Skin in systemic disease Flashcards

Question

what is dress

Answer 1

drug reaction with eosinophilia and systemic symptoms | - rash and systemic upset incorporating haematological and solid organ disturbances

Answer 2

``` based on scoring criteria including: fever >38.5 lymphadenopathy >2 sites, >1cm circulating atypical lymphocytes peripheral hyperesosinophilia internal organ involvement negative ana, hep skin involvement biopsy suggesting DRESS ```

Answer 3

``` liver ( hepatitis) - most frequent cause of death kidneys - interstitial nephritis heart - myocarditis brain thyroid - thyroiditis lungs - interstitial pneumonitis ```

Answer 4

sulfonamides anti epileptics (carbamazepine, phentoin, lamotrigine) allopurinol, antibiotics( vancomycin, amoxicillin, minocycline, piperacillin - tazobactam), ibuprofen

Answer 5

``` urticated papular exanthem - widespread papules maculopapular (morbilliform) eruption erythroderma head/neck oedema erythema multiforme- like ```

Answer 6

withdrawal of culprit corticosteroids = first line treatments, may require them for months mortality - 5-10%

Answer 7

multi organ disease can affect upto 80% of allogenic haematopoetic stem cell transplants, hsct pathogenesis - donor derived t lymphocyte activity against immunocompromised recipient

Answer 8

skin liver gi tract

Answer 9

``` itching without rash - suggestive of internal cause: - haematological: lymphoma, polycythaemia - uraemia - cholestasis iron def/overload hiv/hep abc cancer drugs psychogenic old age look for nodular purigo ```

Answer 10

``` fbc, ldh renal profile lfts ferritin cxr hiv/ hep abc test ```

Answer 11

vit c deficiency spongy gingivae with bleeding and erosion petechiae, ecchymoses, follicular hyperkeratosis corkscrew hairs with perifollicular haemorrhage

Answer 12

kwashiorkor - protein def zinc deficiency vit b3 def

Answer 13

``` hepatomegaly bacterial/ fungal infections diarrhoea loss of muscle mass oedema failure to thrive ```

Answer 14

superficial dequamation large areas of erosion sparse, dry hair soft thin nails cheilitis

Answer 15

plays a role in 200 enzymes - regulation of lipid, protein, nucleic acid synthesis has roles in wound healing, antioxidants and psychological benefits

Answer 16

triad of Dermatitis, Diarrhoea and Depression perioral, acral and perineal skin in particular is affected with scaly erosive erythema

Answer 17

``` dermatitis, diarrhoea dementia and death cutaneous manifestations: - photodistributed erythema casals necklace painful fissures of palms and soles peri-anal, genital and perioral inflammation and erosions ```

Answer 18

signifies metastases of malignant carcinoid tumour 5ht secretion flushing in 25% cases other symptoms: diarrhoea, bronchospasm, hypotension

Answer 19

derm emergency! flu like sick abrupt onset of lesions on trunk, then face and limbs, macules, blisters, erythema blisters merge extensive full thickness mucocutaneous (epidermal) necrosis <2-3days

Answer 20

when less than 10% of epidermal detachment - sjs more than 30% - ten in between is sjsten

Answer 21

cell mediated cytotoxic reaction against epidermal cells drugs cause >80% of cases may be started upto 3 wks prior to onset of rash

Answer 22

ssss- staph scalded skin syndrome thermal burns cutaneous graft versus host disease

Answer 23

``` SCORTEN - score used to help assess severity age >40 hr initial % of epidermal detachment serum urea and glucose and bicarbonate presence of malignancy ```

Answer 24

``` death - overall mortality 30% blindness, dehydration, hypothermia/hyperthermia renal tubular necrosis eroded gi tract interstitial pneumonitis liver and heart failure ```

Answer 25

generalised erythema affecting >90% of body

Answer 26

``` peripheral edema tachycardia loss of fluid and proteins disturbances in thermoregulation risk of sepsis ```

Answer 27

``` drug reactions cutaneous t cell lymphoma - sezary syndrome psoriasis atopic eczema idiopathic ```

Answer 28

``` treat underlying cause hospitalisation if systemically unwell restore fluid and electrolyte balance, circulatory status and manage body temp emollients topical steroids? antibiotics? ```

Answer 29

excoriations/ prurigo xerosis half and half nails calciphylaxis and sign related to primary disease - vasculitis, sle signs related to immunosupression - viral warts, skin cancer

Answer 30

``` muehrckes lines terrys nails jaundice spider telangietasia porphyria cutaneous tarda palmar clubbing ```

Answer 31

20-65% cases occur in setting of dm | plaques with red brown raised edge with yellow atrophic centre

Answer 32

topical/ intralesional steroids

Answer 33

``` terrys nails granuloma annulare neuropathic ulcers ancanthosis nigricans xerosis xanthelesma and xanthomata ```

Answer 34

pretibial myxodem hyperpigmentation acne cutis gyrata verticis

Answer 35

``` severe seborrhoeic dermatitis extensive viral warts norwegian scabies cmv ulceration eosinophilic folliculitis bacillary angiomatosis kaposi sarcoma itch gential/oral ulceration ```

Answer 36

``` associated with ibd: pyoderma gangrenosum orofacial granulomatosis panniculitis aphthous ulceration association with psoriasis, pemphigold associated with celiac: dermatitis herpetiformis ```

Answer 37

inflammed nodules, sterile abcess, sinus tracts, fistulae and hypertrophic scars favours intertriginous zones esp axillary, anogenital and inframammary area

Answer 38

pustule on erythematous base - ulcerates and extends with necrotic undermined disorder painful associated with ibd, leukaemia, seronegative arthiritis

Answer 39

cutaneous metastases malignancy reflecting internal malignancy - e.g pagets genetic condition skin disease asscoiated with malignancies non specific signs