Skin Manifestation of Systemic Disorders Flashcards
Pyoderma Gangrenosum
- cause
- what is this?
- PE
- MC sites
- tx
Cause:
- Chronic Ulcerative Colitis**
- chronic active hepatitis
- Rheumatoid Arthritis
- Crohns Dz
- Hematologic malignancies
What:
- rapidly evolving, chronic, and severely debilitating ulcerative skin dz
- tissue becomes necrotic
- deep ulcers on the legs
PE:
- painful hemorrhagic pustules or painful nodule surrounded by erythematous halo.
- ulcer formation w/ dusky red or purple borders, irregular and raised, boggy with perforations that drain pus
MC sites:
-lower extremities, buttocks, abdomen.
Tx:
- treat underlying dz
- high dose systemic corticosteroids
- systemic immunosuppression
- -sulfazalazine (intense inflamm)
- -cyclosporine (immunosuppression)
- -Infliximab
What skin conditions are associated with DM?
Acanthosis Nigricans
Necrobosis Lipoidica Diabeticorum
Granuloma annulare
Thrush
Intertrigo
Acanthosis Nigricans:
- characteristics
- associated with ?
- PE
- MC sites
- Tx
Characteristics:
-velvety thickening and hyperpigmentation of the skin.
Associated with:
- endocrine disorders such as DM
- obesity
- internal malignancy (GI MC)
PE:
-hyperpigmentation, velvety skin, skin line accentuation, surface becomes wrinkled or creased.
MC sites: axilla, neck, groin, antecubital fossae.
Tx:
- Treat associated disorder
- usually none required.
Necrobiosis lipoidica Diabeticorum (NLD)
- describe this lesion
- tx
Lesion:
- oval, violaceous patch that expands slowly
- advancing border is red and the central area turns yellow-brown
- telangiectasias
- ulceration possible.
Tx:
-refer to derm..
Granuloma Annular:
- describe this lesion
- MC sites
- tx
Description:
- smooth, shiny firm ring of fleshed colored papules and plaques (1-5cm)
- annular with central depression
- central clearing
MC sites: dorsum of hands and feet, extremities, and trunk
Tx:
- topical steroids, but usually clear on their own
- intralesional injections of steroids
Intertrigo:
- what is this?
- what makes this worse?
- associated with?
- MC sites
- PE
- Tx
What: irritation in the skin folds
Worse with heat and moisture
Associated with DM, HIV, obesity
MC sites: axilla, groins, gluteal folds, overlapping abdominal panniculus
PE:
-erythema, +/- pruritis, tenderness, erythematous plaques
Tx:
- keep cool and dry
- tx based on cause:
- -antifungal/antibacterial poweders
- zinc oxide ointment
- topical steroids MUST BE AVOIDED!!!
ThrusH:
- cause
- describe the lesion
- associations
- tx
cause: yeast infection, usually candida
Lesion:
-white plaques or red erosions areas in the moral mucosa
Associations:
-DM, HIV, immunosuppression
Tx:
-antifungal (fluconazole, itraconazole)
**the average person should not get this frequently, if they do you should start thinking about HIV, DM… etc.
Lupus: Chronic Cutaneous (Discoid)
- describe this lesion
- tx
lesion: ;scarring, dispigmented, scaly plaques on the face.
tx: potent topical steroids +/- antimalarials (hydroxychloroquine)
Lupus: Subacute cutaneous
- cause
- describe these lesions
- tx
Cause: may be drug induced.
Lesion: polycyclic scaly plaques in sun exposed areas
**NOT on the face
Tx: antimalarials (hydroxychloroquine) or other immunosuppressants.
Systemic Lupus Erythematosus:
- describe that lesion
- characteristics
- tx
Lesion:
-butterfly facial erythema with is nonscarring
Characteristics
- photosensitivity
- oral ulcers
- discoid lupus
Tx:
-antimalarials and immunosuppression.
Dermatomyositis:
- describe these lesion
- characteristics of disordder
- association
- tx
Lesion:
- erythema, heliotrope eyelid rash
- gottrons papules: on the knuckles, periungual telangiectasia, poikiloderma (red, white, brown)
- calcinosis cutis
Characteristics:
-weakness of proximal muscles
-
90% of the time they have an underlying maignancy associated (adenocarcinoma)
Tx:prednisone daily and methotrexate.
