the skin in systemic disease Flashcards
why is it important to see how the skin is affected by systemic disease
because rashes may be more than skin deep:
Prevent or reduce internal organ damage by early diagnosis
Allow detection of internal malignancy
what can be diagnosed if theres a ring like or annular rash? why is that diagnosis crucial? what do you need to do after you see/ diagnose this?
neonatal lupus, which is important because there is a 50% risk of heart block. It is important to perform an ECG.
what are investigations that you should do when you see skin stuff/ consider differentials
blood tests: FBC, renal, LFT, Infl markers, autoimmune serology
microbiology: viral/ bacterial serology, PCR, cultures, swabs for bacteria and C&S
imaging for vascular stuff and internal organ check
skin biopsy: microscopy
specific stuff: urinalysis, nerve conduction, endocrine investig
what analyses can you send a punch biopsy sample for?
histology: pattern, shape, cell populations and
inflammatory proteins for antibodies in immunofluorescence
tissue culture
what are the two types of lupus erythematosus
systemic lupus erythematosus and cutaneous (discoid) lupus
but they overlap
there are diagnostic criteria for systemic lupus erythematosus. what categories of symptoms do these include?
mucocutaneous, involving cartilage and organs, haematological, immunological
what are the mucocutaneous parameters of systemic lupus e.
chronic or acute cutaneous lupus, oral ulcers, alopecia
what are the “other organ involvement” parameters of lupus
alopecia, synovitis, serositis, renal disorder neuro disorder
spme haematological example parameters for SLE
haemolytic anemia thrombocytopenia, leukopenia
immunologival ex. parameters for SLE
ana anti ds DNA antiSmit antibodies antiphospholipid low comlement and direct coombs test
skin features of systemic lupus
erythematous rash photodistributed(MEANS IN SUN EXPOSED AREAS)
chilblains: itchy swellings ex on toes
livedo reticularis
hairloss
palpable purpura
what do i need to know about the autoantibody profile in dermatomyositis?
there are subtypes of dermatomyositis with some different clinical features that can be predicted by aytoantibody profile
other than the antibody tests what other tests can be used to support dermatomyositis diagnosis
ANA
CK
skin bipsy
LFT (alt often incr)
EMG (muscle elctrophysiological test)
screen for internal malignancy
what are the broadest classifications of vasculitis
small vessel, small and medium vessel, medium and large vessel vasculitis
what are two subtypes of small vessel vasculitis and which usually requires treatment vs the other that doesnt
1)cutaneous small vessel (leukocytoclastic) vasculitis: doesn’t usually require treatment
and
2)special types
what are the types of cutaneous small vessel vasculitis
idiopathic, from infection, from medication exposure, inflammatory (connective tissue disease)- usually no treatment
examples of special types of small vessel vasculitis
IgA vasc. Henoch-Scholelin
urticarial
acute hemorrhagic oedema of infancy
erythema elevatum diutinum
small and medium vasculitis types
cryoglobulinemia type 2 and 3
and
ANCA - associated (has subtypes on slide)
medium vasculitis types
polyarteritis nodosa (PAN) - BENEIGN CUTANEOUS FORM OR SYSTEMIC FORM
large vessel vasculiutis types
temporal arteritis
arteritis tayakasu
what is sarcoidosis and what is an important feature in terms of derm
its a systemic (can affect multiple organs) granulomatous (granulomas- collections of immune cells- form in various places in body) disorder
one of its most important features is how variable cutaneous presentations it can have
justfor better understanding from chat gpt: Sarcoidosis is considered to be a multisystem inflammatory disorder, but its exact cause and pathogenesis are not fully understood. While it shares some similarities with autoimmune diseases, such as the involvement of immune cells and inflammation, sarcoidosis is not typically classified as an autoimmune disease.
In autoimmune diseases, the immune system mistakenly attacks the body’s own tissues and cells, leading to inflammation and tissue damage. In sarcoidosis, the immune system mounts an abnormal inflammatory response, characterized by the formation of granulomas—small clumps of immune cells—primarily in the lungs and lymph nodes, but it is not clearly a result of autoimmunity.
what is an organ commonly affected by sarcoidosis
lungs
what percentage of sarcoidosis cases have cutaneous presentations
33%