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Skin Manifestations of Systemic Disorders Flashcards

1
Q

Characteristics of Pyoderma Gangrenosum

A

Rapidly evolving
Idiopathic
Chronic & severely debilitating ulcerative skin disease

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2
Q

Associated Underlying Inflammatory or Malignant Disease Presenting with Pyoderma Gangrenosum

A 
Chronic UC
Crohn's disease
Chronic active hepatitis
Hematologic malignancies
Rheumatoid arthritis
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3
Q

Hx of Pyoderma Gangrenosum

A

Acute onset
Painful hemorrhagic pustule
Painful nodule surrounding by erythematous halo

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4
Q

PE Findings of Pyoderma Gangrenosum

A

Breakdown with ulcer formation with dusky red or purple borders
Irregular & raised
Boggy with perforations that drain pus

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5
Q

Most Common Sites for Pyoderma Gangrenosum

A

Lower extremities
Buttocks
Abdomen

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6
Q

Treatment of Pyoderma Gangrenosum

A

Treat underlying disease
Avoid trauma
High dose systemic corticosteroids
Systemic immunosuppression

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7
Q

Types of Systemic Immunosuppression

A

Sulfasalazine
Cyclosporine
Infiximab

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8
Q

Diabetic Associations with Skin Issues

A 
Acanthosis nigricans
Necrobosis lipoidica diabeticorum (NLD)
Granuloma annulare
Thrush
Intertrigo
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9
Q

Characteristics of Acanthuses Nigricans

A

Velvety thickening & hyper pigmentation of the skin

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10
Q

Acanthosis Nigricans is Associated with what Issues

A

Diabetes
Insulin resistant syndromes
Obesity
Internal malignancy (GI most common)

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11
Q

History with Acanthuses Nigricans

A

Insidious onset

Darkening of pigmentation

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12
Q

PE Findings of Acanthosis Nigricans

A

Hyperpigmentation
Velvety looking
Skin line accentuated
Surface become wrinkled or creased

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13
Q

Most Common Sites for Acanthosis Nigricans

A

Axilla
Neck (back & sides)
Groin
AC fossae

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14
Q

Treatment of Acanthosis Nigricans

A

R/O DM
Treat associated disorder
Usually none required

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15
Q

PE Findings of Necrobiosis Lipoidica Diabeticorum (NLD)

A 
Oval, violaceous patch
Advancing border is red
Central area turns yellow-brown
Telangiectasias
Ulceration possible esp. after trauma
Usually anterior surface of the legs
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16
Q

Treatment of Necrobiosis Lipoidica Diabeticorum (NLD)

A

Difficult
Refer to derm
DM control doesn’t determine presence of NLD

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17
Q

Type 1 DM Trifecta

A

PVD
Neuropathy
Sugar everywhere

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18
Q

Characteristics of Granuloma Annular

A

Self limiting
Asymptomatic
Chronic dermatosis
Slight association with DM

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19
Q

History of Granuloma Annular

A

Slowly increases over months

Duration variable

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20
Q

PE Findings of Granuloma Annular

A

Smooth, shiny firm ring of flesh colored papule & plaques
Annular with central depression

