Skin in Systemic Disease Flashcards
How are dermatological diagnostic skills useful?
- Prevent or reduce internal organ damage by early diagnosis
- Allow detection of internal malignancy
What are the two main types of lupus erythamtosus?
- systemic lupus
- cutaneous (discoid) lupus
What are the skin features of systemic lupus erythmatosus?
- chilblains
- photodistributed erythematous rash
- livedo reticularis
- palpable purpura
- subacute cutaneous lupus
- alopecia
What are the skin features of discoid lupus erythmatosus?
Scarring
What is dermatomyositis?
- autoimmune connective tissue disease
- proximal extensor inflammatory myopathy
- subtypes with different clinical features can be predicted by antibody profile
What are the skin features of dermatomyositis?
- photodistributed pink-violet rash on scalp, periocular region and extensor surfaces
- Gottron’s papules
- ragged cuticles
- Shawl sign
- Heliotrope rash
What is vasculitis?
Inflammation or swelling of blood vessels
What are the skin features of vasculitis?
- depends on the size of the blood vessel
- small vessel = purpura
- medium vessel = digital necrosis, retiform purpura ulcers, subcutaneous nodules along blood vessels
What is sarcoidosis?
- systmeic granulomatous disorder of unknown origin
- can affect multiple organs, lungs most common
What are the skin features of sarcoidosis?
- highly variable
- red-brown or violet papules on face, lips, upper back, neck and extremities
- lupus pernio (unrelated to LE)
- ulcers
- scars
What is DRESS?
- drug reaction with eosinophilia and systemic symptoms
- rash and systemic upset incorporating hameotological and solid-organ disturbances
What is the scoring criteria for DRESS?
- fever
- lymphodenopathy
- atypical lymphocytes
- peripheral hypereosinophilia
- interanal organs involved
- negative ANA, hepatitis, mycoplasma and chlamydia
- skin involvement
What are the skin features of DRESS?
- widespread papules
- maculopapullar eruption
- erythroderma
- head/neck oedema
- multiform erythma
What is graft vs host disease?
- T-lymphocyte response from the graft’s immune cells against host cells
- affects people with stem cell transplants
- mainly affects skin, liver and GI tract
Which symptoms indicate GvHD rather than DRESS?
- face involvement
- acral involvement
- diarrhoea
What is pruritis?
- itching with no rash
- suggests internal cause
What can chronic skin scratching from pruritis lead to?
Nodular prurigo
What is carcinoid syndrome?
signifies metastasis of a malignant carcinoid tumour
What are the symptoms of carcinoid syndrome?
- seretonin secretion
- flushing (25% of cases)
- diarrhoea
- bronchospasm
- hypotension
What is SJS/TEN?
- Stevens-Johnson syndrome/ toxic epidermal necrolysis
- dermatological emergency
What differentiates SJS and TEN?
- SJS = < 10% epidermal detachment
- TEN = > 30% epidermal detachment
- SJS/TEN = 10-30% epidermal detachment
What causes SJS/TEN?
- cell-mediated cytotoxic reaction against epidermal cells
- mostly caused by drugs (antibiotics and anti-epileptics)
What is the disease progression of SJS/TEN?
- flu-like symptoms
- abrupt onset of lesion on trunk, then face and limbs
- macules, blisters and erythma
- blisters merge causing sheets of skin detachment
- extensive full thickness epidermal necrosis in less than 2-3 days
What is erythroderma?
generalised erythma affecting > 90% of the body surface area
What are the causes of erythroderma?
- drug reactions
- cutaneous T cell lymphoma
- psoriasis
- atopic eczema
- idiopathic
What are the systemic manifestations of erythroderma?
- peripheral edema
- tachycardia
- loss of fluids and proteins
- disturbed thermoregulation
- sepsis
