Skin Signs In Systemic Disease Flashcards by Hayley Gilfillan

Skin manifestations of tuberous sclerosis

Angiofibromas,
peri-ungual fibromas,
Shagreen patches,
ash leaf white macules

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Skin manifestations of neurofibromatosis

Neurofibromas,
cafe au lait macules,
axillary freckling,
Lisch nodules

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Name 3 cutaneous infections that diabetic patients have an increased risk of

Erysipelas
Candidiasis (hyperglycaemia favours candidal growth)
Chronic paronychia

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Hypertrtriglyceridaemia (e.g. in diabetes) can cause what cutaneous presentation

Xanthomata

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Hyperinsulinaemia can cause what cutaneous presentation

Acanthosis Nigricans

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What is the name for the cutaneous skin condition that can occur in diabetic patients and presents as raised, red & shiny patches with a yellow center

Necrobiosis lipodica

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Name a cutaneous complication of diabetes

Leg ulcer

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Why does the thyroid hormone affect the skin?

Thyroid hormone receptors present in keratinocytes, fibroblasts, arrector pili muscle cells, hair follicle cells, smooth muscle cells, sebaceous gland cells, vascular endothelial cells etc

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What effects does the thyroid hormone have on the skin

• Promotes fibroblast activity
• Regulates epidermal differentiation
• Essential for hair formation and sebum production
• Effects on skin perfusion

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Name cutaneous features of hyperthyroidism

• Warm, moist smooth skin
• Facial flushing, palmar erythema
• Fine, thin hair. Diffuse alopecia (slower hair turnover time)
• Hyperhidrosis
• 5% - nail changes (concave, distal onycholysis)
• Pruritus

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Name cutaneous features of hypothyroidism

• Cold, dry pale skin
• Xerosis – may resemble acquired ichthyosis
• Carotenaemia
• Dry, coarse brittle hair, diffuse alopecia
• Loss of lateral 1/3 eyebrow (madarosis)
• Thickened brittle nails
• Myxoedema (e.g. peri-orbital oedema, facial puffiness)

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Name a cutaneous features that is characteristic of Graves’ disease

Pretibial myxoedema

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What is the proposed pathophysiology of pretibial myxoedema

Fibroblasts stimulated by autoantibodies to produce high amounts of glycosaminoglycans which accumulates in the dermis

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Why can hypothyroidism cause carotenaemia (yellow/orange skin that spares the eyes)

conversion of beta-carotene (provitamin A) to vitamin A (retinol) is accelerated by thyroxine.

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Why does hypothyroidism cause myxoedema

dermal accumulation of mucopolysaccharides – mainly hylauronic acid

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Name a cutaneous features of Addison’s disease

•Diffuse hyperpigmentation
•Palmar crease pigmentation
•Buccal pigmentation

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Why does Addison’s cause hyperpigmentation

Absence of normal feedback to pituitary leads to increased ACTH + MSH production leading to increased melanogenesis (common pre-cursor – pro-opiomelanocortin)

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What cutaneous features can occur as a result of an endocrine tumour with androgenic activity

Virilisation
Hirsutism
Acne
Baldness

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Cutaneous / Chronic Discoid LE (CDLE) cutaneous features

• Photosensitivity
• Erythematous indurated plaques on exposed sites
• Follicular plugging
• Heal with scarring / permanent alopecia

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Cutaneous / Chronic Discoid LE (CDLE) diagnosis

Biopsy with immunofluorescence

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Cutaneous / Chronic Discoid LE (CDLE) treatment

sun avoidance
potent steroids
hydroxychloroquine

Subacute cutaneous LE cutaneous features

Annular erythematous scaly plaques, not indurated.
Symmetrical rash with no plugging or scarring
Photosensitivity

Where does subacute cutaneous LE cutaneous features typically occur

On sun-exposed sites, esp upper back / shoulders / arms

Are autoantibodies present in CDLE or SCLE

CDLE may be ANA positive
SCLE may be ANA or Ro or La positive

Subacute cutaneous LE cutaneous diagnosis & treatment

Same as DCLE

Systemic LE (SLE) cutaneous features

- Butterfly, ‘malar’ rash in 50% - Photosensitivity - Prominent capillaries in nail fold - May have CDLE type rash

Dermatomyositis cutaneous features

•Photosensitivity rash like that of L.E. •Heliotrope oedema of eyelids •Linear finger rash with Gottron’s papules

Systemic sclerosis vs scleroderma

Scleroderma is the skin changes of systemic sclerosis

Systemic sclerosis two types

•Diffuse cutaneous •Limited cutaneous (aka CREST)

Systemic sclerosis cutaneous features (scleroderma)

•Pinched mouth – radial furrows •Beaked nose •Matt - like facial telangectasia •Sclerodactyly •Periungual telangiectasia / ragged cuticles •Raynaud’s phenomenon in 85% •(Dysphagia)

Describe erythema multiforme

Typically “Target” or “Iris” lesions

Where does erythema multiforme usually occur on the body

Knees, Elbows, Palms, Soles and Mucosae

Erythema multiforme minor vs Major

•Minor – skin only •Major – skin + mucosal involvement

Erythema multiforme aetiology

- Viral - HSV - Bacterial - TB, Strep, Mycoplasma - Other e.g. drugs (Sulphonamide), autoimmune, malignant

Describe erythema nodosum

Red, tender, diffuse nodules that may be assoc. with joint pains & fever. Typically occurs on the shins

Erythema nodosum aetiology

•Infections – Strep, TB, EB, fungal •Drugs – OCP, sulphonamides •Autoimmune - Inflammatory bowel disease •Sarcoidosis

Describe cutaneous vasculitis

Non-blanching, purpuric rash ± bullae and necrosis.

Where does cutaneous vasculitis typically affect on the body

Lower legs

Cutaneous vasculitis aetiology

Many causes (vasculitis screen) –Drugs –Infective –Autoimmune –Neoplastic

Describe livedo reticularis & state when it is exacerbated

Mottled cyanotic network exacerbated by cold

Livedo reticularis aetiology

–Cardiac failure –Vascular emboli –Drugs –Throbocythaemia –Cryoglobulins –Arteritis (PAN, SLE, RA, DM, lymphoma) –Infections

What is Mycosis Fungoides

Primary cutaneous T cell lymphoma

Describe the presentation of Mycosis Fungoides

1st stage - patch (rash) stage 2nd stage - plaque stage 3rd stage - tumour stage

What is Paget’s disease of the nipple a sign of

Breast cancer

What is sister Mary Joseph nodule

Aka umbilical metastasis Is a common site of GI, breast, lung & pelvic metastasis

What would you want to exclude in a patient presenting with acquired ichthyosis

Lymphoma

Acanthosis nigricans aetiology

Hyperinsulinaemia - Diabetes - Insulin resistance - obesity

What is erythema gyratum repens

rare paraneoplastic type of annular erythema with a distinctive figurate ‘wood-grain’ appearance

Name some skin disorders associated with HIV

•Kaposi’s sarcomas – initial presentation in up to 25%. •Seborrhoeic eczema / folliculitis – seen in at least 50% •Skin infections – herpes, molluscum, candida, staph. etc •New onset / worsening psoriasis •Dry skin / pruritus

Generalised erythroderma aetiology

Skin condition - Psoriasis, dermatitis, ichthyosis, lupus Drug reaction Malignancy - cutaneous T-cell lymphoma

What is important about dermatomyositis

It can be associated with an underlying malignancy