Skin Signs of Systemic Disease

Question 1

What are some reasons why there are different skin findings and give some examples

Answer 1

Endogenous pigment – Addison’s
Exogenous pigment - Argyria
Metabolic – Thyroid and Diabetes
Nutritional – Vitamin deficiencies
Genetic
Structural – Ehlers-Danlos
Abnormal signal – GI cancer syndromes (Gardner’s) Infiltration - Xanthomas
Photo-related - Lupus

Question 2

What are three “neurologic” skin disorders?

Answer 2

a. Seborrheic Dermatitis – A more severe form of common dandruff that can affect the scalp, face and even upper torso
b. Neurofibromas – skin, pink or tan to brown colored soft, rubbery, compressible papules
c. Angiofibromas

Question 3

What are some endocrine-related skin conditions?

Answer 3

1. Diabetes
2. Hyperthyroidism
3. Hypothyroidism
4. Addison’s Disease
5. Cushing’s Syndrome

Question 4

What are some skin conditions related to diabetes?

Answer 4

Acanthosis Nigricans, Yellow skin, Brown patches on lower legs, Foot uclers (mal perforans)

Question 5

List the cardiovascular-related skin disorders

Answer 5

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

Endocarditis: Skin findings include splinter hemorrhages, purpura, nail fold changes,

(For Peds)PHACES Syndrome:
-Cardiac findings include aortic coarctation, atrial and ventricular septal defects

Marfan’s syndrome

Question 6

What happens to your skin pigment with Addison’s disease?

Answer 6

It gets darker (see power point slide of two sisters)

Question 7

How can stretchy skin in Ehlers-Danlos syndrome indicate heart problems?

Answer 7

Some types at risk for aortic and valve disease

Question 8

What organ system is involved in Sarcoidosis, Scleroderma, Tuberculosis?

Answer 8

Pulmonary

Question 9

What are some GI related diseases?

Answer 9

Pyoderma Gangrenosum: punched out ulcers that enlarge
Dermatitis Herpetiformis: gluten sensitivity
Excesses
Genetic: Gardner’s Syndrome, Muir-Torre Syndrome, Peutz-Jeghers
Vitamin deficiencies

Question 10

Out of the 11 criteria for diagnosing lupus, name the four that can be diagnosed with a skin exam

Answer 10

1. M–Malar rash ****
2. D–Discoid rash ****
3. S–Serositis
4. O–Oral Ulcers ****
5. A–ANA+
6. P–Photosensitivity ***
7. B–Blooddisorders
8. R – Renal Involvement
9. A – Arthritis (joint effusions can be seen)
10. I – Immunologic
11. N – Neurologic

***Usually presents with “mystery rash” on face

Question 11

How can seborrheic dermatitis (A more severe form of common dandruff) inform of other diseases?

Answer 11

Seen with Parkinson’s, after head trauma, HIV(New onset severe), chronic neurologic conditions such as cerebral palsy

Question 12

T/F: a good technique for expanding (Pyoderma Gangrenosum) ulcers is debridement

Answer 12

False
NEVER DEBRIDE, will only enlarge

Also, it is often associated with inflammatory bowel disease

Question 13

How can skin findings of thickened skin over fingers and hands, skin tightening around mouth, and Raynaud’s, inform of other diseases?

Answer 13

Scleroderma

Commonly develop pulmonary hypertension, however pericarditis has poorest prognosis

Question 14

Give examples of how renal diseases can show skin signs

Answer 14

a. Metastatic renal cancer commonly metastasizes to the skin and can be noted as a bright red, very vascular, rapidly enlarging lesion
b. Henoch-Schonlein Purpura – vasculitic lesions on legs that extend to buttocks classically (more than lower leg vasculitis) will commonly have renal complication of glomerulonephritis

Question 15

How is Dermatitis Herpetiformis related to GI conditions?

Answer 15

Gluten sensitivity –skin shows extremely pruritic, pinpoint vesicles on extensor elbows, knees and sacrum, often excoriated and crusted when seen

Question 16

How do you recognize dermatomyositis? And how can it indicate other diseases?

