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
