Skin Manifestations of Disease

Question 1

Pyoderma gangrenosum

Answer 1

Rapidly evolving, idiopathic, chronic and severely debilitating ulcerative skin disease
Associated Chronic Ulcerative colitis

Question 2

Pyoderma gangrenosum treatment

Answer 2

Treat underlying disease
High dose systemic corticosteroids**
Systemic immunosuppression:
Sulfasalazine 
Cyclosporine
Infliximab

Question 3

Acanthosis nigricans

Answer 3

Velvety thickening and hyperpigmentation of the skin.
Associated with:
Endocrine disorders (Diabetes, insulin resistance)
Obesity
Internal malignancy (GI most common)

Question 4

Necrobiosis Lipoidica (NL), Diabeticorum

Answer 4

50% of patients with NL are insulin dependent diabetics.
PE:
Oval, violaceous patch that expands slowly.
Advancing border is red and the central area turns yellow-brown…seen on shins

Question 5

Granuloma Annular

Answer 5

Characteristics
Self limiting, asymptomatic, chronic dermatosis
Slight association with diabetes
More common in older women
Smooth, shiny firm ring of flesh colored papules and plaques (1 to 5cm)
Annular with central depression
on dorsum of hands and feet

Question 6

Intertrigo

Answer 6

Irritation in the skin folds
Worse with heat and moisture
Associated with Diabetes, HIV, obesity
Related to Candida, Fungus Irritation and Secondary bacterial infection (Group A & B strep, pseudomonas)
Most common sites:Axilla, groins, gluteal folds, overlapping abdominal panniculus
Topical steroids should be avoided

Question 7

Dermatomyositis

Answer 7

Erythema, photosensitivity, heliotrope eyelid rash
Gottron’s papules –knuckles, periungual telangiectasia, poikiloderma (red, white, brown)
Calcinosis cutis
Myositis: Weakness of proximal muscles
Elevation in muscle enzymes (LFTs and CK)

Question 8

CREST

Answer 8

Calcinosis
Reynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Question 9

Xanthomas

Answer 9

Lipid deposits in skin and tendons.
Yellow-brown, pinkish or orange macules, papules, plaques, nodules

Associations: Hyperlipidemia, Biliary cirrhosis,Diabetes, CRF

Common sites: Upper and lower eyelids, inner canthus

Question 10

Erythema Multiforme

Answer 10

Erythematous “targetoid” macules / patches
on palms and soles
Often due to HSV (minor) or medications (major)

Question 11

Bacterial Endocarditis Skin Lesions

Answer 11

Janeway lesions: Nontender, hemorrhagic maculopapular lesions on palms and soles.
Osler’s node: Painful, red nodules on fingertips
Subungual Splinter hemorrhage
Petechial lesion

Question 12

Mountain Rocky Spotted Fever Rash

Answer 12

Characteristically, rash begins on wrists, forearms, ankles and later on palms

Question 13

Mountain Rocky Spotted Fever Treatment

Answer 13

Doxycycline (except for PG)
Chloramphenical (for pregnant)
Start antibiotics if diagnosis is even suspected!
Doxycyline even in children now, per the CDC!!!
Less effect on teeth than Tetracycline