skin signs in systemic disease Flashcards
what are skin manifestations in tuberous sclerosis?
multiple hamartomas
angiofibromas
peri-ungual fibromas
shagreen patches
ash leaf macules
what are the skin manifestations in neurofibromatosis?
neurofibromas
cafe au lait macules
axillary freckling
lisch nodules
what are the skin manifestations in diabetes?
infections
erysipelas - strep
candidiasis - hyperglycaemia favours proliferation of candida
chronic paronychia
necrobiosis lipoidica
xanthomata
acanthosis nigricans
leg ulcers
what is the role of the thyroid in skin?
promotes fibroblast activity
regulates epidermal differentiation
essential for hair formation and sebum production
effects skin perfusion
what are the skin manifestations in hyperthyroidism?
warm, moist smooth skin
facial flushing, palmar erythema
fine thin hair
hyperhidrosis
nail changes (concave, distal onycholysis)
pruritus
pretibial myxoedema (graves)
urticaria/angioedema
what are the skin manifestations in hypothyroidism?
cold, pal, dry skin
xerosis
carotenaemia
dry, coarse, brittle hair
loss of eyebrows (madarosis)
thickened brittle nails
generalised myxoedema - peri-orbital
facial puffiness
what are the skin manifestations in Addison’s disease?
diffuse hyperpigmentation
palmar crease pigmentation
buccal pigmentation
why is there hyperpigmentation in Addison’s?
absence of normal feedback to pituitary leads to increased ACTH + MSH production = increased melanogenesis
what does MSH-like activity tumours cause and examples of them?
hyperpigmentation
pituitary and lung tumours
what do androgenic activity tumours cause and what are examples?
virilisation
hirsutism
acne
baldness
ovarian tumours
what is seen in chronic discoid lupus erythrmatosus (CDLE)?
photosensitivity
erythematous indurated plaques on exposed sites
follicular plugging
heal with scarring/permanent alopecia
how is diagnosis of CDLE done?
biopsy and IMF
what antibody may be +ve in CDLE?
ANA
what are the risks of DLE?
sun avoidance
potent steroids
oral antimalarials
which antibodies may be seen in subacute cutaneous lupus erythematosus?
+ ANA
may have ro and la too
- not essential for Dx
what are the skin manifestations in SCLE?
annular erythematous scaly plaques, not indurated
symmetrical
no plugging or scarring
photosensitive
widespread rash
what is systemic sclerosis?
microangiopathy leading to inflammation and fibrosis affecting skin and internal organs
what are the skin manifestations in systemic sclerosis?
scleroderma
pinched mouth
beaked nose
matt - facial telangiectasia
sclerodactyly
periungual telangiectasia/ragged cuticles
raynaud’s
dysphasia
calcinosis
(CREST - diffuse)
what are the skin manifestations in dermatomyositis?
photosensitive rash
heliotrope oedema of eyelids
linear finger rash with Gottron’s papules
what are examples of reactive eruptions?
erythema multiforme
erythema nodosum
vasculitis
what are clinical features of erythema multiforme?
HLA subtypes
target/iris lesions
sites: knees, elbow, palms, soles, mucosae
minor - skin only
major - skin + mucosal involvement
what are causes of erythema multiforme?
viral - HSV
infections - TB, strep, mycoplasma
drugs - sulphonamide
malignancy
autoimmune disease
what are clinical features of erythema nodosum?
red, tender, diffuse nodules
joint pains, fever
over shins
slow resolution - like bruise
what are causes of erythema nodosum?
infections - strep, TB, EBV, fungal
drugs - OCP, sulphonamides
IBD
sarcoidosis
