Skin signs of Systemic Disease

Question 1

What is sudden onset seborrheic dermatitis associated with?

Answer 1

Neurological disorders (especially Parkinson’s)

Head trauma

PTSD

HIV

Think = dandruff, above the neck

Question 2

What is acanthosis nigricans associated with?

Answer 2

Can be familial (AD, rare)

Number 1 cause: obesity

Diabetes mellitus (inuslin resistance, metabolic syndrome)

Can be various endocrinopathies: cushing’s, polycystic ovary syndrome

Drugs (rare, nicotinic acid or steroids)

CANCER: rapid onset of acanthosis nigricans associated w/ weight loss, 60% adenocarcinoma oft he stomach (also lung and breast cancer)

Question 3

Janeway lesions
Splinter hemorrhages in nails
Osler nodes
Roth spots

Answer 3

May be symptoms of infective endocarditis -> usually a pre-existing valvular dysfunction, or strep. viridans from teeth

Question 4

Cardiac signs (Ehlers-Danlos and hemangioma over lower face, mouth and neck)

Answer 4

Ehlers-Danlos -> dilated roots, dissections. (stretchy skin)

Kid w/ large hemangioma involving lower face, mouth and neck -> Phacies syndrome, can have hemangioma but whats important is cardiac abnormalities

Question 5

Systemic scleroderma

Answer 5

Skin findings include:

thickened skin over fingers and hands
Skin tightening around the mouth
Raynaud’s
Esophogeal/GI dymotility and strictures

Develop pulmonary hypertension (bad) or pericarditis (worse)

ANA+ 80-90%
Anti-centromere Ab in limited
acti-scl70 in systemic

Question 6

Sarcoidosis

Answer 6

Bilateral hilar lymph adenopathy w/ these skin findings (hyperpigmented, ulcerations) -> sarcoidosis (infiltrative!) -> on biopsies you see granulomas forming, we don’t know what your body is trying to wall off.

Question 7

Lichen plantus

Answer 7

Extremely itchy rash w/ mucosal lesions in 15-25% of people

Purple, polygonal, pruiritic papules

Wickham’s striae - an overlying lace-like pattern on surface

PREVELENCE OF HCV IS PRETTY HIGH!!!

Localized oral only can be associated w/ fillings and improved with removal

Question 8

Porhyria Cutanea Tarda

Answer 8

Assocaited w/ hepatitis
Due to a deficiency in uroporhydrinogen decarboxylase
(often treated w/ serial phlebotomy to decrease iron load)

Question 9

Pyoderma gangrenosum

Answer 9

Expanding ulcer - often begins at site of minor trauma. Necrotic, undermined borders. Lower extremities and very painful.

50-70% have underlying condition - THINK ABOUT INFLAMMATORY BOWEL DISEASE

Sometimes arthritis, monoclonal gammopathy, or other hemologic disorders (leikemia, myelofibrosis…)

Question 10

Koilonychia

Answer 10

Spoon nails!
Seen with chornic iron deficiency anemia

Also can be seen w/ Linday’s (renal disease)

Terry’s - cirrhosis

Question 11

Systemic lupus Erythematosus

Answer 11

M - malar rash
D - discoid rash
O - oral ulcers
P - photosensitivity

Mystery rash and symptoms, think connective tissue disease

Question 12

More signs of malignancy

Answer 12

Leser trellat sign
Dermatomyositis (shawl sign) - lung cancer
Sister mary Joseph node (below belly button?) - direct extension of malignancy, GI.