are some skin conditions that may be associated with malignancy?
- Acanthosis nigricans
- Dermatomyositis
- Bullous pemphgoid
- Sweets syndrome
- Pyoderma gangrenosum
- Acquired ichthyosis
- Cyroglobulinaemia
What are some examples of genetic tumour syndromes?
- Peutz-Jeghers
- Melanosis, colon hamartomas, colon cancer
- Muir-torre
- Sebaceous tumours, keratoacanthomas, GI, breast, GU
- Neurofibromatosis
- Café au late, ax freckles, neurofibromas, nerve sheath, carinoid
- MEN syndromes
- Angiofibromas, neuromas, lichen or macular amyloid (MEN2), endocrine)
- Howel-evans
What cancers compose Peutz-Jeghers syndrome?
- Melanosis, colon hamartomas, colon cancer
What cancers compose Muir-torre syndrome?
- Sebaceous tumours, keratoacanthomas, GI, breast, GU
What cancers compose neurofibromatosis syndrome?
Café au late, ax freckles, neurofibromas, nerve sheath, carinoid
What cancers compose MEN syndromes?
- Angiofibromas, neuromas, lichen or macular amyloid (MEN2), endocrine)