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21
Q

Most Common Sites of Granuloma Annular

A

Dorm of hands & feet
Extremities
Trunk

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22
Q

Treatment of Granuloma Annular

A

Not necessary

If needed: potent topical steroids, or intralesional injections of steroids

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23
Q

Characteristics of Intertrigo

A

Irritation in the skin folds

Worse with heat & moisture

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24
Q

Intertrigo Associated With

A

DM
HIV
Obesity

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25
Intertrigo Related to
Candida Fungus irritation Secondary bacterial infection
26
Most Common Sites of Intertrigo
Axilla Groins Gluteal folds Overlapping abdominal panniculus
27
PE Findings of Intertrigo
Erythema +/- pruritis Tenderness Erythematous plaques
28
Treatment of Intertrigo
Keep cool & dry | Treatment based on cause
29
What should be avoided in the treatment of intertrigo?
Steroids: fungus will spread rapidly
30
Describe Thrush
White plaques or red erosive areas in the oral mucosa
31
Associations with Thrush
DM HIV Immunosuppresion
32
Treatment of Thrush
Antifungal troches Fluconazole Itraconazole
33
Other Systemic Disorders that Manifest Dermatologic Symptoms
Lupus Dermatomyositis Scleroderma Xanthoma
34
3 Types of Lupus
Chronic cutaneous (discoid) Subacute cutaneous Systemic lupus erythematosus (SLE)
35
Describe Chronic Cutaneous Lupus (Discoid)
Scarring, dispigmented, scaly plaques on primarily the face
36
Epidemiology of Chronic Cutaneous Lupus
Women > Men
37
Treatment of Chronic Cutaneous Lupus
Potent topical steroids | +/- anti-malarials
38
Describe Subacute Cutaneous Lupus
Polycyclic scaly plaques in sun exposed areas
39
Epidemiology of Subacute Cutaneous Lupus
White women 15-40 | 50% meet criteria for SLE
40
Treatment of Subacute Cutaneous Lupus
Anti-malarials | Immunosuppressants
41
Symptoms of Systemic Lupus
Severe fatigue Low grade fever that won't go away Glomerulonephritis Joint pain
42
Describe Systemic Lupus Erythematosus (SLE)
"Butterfly" facial erythema Photosensitivity Oral ulcers Discoid lupus
43
Treatment for Systemic Lupus Erythematosus (SLE)
Anti-malarials | Immunosuppression
44
Describe Dermatomyositis
Erythema, photosensitivity, heliotrope eyelid rash | Weakness of proximal muscles
45
Define Gottron's Papules
Knuckles Periungual Telangiectasia Poikiloderma (red, white, brown)
46
Synonym of Scleroderma
CREST Syndrome
47
What does CREST stand for?
``` C: calcinosis R: reynaud's phenomenon E: esophageal dysmotility S: sclerodactyly T: telangiectasia ```
48
What internal organs involved in scleroderma?
Heart Lungs GI Kidney
49
Treatment with Scleroderma
Systemic immunosuppression
50
Define Xanthomas
Lipid deposits in skin & tendons
51
Describe Xanthomas
Yellow-brown, pinkish or orange merciless, papule, plaques, nodules
52
Xanthomas Associated With
``` Hyperlipidemia Biliary cirrhosis DM CRF Hyperthyroid ```
53
Common Sites of Xanthomas
Upper & lower eyelids | Inner canthus
54
Xanthelasma
Most common of all xanthomas Unrelated to hyperlipidemia Individuals >50 y/o
55
Treatment of Xanthomas
Laser Excision Electrodesiccation or topical application of trichloroacetic acid
56
Types of Desquamation Disorders
Erythema Multiforme Stevens-Johnson Syndrome (SJS) Toxic Epidermal Syndrome
57
Erythema Multiforme Presentation
``` Erythematous "targetoid" macules/patches Papules/plaques Vesicles/bullae Wheals (urticaria) Erosions ```
58
En Minor Erythema Multiforme
``` Little/no mucous membrane involvement Few systemic systems Often due to HSV Can be due to medications Extensor surfaces ```
59
En Major Erythema Multiforme
``` Always mucous membrane involvement Skin involvement more widespread Systemic symptoms Hepatitis, nephritis Often due to medications Nikolasky Sign ```
60
Frequent Offenders for Erythema Multiforme
Sulfa containing drugs Anti-epileptic drugs Antibiotics Allopurinol
61
Sulfa Containing Drugs that Cause Erythema Multiforme
Bactrim | Dapsone
62
Anti-epileptic Drugs that Cause Erythema Multiforme
Phenytoin Cabemazepine Pehnobarbital
63
Antibiotics that Cause Erythema Multiforme
Penicillin | Cephalosporins
64
Treatment of Erythema Multiforme
Systemic steroids
65
Define Stevens-Johnson Syndrome
Mucocutaneous drug-induced or idiopathic reaction patterns characterized by skin tenderness & erythema of skin & mucosa, followed by extensive cutaneous & mucosal epidermal necrosis & sloughing
66
Characteristics of Stevens-Johnson Syndrome
``` Onset at any age Associated with drugs Systemic lupus HIV HLS-B12 ```
67
Prodromes of Stevens-Johnson Syndrome
Rash: morbilliform, diffuse erythema Fever Mouth lesions Flu-like symptoms prior to mucocutaneous lesions Mucocutaneous lesion, skin pain, burning & itching
68
Progression of Stevens-Johnson Syndrome
Necrotic epidermis, macular areas Sheet-like loss of epidermis Flaccid blisters that spread with lateral pressure on erythematous areas With trauma: full thickness epidermal detachment yielding expose, red, oozing dermis resembling a 2nd degree burn