Answer 16

Dermatomyositis – Skin findings include purple, heliotrope rash on eyelids, shawl sign on upper torso, erythema/dryness/fissuring or palms, cuticle changes, erythema on dorsal hands over joints (Gottron’s papules)

**Important because can be associated with pulmonary fibrosis and genitourinary cancer, especially in women with rapid onset of severe symptoms

Question 17

How can rapid onset psoriasis be concerning?

Answer 17

Could indicate HIV

Question 18

37 year old Hispanic Female with history of mild hypertension, hypercholesterolemia, BMI 30 and new onset of soft dark areas in skin folds, hands and neck…..

What do you call those dark skin folds and what does it indicate?

Answer 18

Acanthosis nigricans&raquo_space;»> could be diabetic

90% of time is related to glucose/ metabolic problems

Question 19

Your patient has had a fever of unknown origin. Skin findings: 
Splinter hemorrhages in nails
Janeway lesions
Osler nodes
Roth spots

What could it be?

Answer 19

Infective endocarditis!

Question 20

In a child with a large hemangioma on face and neck, what could this indicate?

Answer 20

PHACES syndrome:

Cardiac findings include aortic coarctation, atrial and ventricular septal defects and abnormal cervical and vertebral arteries

Question 21

44 year old Dutch man with new onset of itchy rash on wrists and lower legs, sores in mouth… what could it be?

Answer 21

Lichen Planus

High prevalence with hep C

Question 22

What is the name of the “vampire disease” with the following symptoms and what disease is it associated with?

blistering on hands, light sensitive, urine could glow

Answer 22

Porhyria Cutanea Tarda

hepatic disease, associated with hepatitis

Question 23

What are Cullen’s sign and Grey Turner sign?

Answer 23

Big bruises on abdominal area

***Blood trauma, hemorrhage, pancreatitis

Question 24

What is one of the top reasons for hair loss in women?

Answer 24

Iron deficiency

Question 25

What could be indicated with “nail changes”

Answer 25

Lindsay’s disease (renal)

Cirrhosis, CHF

Question 26

T/F: Cancers commonly metastasize to face

Answer 26

True

Renal, lung and breast cancer mets

Question 27

What’s a “must know” if you see a patient from the south pacific with wood grain spots?

Answer 27

(Erythema gyratum repens)

Lung disease!

Question 28

What’s a “must know” if you see a patient with acquired lanugo on face?

Answer 28

(Hypertrichosis lanuginosa acquisita)

Lung disease!

Question 29

What’s a “must know” if you see a patient with tripe palms?

Answer 29

adenocarcinoma!

Question 30

What’s a “must know” if you see a patient with rapid onset (erupted) seborrheic keratosis everywhere?

Answer 30

Lesser Trellat sign

could lead to malignancies!

Question 31

What’s a “must know” if you see an adult female patient with a shawl sign (sunburn around exposed chest area)?

Answer 31

Dermatomyositis

uterine, ovarian cancer!

Question 32

What’s a “must know” if you see a node by belly button?

Answer 32

Sister Mary Joseph Node

GI or pancreatic cancer!

Question 33

What’s a “must know” if you see plump, shiny, red bumps on head, legs, etc?

Answer 33

Think leukemia or lymphoma

Question 34

What’s a “must know” if you see an old person with large postules on hands and fever?

Answer 34

Underlying heme malignancy

AML!

Question 35

What’s a “must know” if you see target spots/ rashes (erythema multiforme)?

Answer 35

Herpes or drug reaction

***Drug reactions are always on trunk

Question 36

What’s a “must know” if you see big painful nodules on shins

Answer 36

Infection (TB) or pregnancy

Question 37

Describe how some patterns and colors can help you with your diagnosis?

Answer 37

> Red–infection, inflammation, exogenous pigment
Yellow – do not miss subtle scleral icterus, remember exogenous pigment like carotenemia
Blue/Gray – Circulation, pigment, chemo side effect, cold, deposition disease (Argyria)
Sallow–Renaldisease
Pale–Anemia
Flushed – plethoric, habitus, exertion etc
Brown–chemo reaction, Addison’s,medicationsideeffect
Geometric – likely not internal cause
Photodistributed – Rheumatologic, genetic, medication related