Skin presentation of systemic disease Flashcards
What are some skin manifestations of diabetes?
Small and large vessel angiopathy
Xanthomata
Xanthelasma
Erysepelas (Caused by hyperglycaemia leading to infection)
Necrobiosis lipidoica
Acanthosis nigricans
What is necrobiosis lipidoica?
A granulomatous inflammatory reaction around destroyed collagen, usually found in diabetes
What condition is shown?
Erysipelas
What condition is shown?
Necrobiosis lipidoica
What condition is shown?
Xanthelasma
What condition is shown?
Acanthosis nigricans
What cells contain thyroid hormone receptors in the skin?
Keratinocytes, fibroblasts, arrector pili muscle cells, hair follicle cells, smooth muscle cells, sebaceous gland cells, vascular endothelial cells
What are the effects of thyroid hormone on the skin?
- Promotes fibroblast activity
- Regulates epidermal differentiation
- Essential for hair formation and sebum production
What are some skin presentations of hyperthyroidism?
- Warm, moist smooth skin
- Facial flushing, palmar erythema
- Fine, thin hair. Diffuse alopecia (increased hair turnover time)
- Hyperhidrosis
- 5% - nail changes (concave, distal onycholysis)
- Pruritus
- Graves disease – pretibial myxoedema also present
- Urticaria / angioedema (uncommon – linked to thyroid autoimmunity)
What condition is shown?
Pre-tibial myxoedema - Fibroblasts stimulated by autoantibodies to produce high amounts of GAGs, which accumulates in the dermis
What are some skin presentations of hypothyroidism?
- Cold, dry pale skin
- Xerosis – may resemble acquired ichthyosis
- Carotenaemia - The conversion of beta-carotene (provitamin A) to vitamin A (retinol) is accelerated by thyroxine.
- Dry, coarse brittle hair, diffuse alopecia
- Loss of lateral 1/3 eyebrow (madarosis)
- Thickened brittle nails
- Generalised myxoedema
- Peri-orbital oedema
- Facial puffiness
What causes myxoedema?
Dermal accumulation of mucopolysaccharides, mainly hyaluronic acid, which disappears with correction of T4 level
What are some skin changes in Addison’s disease?
- Diffuse hyperpigmentation
- Palmar crease pigmentation
- Buccal pigmentation
What are some skin presentations of tumours with MSH-like activity (E.g. pituitary tumours)?
Hyperpigmentation
What are some skin presentations of tumours with androgenic activity (E.g. ovarian tumours)?
Virilisation
Hirsutism
Acne
Baldness
What are some skin presentations of chronic discoid lupus?
- Photosensitivity
- Erythematous indurated plaques on exposed sites
- Follicular plugging
- Heal with scarring / permanent alopecia
What are some skin presentations of subacute cutaneous lupus?
- Annular erythematous scaly plaques
- Symmetrical
- No plugging or scarring
- Photosensitive
What are some skin presentations of SLE?
- UV sensitivity
- Nail fold capillaries prominent
- May have widespread DLE type rash
What condition is shown?
Subacute cutaneous lupus
What are some skin presentations of systemic sclerosis?
- Pinched mouth – radial furrows
- Beaked nose
- Matt - like facial telangectasia
- Sclerodactyly
- Periungual telangiectasia / ragged cuticles
- Raynaud’s phenomenon in 85%
What condition is shown?
Sclerodactyl
What condition is shown?
Calcinosis
What are some skin presentations of dermatomyositis?
- Photosensitivity rash like that of L.E.
- Heliotrope oedema of eyelids
- Linear finger rash with Gottron’s papules
What are some causes of erythema multiforme?
Viral (E.g. Herpes simplex)
Other infection (E.g. TB, Strep. sp, mycoplasma)
Drugs (E.g. sulphonamide)
Malignancy
Autoimmune disease
How does erythema multiforme present on the skin?
Target lesions on the knees, elbows, palms, soles and mucosae
What condition is shown?
Erythema multiforme
What condition is shown?
Erythema nodosum
How will erythema nodosum present on the skin?
- Red, tender, diffuse nodules, may be assoc. with joint pains, fever
- Over Shins ; sometimes other sites
- Slow resolution - like bruise, 6-8 weeks
What are some causes of erythema nodosum?
- Infections – Strep, TB, EB, fungal
- Drugs – OCP, sulphonamides
- Inflammatory bowel disease
- Sarcoidosis
What are some causes of livedo reticularis?
–Cardiac failure
–Vascular emboli
–Drugs
–Throbocythaemia
–Cryoglobulins
–Arteritis (PAN, SLE, RA, DM, lymphoma)
–Infections
What condition is shown?
Mycosis fungoides - Caused by cutaneous T-cell lymphoma
What condition is shown?
Sister Mary Joseph nodules - Metastatic deposits
What skin presentation can be caused by cholestatic jaundice?
Pruritus
What skin presentation can be caused by IVC obstruction?
Visible venous dilation around the chest
What are some skin manifestations of occult malignancy?
- Dermatomyositis
- Generalised Erythroderma (Red skin)
- Annular Erythemas - e.g.
- Erythema Gyratum Repens (”wood grain” effect)
- Acanthosis Nigricans
- Acquired Ichthyosis (“Fish scale” skin)
- Generalised pruritus (lymphoma)
What are some skin presentations of HIV?
- Kaposis sarcoma
- Seborrhoeic eczema / folliculitis (50%)
- Skin infections (E.g. herpes, molluscum, candida, staph. etc)
- New onset / worsening psoriasis
- Dry skin / pruritus
