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DERM > SKIN MANIFESTATIONS OF SYSTEMIC DISEASES > Flashcards

SKIN MANIFESTATIONS OF SYSTEMIC DISEASES Flashcards

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Dermatology Board Prep flashcards
1
Q

PYODERMA GANGRENOSUM ASSOCIATIONS

A
  • idiopathic
  • chronic & severely debilitating ulcerative skin disease
***ASSOCIATED WITH CHRONIC UNDERLYING INFLAMMATORY OR MALIGNANT DISEASES**
Chronic Ulcerative colitis
Chronic active hepatitis
RA
Crohn's 
Hematologic malignancies

HLA B27 diseases

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2
Q

associated with UC & crohns

A

Pyoderma Gangrenosum

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3
Q

Acute onset with painful hemorrhagic pustule or painful nodule surrounded by erythematous halo.

A

pyoderma gangrenosum

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4
Q

most common sites of pyoderma gangrenosum

A

lower extremities (shins), buttocks, abdomen

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5
Q

pyoderma gangrenosum

A

History:
Acute onset with painful hemorrhagic pustule or painful nodule surrounded by erythematous halo.

PE:
Breakdown with ulcer formation with dusky red or purple borders, irregular and raised, boggy with perforations that drain pus.

Most common sites:
Lower extremities (shins), buttocks, abdomen
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6
Q

Skin conditions associated with Diabetes

A 
Acanthosis nigricans
Necrobosis lipoidica diabeticorum
Granuloma annulare
Thrush
Intertrigo
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7
Q

acanthosis nigricans is associated with

A

endocrine disorders (diabetes, insulin resistant syndromes)

obesity

internal malignancy (most commonly GI)

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8
Q

velvety thickening & hyperpigmentation of skin

A

acanthosis nigricans

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9
Q

first visible change of acanthosis nigricans

A

darkening of skin

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10
Q

acanthosis nigricans

hx

PE

most common sites

A

HX = insidious onset; first visible change = darkening of pigmentation

PE = hyperpigmentation, velvety looking, skin line accentuation, surface becomes wrinkled or creased

MOST COMMON SITES = axilla, neck (back & sides), groin, antecubital fossa

if < 40 = usually diabetes or endocrinopathy
if > 40 = should rule out adenocarcinomas of the colon
if dark thickening in the mouth = think malignancy

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11
Q

treatment of acanthosis nigricans

A
  • 1) rule out diabetes
  • 2) treat associated disorder
  • 3) usually no tx required
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12
Q

NECROBIOSIS LIPOIDICA DIABETICORUM

A
  • origin unknown
  • 50% of pts with NLD = are insulin dependent diabetics

PE = oval, violaceous patch that expands slowly. the advancing border is red and the central area turns yellow-brown. Telangiectasias = prominent. Ulceration is possible, especially after trauma

sharply circumscribed, multi-colored, anterior & lateral surfaces of lower shins
shins =most common areas
0.3% of diabetic population will develop this, but cause unknown

TREATMENT = DIFFICULT, REFER TO DERM!
really good diabetes control doesn’t seem to manage this manifestation

  • advacing border that turns different colors, telangiectasias that become more prominent
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13
Q

granuloma annulare

A
  • self-limiting asymptomatic chronic dermatosis
  • slight association with DM (20% of patients with DM)
  • more common in older women

HX = slowly increases over months; duration = variable
PE = smoothy shiny firm rings of flesh colored papules and plaques; annular with central depression
MOST COMMON SITE = dorsum of hands & feet, extremities, and trunk

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14
Q

treatment for granuloma annulare

A

not necessary, as it disappears in 75% of pts in 2 years

  • if needed - potent topical steroids or can do ILK
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15
Q

intertrigo is associated with

A

⦁ Diabetes
⦁ HIV
⦁ Obesity

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16
Q

INTERTRIGO

A
  • irritation in skin folds; worse with heat & moisture
  • associated with
    ⦁ Diabetes
    ⦁ HIV
    ⦁ Obesity
  • related to Candida, fungus irritation, and secondary bacterial infection (group A / B strep, pseudomonas)

Most common sites = axilla, groin, gluteal folds, and overlapping abdominal panniculus (folds)

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17
Q

intertrigo treatment

A
  • keep cool & dry (hair dryer)
  • AVOID TOPICAL STEROIDS***
  • antifungal / antibacterial powders (nystatin)
  • zinc oxide ointment reduces friction
18
Q

intertrigo symptoms

A

have erythema, may or may not have pruritus, tenderness, erythematous plaques

19
Q

satellite lesions are pretty classic for

A

candida

20
Q

thrush treatment

A
  • antifungal troches
  • fluconazole (diflucan)
  • itraconazole (sporanox)
21
Q
  • yeast infection in the mouth = usually candida

