Systemic Disease Flashcards
what is necrobiosis nigricans
shiny atrophic plaques on legs seen in type 1 diabetes
what are xanthomas due to
hyperlipidaemia - lipid laden macrophage ‘foam cells’ in the skin
- seen in diabetes
velvety hyperpigmented patches commonly found in skin folds e.g. axillae
acanthosis nigricans
what metabolic condition causes acanthosis nigricans
diabets
what malignancy causes acanthosis nigricans
GI adenocarcinoma
red spot that blances on pressure + fills from centre
spider naevi
difference between spider naevi and telangectasia
spider naevi fill from centre
telangectasia fill from edge
what causes spider naevi
liver disease
oral contraceptive pill
pregnancy
what is addisons disease
autoimmune antibodies against adrenal cortex causing deficiency of glucocorticoids and mineralocorticoids
skin manifestations of addisons disease
skin hyperpigmentation
- especiialy in sun exposed areas/skin creases/mucosa
palmar crease pigmentation
why is hyperpigmentation seen in addisons disease
reduced negative feedback of pituitary hormones – increased ACTH production
ACTH made from same precursor as melanocyte stimulating hormone
symmeytrical erythematous lesions on legs, shiny orange peel skin
Pretibial myoxedema
- Grave’s disease
pathophysiolgy of pretibial myoxedema
hyaluronic acid deposition in dermis – pink colouration + thickening
skin manifestations of Grave’s disease
pretibial myoxedema
warm, flushed skin
Grave’s eye disease - driven by lymphocyte infiltration of connective tissue, hyaluronic acid deposition + lipogenesis
hair thinning
skin manifestations of hypothyroidism
brittle, course hair
dry skin
periorbital odema
facial puffiness
what is pellagra
Vitamin B3 deficiency
features of pellagra
3 D’s
- Weeping Dermatitis
- Dementia
- Diarrhoea
what is scurvy
vitamin C deficiency
features of scurvy
bleeding gums
perifollicular haemorrhages
corkscrew hairs
itially red pustules/papules that coalesce to progress to necrotic ulcers with violaceous borders
characteristic of?
pyogerma gangrenosum
causes of pyogerma gangrenosum
IBD - UC/crohn’s
Myeloma
Acute myeloid leukaemia
treatment pyoderma gangrenosum
oral steroids
acutely unwell + tender papules/plaques but no ulcers
characteristic of?
febrile neutrophilic dermatosis
(also known as sweet syndrome)
what caues febrile neutrophilic dermatosis
IBD
pregnancy
URTI
gastroenteritis
raised, red, tender nodules on shins
erythema nodosum
where is the inflammation in erythema nodosum
panniculitis - inflammation of subcutaneous fat
causes of erythema nodosum
SITS On legS
Strep infection
IBD
TB
Sarcoidosis
Oral contraceptive
Sulphonamides
what is lupus erythematosus
autoimmune type 3 hypersensitivity disease that can have multi-system involvement
what are the clinical varients of lupus
- chronic discoid lupus (CDLE)
- subacute cutaneous
- Systemic lupus (SLE)
features of chronic discoid lupus (CDLE)
Fixed, erythematous, scaly, plaques with telangectasia often found on face/sun exposed sites – heal with scarring
photosensitivity
scarring alopecia
antibodies found in lupus
ANA
anti-dsDNA
anti-smith
treatment of CDLE
potent topical steroids
oral hydroxychloroquine
features of subacute cutaneous lupus
widespread annular erythematous scaly plaques
symmetrical distribution
upper back/shoulders/arms most common sites
treatment of subacute lupus
hydroxychloroquine
cutaneous features of systemic lupus (SLE)
butterfly rash
photosensitive
prominent nail fold cappillaries
blood results in lupus
FBC: low Hb, Low lymphocytes, low platelets
Increased ESR
CRP normal
increased urea
increased creatinine
what is systemic sclerosis
multi system autoimmune disease characterised by inflammation damage + fibrosis of skin and internal organs
pathophysiology of skin changes in systemic sclerosis
thicking of connective tissue due to over production of collagen + fibrilin
what is scleroderma
thickened, firm, tight skin
- commonly affects the fingers – sclerodactyly
what are the two types of systemic sclerosis
- limited
- fibrosis restricted to hands, distal arms, face + neck - diffuse
- fibrosis affects chest, abdomen, upper arms.
- internal organ disease common
antibody associated with systemic sclerosis
anti-centromere
features of systemic sclerosis
CREST
Calcinosis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangectasia
treatment of scleroderma
cyclophosphamide / methotrexate
treatment of reynauds
calcium channel blockers e.g. amlodipine
heliotrope rash
gottons papules
characteristic of?
dermatomyositis
features of dermatomyositis
heliotrope rash
gottrons papules - back of hands
proximal muscle weakneass
myositis - raised CK
may be due to underlying malignancy
features of vasculitis
raised + palpable painful purpuric rash
often localised to shins
can blister + ulcerate
what is mycosis fungoides
cutaneous T cell lymphoma
presentation of mycosis fungiodes
itchy, patchy rash slowing progressing to plaque stage and eventual tumour stage
often on trunk
lymphadenopathy
treatment mycosis fungoides
topical steroids
unilateral nipple eczema may be suggestive of what disease?
pagets disease of the nipple
presentation of kaposi’s sarcoma
purple papules / plaques which may ulcerate
what causes kaposi’s sarcoma
human herpes virus 8 (HHV-8)
- affects people with HIV
