Skin + Systemic Disease Flashcards
What is carcinoid syndrome
Facial telengiectasis Flushing Diarrhoea N+V No sweating
What does carcinoid syndrome indicate
GI cancer with liver mets
Bronchial
Ovarian Ca
What does Ectopic ACTH do
Release of melanin
Hyperpigmentation of skin, gums and greases
How does Paraneoplastic pemphigus present
Erosive stomatitis
Ulceration of mouth and lips
Rash
What is associated with it
Non-Hodgkin’s
Castleman’s disease
What is erythema Graytum Repens
Parenoplastic erythematous lesion
Look at pics
Associated with malignancy particularly lung
What is acquired hypertrichosis
Androgen indedendent hair growth
Acute onset of lanugo hairs at face and body
What causes
Colorectal cancer
Lung and breast
Drugs
Anoreixa
What is Bazex syndrom
Hyperkeratosis of extremeties
Can look like psoriasis so biopsy
What underlies Bazex syndrome
SCC
Gastric / colon / biliary adenocarcinoma
What is Aconthosis Nigrican’s
Symmetrical brown, velvet plaques
Often neck, axilla or groin
Hyperkeratosis
Hyperpigmentation
What is associated with aconthosis nigrican’s
Insulin resistance = benign
- Type II DM
- Obesity
- PCOS
- Acromegaly / Cushing / hypothyroid
- Prader-Willi
- OCP
Malignancy
- GI adenocarcinoma
What is concerning
Lip involvement
Weight loss
What should you look for if dermatomyositis and how
Underlying malignancy in 30% Muscle and skin biopsy CK Ab - ANA / ANti-Jo1 Age / gender cancer screen and follow up 5 years - Smear - PSA - Colonoscopy
How does it present
Inflammatory myopathy Shawl sign - photosensitivity / violet discolouration on sun exposed area Helitrope Rash - violet around eye Telangiectasia Gottron's papules on knuckles Scalp erythema
What is Sweets Syndrome
Juicy nodules limited to neck and UL
What can cause
Post infection
Medication
Tumour
What is acquired ichthyosis
Dry rough skin with scaling
What can cause
Congenital Lymphoproliferaive disorder Autoimmune Nutritional deficiency Tumours Medication
Genetic tumour syndromes
See genetics
What is hereditary haemorrhagic telangiectasia and what system related too
AD
GI
Telangiectasia over skin and mucous membrane
What is criteria
Epistaxis
Telangiectasis of lips / oral cavity / nose
Visceral lesions
FH
What visceral lesions
Hepatic, cerebral or spina AVN
GI telangiectasia with or without bleeding
Risk of haemorrhage
What is needed for Dx
2+ = possible 3+ = definite
What is erythema nodosum
Hypersensitivity reaction leading to inflammation of SC fat
Usually over shins
NOT bruises
Painful, blue red raised nodular lesion
How do you Dx and how long to resolve
6 weeks
Rest and analgesia
Steroid to reduce inflammation
Arrange follow up
Dx = clinical Depends on cause Biopsy CRP and ESR Throat swab for strep Stool MC+S Faecal calprotectin CXR to exclude sarcoid / malignancy / pneumonia Serum ACE
What causes
Granulomatous condition - IBD / Sarcoid / TB / fungal (macrophage around insult)
Drugs - penicillin / COCP / NSAID
Infection - strep / TB / gastroenteritis
Malignancy
Pregnancy
Pneumonic NO - idiopathic D - drugs - penicillin / COCP O - OCP / pregnancy S - sarcoid / TB U - UC / Chron's / Bechet's M - strep / Mycoplasma / EBV
MOST COMMON SARCOID / IBD IN EXAM
What causes pyoderma gangrenosum
IBD Autoimmune hepatitis PBC Granulomatosis with polyangiitis Myeloma Myeloproliferative RA / SLE
How does pyoderma gangreonsum present
Initially small red papule Develop pustular ulcers Tender red / blue Overhanging necrotic edge Purulent surface System fever / myalgia LL
How do you Rx
Oral steroid + ciclosporin = 1st line
What kind of skin disease does Chron’s have
Orofacial granulmatosis - lip swelling, fissures, ulcers
Erythema nodosum
Pyoderma gangrenous
What is another shin lesion relating to Graves’
Pretibilal myxoedema
Symmetrical erythematous lesions above lateral malleoli
