The skin and systemic disease Flashcards
What are the cutaneous manifestations of diabetes?
Granuloma annulare
Necrobiosis lipoidica
Fungal and bacterial infections
Leg ulcers
Diabetic dermopathy
Acanthosis Nigricans
Who does granuloma annulare most commonly affect?
Diabetics who are:
children
and
young adults
What are the symptoms of granuloma annulare?
Mainly only the cosmetic appearance
Where are granuloma annulare generally found?
Extremities - hands and feet
there can be multiple lesions
Where are necrobiosis lipoidica lesions generally found?
The shin (there can be multiple lesions)
What is a particular issue with necrobiosis lipoidica?
They ulcerate after minor trauma
What are the cutaneous manifestations of thyroid disease?
Graves’ disease causes pretibial myxoedema
Diffuse hair loss
Thyroid acropachy
What type of thyroid disease is graves?
hyperthyroidism
What causes pretibial myxoedema?
mucin deposition which results in waxy
indurated plaques and nodules
which are normally on the lower legs of feet
What are the cutaneous manifestations of systemic lupus erythematosus (SLE)?
butterfly / malar rash
Which type of SLE does the butterfly / malar rash occur in?
Acute SLE
Where do the malar rashes of SLE occur?
On sun-exposed sites
Are the butterfly/malar rashes of SLE scarring?
Not usually scarring
What antibodies is SLE often associated with?
anti-dsDNA
Name the cutaneous manifestations of internal cancers.
acanthosis nigricans
acquired ichthyosis
pyoderma gangrenosum
dermatomyositis
What is the cause of dermatomyositis?
Presumed to be autoimmune
What are the two forms of dermatomyositis?
Juvenile
Adult
Which of the types of dermatomyositis is associated with malignancy?
Adult dermatomyositis
What are the manifestations of dermatomyositis?
proximal muscle weakness
characteristic skin eruption
nail fold changes
Which cancers are associated with adult dermatomyositis? (how much increased risk)
Ovarian
Breast
Lung
Colorectal
(30% increase in risk)
What are the two types of acanthosis nigrans?
1) associated with DM
2) associated with malignancy
Which types of malignancy is acanthosis nigrans associated with?
adenocarcinoma of the stomach and GI tract
Which of the two types of acanthosis nigrans has a quicker onset?
acanthosis nigrans associated with malignancy
Describe the course of pyoderma gangrenosum.
uncommon
chronic
recurrent
ulcerative condition
What signs are most types of pyoderma gangrenosum associated with?
fever
signs of toxicity
What conditions are associated with pyoderma gangrenosum? (what proportion of patients will have one of these diseases)
(60% will have one of the following)
Inflammatory bowel disease:
Ulcerative colitis
Crohn’s disease
Arthritis:
RA
seronegative
Haematological malignancies:
Myeloma
Leukaemia
Which condition is most commonly associated with pyoderma gangrenosum?
Inflammatory bowel disease:
Ulcerative colitis
Crohn’s disease
What is erythema nodosum?
panniculitis meaning inflammation of the fat layer
Who is erythema nodosum most common in?
younger women
What signs and symptoms is erythema nodosum associated with?
general malaise
fever
joint pains
How long usually is the course of erthema nodosum?
2-4 weeks
What is thought to be the cause of erythema nodosum?
a delayed hypersensitivity response
to a variety of antigenic stimuli
What are the groups of causes that cause erythema nodosum?
Idiopathic
Infections (mainly URTI)
Drugs
Sarcoidosis
Inflammatory bowel disease (UC+Crohn’s)
What are the infectious causes of erythema nodosum?
(mainly URTI)
Streptococcus
TB
What are the medications that can cause erythema nodosum?
Sulphonamides
COC
What are the causes of cutaneous vasculitis?
Infections
Drugs
Connective tissue disease
Neoplasms
How does Henoch-Schonlein purpura/vasculitis present?
palpable purpuric lesions on limbs and buttocks
What are purpura?
purple or brownish-red spots
on the skin or mucous membranes
caused by the extravasation of blood
What infection Henoch-Schonlein purpura/vasculitis frequently associated with?
respiratory tract infections
Who Henoch-Schonlein purpura common in and why is this an issue?
Common in children,
a risk as it is more likely to have systemic symptoms in children
What systemic symptoms is Henoch-Schonlein purpura associated with?
Arthralgia + arthritis
Haematuria and abdominal pain
Nephrotic syndrome and renal failure
How is Henoch-Schonlein vasculitis diagnosed?
immunofluorescence to identify:
IgA immune deposits
What skin eruptions are associated with drug reactions?
urticaria
erythema multiforme
Stevens-Johnson syndrome
toxic epidermal necrolysis
Typically how long does it take for skin eruptions to occur after taking a drug?
1-3 weeks
What is the typical prodrome of Stevens-Johnson syndrome (SJS)?
fever
upper respiratory tract symptoms
How long is the course of SJS typically?
3 weeks
What are the categories of causes of SJS?
Infection
Drugs
Idiopathic
What are the typical infectious causes of SJS?
Mycoplasma
Herpes simplex
What is the mortality of toxic epidermal necrosis (TEN)?
35% mortality
What are the typical causes of TEN?
NSAIDs
antibiotics
antiepileptics
What should the management of skin failure entail?
Withdraw the offending drug
Supportive care –> Burns unit/ITU
Careful wound care:
Hydration
Nutritional support
What is thyroid acropachy?
soft-tissue swelling of the hands and clubbing of the fingers
Which cause of vasculitis maybe associated with ASLO?
SLE
