Skin Manifestations of Systemic Disease

Question 1

Erythema Nodosum Overview

Answer 1

Painful blue-red lesions on anterior shins

Question 2

Erthema Multiforme Overview

Answer 2

Symmetrical target lesions on palms, soles and limbs
Possibly mediated by IgM deposition 
Usually due to 2ary infection
Infections: HSV (70%), myocplasma 
Drugs: SNAPP

Question 3

SJS and TEN Overview

Answer 3

Severe variants of EM
Nearly always drug-induced
Fever, mucosal and skin ulceration and necrosis

Question 4

Pyoderma Gangrenosum Overview

Answer 4

Wide (10cm), deep ulceration w/ violaceous border
Purulent surface
Undermined edge
Commonly occurs on legs
Heal w/ cribiform (pitted scars)
Associated w/ IBD, AIH, Wegener’s, RA, leukaemia
Rx: High-dose systemic steroids

Question 5

Vitiligo Overview

Answer 5

Chalky white patches w/ hyperpigmented borders
Itch in sunlight
Associated w/ autoimmune disorders

Question 6

Livedo Reticularis Overview

Answer 6

Persistent mottled red/blue lesions that don’t blanch
Commonly found on the legs
Triggered by cold
Causes: idiopathic, vasculitis (RA, SLE, PAN), obstruction (anti-phospholipid, cryoglobulinaemia), Sneddon’s syndrome (LR + stroke)

Question 7

Skin Condition Associated w/ Rheumatic Fever

Answer 7

Erythema marginatum

Question 8

Skin Condition associated w/ Lyme’s disease

Answer 8

Erythema chronicum migrans

Question 9

Skin conditions associated w/ Crohn’s disease

Answer 9

Perianal ulcers and fistulae
EN
Pyoderma gangrenosum

Question 10

Skin conditions associated w/ dermatomyositis

Answer 10

Heliotrope rash on eyelids 
Shawl sign (macular rash)
Gottron's papules 
Mechanic's hands 
Nailfold erythema, telangiectasia

Question 11

Skin conditions associated w/ DM

Answer 11

Ulcers
Candida
Kyrle disease 
Acanthosis nigricans 
Necrobiosis lipoidica (shins)
Granuloma annulare (hands, feet)

Question 12

Skin conditions associated w/ Sarcoidosis

Answer 12

Erythema nodosum
Erythema multiforme 
Lupus pernio
Hypopigmented areas
Red/violet plaques

Question 13

Skin condition associated w/ Coeliac

Answer 13

Dermatitis herpetiformis (elbows)

Question 14

Skin condition associated w/ Graves’

Answer 14

Pre-tibial myxoedema (lateral malleolus)

Question 15

Skin conditions associated w/ RA

Answer 15

Rheumatoid nodules

Vasculitis (palpable purpura)

Question 16

Skin condition associated w/ SLE

Answer 16

Facial butterfly rash

Question 17

Skin conditions associated w/ Systemic sclerosis

Answer 17

Calcinosis
Raynaud's 
Sclerodactyly
Telangiectasia 
Generalised skin thickening

Question 18

Skin conditions associated w/ Liver disease

Answer 18

Palmar erythema 
Spider naevi 
Gynaecomastia 
Decreased 2ary sexual hair 
Jaundice 
Bruising 
Excoriations

Question 19

Skin conditions associated w/ end-stage CKD

Answer 19

Associated w/ cause: DM, vasculitis, sclero, RA, SLE
Associated w/ end-stage CKD: pruritus, xerosis, pigment change, bullous disease
Associated w/ transplant: Cushingoid, gingival hyperplasia, infections, BCC, SCC, melanoma, Kaposi’s

Question 20

Skin condition associated w/ Neoplasia

Answer 20

Acanthosis nigricans
Dermatomyositis
Thrombophlebitis migrans
Acquired ichthyosis