Skin Signs of Systemic Disease

Question 1

What neurological diseases are associated with seborrheic dermatitis?

Answer 1

1. Parkinson’s Disease 2. Head trauma 3. HIV (New onset severe) 4. Cerebral palsy

Question 2

What neurological disease is associated with neurofibromas?

Answer 2

Neurofibromatosis

Question 3

What neurological disease is associated with angiofibromas?

Answer 3

Tuberous sclerosis complex

Question 4

A patient comes in with acanthosis nigricans, yellow skin, brown patches on lower legs and foot ulcers (mal perforans). What do you suspect this person is suffering from?

Answer 4

Diabetes

Question 5

Hyperthyroidism is associated with what skin findings?

Answer 5

Smooth, warm, moist skin. Pretibial myxedema

Question 6

A patient comes in with dry skin, brittle nails, sparce hair, delayed wound healing, puffy madarosis (loss of lateral 3rd of eyebrow). What endocrinological disorder should you associate with these symptoms?

Answer 6

Hypothyroidism

Question 7

Addison’s disease has what associated skin finding?

Answer 7

Increased pigmentation including diffusely on skin, especially on palmer creases

Question 8

A patient comes in with round face, moon facies, “buffalo hump”, increased fat in arms, legs and waistline, skin thinning, increased ecchymosis and purpura, striae, and delayed wound healing. What is your diagnosis?

Answer 8

Cushing’s Syndrome

Question 9

A patient comes in with increased joint and skin elasticity, poor wound healing with large scars and increased ecchymoses? What disease does this patient most likely have? What other symptoms would you worry about?

Answer 9

Ehlers-Danlos -Some types at risk for aortic and valve disease

Question 10

PHACES syndrome is associated with aortic coarctation, atrial and ventricular septal defects and abnormal cervical and vertebral arteries. What dermatologic symptoms is also found with this disorder?

Answer 10

Large hemangioma of face and neck

Question 11

You’ve been seen John, a Marfan’s patient, for 2 years in you family practice clinic. He is at risk of dilation and dissection of the ascending aorta, mitral valve prolapse and regurgitation. What dermatological findings does you patient most likely have?

Answer 11

Decreased subcutaneous fat

Question 12

Sarcoidosis has what associated skin findings?

Answer 12

Hyperpigmented plaques, erosive and ulcerated plaques, granulomatous reactions in tattoos

Question 13

Scleroderma has what skin findings?

Answer 13

Thickened skin over fingers and hands, skin tightening around mouth, Raynaud’s

Question 14

Tuberculosis has what skin findings?

Answer 14

Scrofuloderma on neck Lupus vulgaris Tuberculoid reactions Cutaneous TB lesions when disseminated

Question 15

Viral hepatitis B and C leads to what skin findings?

Answer 15

Lichen planus

Vasculitis

Cryoglobulinemia

Polyarteritis nodosa

Porphyria cutanea tarda

Prurius

Question 16

What causes blistering lessions on hands with sun exposure, hypertrichosis and trophic scars with milia?

Answer 16

Porphyria Cutanea Tarda

Question 17

Name three gastrointestinal related genetic disorders that result in skin involvment.

Answer 17

1. Gardner’s Syndrome
2. Muir-Torre Syndrome
3. Peutz-Jeghers

Question 18

What genetic condition results in 100% cancer risk, multiple epidermoid cysts in almost all, desmoid tumors, fibromas, lipomas, osteomas of mandible/maxilla, impacted teeth, supernumerary teeth, dental cysts, and early tooth loss?

Answer 18

Gardner’s Syndrome

Question 19

What genetic condition results in polups, GI/breast/uterine/laryngeal cancer, NHL, sebaceous neoplasms on the skin and multiple keratoacanthoma type of squamous cell carcinoma?

Answer 19

Muir-Torre Syndrome

Question 20

What genetic condition results in polyps, GI bleed and intussusception, testicular/breast/ovary/pancreatic/gallbladder cancer risk, shows freckling around mouth, on lips and mucosa from young age?