- get white plaques or red erosive areas in oral mucosa

A

thrush

22
Q

associations with thrush

A

diabetes
HIV
immunosuppression

23
Q

3 different types of lupus

A

⦁ Chronic cutaneous lupus (discoid lupus)
⦁ Subacute cutaneous lupus
⦁ Systemic Lupus Erythematosus (SLE)

24
Q

chronic cutaneous (discoid) lupus

A
  • scarring, depigmented, scaly plaques on face primarily (butterly rash)
  • more common in women 2:1
  • progression to systemic lupus is uncommon
  • TX = potent topical steroids +/- antimalarials (hydroxychloroquine)
25
Q

subacute cutaneous lupus

A
  • or cutaneous lupus erythematosis
  • white women; age 15-40
  • polycyclic scaly plaques in sun exposed areas
  • 50% meet criteria for systemic lupus
  • can be drug induced
  • TX = with antimalarials or other immunosuppressants

the prognosis for subacute cutaneous lupus = much better than for systemic lupus
- sun exposed areas, not a lot of scarring. Lot of plaques, but they go away

26
Q

systemic lupus erythematosis

A
  • “butterfly” erythema - nonscarring
  • photosensitivity
  • oral ulcers
  • discoid lupus + systemic involvement
  • skin involvement in 80% of SLE

TX = antimalarials + immunosuppression

affects multiple organ systems: kidneys, eyes, heart,
complement goes down
ANA, anti-smith, anti-double-stranded DNA, anti-RO/LA
- have antigen antibody complexes depositing in organs / vasculature / etc.

27
Q

DERMATOMYOSITIS

A
  • erythema
  • photosensitivity
  • heliotrope eyelid rash
  • Gottron’s Papules = raised scaly eruptions on knuckles
  • Calcinosis Cutis
  • “Shawl’s sign”
  • MYOSITIS - weakness of proximal muscles, elevation in muscle enzymes (aldolase & creatinine kinase)
    increased ESR
  • poikiloderma
28
Q

SCLERODERMA

A 
- CREST
⦁	Calcinosis
⦁	Raynaud's phenomenon
⦁	Esophageal Dysmotility
⦁	Sclerodactyly
⦁	Telangiectasia
  • Progressive systemic sclerosis - progresses to internal organ involvement (heart, lungs, GI, kidneys)
  • tightening of the skin
  • usually die from pulmonary HTN (lungs become fibrotic –> cor pulmonale)

TX = systemic immunosuppression

29
Q

associations with xanthomas

A

⦁ Hyperlipidemia
⦁ Biliary cirrhosis
⦁ Diabetes
⦁ CRF

30
Q

XANTHOMAS

A
  • lipid deposits in skin & tendons
  • yellow-brown, pinkish or orange macules/papules/plaques/nodules
- Associations
⦁	Hyperlipidemia
⦁	Biliary cirrhosis
⦁	Diabetes
⦁	CRF

COMMON SITES = upper & lower eyelids, inner canthus

31
Q

lipid deposits in skin & tendons

A

xanthomas

32
Q

where xanthomas are most common

A

tendons

33
Q

different types/locations of xanthomas

A

⦁ eruptive xanthomas = can be anywhere on skin
⦁ tuberous xanthomas = usually over joints
⦁ tendinous xanthomas = around tendons = where xanthomas are most common

34
Q

most common of all xanthomas

A

xanthelasma

35
Q

XANTHELASMA

A
  • most common of all xanthomas
  • most cases = unrelated to hyperlipidemia (if lipids are normal = don’t need further workup)
  • occurs in ppl > 50
  • when seen in children or young adults = associated with familial hypercholesterolemia
36
Q

EM minor = often due to

EM major = often due to

A

HSV

Medications

37
Q

meds that can cause erythema multiforme

A

⦁ Sulfa containing drugs (bactrim, dapsone)*****
⦁ anti epileptics (phenytoin, carbemazepine, phenobarbital)
⦁ ABX (PCN, cephalosporins)
⦁ Allopurinol

38
Q

leading cause of SJS / TEN

A

drugs

39
Q

other organs may be involved in SJS / TEN other than skin

A

⦁ Hepatitis, Nephrititis, Pneumonitis

kidneys
liver
lungs

40
Q

tx for drug rash

A
  • benadryl
  • IV / IM steroids
  • steroid dose pack
  • try not to sweat at night, don’t use covers

DERM (12 decks)

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