Skin S/S of systemic Dz

Question 1

3 manifestations of hyperthyroidism?

Answer 1

Diffuse goiter
Ophthalmopathy (lid lag, proptosis, chemosis, conjectivitis, exophthalmos)
Dermopathy (pretibial myxedema)
Occuring Independent or together

Question 2

Hyperthyroidism morphology

Answer 2

Moist, smooth, warm skin
Hyperhidrosis
Palmer erythema
Soft, fine, or thinning hair
Bronze tint to skin
Thyoid acropachy - digital clubbing, periosteal change
Plummers Nail - Onycholysis (brittle concave nails)

Question 3

Hypothyroidsm features

Answer 3

Flat affect
Large smooth red clumsy tongue
Skin - swollen, cool, waxy, dry, coarse, pale, wrinkles
Eyelid puffy
Yellow tint to palm/soles - carotenemia
Hair is dry , coarse and brittle
Lat 3rd eyebrow = alopecia
Nails gorw slow and are brittle

Question 4

Thyroid disease Pretibial myxedema Early S/S

Answer 4

Bilateral, asymmetric, firm nonpitting nodules and plaques

Pink or purple skin color

Question 5

Thyroid disease Pretibial myxedema Late S/S

Answer 5

Confluence of nodules becomes symmetric
Severe = lower legs/dorsal feet disfigured
Exaggeration of hair follicles (orange peel look)

Question 6

Pretibial myxedema occurs w/?

Answer 6

Hyper or hypo-thyroidism
Even can occurs w. Euthyroid pts
MC- ass/w graves Dz

Question 7

TXT Pretibial myxedema

Answer 7

Topical Steroids w/ occl.
Compression stockings (20-40mm Hg)
Intralesional Triamcinolone

Question 8

Hyperthyroidism Systemic TXT?

Answer 8

Surgical ablation or radioactive Iodine

Anti-thyroid drugs (PTH-methimazole)

Question 9

Hypothyroidism TXT?

Answer 9

Replacement therapy w/ Levothyroxine (T4)

-will correct skin defects

Question 10

Vitiligo is

Answer 10

Acquired loss of pigmentation due to absence of melanocytes because of Autoimmune Dz or genetics

Question 11

Types of vitiligo?

Answer 11

Type A (MC) - generalized
Type B - segmental

Question 12

Type A Vitiligo attributes

Answer 12

Systemic - White macules
-Dorsal hands, Face, Body folds, genitalia, orifices
-Koebnerized at elbows or w/ sunburn
Ass/w Halo nevi

Question 13

Type B Vitiligo attributes

Answer 13

Asymmetric pattern
Follicles also depigmented
Earlier onset

Question 14

Vitiligo concerns -

Answer 14

Psychologic
Eye - depigment retinal epithelium = uveitis risk
Ear - depigment membranous labyrinth = hearing issue
Aseptic meningitis - leptomeningeal melanocyte death

Question 15

Vitiligo comorbidities?

Answer 15

Alopecia areata
Hypothyroidism
Graves Dz
Addison Dz
Pernicious anemia
DM1
Melanoma

Question 16

Vitiligo TXT

Answer 16

Fair skin - no TXT (Avoid tanning)

Stim melanocyte migration w/in hair follicle reservoir

Question 17

Cushing syndrome/Disease is?

Answer 17

Resdistribution of adipose

Question 18

Cushing syndrome/Disease well known S/S?

Answer 18

Central obesity
moon facies
buffalo hump
Abd purple striae
Distal extremitis muscle wasting

Question 19

Cushing syndrome/Disease atrophic skin S/S?

Answer 19

Bright purple straie, eccymosis

Question 20

Cushing syndrome/Disease other skin S/S?

Answer 20

Steroid acne

Hirsutism

Question 21

What is hirsutism?

Answer 21

Adrenal androgens

• Facial hypertrichosis
• Androgenic alopecia - Females

Question 22

Cushing syndrome/Disease etiology

Answer 22

Adrenal axis Dysfx

Iatrogenic - (PO/Top) CCS

Question 23

Cushing syndrome/Disease labs

Answer 23

Overnight dexamethasone suppression test

Question 24

Cushing syndrome/Disease TXT?