Answer 20

Peutz-Jeghers

Question 21

What disorder results in punched out ulcers that can rapidly enlarge, is associated with inflammatory bowel disease, and can present with internal lesions on organs?

Answer 21

Pyoderma Gangrenosum

Question 22

What disorder reults in this? Should you debride?

Answer 22

Pyoderma gangrenosum

NOOOOOOO NEVVVVVVEEEEERRRRRR!

Question 23

Vitamin A deficiency leads to….

Answer 23

phrynoderma or toad skin, diffuse xerosis and xerophthalmia, Bitot’s spots, increase mortality with measles

Question 24

Vitamin K results in….

Answer 24

Bruising, purpura, increased bleeding

Question 25

B1/Thiamine deficiency leads to…

Answer 25

Beri Beri, glossitis, glossodynia, edema

Question 26

B3/Niacin deficiency leads to….

Answer 26

Pellagra

Dermatitis

Diarrhea

Dementia

Question 27

B6/Pyridoxine deficiency leads to…

Answer 27

Glossitis with ulcerations

Seborrheic dermatitis

Cheilitis

Question 28

B12/Cyanocobalamin deficiency leads to…

Answer 28

Atrophic red tongue

Hyperpigmentation

Hair loss

Graying of Hair

Vitiligo like changes

Question 29

Vitamin C deficiency leads to…

Answer 29

Corkscrew hairs

Gingival bleeding

perifollicular bleeding/petechiae

Increased hemorrhage

Pseudoparalysis

Question 30

Zinc deficiency leads to….

Answer 30

Erythema and peeling around mouth, anus/groin and hands and feet

Hair loss

Pustules or bleeding lesions around nails

Blepharitis

Stomatitis and glossitis

Question 31

Iron deficiency leads to…

Answer 31

koilonychia

Hair loss

angular cheilitis

Question 32

What is marasmus?

Answer 32

Disorder due to lacking of protein and calories >>>

dry, loose, wrinkled skin

Question 33

What leads to kwashiorkor?

Answer 33

A lack of just proteins>>Potbelly, loss of color in hair to red or grey and flag sign in hair

Question 34

A hippie chick is eating a crap ton of vegetables and no meat. She’s turning orange, it’s hilarious. What does she have?

Answer 34

Carotenemia

Question 35

What causes dermatitis herpetiformis?

Answer 35

Gluten sensitivity- skin shows extremely pruritic, pinpoint vesicles on extensor elbows, knees and sacrum

Question 36

Where does Henoch-Schonlein Purpura commonly present?

What system is asssociated with Henoch-Schonlein Purpura?

Answer 36

Vasculitic lesions on legs that extend to buttock classically

Renal complication of glomerulonephritis

Question 37

4 out of the 11 creiteria for lupus are diagnosed through the skin exam. What are they?

Answer 37

Malar rash

Discoid rash

Oral ulcers

Photosensitivity

Question 38

Neonatal lupus presents with

Answer 38

erythematous annular lesions

THESE BABIES HAVE HEART BLOCKS 50% OF THE TIME

Question 39

CREST- painful calcium filled lesions in fingers is associated with what rheumatological disorder?

Answer 39

Scleroderma

Question 40

What are the skin findings of someone with dermatomyositis?

Answer 40

Skin findings include:

purple

Heliptrope rash on eyelids

Shawl sign on upper torso

Erythema/dryness/fissuring or palms

Cuticle changes

Erythema on dorsal hands over joint (Gottron’s papules)

Question 41

Why is it important to make a quick diagnosis of dermatomyositis?

Answer 41

Because it is associated with pulmonary fibrosis and genitourinary cancer

Question 42

Acantosis nigricans with tripe palms, paraneoplastic pemphigus, and erythema gyratum repens (wood grain rash on torso) are all signs of what underlying disorder?

Answer 42

Paraneoplastic syndrome (Think GI malignancy)

Question 43

What is telogen effluvium?

Answer 43

Rapid hair loss

Question 44

Ear creases can indicate what risk?

Answer 44

Cardiovascular risk