Skin sign of systemic disease and drug eruptions Flashcards
Nail changes:
Clubbing
Inherited clubbing is associated with _________.
Clubbing is caused by enlargement of the soft tissue of the distal digit.
The nail plate is enlarged and excessively curved with a greater than 180 degree widening of the angle between the proximal nail fold and the nail plate.
Idiopathic or primary clubbing is rare
-Inherited is associated with pachydermoperiostosis (young males)
Diseases that clubbing is associated with:
Pulmonary disease
65% of patients with idiopathic _________.
What about cardiac disease?
Pulmonary disease
–65% of patients with idiopathic pulmonary fibrosis
–29% of patients with lung cancer
Cardiac disease - Cyanotic congenital heart disease
Diseases clubbing is associated with:
Gastrointestinal disease:
38% of patients with______ disease, 15% of patients with _________, and 8% of patients with________.
Miscellaneous causes could related to hypoxemia with long term ________.
Gastrointestinal disease
–38% of patients with Crohn disease, 15% of patients with ulcerative colitis, and 8% of patients with proctitis.
Malignancies
–Thyroid cancer, thymus cancer, Hodgkin disease
Miscellaneous conditions:
–hypoxemia possibly related to long term cannabis smoking
Nail changes:
Terry’s Nails
What is leukonychia?
Associated with Liver cirrhosis in up to 82% patients
-Leukonychia affects the entire nail except for a 1-2 mm distal band.
Leukonychia (or leuconychia), also known as white nails or milk spots, is a medical term for white discolouration appearing on nails. It is derived from the Greek words leuko (“white”) and nychia (“nails”). The most common cause is injury to the base of the nail (the matrix) where the nail is formed.
Nail changes:
Half-n-half nails
Distal nail is _______, and proximal nail is _______.
Occurs in 10% of patients with ________.
Distal nail is normal, proximal nail is white.
Occurs in 10% patients with *chronic renal failure, also seen in normal patients.
Nail changes;
Proximal Subungual White Onychomycosis
With what disease is it associated?
What microorganism is the cause?
Associated with HIV disease
Usually due to Trichophyton rubrum
Skin signs of Thyroid Disease
What are they?
Vitiligo
Alopecia Areata
Exophthalmos
Pretibial myxedema
Exophthalmos
- Dry skin, brittle nails, sparse hair, delayed wound healing
- Madarosis: loss of lateral 3rd of eyebrow
- A yellowish hue to the skin secondary to carotenemia
Pretibial Myxedema
Seen in what condition of the thyroid?
Due to a generalized excess of ________ in the dermis
What appearence does it have?
Seen in hyperthyroidism, Grave’s Disease.
Due to mucinosis, a generalized excess of glycosaminoglycans in the dermis.
–>Reddish, tender nodules and plaques occur on the shins, calves and feet.
–>There may be violaceous or yellow‐brown discoloration of the overlying skin with prominent hair follicles giving an **orange‐peel (peau d’orange) appearance
Alopecia Areata
Associated with autoimmune diseases such as?
Hairs often regrow with _____.
Associated with other autoimmune diseases including: thyroid, vitiligo and inflammatory bowel disease.
–>Occurs as round or oval patches of hair loss
Short “exclamation point” hairs, broader at the distal end.
Hairs often re-grow with depigmentation
Vitiligo
Characterized by the development of totally white macules and patches.
There is a complete absence of?
- Characterized by the development of totally white macules and patches.
- Histology shows a ***complete absence of melanocytes.
Vitigilio is associated with?
Commonly associated with thyroid disease (up to 30% of all cases)
–Hashimoto’s thyroiditis
–Graves’ disease
Other endorcine disorders
–*Diabetes Mellitis
–*Pernicious Anemia
–*Addison’s disease
Vitigilio treatment:
What kind of topic inhibitors are used as a treatment?
For depigmentation what cream is used?
—>Topical Steroids
–>Topical Calcineurin Inhibitors (Protopic ointment)
Narrow-band UVB (311 nm)
–Excimer Laser (308 nm)
–>Psoralens plus UVA (PUVA)
–>Minigrafting
–>Depigmentation (monobenzylether of hydroquinone cream)
Skin and GI disorders
Hepatitis C Virus
–Lichen Planus (An inflammatory condition of the skin and mucous membranes).
Inflammatory Bowel Disease
–Erythema Nodosum
–Pyoderma Grangrenosum
Inflammatory bowel disease:
Erythema nodosum
More common in ________.
Histopathology shows ___________.
- More common in women
- May also have fever, arthralgias and malaise
- Histopathology shows a septal panniculitis with neutrophils (inflammation in the subcutaneous fat)
***Septal panniculitis is a condition of the subcutaneous fat affecting the layer of adipose tissue that lies between the dermis and underlying fascia, of which there are two forms: acute erythema nodosum and chronic erythema nodosum.
Inflammatory bowel disease
Erythema nodosum
Where in the body is it usually found?
What kind of hypersensitivity is considered?
What is the most common single cause?
What inflammatory has a stronger correlation than ulcerative colitis?
Painful, erythematous subcutaneous nodules
Usually found symmetically over the *pretibial lower extremities
Develop a bruise-like appearance in later stages.
Considered a delayed hypersensitivity to a variety of antigenic stimuli, most commonly infections.
–**Streptococcal infections, especially URI (single most common cause)
-Other infections (1/3 cases)
–Viral URIs, Mycoplasma, tuberculosis
-Coccidioidomycosis
Erythema nodosum uncommon associations:
Treatment of erythema nodosum
What two antibiotics are used?
-Naproxen and indomethacin
Inflammatory bowel disease:
Pyoderma grangrenosum
What is the initial lesion?
What is a characteristic lesion?
Where are lesions most commonly located?
–>Initial lesion is often a pustule (pimple in the skin containing pus) on an erythematous base or an erythemaous nodule.
–>Characteristic lesion is an ulcer with a necrotic, undermined border.
–>Often begins in sites of minor trauma (Pathergy: is an exaggerated skin injury occurring after minor trauma such as bump, bruise, needle stick injury).
–>Lesions are painful, and most commonly located on the lower extremities
Lichen planus
What is Wickham’s striae?
–>Purple, polygonal, pruritic papules
–>Wickham’s striae: an overlying lace-like pattern of white lines on the surface.
–>Mucosal lesions may occur without skin findings in 15-25% pts
–> **Nail involvement occurs in 10% and may be the only site of involvement
Lichen planus
Clinical variants:
Lichen planus associations:
Acanthosis Nigricans?
What are the most affected areas?
happens due to factors stimulating ________ and dermal firoblast proliferation.
–Velvety hyperpigmentation of the intertriginous surfaces and, less often, the extensor surfaces
–The areas most often affected are the neck, axillae, and dorsal hands.
–Due to factors stimulating epidermal keratinocyte and dermal fibroblast proliferation
Acanthosis Nigricans
ASSOCIATIONS
Acanthosis Nigricans
MALIGNANCY
Acanthosis Nigricans
TREATMENT
Celiac’s disease
Loss of _____.
- >Celiac sprue results in inflammation in the small intestine when eating gluten.
- >This chronic inflammation leads to loss of villi in the intestine and can put patients at risk of lymphoma.
Dermatitis Herpetiformis
–>Intensely itchy herpetiform vesicles within erythematous or urticated plaques
–> Excoriated erythematous, crusted, grouped papules
–>Symmetrical distribution on extensor surfaces: elbows, knees, shoulders and buttocks