Answer 24

Decrease or D/C CCS

Endocrine W/U to correct UC

Question 25

Acanthosis Nigricans is?

Answer 25

Nonspecific rxn patten of symmetrical brown thickening of skin that has velvety texture and is hyperpigmented Can become leathery, warty, or papillomatous

Question 26

A pt w/ Acanthosis Nigricans must go see who?

Answer 26

GI referal to R/O stomach cancer

Question 27

Acanthosis Nigricans distro?

Answer 27

``` MC - Axilla Flexors of neck Groin Belt line Dorsal surfaces of fingers Around areola ```

Question 28

Acanthosis Nigricans MC etiology?

Answer 28

``` Gastic Malig (Others is endorcinopathy) ```

Question 29

Acanthosis Nigricans TXT?

Answer 29

Asymptomatic Lesions - dont req TXT Ammonium lactate - softens lesions Tretinoin cream - Thins Hyperkeratotic skin TXT malig or endocrinopathy PRN

Question 30

Xanthomas is?

Answer 30

Lipids deposits in the skin and tendons 2/2 to hyperlipidemia

Question 31

Xanthomas 5 major types?

Answer 31

``` Xanthelasma -MC - Check lipids Eruptive Plane Tuberous Tendinous ```

Question 32

Xanthelasma attributes -

Answer 32

MC | Superficial, flat, yellow plaques around eyes (inner/outer canthus)

Question 33

Xanthelasma is an independent RF for?

Answer 33

CV death (Even tho 50% of pts have normal lipids)

Question 34

Eruptive xanthomas attributes -

Answer 34

Yellow 1-4mm papules w/ red halo Sudden onset of crops Distro - Ext surfaces arm/legs, ass, pressure points Clears rapidly -serum lipids levels decrease S/S of hypertriglyceridemia

Question 35

Tuberous Xanthoma attributes -

Answer 35

Slow evolving yellow papules, nodules, tumors Distro- Knees, elbows, ext surfaces of palms and body painless S/S of hypertrigly or biliary cirrhosis Can persist post TXT

Question 36

Tendinous Xanthoma attributes -

Answer 36

Smooth deeply situated nodules Nodules attach to tendons, ligaments, fascia MC attachment is Achilles S/S of hyperlipidemia or Biliary cirrhosis May persist post TXT

Question 37

Xanthom TXT

Answer 37

``` Low fat/calorie diet Stop Smoking Exercise TXT dyslipidemia Trichloroacetic acid (TCA) for cosmetic purposes ```

Question 38

Granuloma Annulare is a?

Answer 38

Self limiting condition w/ no etiology that affects children or young adults (F:M 2:1)

Question 39

Granuloma Annulare morphology?

Answer 39

Ring of small firm flesh colored red papules Localized - lateral/dorsal hands/feet (MC) (Bo/knee) Undegoes central involution Ring of papules slowly increase in diameter

Question 40

Granuloma Annulare generalized form is ass/w?

Answer 40

DM or HIV

Question 41

Granuloma Annulare TXT?

Answer 41

None - Spon resolve Toublesome - Topical steroid w/ occl. - Intralesional steroid - Triamcinolone acetonide in ring Disseminated GA - PUVA (or Dapsone, isotretinoin, hydroxychloroquine)

Question 42

Sarcoidosis is a? pop? presents?

Answer 42

Systemic granulomatous dz affecting <40yo | Fever, Fatigue, wgt loss, dyspnea

Question 43

Sarcoidosis Morphology early?