69
Define Nickolsky Sign
Flaccid blisters that spread with lateral pressure on erythematous areas
70
Other Organs that may be Involved in Stevens-Johnson Syndrome
Hepatitis Nephrititis Pneumonitis
71
Drugs Associated with SJS & TEN
``` Sulfa drugs Barbituates Allopurinal Diclofenac Sulindac Ketoprofen Ibuprofen Naproxen Cephalosporins Fluroquinolones Vancomycin Aminopenicillins Rifampin Ethambutol ```
72
Treatment of EM Minor/Major
Antiviral prophylaxis to control HSV | Early diagnosis & cessation of suspected causative drug
73
Treatment of SJS/TEN
Early diagnosis & cessation of suspected causative drug Supportive care: ICU, fluids Systemic steroids controversial Growing evidence for the use of IVIG Treat eye lesions with erythromycin ointment Transfer to burn unit if widespread sloughing
74
Treatment of Drug Reactions
Benadryl IV/IM steroids Steroid dose pack Don't use covers
75
Characteristics of Bacterial Endocarditis
Staph aureas, strep viridans Proliferation of microorganisms on the endocardium Incidence increasing in the elderly, IVDU, & prosthetic valves
76
History of Bacterial Endocarditis
``` Fever Chills Sweats Anorexia Weight loss Malaise ```
77
PE Findings of Bacterial Endocarditis
Heart murmur Arterial emboli Splenomegaly
78
Skin Lesions Associated with Bacterial Endocarditis
January lesions Osler's nodes Subungual splinter hemorrhage Petechial lesion
79
Define Janeway Lesions
Nontender, hemorrhagic maculopapular lesions on palms & soles
80
Define Osler's Nodes
Painful, red nodules on fingertips
81
Define Petechial Lesions
Small, non-blanching, reddish-brown merciless on extremities, upper chest, mucus membranes Occur in crops
82
Work Up for Bacterial Endocarditis
``` Identify patients at risk & prophylaxis Blood cultures CBC Chem panel Coags Echo ```
83
Treatment of Bacterial Endocarditis
``` PCN-G Nafcillin Gentamycin Vanco in MRSA Zyvox in MRSA ```
84
What is the most common cause of bacterial endocarditis in IVDU?
Fungus
85
What is the most common cause of bacterial endocarditis in tooth extractions?
Strep viridans
86
Characteristics of Rocky Mountain Spotted Fever
Rickettsia rickettsii spirochete Common May-September Fatal if not treated
87
History of Rocky Mountain Spotted Fever
Hx of tick bite Ask about outdoor activity Prodrome: anorexia, irritability, malaise
88
PE Findings of Rocky Mountain Spotted Fever
``` Fever >102 Chills Weakness Headache Photophobia Pronounced joint pain ```
89
Skin Lesions of Rocky Mountain Spotted Fever
2-6 mm, pink blanching merciless begin on extremities & spread centrally Evolve to papules & petechiae Begins on wrists, forearms, ankles
90
Treatment of Rocky Mountain Spotted Fever
Doxycycline (except for PG) | Chloramphenical (for PG)
91
Lyme Disease can Cause What Kind of Problems
Skin Joint Heart Nervous system
92
How is Lyme disease transmitted?
Bite of an infected tick or flea
93
Ticks that cause Lyme Disease
Deer tick Lone star tick Rocky Mountain tick
94
Signs/Symptoms of Stage 1 Lyme Disease
``` Flu-like symptoms Fatigue Headache Fever/chills Muscle/join pain N/V Dizziness Non-productive cough Small, red circular rash skin lesions ```
95
Signs/Symptoms of Stage 2 Lyme Disease
``` Severe headache Neck pain or stiffness Arthritis Neurological symptoms Psychiatric problems ```
96
Preventing Lyme Disease
Take protective measures when outdoors | Keep pets free of ticks
97
Protective Measures when Preventing Lyme Disease
``` Wear light-colored clothing Tuck pants into boots or socks Use repellant containing DEET Walk in the center of trails Avoid contact with high grass & brush at trail edges ```
98
Characteristics of Meningococcemia
Mid-winter to early spring | Most rapidly lethal form of septic shock
99
PE Findings in Meningococcemia
``` High fever Tachycardia Mild hypotension Signs of meningeal irritation Patient appears acutely ill ```
100
Early Exanthema in Meningococcemia
Soon after onset Pink 2-10 mm macules/papules Sparsely distributed on trunk/lower extremities, face, palate, conjunctivae
101
Later Lesions in Meningococcemia
Petechiae in center of merciless Lesions become hemorrhagic Purpura fulminans Hemorrhagic bullae
102
Work Up of Meningococcemia
Blood cultures Pus from nodular lesions D-dimers LP
103
What will LP show?
``` Increased pressure Cloudy Decreased sugar Increased protein Gram negative diplo-cocci ```
104
Treatment of Meningococcemia
Cefotaxine (Claforin) Ceftriaxone (Rocephin) PCN-G Hemodynamic stabilization
105
Characteristics of Gonococcemia
Bacteremic phase: tenosynovitis, arthralgias, & dermatitis Males age 20-24 Females aged 15-19 Acral hemorrhagic pustules lesions
106
Most Common Joints Affected in Gonococcemia
``` Wrists Fingers Elbows Knees Ankles Migratory polyarthralgia ```
107
Labs to Determine Gonococcemia
CBC ESR Culture
108
Treatment of Gonococcemia
Hospitalization with IV antibiotics
109
IV Antibiotics Use to Treat Gonococcemia
Empiric with Rocephin PCN-G Augmentin Doxycycline & Azithromycin

Dermatology (13 decks)

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