The Skin and Systemic Disease

Question 1

What is acanthuses nigerians a sign of?

Answer 1

abdominal malignancy

Question 2

What is dermatomyositis a sign of?

Answer 2

several malignancies

Question 3

What is generalised pruritis a sign of?

Answer 3

lymphoma

Question 4

What is superficial thrombophlebitis a sign of?

Answer 4

pancreas probs

Question 5

What are the skin manifestations of liver disease?

Answer 5

pruritis spider nave palmar erythema jaundice white nails

Question 6

What are the skin manifestations of diabetes?

Answer 6

lipoidicagranuloma annulare diabetic dermopathyskin infections leg and foot ulcers

Question 7

What is Erythema Nodosum?What causes it?

Answer 7

Immunological reaction patternMay be idiopathic caused by infection - streptococcal, primary TB, drugs, UC, etc

Question 8

How does Erythema Nodosum appear?

Answer 8

tender nodules on shins

Question 9

What is Erythema Multiforme?What causes it?

Answer 9

Skin reaction patternMay be idiopathicMild forms Drugs - sulphonamides, anticonvulsants, penicillinSevere form often drug relate - Steven Johnson’s syndrome

Question 10

How does Erythema Multiforme present?

Answer 10

target lesions at acral sites

Question 11

What is Pyoderma Gangrenosum?

Answer 11

skin reaction pattern purplish nodule or ulcer with undermined edge

Question 12

What causes Pyoderma Gangrenosum?

Answer 12

may be precipitated by trauma (surgery), can be idiopathic may be underlying bowel disease, inflammatory arthritis, paraproteinaemia, myeloma, Bechets disease

Question 13

What is erythroderma?

Answer 13

Skin failure

Question 14

What are the systemic problems caused by erythroderma?

Answer 14

temperature regulation increased fluid loss this can result in cardiac failure, tachycardia, anaemia, dehydration, electrolyte and protein loss, hypothermia and death from sepsis

Question 15

What are the non-allergic drug reactions?Give exmaples

Answer 15

Intrinsic action of drug on the skin due to pharmacological properties (predictable and dose related) e.g. steroids and stretch marks exacerbation of pre existing condition e.g lithium and psoriasis Idiosyncratic - e.g. fixed drug eruption from phenolpthalein

Question 16

What are some more examples of intrinsic drug action causing a reaction on the skin?

Answer 16

stretch marks with systemic steroidscracked lips from retinoids photosensitivity from tetracycline candidiasis from antibiotics infections from immunosuppressants discolouration from amiodarone

Question 17

Describe allergic drug reactions

Answer 17

unpredictable and occur in minority of patients occur in the latent period internal organs may be involved and they can be life threatening may be IgE, cytotoxic, immune complex mediated or cell mediated

Question 18

What are the other non specific drug eruptions?

Answer 18

Uticaria and angioedema (salicylate, ACE inhibitors) Vaculitis (sulphonamides, indomethacin) Erythema multiforme (sulphonamides, barbiturates)

Question 19

Which drugs commonly cause rashes?

Answer 19

penicillins/sulphonamides Anticonvulsants NSAIDS Thiazide diuretics Allopurinol Gold and penicillamine

Question 20

How should drug rashes be treated?

Answer 20

stop drug Consider measures to reduce drug in the system symptomatic oral steroids are controversial avoid drug in future label medical records