Answer 43

``` Skin colored papules or brown/purple plaues on face, ext, buttocks, trunk Erythema nodosum (MC) Nonspecific lesion ```

Question 44

Sarcoidosis morphology later?

Answer 44

Hyper/hypepigmented macules, papules, blue/red plaques | Affinity for scars

Question 45

Sarcoidosis appearance under a slide?

Answer 45

Apple jelly appearance

Question 46

MC nonspecific lesions for Sarcoidosis?

Answer 46

Erythema nodosum - Red node-like swelling over shins w/ ill-defined border preceded by flu-;like systems

Question 47

Sarcoidosis and lupus pernio?

Answer 47

Diffuse violaceous, soft, doughy, infltrations of nose, cheeks or earlobes

Question 48

Lupus pernio is ass/w

Answer 48

Sarcoidosis

Question 49

Sarcoidosis disto?

Answer 49

Skin - Anywhere (Esp. Face, Eyes-uveitis, Nose, Mouth, Ext) | Sys - Lung, Bones

Question 50

Sarcoidosis W/U?

Answer 50

``` Broncoscopic, lesional, lymph node Bx CXR Eye exam EKG Labs (^Ca, Bun/Cr) ```

Question 51

Sarcoidosis confirmational Dx?

Answer 51

Broncoscopic, lesional, lymph node Bx

Question 52

Sarcoidosis CXR results?

Answer 52

Hilar LAD | Pulm infiltrate

Question 53

Sarcoidosis TXT?

Answer 53

(PO) Steroids - skin, ocular, pulm, heart Dz Sml lesions - Intralesional CCS - Triamcinolone Failed (PO) Steroids > Methotrexate

Question 54

Necrobiosis Lipoidica disto

Answer 54

Anterior tib/fib

Question 55

Necrobiosis Lipoidica morphology

Answer 55

Starts - Oval, violaceous, patch, that expands slowly Evolves-red advancing border, w/ yellow-brown center -atrophies, waxy, prominent telangiectasia Ulcerates

Question 56

Necrobiosis Lipoidica Dx how?

Answer 56

Clinically

Question 57

Necrobiosis Lipoidica - Degenerative ischemic changes

Answer 57

Thinning, Shallow depressed scars, Woody induration DM dermaopathy w/w/out vesicles/bulla

Question 58

Necrobiosis Lipoidica etiology ass/w?

Answer 58

DM (and/or microangiopathy)

Question 59

Necrobiosis Lipoidica can evolve into?

Answer 59

SCC - rare

Question 60

Necrobiosis Lipoidica TXT -

Answer 60

``` No evidence based guidelines - Top/IL steroids (stops inflam but causes atrophy) Systemic PO steroids - 3-5wk -Pentoxifylline -ASA ```

Question 61

Kaposi's Sarcoma is?

Answer 61

Vascular neoplasm (Aids related)

Question 62

Kaposi's Sarcoma 5 sub-types

Answer 62

``` Classic African Cutaneous African LAD AIDS Immunosuppressive ```

Question 63

Classic Kaposi's Sarcoma attributes?

Answer 63

Older men Slow progression Distro - Hands/feet, Low legs (progress up arms/legs) HIV/AIDS distro anywhere, (MC - trunk, head, neck)

Question 64

What is the MC tumor in AIDS pts?

Answer 64

Classic Kaposi's Sarcoma

Question 65

Classic Kaposi's Sarcoma AIDS related morphology?

Answer 65

Slightly raised elongated/oval rust colored infilitrates that are poorly demarcated Progress rapidly to > Red/Purple nodules/plaques Ulcerates and bleeds

Question 66

How to differ Lichen Planus vs Kaposi's Sarcoma?

Answer 66

Firm pressure > decreases size of nodules Releasing pressure > returns to/increases in size Sign of Kaposi's Sarcoma

Question 67

Kaposi's Sarcoma disto?

Answer 67

Older men on legs | HIV - trunk/face

Question 68

Kaposi's Sarcoma Dx?

Answer 68

Bx - proliferated BVs w/ neoplastic endothelial cells

Question 69

Does someone have to have aids to have Kaposi's Sarcoma?

Answer 69

No

Question 70

Kaposi's Sarcoma etiology

Answer 70

HHV-8 human herpes virus (oral cavity primary source M2M sex)

Question 71

Kaposi's Sarcoma TXT

Answer 71

Liqoud nitrogen cryotherapy Excise Intralesional chemo (nodular lesions >1cm) -Vinblastine Radiotherapy for LRG tumor masses HAART for extensive AIDS related Dz (anti-retovirals)