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Dermatology > Skin Manifestations of Systemic Disorders > Flashcards

Skin Manifestations of Systemic Disorders Flashcards

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1
Q

Characteristics of pyoderma gangrenosum? Assoc with what diseases?

A
  • rapidly evolving, idiopathic, chronic and severely debilitating ulcerative skin disease
  • assoc with chronic underlying inflammatory or malignant disease:
    chronic UC**
    chronic active hepatitis
    RA
    Crohn’s
    heme malignancies
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2
Q

Hx and PE of pyoderma gangernosum? MC sites?

A
  • Hx: acute onset painful hemorrhagic pusule or painful nodule surrounded by erythematous halo
  • PE: breakdown of ulcer formation with dusky red or purple borders, irregular and raised, boggy with perforations that drain pus
  • MC sites: lower extremities, buttocks, abdomen
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3
Q

Tx of pyoderma gangrenosum?

A
  • tx underlying disease
  • avoid trauma
  • high dose syst. steroids
  • systemic immunosuppression: sulfasalazine, cyclosporine, and infliximab
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4
Q

Assoc skin conditions with diabetes?

A
  • Acanthosis nigricans
  • necrobosis lipoidica diabeticorum
  • granuloma annulare
  • thrush
  • intertrigo
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5
Q

Characteristics of Acanthossis nigricans? Assoc with?

A
  • velvety thickening and hyperpigmentation of skin
  • assoc with:
    endocrine disorders: diabetes, insulin resistant syndromes
  • obesity
  • internal malignancy: GI MC
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6
Q

Hx, PE and MC sites of acanthosis nigricans?

A
  • hx: insidious onset, first visible change in darkening of pigmentation
  • PE: hyperpigmentation, velvety looking, skin line accentuated, surface becomes wrinkled or creased
  • MC sites: axilla, neck (back and sides), groin, antecubital fossae
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7
Q

Tx of acanthosis nigricans?

A
  • R/O diabetes
  • tx assoc disorder
  • usually none reqd
  • if mucous membrane involvement think malignancy: GI adenocarcinoma MC
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8
Q

PE of necrobiosis Lipoidica (NL), Diabeticorum? Tx?

A
  • origin is unknown, 50% of pts with NL are insulin dependent diabetics (diabetic control doesn’t prevent this)
  • PE:
    oval, violaceous patch that expands slowly
    advancing border is red and central area turns yellow-brown
  • telangiectasis becomes prominent
  • ulceration is possible esp. after trauma
  • tx: is difficult, refer to derm
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9
Q

Characteristics of granuloma annular? Hx, PE, MC site?

A
  • self limiting, asx, chronic dermatitis
  • sight assoc with diabetes: 20% of pts with DM
  • more common in older women
  • Hx: slowly increases over months, duration variable
  • PE: smooth, shiny firm ring of flesh colored papules and plaques (1-5 cm), annular with central depression
  • MC site: dorsum of hands, feet, extremities and trunk
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10
Q

Tx of granuloma annular?

A
  • not necessary: disappear in 75% of pts in 2 yrs
  • if needed:
    potent topical steroids, intralesional injections of steroids
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11
Q

Characteristics of intertrigo? MC sites?

A
  • irritation in skin folds, worse with heat and moisture
  • assoc with diabetes, HIV, obesity
  • related to candida, fungus irritation and 2nd bacteral infection (Group A and B strep, pseudomonas): culture if in doubt
  • MC sites: axilla, groin, gluteal folds, overlapping abdominal panniculus
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12
Q

PE and tx of intertrigo?

A
  • PE: erythema, +/- pruritus, tenderness, erythematous plaques
  • tx:
    keep cool and dry, tx based on cause:
    antifungal/antibacterial powders
    zinc oxide ointment reduces friction, topical steroids should be avoided
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13
Q

What is thrush? Assoc diseases? Tx?

