Skin & Systemic Disease Flashcards
In Diabetes Mellitus, what condition is this called?
Describe it.
Diabetic Dermopathy
Atrophic macules and patches on the shins.
(Possibly due to trauma)
In Diabetes Mellitus, what condition is this called?
Diabetic Bullae
Tense non-inlammatory bullae on the lower limbs.
Unknown why it happens.
In Diabetes Mellitus, what condition is this called?
Describe it.
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.
In Diabetes Mellitus, what condition is this called?
Describe it.
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)
In Diabetes, What condition is this?
Partial Lipodystrophy
Atrophy of subcutaneous tissue secondary to insulin use.
In Diabetes, what condition is this called?
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.
In thyroid disease, what is this called?
Is it common?
What form of thyroid disease is it associated with?
Thyroid Acropachy
- Not Common
- Grave’s Disease
In Thyroid disease, What is this?
What form of thyroid disease is it associated with?
Does it reverse with treatment?
Pretibial Myxoedema
- Associated with Grave’s Disease
- Peau dórange appearance
- Treatment: intralesional steroids or steroids under occlusion.
- It does not reverse with treatment.
What can happen to eyebrows in thyroid disease?
The lateral third of the eyebrow may be lost.
What cutaneous features do we see in Cushings Disease?
- 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.
What are some cutaneous manifestations in addison’s disease?
The Excess ACTH stimulates melanin production by melanocytes
- Pigmentation in mucosal surfaces, palmar creases, nail beds and in scars.
- Vitiligo
In IBD, what is this?
What are some other non-IBD causes for it?
Erythema Nodosum
- idiopathic - most common
- Streptococcal infections - upper respiratory tract.
- Drugs - oestrogens, COCP, pinicillin, iodides, sulphonamides.
- Sarcoidosis
- Behcet’s disease
- Sweet’s syndrome
- Pregnancy
What investigations should be done in Erythema Nodosum?
- 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.
What is the treatment for Erythema Nodosum?
- Treat the underlying cause.
- Rest and NSAIDs
What is this?
Leucocytoclastic Vasculitis
(Seen in both UC and Crohns)
What condition is this in IBD and where on the body is it usually found?
What investigations should you do?
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.
What is the most common skin manifestation in Coeliac disease?
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.
Whats a cutaneous sign of liver cirrhosis?
Palmar erythema
What are some signs of Hepatitis C infection?
- 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.)
What pattern of lupus is this?
Tell me a bit about it
Lupus Pernio
- Nodules & plaques
- Form on the nose, ears, cheeks.
- 75% have chronic lung involvement
- It is resistant to treatment
- Scarring
What pattern of sarcoid is this?
Annular Sarcoid
What pattern of sarcoid is this?
Paular and Nodular Sarcoid
What is this?
Lupus Vulgaris
(The Commonest form of Cutaneous TB)
An apple jelly appearance under dermoscopy.
What is the triad of Wegner’s Granulomatosis?
What cutaneous manifestations can occur with it?
- Systemic vasculitis
- Necrotising Granulomatous Inflammation of the repistory tract
- Glomerulonephritis
Skin lesions can be
- Nodules
- Petechiae
- Purpura
- Pyoderma-gangrenosum-like lesions.
What is this called?
What is it associated with?
Migratory Erythemas
Associated with malignancy so ALWAYS do a full malignancy screen.
What is this?
Heliotropic exfoliative plaques affecting the eyelids and cheeks
(Classic of Dermatomyositis)
What is this?
What is it associated with?
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.
What is this?
Reactive Perforating Collagenosis
- Seen in dialysis patients.
- Grouped with a central core.
- Collagen is being pushed out of the skin
What is this condition and what is it associated with?
Palmoplantar Keratoderma
Associated with lymphomas and certain adenocarcinomas.
What condition is this?
Paraneoplastic Pemphigus
- Severe Erosive Gum Disease
- Associated with lymphomas and Castleman’s disease.
- Very Resistant to Treatment.
What is this condition?
What must be done when seen?
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.
