Skin Findings in Lung Diseases Flashcards
annular plaques
*hyperpigmented plaques with raised rim and central depression, absence of scales
*looks like ringworm lesions WITHOUT the scale
*pathology: diffuse nodular dermal infiltrates of histiocytes and multinucleated cells, forming non-caseating (naked) granulomas (see image)
*seen in SARCOIDOSIS
erythema nodosum
*inflammatory panniculitis (inflammation of the subcutaneous fat in the skin)
*tender red firm nodules on anterior legs and ankles
*can be seen in association with SARCOIDOSIS, especially Lofgren Syndrome, or in TB, among other disorders
*Lofgren Syndrome = erythema nodosum + fever + hilar lymphadenopathy + anterior uveitis
lupus pernio
*NOT actually lupus
*type of SARCOIDOSIS where skin involvement favors nose & ears
*indolent reddish-purplish plaques and nodules on nose, cheeks, ears
*high association with sinus & lung involvement in sarcoidosis
skin findings that might be seen in sarcoidosis
*annular plaques
*erythema nodosum (as part of Lofgren Syndrome)
*lupus pernio
lupus vulgaris
*a type of skin TB
*NOT actually lupus
*well-demarcated solitary violaceous-appearing plaque with superimposed scale and crusting
*chronic form of TB in the skin, lasts for years
*can become disfiguring
*pathology: granuloma formation with CENTRAL/CASEATING NECROSIS (see image)
direct inoculation of skin with TB
*occurs after direct inoculation of TB into skin in someone who has been previously infected with mycobacteria
*violaceous or red warty growth
*lesions at sites of skin trauma like knees, elbows, hands, feet
*lesions may persist for years but can clear up even without treatment
scrofuloderma
*a type of skin TB
*skin lesions from direct extension of underlying TB infection of lymph node
*usually seen in axilla, neck, or along jawline
*often associated with TB of the lungs
*firm, painless lesions that eventually ulcerate
skin findings that might be seen in TB
*lupus vulgaris
*scrofuloderma
*direct inoculation of skin with TB
*erythema nodosum
note - TB infections rarely have skin findings; if present, skin findings are more likely to be in patients with compromised immune systems (ex. HIV/AIDS)
skin findings seen in smoking
*nicotine causes vasoconstriction of small capillaries in skin → impaired wound healing
*inflammation caused by noxious chemicals in cigarettes leads to activation of enzymes which break down collagen in skin
→advanced aging of skin
→increased lines and wrinkles, especially around mouth
cyanosis in chronic bronchitis
*some patients with chronic bronchitis subtype of COPD can have subtle cyanotic appearance to skin
*due to relatively higher CO2 levels in blood, causing deoxygenation of hemoglobin
digital clubbing
*clubbing refers to bulbous appearance of distal digits along with a change in the angle between the finger and the nail
*can be seen in a variety of pulmonary and cardiac diseases
nicotine staining
*chronic tobacco use leads to staining of the nails and hands
*brown to yellow discoloration noted
telangiectasias
*mat telangiectasias are blanching red vascular macules associated with systemic sclerosis/SCLERODERMA
*often most noticeable on face, chest, and palms
Raynaud’s phenomenon
*a vasospastic response to mild fluctuations in temperature
*fingers turn white or blue and become cold and painful
*over time, small ulcers can develop, sometimes referred to as “rat bite ulcers”
*can be seen in systemic sclerosis/SCLERODERMA (but not specific)
taut skin
*patients with systemic sclerosis can have diffuse hardening of the skin, most noticeable around the mouth (causing impaired opening) and on extremities
