skin manifestations in systemic diseases Flashcards
types of skin manifestations associated with diabetes
metabolic
venous
bullous
miscellaneous
diabetic foot
necrobiotic
acanthosis nigricans
- Velvety hyperpigmentation of the skin folds
- Hyperkeratotic with multiple skin tags
associatiions of acanthosis nigricans
hereditary
endocrine causes of insulin resistance
Obesity
Drug induced
Malignant
C/P of eruptive xanthomas
- Papules are dome shaped, discrete, initially red, then yellow center with red halo, they appear suddenly
- Lesions may be scattered, discrete, in a localized region [e.g., elbows, knees, buttocks] or appear as tight clusters
cause of eruptive xanthomas
- A sign of a very rare familial lipoprotein lipase deficiency, and diabetes out of control.
management of eruptive xanthomas
React very favorably to a low-calorie and low-fat diet.
changes associated with diabetic foot syndrome
neuropathic ulcers
presence of calluses is pathognomonic
non painful ulcerations commonly found under the metatarsal head and the toes
other skin changes associated with diabetes
diabetic dermopathy - brown atrophic macules and patches on the leg possibly precipitated by trauma
bullous diabeticorum - bullae arises on a non erythematous base and oozes red erosions when erupted
Necrobiosis lipoidica:
- Yellow atrophic patches, most often on the shins.
- An erythematous rim may indicate activity at the
border. - Ulcerations common.
granuloma annulare
- Merged, pearly papules forming a well- demarcated ring with central regression.
- Commonly on the dorsa of the hands, feet, elbows, and knees
necrosis of the finger tips or the toes in diabetes
Acral dry gangrene
association of necrobiosis lipoidica and diabetes
not all pts who have necrobiosis lipoidica have diabetes
control of diabetes s not associated with healing or presentation of necrobiosis lipoidica
what are the skin diseases associated with diabetes
ØPsoriasis
ØVitiligo
ØLichen planus
ØHidradenitis suppurativa
common skin infections associated with diabetes
primary - furnuclees and carbuncles
secondary - staph aureus infection
cellulitis
dermatophytoses
candidiasis
skin manifestations associated with DM medications
insulin : local reaction - lipodystrophy , urticarial lesion at the site of the reaction
systemic insulin allergy : urticaria
oral hypoglycaemic agents : Exanthematous eruptions, urticaria, erythema multiforme, photosensitivity
when are skin tags and acanthosis nigricans observed
in the pre-diabetic stage
long standing diabetes and poor glycemic control skin changes
Bullosis diabeticorum, diabetic dermopathy and scleroedema diabeticorum ( thickening of the skin )
additional investigations for patients presenting with diabetic dermopathy
examined for retinopathy and nephropathy
cutaneous changes in hyperthyroidism vs hypothyroidism
hyperthyroidism :
* Fine, velvety, smooth skin
Warm and moist due to increased sweating
* Hyper-pigmentation
* Localized or generalized Pruritus
hypothyroidism :
* Dry, rough, coarse skin Cold and pale
* Boggy and edematous skin (myxedema).
* Yellow discoloration as a result of carotenemia.
* Easy bruising (capillary fragility)
cutaneous disease associated with hyperthyroidism vs hypothyroidism
hyperthyroidism :
* Pretibial myxedema, thyroid acropachy ( associated with clubbing and is seen in graves)
* Urticaria, dermato-graphism
* Increased incidence of vitiligo
hypothyroidism :
* Ichthyosis and palmoplantar keratoderma
* Eruptive and/or tuberous xanthomas
type of alopecia associated with hypo and hyperthyroidism
hyperthyroidism - alopecia areata
hypothyroidism - alopecia in the lateral third of the eyebrow
skin manifestations of liver cirrhosis
- Spider angiomas, telangiectasias
- Palmar erythema
- Sparse axillary, pubic and pectoral hair
- Gynecomastia
- Pruritus, Jaundice
skin manifestations in hepatitis C and B
- Lichen planus – particularly erosive oral
disease - Erythema multiforme
- Erythema nodosum
Hemochromatosis skin manifestations
also called bronze diabetes
presents with generalized hyper-pigmentation
cutaneous findings in end stage renal disease
- Oedema
- Pallor
- Xerosis
- Pruritus
- Calciphylaxis
- Uremic frost
what is the aetiology calciphlaxis
progressive cutaneous necrosis associated with small- and medium-sized vessel calcification and thrombosis.
when does calciphlaxis occur and what are the disease association ?
after the initiation of dialysis
associated with DM, end stage renal disease and secondary hyperparathyroidism
what does calciphlaxis look like
Usually in lower extremities, pre-infarctive lesions show mottling or livedo reticularis pattern, dusky red
then changes into
black leathery ulcer that is extremley painful
granulomatous lesions in sarcoidosis
papules, translucent yellow-red with apple jelly appearance on diascopy
most common non specific lesion in skin in early sarcoidosis
eryhthema nodosum
presence suggests a good prognosis
what is lofgren syndrome
specific to sarcoidosis , includes the triad of
fever, erythema nodosum, and bilateral hilar adenopathy
granulomatous lesions of sarcoidosis
lupus pernio
seen on the nose and cheeks
diascopy positive
apple jelly apperancee
diascopy finding in erythema nodosum
paniculitis
erythema nodosum and the diseases associated with it
painful red nodules on the lower leg
nodular upon palpitation
SORE SHINS C
streptococci
ocp
rickets
r behcet
sulfonamide
hansen disease ( leprosy )
ibd
nhl
sarcoidosis
cutaneous TB
