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Dermatology Diploma > Skin & Systemic Disease > Flashcards

Skin & Systemic Disease Flashcards

1
Q

In Diabetes Mellitus, what condition is this called?

Describe it.

A

Diabetic Dermopathy

Atrophic macules and patches on the shins.

(Possibly due to trauma)

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2
Q

In Diabetes Mellitus, what condition is this called?

A

Diabetic Bullae

Tense non-inlammatory bullae on the lower limbs.

Unknown why it happens.

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3
Q

In Diabetes Mellitus, what condition is this called?

Describe it.

A

Necrobiosis Lipoidica

  • Very common. Yellow atrophic plaques on the anterior shins.
  • Collagen degeneration with a granulomatous response.
  • SCC can develop from chronic lesions.
  • Can Ulcerate.
  • TREATMENT: Very resistant. Can try potent topical steroids, intralesional steroids, topical PUVA or narrow band UVB. Occasionally tacrolimus.
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4
Q

In Diabetes Mellitus, what condition is this called?

Describe it.

A

Acanthosis Nigricans

  • Common in high BMI and insulin resistance.
  • Pathology: IGF propagates epidermal growth.
  • More common in pigmented skin.
  • Treatment: Pigmanorm or topical retinoids.
  • Pigmanorm( hydroquinone 5%, tretinoin 0.1g, hydrocortisone 1g)
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5
Q

In Diabetes, What condition is this?

A

Partial Lipodystrophy

Atrophy of subcutaneous tissue secondary to insulin use.

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6
Q

In Diabetes, what condition is this called?

A

Scleredema of Buschke

  • Only seen in diabetes
  • Induration of the skin in the upper back and nape of neck.
  • Due to deposits of glycosaminoglycans.
  • Skin feels woody and hard to touch.
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7
Q

In thyroid disease, what is this called?

Is it common?

What form of thyroid disease is it associated with?

A

Thyroid Acropachy

  1. Not Common
  2. Grave’s Disease
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8
Q

In Thyroid disease, What is this?

What form of thyroid disease is it associated with?

Does it reverse with treatment?

A

Pretibial Myxoedema

  • Associated with Grave’s Disease
  • Peau dórange appearance
  • Treatment: intralesional steroids or steroids under occlusion.
  • It does not reverse with treatment.
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9
Q

What can happen to eyebrows in thyroid disease?

A

The lateral third of the eyebrow may be lost.

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10
Q

What cutaneous features do we see in Cushings Disease?

A
  • Subcutaneous fat redistribution - mood face, buffalo hump.
  • Skin atrophy - global atrophy of epidermis and dermis.
  • Cutaneous infections - candidiasis, pityriasis versicolor.
  • Appendageal effects - steroid-related acne, hirsutism.
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11
Q

What are some cutaneous manifestations in addison’s disease?

A

The Excess ACTH stimulates melanin production by melanocytes

  • Pigmentation in mucosal surfaces, palmar creases, nail beds and in scars.
  • Vitiligo
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12
Q

In IBD, what is this?

What are some other non-IBD causes for it?

A

Erythema Nodosum

  • idiopathic - most common
  • Streptococcal infections - upper respiratory tract.
  • Drugs - oestrogens, COCP, pinicillin, iodides, sulphonamides.
  • Sarcoidosis
  • Behcet’s disease
  • Sweet’s syndrome
  • Pregnancy
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13
Q

What investigations should be done in Erythema Nodosum?

A
  • Thorough drug history
  • Infection screen - viral and bacterial cultures, stool cultures, urine, Sputum, Serum ACE levels & Calcium, CXR and Heaf test.
  • Skin Biopsy - needs ot be a deep incisional biopsy - not a punch biopsy - subcutis needs to be obtained where a panniculitis is seen.
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14
Q

What is the treatment for Erythema Nodosum?

A
  • Treat the underlying cause.
  • Rest and NSAIDs
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15
Q

What is this?

A

Leucocytoclastic Vasculitis

(Seen in both UC and Crohns)

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16
Q

What condition is this in IBD and where on the body is it usually found?

What investigations should you do?

A

Pyoderma gangrenosum

  • Lower limbs
  • Investigations: look for inflammatory bowel disease, rheumatoid arthritis or malignancy.
    • Biopsy - primarily to exclude other causes.
  • DO NOT HAVE SURGEONS DEBRIDE - it will only make it worse.
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17
Q

What is the most common skin manifestation in Coeliac disease?

A

Dermatitis Herpetiformis

  • Intensly itchy
  • Most common on buttocks, scalp and extensor surfaces.
  • Biopsy shows neutrophil microabscesses in the dermal papilla.
    • IMF has granular IgA deposition.
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18
Q

Whats a cutaneous sign of liver cirrhosis?

A

Palmar erythema

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19
Q

What are some signs of Hepatitis C infection?

A
  • Lichen Planus
  • Small vessel vasculitis
  • Cryoglobuinaemia
  • Pruritus
  • Porhyria Cutanea Tarda

(Picture on the other page is lichen planus)

(This picture - Porphyria Cutanea Tarda - blisters and erosions and milia on sun-exposed areas.)

20
Q

In patients with sarcoidosis, what fraction have affected skin?

21
Q

What organ is most commonly affected in sarcoidosis?