A
  • yeast infection, usually candida, white plaques or red erosive areas in oral mucosa
  • assoc: diabetes, HIV, immunosuppression
  • tx: antifungal troches, fluconazole, itraconazole
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14
Q

What are sysetmic disorders other than DM that manifest derm sxs?

A
  • lupus
  • dermatomyositis
  • scleroderma
  • xanthoma
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15
Q

Derm manifestations of chronic cutaneous (discoid) lupus?

A
  • scarring, dispigmented, scaly plaques on face primarily
  • women to men 2:1
  • progression to systemic lupus is uncommon
  • tx with potent topical steroids +/- antimalarials (hydroxychloroquine)
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16
Q

Derm manifestations of subacute cutaneous lupus?

A
  • white women 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
  • not going to appear on face, don’t have serious lupus sxs
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17
Q

Derm manifestations of SLE?

A
  • butterfly facial erythema which is nonscarring
  • photosensitivity
  • oral ulcers
  • discoid lupus
  • skin involvement in 80% of SLE
  • tx: antimalarials and immunosuppression
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18
Q

Manifestations of dermatomyositis?

A

dermatitis:

  • erythema, photosensitiviy, heliotrope eyelid rash
  • gottron’s papules: knuckles, periungual, telangiectasia, poikiloderma (red, white, brown), calcinosis cutus

myositis: weakness of proximal muscles, elevation in muscle enzymes
- 90% of time: underlying malignancy

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19
Q

What does CREST stand for? Used for what disease?

A 
- for scleroderma
CREST:
C= calcinosis
R= reynauds
E= esophageal dysmotility
S=sclerodactyly
T= telangiectasia 
- have really painful, tight skin
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20
Q

What is progressive systemic sclerosis of scleroderma? Tx?

A
  • multi-system: generalized sclerosis with internal organ involvement (heart, lungs, GI, kidney)
  • tx with systemic immunosuppression
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21
Q

What are xanthomas? Assoc with? Common sites?

A
  • lipid deposits in skin and tendons, yellow brown, pinkish or orange macules, papules, plaques, nodules
  • assoc: hyperlipidemia, biliary cirrhosis, diabetes, CRF
  • *high risk for atherosclerotic disease - may be first manifestation
  • common sites: upper and lower eyelids: inner canthus
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22
Q

Diff types of xanthomas?

A
  • eruptive
  • tuberous
  • tendinous
  • xanthelasmas
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23
Q

What are xanthelasmas?

A
  • MC of of all xanthomas
  • Most cases unrelated to hyperlipidemia
  • occurs in individuals older than 50
  • when seen in kids or young adults: assoc with familial hypercholesterolemia
  • seen along eyes - creamy orange in color
24
Q

What should you check if pt presents with xanthomas? Tx?

A
  • check for hyperlipidemia, although more than 50% of these pts have no metabolic disturbance
  • if + for hyperlipidemia, CV disease may be expected
  • tx:
    laser, excision, electrodesiccation or topical application of trichloracetic acid
25
Q

What are the desquamation disorders?

A
  • erythema multiforme
  • SJS
  • Toxic epidermal necrolysis syndrome
26
Q

What are the presentations of erythema multiforme?

A
  • erythematous targetoid macules/patches
  • papules/plaques
  • vesicles/bullae
  • wheals (urticaria)
  • erosions
  • usually follows bad infection, or drug exposure
  • HSV
27
Q

Characteristics of EM Minor?

A
  • little or no mucous membrane involvement
  • few if any systemic sxs
  • often due to HSV (sometimes subclinical, often recurrent)
  • can be due to meds
28
Q

Characteristics of EM Major?

A
  • always with mucous membrane involvement (2 or more sites)
  • skin involvement more widespread
  • systemic sxs such as a fever
  • hepatitis, nephritis
  • often due to meds
  • this can progress to SJS and then to TENS
  • Serious!!!
29
Q

Frequent offenders of Erythema Multiforme?