Oedema
Shiny orange peel skin
What skin disease associated with rheumatic fever
Erythema marginatum
Pink coalescent rings on trunk
Come and go
What is coeliac associated with
Dermatitis herpetiform
What is dermatitis herpetiform and what leads to this
Autoimmune blistering skin condition due to deposition of IgA in dermis
Itchy vesicles on extensor surfaces in clusters
Cal appear like chicken pox
Systemically well
How do you Dx
Biopsy
Immunoflourescene showing IgA
Coeliac serology - anti-TTG
How do you Rx
Dapsone = Ax and anti-inflammatory
Emollient
Topical steroid
Gluten free diet
What skin manifestations of liver disease
Palmar erythema Spider naevi Gynaecomastia Decreased pubic hair Bruising Scratch marks
What skin manifestation of malabsorption
Dry pigmented skin
Bruising
Hair loss
What skin conditions associated with underlying malignancy
Acanothosis nigrican
Dermatomyositis
Thrombophlebitis
Mets in skin
What can DM cause
Acanthosis nigrican Diabetic bullae Eruptive xanthoma due to hyperlipid Diabetic dermopathy Carotenemia Acral erythema Disseminated granuloma
What is disseminated granuloma
Papular lesion
Hyperpigemnted
Dorsal surface of hands, feet and extensors of arms and legs
Who is at risk of vitamin deficiency
Elderly
Alcohol
Eating disorder
Isoniazid therapy - B3
What vitamin important for skin and what happens if deficienct
Vit A
Hyperkeratosis
What are the 5D’s of niacin (B3) deficiency ‘pellagra’ and where does it affect
Neck region + photosensitive areas Dermatitis Dementia Diarrhoea Depression Death
What is scurvy
Lack of vitamin C
What can scurvy cause
Bruising Gum infection Hair loss Fatigue Weakness GI haemorrhage
What is alopecia acreata
Autoimmune condition causing localised, well demarcated patterns of hair loss
May have small broken exclamation marks at edge of hair loss
Can it grow back
Yes
What are DDX
Scarring alopecia Androgenic alopecia PCOS Stress Hypothyroid
What is scarring
Attack of follicle = fibrosis
Will not grow back
What is androgenic linked to
Autoimmune thyroid
Pernicious anaemia
How do you investigate
FBC, ferritin, thyroid if generalised hair loss
Ask about menstrual if suspect PCOS
How do you Rx
Topical steroid
Phototherapy
Immunotherapy
Wigs
What is vitiligo
Autoimmune condition resulting in loss of melanocytes and depigmentation Causes white patches Well demarcated Hyperpigmented Sunlight = itch Koebner +Ve
What is associated
Type 1 DM Addison Autoimmune thyroid Pernicious anaemia Alopecia acreata Premature ovarian failure
How do you Rx
Suncream
Camoflauge make up
Topical corticosteroids can reverse
If patients presents with nail ridging what should you do
Routine bloods
Can be a sign of a more serious underlying problem / anaemia
What is Peutz Jegher
AD
Haemartous polyp
Pigmented macule around lips, face, palms, soles
Can cause obstruction / intusscetpion / GI bleed
What can it be a sign of
COlon cancer
What are Muir Torre
Facial bumps
What do you do
Biopsy to see if sebaceous tumour
If lots
Risk of GI and breast cancer
What is Xeroderma pigmentosum
Genetic inability to repair sun damage
What can be underlying
Sarcoma
Leukaemia
GI
Lung
What is Howel exams
Palmar keratoderma
What is underlying
Usually oesophageal cancer
What is Kaposi Sarcoma
Vascular malignancy driven by HHV-8
How does it present
Mucosal and cutaneous purple tumour
Can be visceral
Who is affected
Immunocompromised
How do you investigate
HIV test for all
Biopsy as could be bacillary angiomatosis (bacteria)
How do you Rx
ART
Lower dose immunosuppressoin
Direct removal
What is migratory thrombophlebitis
Palpable nodular cord
Pain and induration along superficial vein
Can have previous episodes
What causes
Clots leading to inflammation
Often underlying malignancy
Typically pancreatic
How do. you investigate
USS / CT for pancreatic
