Systemic disease

Question 1

Diabetes

Answer 1

necrobiosis lipoidica: yellow/brown plaques, atrophy, telangiectasia; shins
acanthosis nigricans
granulosum annulare: hadns/feet, papules/annular plaques
dermopathy (hyperpig), infection, rubeosis, vitiligo, lipodystrophy, xanthomata

Question 2

thyroid

Answer 2

pretibial myyxoedema: waxy indurated nodules/plaques; lower legs; pain +/- pruritic
xerosis, pruritus, hair loss, periorbital/facial oedema, acropachy (‘clubbing’)

Question 3

SLE

Answer 3

butterfly malar rash: transient, sun sites, non-scarring alopecia
anti-dsDNA, ^ASOT

Question 4

acanthosis nigricans

Answer 4

velvety hyperpigmented patches; plexural; papillomatous

insulin/DM, obesity, Cushing’s/PCOS, CST, abdo AC

Question 5

acquired icthyosis

Answer 5

dry skin

lymphoma ???

Question 6

pyoderma gangrenosum

Answer 6

recurrent painful ulceration
inflammed pustule/nodule
purple/violaceous border, necrotic basis
rapid growth, atrophic scale + red halo

RhA, IBD, DM, blood cacner

Rx: steoids, ciclo

Question 7

dermatomyositis

Answer 7

purple rash (photo) + muscle pain/weakness (prox)
heliotrope rash (photo)
Gottron’s papules (bony prominences, purple)
nail fold telangiectasia

risk of Ca (10-50%): ovarian, breast, lung, CRC, panc, HL

Question 8

erythema nodosum

Answer 8

hot very tender red nodules (‘bruise-like’)
shins, forearms
general malaise, fever, arthropathy

strep, drugs, IBD, sarcoid
Rx: cause + NSAIDs; resolves 2-4 weeks

Question 9

dermatitis herpetiformis

Answer 9

Coeliac, vesicles on buttocks

Question 10

cutnaeous vasculitis

SLE, Rh, Wegener’s, meno, strep, hep C, drugs, Ca

Answer 10

palpable purpura = vasculitis (small vessel)

HSP: URTI, IgA, palpable papules on limbs/buttocks; nephrotic syndrome

Question 11

urticaria

Answer 11

wheals; 2 colours; resolves 24h

Question 12

erythema multiforma

Answer 12

target lesions (>3 colours): central clearing + dark centre spot/vesicle
macular or raised
symmetrical, extremities, extensors

strep/herpes, drugs,
Rx: stop cause + support; resolves 10d

Question 13

SJS and TEN

Answer 13

SJS: NSAIDs, ABx, AED
fever + resp symptoms
2+ mucosal sites; may involve eye/mouth
targetoid or non-specific (red, tender, blisters); erythema, tender; 5-12% mortality

30% = TEN: rare, 35% mort; epidermal detachment (Nikolsky), dusky erythema, MM; 7-21d after ingestion

Question 14

Skin failure management

Answer 14

early diagnosis
stop causative drug
supportive care (ITU/burns)
wound care, hydration, nutrition
don't debride
MDT incl. dermatologists

Question 15

Mechanisms

Answer 15

same disease process:
unknown internal:
indicates underlying disease:
systemic skin disease

Question 16

adrenal

Answer 16

excess cortisol:
truncal obesity, moon face and buffalo hump, telangiectasia, ecchymoses, striae, hypertrichosis

reduced cortisol: increased pigment in mucosal sites, palmar screases, scars, friction sites, areola skin, genital skin, hair, diffuse

Question 17

hyperlipidaemia

2o: DM, hypothyroid, pancreatitis, obstructive liver disease, kidney failure

Answer 17

xanthelasma
eruptive xanthoma
tuberous xanthoma
tendinous xanthoma

Question 18

hepatic

Answer 18

jaundice
pruritis
spider naevi
palmar erythema
nail changes

Question 19

generalised pruritus

Ix: baselines, iron, Ig, hep B, BM

Answer 19

• metabolic/endocrine: hyper/hypothyroid, chronic renal failure (uraemia), carcinoid
• malignancy: lymphoma, leukaemia, myeloma, solid cancer (Rare)
• drugs: aspirin, alcohol, morphine, codeine
• haematological: polycythaemia rubra vera, Iron deficiency (even without anaemia)
• hepatic disease: obstructive biliary disease/cholestatic jaundice, cholestasis of pregnancy
• pregnancy (without cholestasis)
• xerosis: dry skin

Question 20

drug eruption culprits

Answer 20

ABx esp. sulphonamides
anti-convulsants
NSAIDs
allopurinol

Question 21

granulosum annulare

Answer 21

DM, kids/YA
small grouped papules, erythema, annular, can coalesce into plaques with central depression
aSx

Question 22

toxic erythema (TEN)

Answer 22

morbilliform: erythematous macules, trunk, confluent
pruritus, malaise, fever
7-14 days after new drug