Skin Manifestations of Systemic Disease

Question 1

Behcet’s disease etiology and related dermatoses

Answer 1

Autoimmune

Painful aphthous ulcers in oral cavity ± genital mucous membranes, erythema nodosum, acneiform papules

Question 2

Buerger’s disease etiology and related dermatoses

Answer 2

Autoimmune

Superficial migratory thrombophlebitis, pallor, cyanosis, gangrene, ulcerations, digital resorptions

Question 3

Dermatomyositis etiology and related dermatoses

Answer 3

Autoimmune

Periorbital and extensor violaceous erythema, heliotrope with edema, Gottron’s papules (violaceous flattopped papules with atrophy), periungual erythema, telangiectasia, calcinosis cutis

Question 4

Polyarteritis nodosa etiology and related dermatoses

Answer 4

Autoimmune

Subcutaneous nodules, stellate purpura, erythema, gangrene, splinter hemorrhages, livedo reticularis, ulceration

Question 5

Reactive arthritis etiology and related dermatoses

Answer 5

Autoimmune

Keratoderma blennorrhagica (on feet), balanitis circinata (on male penis)

Question 6

Rheumatic fever etiology and related dermatoses

Answer 6

Petechiae, urticaria, erythema nodosum, rheumatic nodules, evanescent rash

Question 7

Scleroderma etiology and related dermatoses

Answer 7

Autoimmune

Raynaud’s, nonpitting edema, waxy/shiny/tense atrophic skin (morphea), ulcers, cutaneous calcification, periungual telangiectasia, acrosclerosis, salt-and-pepper pigmentation

Question 8

SLE etiology and related dermatoses

Answer 8

Autoimmune

Malar erythema, discoid rash (erythematous papules or plaques with keratotic scale, follicular plugging, atrophic scarring on face, hands, and arms), hemorrhagic bullae, palpable purpura, urticarial purpura, patchy/ diffuse alopecia, mucosal ulcers, photosensitivity

Question 9

Crohn’s disease/UC etiology and related dermatoses

Answer 9

Autoimmune

Pyoderma gangrenosum, erythema nodosum, Sweet’s syndrome

Question 10

Addison’s disease etiology and related dermatoses

Answer 10

endocrine

Generalized hyperpigmentation or limited to skin folds, buccal mucosa, and scars

Question 11

Cushing’s syndrome etiology and related dermatoses

Answer 11

endocrine

Moon facies, purple striae, acne, hyperpigmentation, hirsutism, atrophic skin with telangiectasia

Question 12

Diabetes mellitus etiology and related dermatoses

Answer 12

Endocrine

Infections (e.g. boils, carbuncles, Candidiasis, S. aureus, dermatophytoses, tinea pedis and cruris, infectious eczematoid dermatitis), pruritus, eruptive xanthomas, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic foot, diabetic bullae, acanthosis nigricans, calciphylaxis

Question 13

Hyperthyroidism etiology and related dermatoses

Answer 13

Endocrine

Moist, warm skin, seborrhea, acne, nail atrophy, hyperpigmentation, toxic alopecia, pretibial myxedema, acropachy, onycholysis

Question 14

Hypothyroidism etiology and related dermatoses

Answer 14

Endocrine

Cool, dry, scaly, thickened, hyperpigmented skin; toxic alopecia with dry, coarse hair, brittle nails, myxedema, loss of lateral 1/3 eyebrows

Question 15

HIV-related Infections related dermatoses

Answer 15

Viral (e.g. HSV, HZV, HPV, CMV, molluscum contagiosum, oral hairy leukoplakia),

bacterial (impetigo, acneiform folliculitis, dental caries, cellulitis, bacillary epithelioid angiomatosis, syphilis),

fungal (candidiasis, histoplasmosis, cryptococcus, blastomycosis)

Question 16

HIV-related Inflammaotry dermatoses

Answer 16

Seborrhea, psoriasis, pityriasis rosea, vasculitis

Question 17

HIV-related Malignancies related dermatoses

Answer 17

Kaposi’s sarcoma, lymphoma, BCC, SCC, MM

Question 18

Adenocarcinoma (GI and cervix/anus/rectum) related dermatoses

Answer 18

GI - Peu z-Jeghers: pigmented macules on lips/oral mucosa

Cervix/anus/rectum - Paget’s disease: eroding scaling plaques of perineum

Question 19

Carcinoma (Breast, GI, thyroid, breast/lung/ovary) related dermatoses

Answer 19

Breast - Paget’s disease, eczematous and crusting lesions of the skin of the nipple and usually areola of the breast

GI - Palmoplantar keratoderma: thickened skin of palms/soles

Thyroid - Sipple’s syndrome: multiple mucosal neuromas

Breast/lung/ovary - Dermatomyositis: heliotrope erythema of eyelids and violaceous plaques over knuckles

Question 20

Lymphoma/leukemia (Hodgkin’s, acute leukemia) related dermatoses

Answer 20

Hodgkin’s - Ataxia Telangiectasia: telangiectasia on pinna, bulbar conjunctiva

Acute leukemia - Ichthyosis: generalized scaling especially on extremities, Sweet’s syndrome Bloom’s syndrome: butterfly erythema on face, associated with short stature

Question 21

Multiple myeloma related dermatoses

Answer 21

Amyloidosis: large, smooth tongue with waxy papules on eyelids, nasolabial folds and lips, as well as facial petechiae

Question 22

Liver disease related dermatoses

Answer 22

Pruritus, hyperpigmentation, spider nevi, palmar erythema, white nails (Terry’s nails), porphyria cutanea tarda, xanthomas, hair loss, jaundice

Question 23

Renal disease related dermatoses

Answer 23

Pruritus, pigmentation, half and half nails, perforating dermatosis, calciphylaxis

Question 24

Pruritic urticarial papules and plaques of pregnancy related dermatoses

Answer 24

Erythematous papules or urticarial plaques in distribution of striae distensae: buttocks, thighs, upper inner arms and lower back

Question 25

Cryoglobulinemia related dermatoses

Answer 25

Palpable purpura in cold-exposed areas, Raynaud’s, cold urticaria, acral hemorrhagic necrosis, bleeding disorders, associated with hepatitis C infection

Question 26

Raynaud’s Phenomenon DDx

Answer 26

COLD HAND

Cryoglobulins/Cryofibrinogens
Obstruction/Occupational
Lupus erythematosus, other connective tissue disease
DM/Drugs

Hematologic problems (polycythemia, leukemia, etc) 
Arterial problems (atherosclerosis) 
Neurologic problems (vascular tone) 
Disease of unknown origin (idiopathic)

Question 27

Acanthosis Nigricans description and associated conditions

Answer 27

An asymptomatic dark thickened velvety hyperpigmentation of flexural skin most commonly around the neck.

Associated with DM, obesity, and other endocrine disorders and malignancy. It is a cutaneous marker of tissue insulin resistance