Skin Signs of Systemic Disease Flashcards
What are some reasons why there are different skin findings and give some examples
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
What are three “neurologic” skin disorders?
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
What are some endocrine-related skin conditions?
- Diabetes
- Hyperthyroidism
- Hypothyroidism
- Addison’s Disease
- Cushing’s Syndrome
What are some skin conditions related to diabetes?
Acanthosis Nigricans, Yellow skin, Brown patches on lower legs, Foot uclers (mal perforans)
List the cardiovascular-related skin disorders
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
What happens to your skin pigment with Addison’s disease?
It gets darker (see power point slide of two sisters)
How can stretchy skin in Ehlers-Danlos syndrome indicate heart problems?
Some types at risk for aortic and valve disease
What organ system is involved in Sarcoidosis, Scleroderma, Tuberculosis?
Pulmonary
What are some GI related diseases?
Pyoderma Gangrenosum: punched out ulcers that enlarge
Dermatitis Herpetiformis: gluten sensitivity
Excesses
Genetic: Gardner’s Syndrome, Muir-Torre Syndrome, Peutz-Jeghers
Vitamin deficiencies
Out of the 11 criteria for diagnosing lupus, name the four that can be diagnosed with a skin exam
- M–Malar rash ****
- D–Discoid rash ****
- S–Serositis
- O–Oral Ulcers ****
- A–ANA+
- P–Photosensitivity ***
- B–Blooddisorders
- R – Renal Involvement
- A – Arthritis (joint effusions can be seen)
- I – Immunologic
- N – Neurologic
***Usually presents with “mystery rash” on face
How can seborrheic dermatitis (A more severe form of common dandruff) inform of other diseases?
Seen with Parkinson’s, after head trauma, HIV(New onset severe), chronic neurologic conditions such as cerebral palsy
T/F: a good technique for expanding (Pyoderma Gangrenosum) ulcers is debridement
False
NEVER DEBRIDE, will only enlarge
Also, it is often associated with inflammatory bowel disease
How can skin findings of thickened skin over fingers and hands, skin tightening around mouth, and Raynaud’s, inform of other diseases?
Scleroderma
Commonly develop pulmonary hypertension, however pericarditis has poorest prognosis
Give examples of how renal diseases can show skin signs
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
How is Dermatitis Herpetiformis related to GI conditions?
Gluten sensitivity –skin shows extremely pruritic, pinpoint vesicles on extensor elbows, knees and sacrum, often excoriated and crusted when seen
How do you recognize dermatomyositis? And how can it indicate other diseases?
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
How can rapid onset psoriasis be concerning?
Could indicate HIV
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?
Acanthosis nigricans»_space;»> could be diabetic
90% of time is related to glucose/ metabolic problems
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?
Infective endocarditis!
In a child with a large hemangioma on face and neck, what could this indicate?
PHACES syndrome:
Cardiac findings include aortic coarctation, atrial and ventricular septal defects and abnormal cervical and vertebral arteries
44 year old Dutch man with new onset of itchy rash on wrists and lower legs, sores in mouth… what could it be?
Lichen Planus
High prevalence with hep C
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
Porhyria Cutanea Tarda
hepatic disease, associated with hepatitis
What are Cullen’s sign and Grey Turner sign?
Big bruises on abdominal area
***Blood trauma, hemorrhage, pancreatitis
What is one of the top reasons for hair loss in women?
Iron deficiency
What could be indicated with “nail changes”
Lindsay’s disease (renal)
Cirrhosis, CHF
T/F: Cancers commonly metastasize to face
True
Renal, lung and breast cancer mets
What’s a “must know” if you see a patient from the south pacific with wood grain spots?
(Erythema gyratum repens)
Lung disease!
What’s a “must know” if you see a patient with acquired lanugo on face?
(Hypertrichosis lanuginosa acquisita)
Lung disease!
What’s a “must know” if you see a patient with tripe palms?
adenocarcinoma!
What’s a “must know” if you see a patient with rapid onset (erupted) seborrheic keratosis everywhere?
Lesser Trellat sign
could lead to malignancies!
What’s a “must know” if you see an adult female patient with a shawl sign (sunburn around exposed chest area)?
Dermatomyositis
uterine, ovarian cancer!
What’s a “must know” if you see a node by belly button?
Sister Mary Joseph Node
GI or pancreatic cancer!
What’s a “must know” if you see plump, shiny, red bumps on head, legs, etc?
Think leukemia or lymphoma
What’s a “must know” if you see an old person with large postules on hands and fever?
Underlying heme malignancy
AML!
What’s a “must know” if you see target spots/ rashes (erythema multiforme)?
Herpes or drug reaction
***Drug reactions are always on trunk
What’s a “must know” if you see big painful nodules on shins
Infection (TB) or pregnancy
Describe how some patterns and colors can help you with your diagnosis?
> 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
