The skin and systemic disease

Question 1

What can changes in the skin be a marker of?

Answer 1

• Endocrine disease
• Internal malignancy
• Nutritional deficiency
• Systemic infection
• Systemic inflammatory disease

Question 2

What endocrine conditions can cause skin changes?

Answer 2

• Thyroid related conditions
• Diabetes
• Cushings/steroid excess
• Sex hormones

Question 3

What skin change may be seen in hypothyroidism?

Answer 3

Dry skin

Question 4

What skin change may be seen in Grave’s disease?

Answer 4

• Thyroid demopthy
• Pretibial myxoedema
• Thyroid acropachy

Question 5

What skin changes may be seen in diabetes?

Answer 5

• Necrobiosis lipoidica (waxy yellow legs)
• Diabetic dermopathy (inflammatory patches)
• Scleredema (thick, red, warm skin)
• Leg ulcers
• Granuloma annulare

Question 6

What is necrobiosis lipoidica?

Answer 6

• Waxy appearance which may have areas of yellow discolouration
• Often on the shins
• Occasionally ulcerates and scars
• Associated with diabetes

Question 7

What is diabetic dermopathy?

Answer 7

• Spots of brown or red
• Normally on the shins
• Mild itch

Question 8

What is scleredema?

Answer 8

• Progressive thickening and hardening of the skin
• Warm to the touch
• Can’t pinch the skin
• Red skin

Question 9

What is Granuloma Annulare?

Answer 9

• Ring of red/pink/purple

* Can be itchy

Question 10

What skin changes are associated with steroid excess?

Answer 10

• Acne
• Striae
• Erythema
• Gynaecomastia

Question 11

What skin changes are associated with steroid insufficiency? (Addison’s)

Answer 11

• Hyperpigmentation

* Acanthosis nigracans (dry dark patches of skin)

Question 12

What are the signs of Cushing’s disease?

Answer 12

• Buffalo hump
• Striae on abdominal flanks, arms, thighs
• Moon facies
• Increased central adiposity
• Global skin atrophy, epidermal and dermal components
• Purpura with minor trauma - reduced connective tissue

Question 13

What are the signs of Addison’s disease

Answer 13

• Skin pigmentation (hyperpigmentation)

* Acanthosis Nigracans

Question 14

What skin changes can testosterone cause?

Answer 14

• Acne

* Hirsutism

Question 15

When may testosterone be raised?

Answer 15

• PCOS
• Testicular tumour
• Testosterone drug therapy

Question 16

What skin changes can progesterone cause?

Answer 16

• Acne

* Dermatitis

Question 17

What can cause elevated progesterone?

Answer 17

• Congenital adrenal hyperplasia

* Contraceptive treatment

Question 18

What is necrolytic migratory erythema?

Answer 18

• Sometimes called glucagonoma syndrome
• Erythematous, scaly plaques on acral, intertringinous and periorificial areas
• Islet cell tumour of the pancreas

Question 19

What is the treatment of necrolytic migratory erythema?

Answer 19

Removal of tumour

Question 20

What are the signs of glucagonoma syndrome?

Answer 20

• hyperglycaemia
• Diarrhoea
• Weight loss
• Glossitis
• Necrolytic migratory erythema

Question 21

What skin conditions can manifest due to internal malignancy?

Answer 21

• Necrolytic migratory erythema
• Erythema gyratum repens
• Acanthosis nigricans

Question 22

What is erythema gyratum repens?

Answer 22

• Rare, distinctive skin disease
• Reddened concentric bands whorled woodgrain pattern
• Severe pruritus and peripheral eosinophilia

Question 23

What is the association of erythema gyratum repens?

Answer 23

• Strong association with lung cancer

* Association with breast, cervical and GI cancer

Question 24

What is the treatment of erythema gyratum repens?

Answer 24

Treat the underlying malignancy

Question 25

What is acanthosis nigricans?

Answer 25

• Smooth, velvet like, hyperkeratotic plaques in intertriginous areas (groin, axillae, neck)
• There are three types

Question 26

Type 1 acanthosis nigricans

Answer 26

• Associated with malignancy
• Adenocarcinoma, especially of the GI tract
• sudden onset and more extensive

Question 27

Type 2 acanthosis nigricans

Answer 27

• Familial type
• Autosomal dominant
• Very rare, appears at birth
• No malignancy

Question 28

Type 3 acanthosis nigricans

Answer 28

• Associated with obesity and insulin resistance

* Most common type

Question 29

What is sister Mary Joseph nodule?

Answer 29

An umbilical metastasis nodule

Question 30

What are the signs of a vitamin B6 deficiency?

Answer 30

•Dermatitis

Question 31

What are the signs of a B12 deficiency?

Answer 31

Angular chelitis

Question 32

What are the signs of a B3 deficiency?

Answer 32

• Pellagra

* Dementia, dermatitis, diarrhoea

Question 33

What are the signs of a zinc deficiency?

Answer 33

• Acrodermatitis enteropathica

* Pustules, bullae, scarring (acral and perineal distribution)

Question 34

What are the causes of a zinc deficiency?

Answer 34

• Inherited SLC39A mutation which encodes the intestinal zinc transporter
• In infants it can follow breast feeding if breast milk contains low levels of zinc
• In adults: alcoholism, malabsorption states, IBD, bowel surgery

Question 35

What are the signs of a vitamin C deficiency?

Answer 35

• Punctate purpura/bruising
• Corkscrew spiral curly hairs
• Patchy hyperpigmentation
• Dry skin and hair
• non healing wounds
• Inflamed gums

Question 36

What is erythema nodosum?

Answer 36

•Tender red bumps on the shins
•Caused by: 
 - streptococcal infection 
 - pregnancy/oral contraceptive 
 - sarcoidosis 
 - drug induced 
 - bacterial/viral infection 
 - other

Question 37

What is polyderma gangrenosum?

Answer 37

•large painful sores, often on legs
•Caused by: 
 - IBD: crohn's and ulcerative colitis 
 - Rheumatoid arthritis 
 - myeloma

Question 38

What causes hair thinning?

Answer 38

• B12 deficiency
• Iron deficiency
• Lupus
• Hypothyroidism

Question 39

What causes male pattern balding?

Answer 39

Androgen excess (or receptor sensitivity)