Skin manifestations of systemic disease Flashcards
List the different skin signs of diabetes
- Infection e.g. candida, impetigo, cellulitis etc
- Ulcers
- Xanthomata
- Necrobiosis lipoidica
- Acanthosis nigrans
- Granuloma annulare
- Diabetic dermopathy
- Perforating disorders
- Bullae formation - blister-like lesions that occur spontaneously on the feet and hands of diabetic patients.
What is diabetic dermopathy ?
- It is a skin condition characterised by light brown or reddish, oval or round, slightly indented scaly patches most often appearing on the shins.
- Although these lesions may appear in anyone, particularly after an injury or trauma to the area
- They are one of the most common skin problems found in patients with diabetes mellitus.
What is acanthosis nigrans ?
- It is a skin disorder characterised by darkening (hyperpigmentation) and thickening (hyperkeratosis) of the skin, occurring mainly in the folds of the skin in the armpit (axilla), groin and back of the neck.
- Causes include - DM, cushings, PCOS, malignancy, idiopathic etc
What is Necrobiosis lipoidica?
It is a rare skin disorder where one or more yellowish brown patches develop slowly on the lower legs over several months.
The centre of the patch becomes shiny, pale, thinned, with prominent blood vessels (telangiectasia).
What is granuloma annulare and what are the different causes
- A common skin condition in which there are smooth discoloured plaques.
- The plaques are usually thickened and ring-shaped or annular in shape
- One or more skin coloured bumps occur in rings in the skin over joints, particularly the knuckles.
- Generalised granuloma annulare usually presents in adults, as widespread skin-coloured, pinkish or slightly mauve-coloured patches.
What is xanthoma and what is it a sign of?
- A skin lesion caused by the accumulation of fat in macrophage immune cells in the skin
- It may be a result of a genetic defect (e.g. primary hyperlipoproteinaemia) or from some underlying systemic disorder such as diabetes mellitus, hypothyroidism, or nephrotic syndrome.
What is the most common form of xanthoma ?
- Xanthelasma = xathoma lesions in the upper & lower eyelids
- Lesions are soft, velvety, yellow, flat papules or plaques
What is shown in the pic ?
Eruptive xanthoma = crops of small, red-yellow papules. Most commonly arise over the buttocks, shoulders, arms and legs
What is shown in this pic ?
Xanthomata:
- 1st pic = xanthelasma
- 2nd pic = eruptive xanthoma
What are the skin manifestations of hyperthyroidism ?
- Warm, moist smooth skin
- Facial flushing & palmar erythema
- Fine, thin hair, may even be as severe as diffuse alopecia
- Hyperhidrosis (excessive sweating)
- Nail changes - thyroid acropachy (distorted & overgrown), oncholysis (lifting of nailbed)
- Hyperpigmentation
- Pruiritus
- Graves disease - pretibial myxoedema
- Urticaria & angioedema
Describe the features of pretibial myxoedema
- Reddish, tender, swelling, nodules and plaques occur on the shins, calves and feet.
- There may be violaceous or yellow-brown discolouration of the overlying skin with prominent hair follicles giving an orange-peel appearance.
What are the skin manifestations of hypothyroidism ?
- Cold peripheries with dry & pale coarse skin
- Xerosis (dry skin) – may resemble acquired ichthyosis
- Carotenaemia = yellow-orange skin discolouration esp noticable in the palms & soles of the feet
- Dry, coarse brittle hair may be severe resulting in diffuse alopecia
- Loss of lateral 1/3 eyebrow
- Slow growing thickened brittle nails
- Myxoedema, resulting in puffy face, eyelids, hands and feet;
- Autoimmune causes may be assoc. with alopecia areata
What are the skin manifestations of addisons disease?
- Generalised darkening of the skin (hyperpigmentation) that may look like an inappropriate tan on a very ill person
- Palmar crease pigmentation
- Buccal pigmentation
What tumours can result in MSH-like activity (hyperpigmentation of the skin)?
- Pituitary adenomas or lung tumours may result in this
- Due to some of these tumours inappropriately secreting MSH which stimulating melanin production
What are the skin manifestations of systemic sclerosis ?
Think CREST:
- Calcinosis - deposits of calcium in the skin
- Raynaulds phenomneon
- (o)esophageal dysmotility - dysphagia
- Sclerodactyly - skin thickening of fingers & toes
- Telangectasia - periungual (fingernails & toenails) or facial
Also Pinched mouth (radial furrows) & Beaked nose
What skin feature is shown and what is it linked to ?
Calcinosis - seen in systemic sclerosis
What are the skin manifestations of dermatomyositis ?
- Heliotrope rash = pink-purple coloured rash on or around the eyelids
- Gottron papules = purple papules or plaques on bony prominences esp. the knuckles
- Photosensivity rash (reddish or blueish-purple colour) most often affecting sun-exposed areas
What skin feature is shown and what condition is it linked to ?
Gottron papules - linked to dermatomyositis
What is shown in this pic and list the potential causes
Livedo recticularis = mottled cyanotic network discolouration of the skin (net-like or lace-like). This is exacerbated by the cold
Causes include:
- Idiopathic (primary)
- Cardiac failure
- Vascular emboli
- Drugs
- Throbocythaemia
- Cryoglobulins
- Arteritis (PAN, SLE, RA, DM, lymphoma)
- Infections
What are the features of mycosis fungoides in stage one (the patch stage)?
- Skin lesions are flat.
- Usually oval or ring-shaped (annular) pink dry patches on covered skin.
- They may spontaneously disappear, remain the same size, or slowly enlarge
What are the features of mycosis fungoides in stage two (the plaque stage)?
In plaque stage mycosis fungoides, the patches become thickened and may resemble psoriasis. They are usually itchy.
What are the features of mycosis fungoides in stage three (the tumour stage)?
- In tumour stage mycosis fungoides, large irregular lumps develop from plaques, or de novo.
- They may ulcerate.
- At this stage, spread to other organs is more likely than in earlier stages
What is shown in this pic ?
Pagets disease of the nipple
What is shown in this pic ?
Cholestatic jaundice (+ ascites most likely)
What is shown in this pic ?
IVC obstruction
What is erythema gyratum repens?
- A rare paraneoplastic type of annular erythema with a distinctive figurate ‘wood-grain’ appearance. It has a strong association with malignancy.
- The rings progress in waves, with the leading edge migrating about 1 cm/day. A trailing or collarette scale may be seen.
- It is very itchy
What is aquired ichthyosis and what needs to be excluded if someone presents with it ?
Ichthyosis is a disorder of cornification, characterised by persistently dry, thickened, ‘fish scale’ skin.
Acquired ichthyosis appears in adult life.
People with ichthyosis may have a systemic disease, such as:
- Hodgkin lymphoma
- Underactive thyroid
- Sarcoidosis
- Cancer (ichthyosis may be a cutaneous marker of internal malignancy)
- HIV infection
Aquired ichthyosis presents similar to ichthyosis vulgaris