Scleroderma: -what are the CREST characteristics -other signs and sx -prognosis -tx
CREST:
- Calcinosis
- Reynauds phenomenon
- Esophageal dysmotility
- sclerodactyly
- telangiectasia
Other:
-flexion contractures, painful, edematous face (too much botox)
Prognosis:
-progressive systemic sclerosis
Tx:
-with systemic immunosuppression
Xanthomas:
- describe this lesion
- assocations
- MC sites
- tx
Lesion:
- lipid deposits in skin and tendons
- yellow-brown, pinkish or orange macules, papules, plaques, nodules
Associations:
- hyperlipidemia
- biliary cirrhosis, DM, CRF
MC sites:
-upper and lower eyelids, inner canthus
Tx:
-laser exicison, electrodessication or topical application of trichloroacetic acid.
Erythema Multiforme:
- describe the lesions
- cause
- MC predisposing infection?
- Tx
Lesions:
- erythematous “targetoid” macules/patches
- papules/plaques
- vesicles/bullae
- wheals
- *MC on the extensor surfaces**
Cause: immune mediated, usually follow bad infection or drug exposure.
MC drugs are:
-sulfa (bactrim, dapsone)**
-anti-eleptic drugs (pheytoin, carbemazepine)
-abx: pcn, cephalosporins
-allopurinol
MC predisposing infection is herpes simplex
Tx:
steroids (heather said this)
-antiviral prophylaxis to control HSV
-early dx and cessation of suspected causitive drug.
Describe each of the following in both erythema Multiforme Minor and Major
- mucous membrane involvment
- sx systemic or not?
- Cause
MINOR:
- little or NO mucous membrane involvement
- few if any systemic sx
- often do to HSV or medications.
MAJOR:
- ALWAYS mucous membrane involvement
- systemic sx such as fever
- often due to medications, hepatitis, nephritis
Steven Johnson Syndrome & Toxic epidermal necrolysis:
-what is this?
-mucocutaneous drug-induced or idiopathic rxn patters characterized by skin tenderness and erythema of skin and mucosa. followed by extensive cutaneous and mucosal epidermal necrosis and sloughing.
SJS is considered maximal variant of erythema multiform major
TEN is considered maximal variant of SJS.
SJS & TEN:
- associated with?
- prodrome
- progression
association:
- drugs**
- SLE
- HIV
- HLS-B12
Prodrome:
- rash (morbilliform)
- fever
- mouth lesions
- flu like sx 1-3d prior to mucocutaneous lesions.
- mucocutaneous skin lesion
- burning and itching
Progression:
- necrotic epidermis, macular areas
- sheet like loss of epidermis
- flaccid blisters that spread with lateral pressure (Nickolsky sign)
- with trauma, full thickness epidermal detachment yeilding exposed, red, oozing dermis resembling a 2nd degree burn.
SJS and TEN:
-tx
early dx and cessation of suspected causative drug
- supportive care in ICU
- systemic steroids (controversial)
- IVIG may halt progression with administered early
- eye lesions with erythromycin ointment
- transfer to burn unit if widespread sloughing.
Drug rash
- when does this occur?
- MC with which drug?
- describe this rash
- tx
Can happen within 2days of onset of therapy to weeks after therapy is over.
MC with bactrim.
Rash is morbiliform rash.
Tx:
- benadryl
- IV/IM steroids
- Steroid dose pack
- try not to sweat at night, dont use covers.
Lymes dz:
- ticks that cause lymes?
- describe the 2 stages of lymes:
- -sx
- -skin lesion
Ticks:
-Deer tick, Lone star tick, rocky mountain tick
Stage 1:
- 1-30d post bite: flu-like, fatigue, HA, fever and chills, muscle and joint pain, nausea, vomiting, dizziness, and non-productive cough
- skin lesion appear as small red circular rash
Stage 2:
-weeks or months post bite: severe HA and neck pain or stiffness, arthritis, if severe neurological sx
What are meningeal signs?
nuchal rigidity and back pain
kernigs sign: flexion of hip 90 degrees with subsequent pain and limitation with extension of the leg
brudzinski sign: involuntary flexion of the knees and hips after passive flexion of the neck while pt is supine.
Gonococcemia:
- Cause
- sx
- MC at what age?
- describe the skin lesion
- tx
cause: neisseria gonorrhoeae
Sx: tenosynovitis (inflamm of tendon and its sheath)
- arthralgias
- dermatitis
Peak age in males is 20-24 and then females 15-19YO
skin lesions are acral hemorrhagic pustules
Tx:
- hospitilization with IV abx:
- -empiric tx with rocephin
- -PCN G
- -Augmentin
- -Doxy and azithro
