Skin Signs of Systemic Disease - Wilson Flashcards
What are some skin manifestations seen in Diabetes Mellitus?
Diabetic Dermopathy, Bullous Diabeticorum, Necrobiosis Lipoidica, and Acanthosis Nigricans.
Tinea/Candidiasis, Cellulitis, MRSA, Neuropathic ulcers, PAD & gangrene.
Acanthosis Nigricans
In which conditions is it seen?
Where is it distributed?
Describe its appearance.
Acanthosis Nigricans
Type II DM. (3; 1 = familial, 2 = malignancy)
Intertriginous skin (less on extensor surfaces).
“Velvety hyperpigmentation” & thickening. Acanthosis = separation of epidermis & dermis.
Diabetic Dermopathy
Describe its appearance & distribution.
What does it signify?
Diabetic Dermopathy
Atrophic macules in the lower legs.
May be a marker for poor diabetic management.
Bullous Diabeticorum
Describe its appearance and distribution.
Anything else interesting?
Bullous Diabeticorum
Blisters of the lower extremity, generally in acral locations.
M>F. Recurrent, w/ no treatment available.
Necrobiosis Lipoidica
Describe its appearance & distribution.
How does it compare to the other diabetic skin findings?
Necrobiosis Lipoidica
Yellow-orange atrophic plaques on the bilateral shins. May ulcerate.
Rarest. Very hard to treat.
Contrast the skin findings in hyperthyroidism with hypothyroidism.
Hyper: Smooth, warm & moist skin. Hyperpigmented. Fine hair. Pruritis & onycholysis.
Hypo: Rough, cool & dry skin. Pale. Coarse hair. Carotenemia & keratoderma. Brittle nails.
What is pretibial myxedema?
What condition is it usually associated with?
Mucinous infiltration of the pretibial skin. Firm? Peau d’orange.
Seen in 1-5% of Grave’s disease (hyperparathyroidism)
Why is hyperpigmentation seen in Addison’s disease?
Recall some of the other skin findings.
ACTH acts somewhat like MSH to darken the skin.
Loss of ambisexual hair, fibrosis/calcification of cartilage (eg ear).
Cushing’s disease has many characteristic symptoms (“Milwaukee syndrome”). Try to recall the ones that involve the skin.
Striae Distensae and Hirsutism are the skin findings.
Others: Moon facies, buffalo hump, truncal obesity & spindly limbs.
Distinguish between skin findings in acute SLE and DLE (“Discoid Lupus Erythematosus”)
Acute SLE: Malar rash (sometimes photosensitive). Resolves without scarring.
Discoid SLE: Hyperkeratotic, violaceous plaques that leave scarring.
*Discoid findings sometimes (but not always) seen in acute SLE.
What the heck is SCLE? What are its skin findings?
Subacute cutaneous Lupus Erythematosus; usually skin-limited. Polycyclic, scaly pink rashes on sun-exposed areas.
See if you can remember the skin signs of Dermatomyositis.
What are some other clinical signs of this illness?
Heliotropic rash (on eyelids), Gottron’s papules. Photosensitive Dermatitis. Nailbed vascular knockout.
Inflammatory markers, proximal muscle weakness, elevated CK, abnormal EMG & MRI?
What patient populations are often affected by dermatomyositis?
Recall an important association with dermatomyositis.
Adults & children equally, but preference for women.
In adults, associated with cancers, especially ovarian.
What is sarcoidosis characterized by?
How does it present in the skin?
What is Lofgren’s syndrome?
Non-caseating granulomas.
Nonspecific brown-red papules/plaques. Periorbital?
An acute form of sarcoidosis characterized by hilar lymphadenopathy, erythema nodosum, fever, iritis and arthritis.
What is the defect seen in Porphyria cutanea tarda?
What are the skin findings?
Either genetic defect in uroporphyrin decarboxylase or system stress by HepC/EtOH/drugs/iron.
Fragile blistering due to trauma or sun. Hands. Face hypertrichosis?