A 
- almost any med
frequent meds -
- sulfa drugs (bactrim, dapsone)
- anti-epileptic drgus (phenytoin, carbemazepine, phenobarbital)
- abx: PCN, cephalosporins
- allopurinol
30
Q

What is SJS and TENS?

A
  • mucocutaneous drug induced or idiopathic rxn patterns characterized by skin tenderness and erythema of skin and mucosa, followed by extensive cutaneous and mucosal epidermal necrosis and sloughing
  • SJS is considered a maximal variant of EM major
  • TEN is considered maximal variant of SJS
31
Q

Characteristics of SJS and TENS?

A
  • onset at any age, but MC over 40
  • assoc with:
    drugs**: onset 1-3 wks after exposure
    SLE
    HIV
    HLA-B12
32
Q

Prodromes of SJS and TENS?

A
  • rash: morbilliform, diffuse erythema
  • fever
  • mouth lesions
  • flu like sxs 1-3 days prior to mucocutaneous lesions
  • mucocutaneous lesion, skin pain, burning and itching
33
Q

Progression of SJS and TENS?

A
  • necrotic epidermis, macular areas
  • sheet like loss of epidermis
  • flaccid blisters that spread with lateral pressure (Nickolsky sign) on erythematous areas
  • with trauma, full thickness epidermal detachment yieldign exposed, red, oozing dermis resembling 2nd degree burn
  • these pts die of acute renal failure
  • other organs involved: hepatitis, nephritis, pneumonitis
  • 5-40% mortality rate with TEN
34
Q

Drugs assoc with SJS and TENS?

A
  • sulfa drugs
  • barbituates
  • allopurinal
  • dclofenac
  • sulindac
  • ketoprofen
  • ibuprofen
  • naproxen
  • cephalosporins
  • fluoroquinolones
  • vanco
  • aminopenicillins
  • rifampin
  • ethambutol
35
Q

Tx of EM minor/major?

A
  • antiviral prophylaxis to control HSV

- early dx and cessation of suspected causative agent

36
Q

Tx of SJS and TENS?

A
  • early dx and cessation of suspected causative drug
  • supportive care: ICU, fluids
  • systemic steroids controversial: maybe helpful in early disease
  • growing evidence for use of IVIG, halts progression if admin early
  • tx eye lesions with erythromycin ointment, transfer to burn unit if widespread sloughing
37
Q

What is a drug rash commonlly assoc with?

A
  • very common with bactrim (septra)

- can happen w/in 2 days of onset of therapy to weeks after therapy is over

38
Q

Tx of drug rash?

A
  • benadryl
  • IV/IM steroids
  • steroid dose pack
  • try not to sweat at night, don’t use covers
39
Q

Characteristics of bacterial endocarditis? Hx, PE?

A
  • staph aureus, strep viridans
  • proliferation of microorganisms on endocardium of the heart
  • incidence is increasing in elderly, IVDU, and those with prosthetic valves
  • Hx: fever, chills, sweats, anorexia, wt loss, malaise
  • PE: heart murmur, arterial emboli, splenomegaly
40
Q

What are the skin lesions assoc with bacterial endocarditis?

A
  • janeway lesions: nontender, hemorrhagic maculopapular lesions on palms and soles
  • osler’s nodes: painful, red nodules on fingertips
  • subungual splinter hemorrhages
  • petechial lesions: small, non-blanching reddish brown macules on extremities, upper chest, mucus membranes, occur in crops
    asx red streaks in nail bed
41
Q

Dx and Tx bacterial endocarditis?

A
  • ID at risk pts and prophylaxis
  • blood cultures
  • CBC, chem panel, coags, echo
  • tx:
    PCN-G
    Nafcilin
    gentamycin
    Vanco in MRSA
    Zyvox in MRSA
42
Q

RMSF:
characteristics
Hx
PE?