22
Q

What are the cutaneous patterns sarcoidosis can manifest like?

A
  • Papules
  • Plaques
  • Hypopigmented patches
  • Subcutaneous Nodules (including Erythema Nodosum)
  • Annular
  • Ulcerative
  • Scar sarcoid
23
Q

What pattern of lupus is this?

Tell me a bit about it

A

Lupus Pernio

  • Nodules & plaques
  • Form on the nose, ears, cheeks.
  • 75% have chronic lung involvement
  • It is resistant to treatment
  • Scarring
24
Q

What pattern of sarcoid is this?

A

Annular Sarcoid

25
Q

What pattern of sarcoid is this?

A

Paular and Nodular Sarcoid

26
Q

What ungual (nail) signs can be seen in sarcoidosis?

A
  • Clubbing
  • Subungual hyperkeratosis
  • Onycholysis
27
Q

What is the hallmark feature of sarcoid?

A

Naked Granulomas

“Dermal epithelioid granulomas without an inflammatory infiltrate.”

28
Q

What are some other investigations for Sarcoid?

A
  • Chest X-Ray usually shows pulmonary infiltrates + Bi-Hilar Lymphadenopathy.
  • ANA is usually positive (30%)
  • Serum ACE is raised in 60%.
  • Lymphopenia and Hypercalcaemia can also be present.
29
Q

What is the treatment of sarcoidosis?

A
  • Corticosteroids (topically, intralesionally or sometimes systemically.)
  • Calcineurin inhibitors (Tacrolimus) & Hydrocychloroquine can be useful adjuncts.
  • Immunosuppression - methotrexate - this usually requires an MDT approach.
30
Q

What is this?

A

Lupus Vulgaris

(The Commonest form of Cutaneous TB)

An apple jelly appearance under dermoscopy.

31
Q

What is the triad of Wegner’s Granulomatosis?

What cutaneous manifestations can occur with it?

A
  1. Systemic vasculitis
  2. Necrotising Granulomatous Inflammation of the repistory tract
  3. Glomerulonephritis

Skin lesions can be

  • Nodules
  • Petechiae
  • Purpura
  • Pyoderma-gangrenosum-like lesions.
32
Q

What is this and what conditions is it associatied with if secondary/acquired? (Hence to always test for)

A

Acquired/Secondary Ichthyosis

  • Lymphoma
  • HIV
33
Q

What is this called?

What is it associated with?

A

Migratory Erythemas

Associated with malignancy so ALWAYS do a full malignancy screen.

34
Q

What is this?

A

Heliotropic exfoliative plaques affecting the eyelids and cheeks

(Classic of Dermatomyositis)

35
Q

What are the two types of dermatomyositis?

What is malignancies is adult dermatomyositis associated with?

A

Juvenile and Adult Dermatomyositis

  • ONLY Adult dermatomyositis is associated with malignancy (10-50%)
  • Commonest malignancies are:
    • Genitourinary (Especially Ovarian)
    • Breat
    • Lung
    • Gastric
36
Q

What malignancies are associated with acanthosis nigricans?

A
  • Adenocarcinoma of the stomach (most common)
  • Gastrointestinal
  • Genitourinary
37
Q

What is this?

What is it associated with?

A

Calciphylaxis

Calcium is deposited in the small vessels in the skin resulting in necrosis.

It occurs in renal failure patients undergoing dialysis. Calcium/phosphate imablances.

It can also occur in patients with a hypercoagulable state.

38
Q

What is this?

A

Reactive Perforating Collagenosis

  • Seen in dialysis patients.
  • Grouped with a central core.
  • Collagen is being pushed out of the skin
39
Q

What is this condition and what is it associated with?

A

Palmoplantar Keratoderma

Associated with lymphomas and certain adenocarcinomas.

40
Q

What condition is this?

A

Paraneoplastic Pemphigus

  • Severe Erosive Gum Disease
  • Associated with lymphomas and Castleman’s disease.
  • Very Resistant to Treatment.
41
Q

What is this condition?

What must be done when seen?

A

Sweet’s Syndrome

  • Erythematous plaques with pustules on the face and upper arms.
  • Associated fever and neutrophilia.
  • Biopsy shows - nuetrophils.
  • Search for malignancy is mandatory.
42
Q

What is interesting about itch being a cause for malignancy?

A

The itch may predate the malignancy by many eyars.

43
Q

What is the difference between primary and secondary itch?

A

Primary - due to a dermatological condition (Eczema)

Secondary - due to an underlying cause

44
Q

What are some causes of pruritus without dermatosis?

A

ITCH

  • Iron deficiency/Internal Malignancy
  • Thyroid problems
  • Chronic RENAL and LIVER disease.
  • HIV
  • Haematological disorders
    • Hodgkins or non-Hodgkins lymphoma
    • Leukaemia
    • Myeloma
    • Polycythaemia
45
Q

How do you treat pruritus?

A
  1. Identify the underlying cause
  2. Emollients
  3. Steroids
  4. Antihistamines - hydroxyzine.
  5. Low dose doxepin and amitryptiline at night.
  6. Liver disease itch –> Naltrexone
  7. CKD –> UVB or Gabapentin/Pregabalin

Dermatology Diploma (39 decks)

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