A
  • characteristics: Rickettsia rickettsii spirochete, common May-Sept, can be fatal if not tx, esp in elderly
  • hx:
    hx of bite in 60% of cases, ask about outdoors, prodrome of anorexia, irritability, malaise
  • PE:
    1-2 wks after: fever over 102, chills weakness, HA, photophobia
43
Q

Skin lesions of RMSF?

A
  • 49% have rash
  • initially 2-6mm, pink blanching macules begin on extremities and spread centrally: characteristically begins on wrists, forearms, ankles, and later palms
  • evolve to papules and petechiae over hours to couple of days
44
Q

Tx of RMSF?

A
  • doxy (except for PG)
  • chloramphenical (for PG)
  • start abx if dx is even suspected: doxy even in kids
  • mortality rate if left untx in elderly: 60%
45
Q

What is lyme disease? what is the cause?

A
  • MC tick/insect born disease in US
  • disease that can cause skin, jt, heart and nervous system problems
  • lyme disease can affect people of all ages
  • spirochete is the cause, transmitted by bite of an infected tick or flea
46
Q

What ticks can cause lyme’s?

A
  • deer tick: found in North central and NE US
  • lone star tick: Texas
  • Rocky Mt tick: can transmit lyme disease as well as RMSF
47
Q

Signs and sxs of lyme disease - Stage 1?

A
  • 3-30 days after bite
  • flu like sxs develop w/in 7-14 days
  • sxs include fatigue, HA, fever, chills, muscle, jt pain, N/V, dizziness, non-productive cough
  • skin lesions may appear as a small red circular rash around bite and expand
  • secondary skin rashes appear in nearly 80% of individuals with lyme disease
48
Q

Signs and sxs of lyme disease - stage 2?

A

late: may occur weeks or months after onset of lyme disease:
- severe HA and neck pain or stiffness
- arthritis will develop in 60% of pts weeks or months after infection (rarely more than 2 yrs)
- 15% of people infected with lyme disease develop neuro sxs, including psych problems

49
Q

Characteristics of meningococcemia?

A
  • N. meningitids
  • highest incidence: b/t 6 mos- 3 yo
  • highest incidence, midwinter, early spring
  • most rapidly lethal form of septic shock
50
Q

PE, early exanthem and later lesions of meningococcemia?

A
  • PE: high fever, tachycardia, mild hypotension, signs of meningeal irritation, pt appears acutely ill
  • early exanthem: occurs soon after onset, pink 2 mm-10 mm macule/papules, sparsely distributed on trunk/lower extremities, face, palate, conjunctivae
  • later lesions: petechiae in center of macules, lesion becomes hemorrhagic w/in hours, purpura, purpura fuminans and hemorrhagic bullae
51
Q

Tx of meningococcemia?

A
  • cefotaxine (claforin)
  • ceftriaxone (rocephin)
  • PCN-G
  • hemodynamic stabilization
52
Q

What is gonococcoemia?

A
  • N. gonorrhoeae
  • early bacteremic phase consisting of tenosynovitis, arthralgias, and dermatitis
  • peak incidence in males aged 20-24 and females 15-19
  • classic skin lesions are aural hemorrhagic pustules
53
Q

What jts are most commonly involved in gonococcemia?

A
  • wrists, fingers, elbows, knees, ankles with 70% of pts experiencing migratory polyarthralgia of 1-3 jts and the remaining 30% having involvement of more than 3 jts
  • about 75% of pts experience a dermatitis that can vary from macular/papular to vesicular/pustular to necrotic or hemorrhagic erythema
54
Q

Labs for gonococcemia?

A
  • CBC
  • ESR
  • culture (gram - diplococci)
55
Q

Tx of gonococcemia?

A
  • hospitalization with IV abx
  • empiric tx with rocephin
  • PCN-G
  • augmentin
  • doxy and azithromycin (b/c of increasing resistance of STIs to abx therapy)
56
Q

What should be at top of differential when pt presents with a fever and a rash?

A
  • meningitis

- tick bites

Dermatology (12 decks)

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