Rashes Associated With Systemic Disease And Pregnancy

Question 1

Erythema nodosum presentation

Answer 1

Red lumps on shins (and sometimes thighs and forearms)
Type of panic unlit is (inflammatory disorder affecting subcutaneous fat)
Symptoms of underlying disease eg.sore throat
Red lumps hot and painful and fade through colour changes of bruise
Fever, joint pain, feeling unwell

Question 2

Age range for most cases of erythema nodosum

Answer 2

20-45

Question 3

Erythema nodosum causes

Answer 3

Infection (viral, bacterial, TB)
Sarcoidosis
Pregnancy
Combined contraceptive pill
Drugs (sulphonamides, salicylates, NSAIDs, bromides and gold salts)
IBD
Idiopathic

Question 4

What tests should be done in erythema nodosum?

Answer 4

Throat swab
Sputum or gastric washing if TB suspected
FBC, ESR, CRP
ASO titre (streptococcal infection test)
Chest X-ray (looking for TB/sarcoidosis)

Question 5

What is cutaneous vasculitis?

Answer 5

Group of disorders in which there are inflamed blood vessels in skin

Question 6

Skin presentation in small vessel vasculitis

Answer 6

Palpable purpura

Question 7

Skin presentation in medium vessel vasculitis

Answer 7

Nodules and livedo reticularis

Question 8

Skin presentation capillaritis

Answer 8

Pigmented purpura
Petechiae resolving with haemosiderin deposition

Question 9

3 types of cutaneous vasculitis

Answer 9

Capillaritis
Small vessel vasculitis
Medium vessel vasculitis

Question 10

Cutaneous vasculitis causes

Answer 10

Infection (viral, bacteria, mycobacteria)
Connective tissue disease
Malignant
Drugs (antibiotics)
Idiopathic (IgA vasculitis)

Question 11

Pyoderma gangrenosum presentation

Answer 11

rapidly enlarging, very painful ulcer
normally has purulent base
ragged, purple, undermined edge

Question 12

Pyoderma gangrenosum causes

Answer 12

IBD
myeloproliferative disease
RA
drugs
MGUS
idiopathic

Question 13

How is pyoderma gangrenosum diagnosed?

Answer 13

clinical picture
swabs to rule out infection
biopsy to rule out other causes of ulcers

Question 14

What is necrobiosis lipoidica?

Answer 14

granulomatous skin disorder which can affect the shin of insulin-dependent diabetics
can sometimes occur in non-diabetic patients
cause unknown

Question 15

Necrobiosis lipoidica clinical picture

Answer 15

tender yellowish/brown patches develop slowly on lower legs over several months
round, oval or an irregular shape
centre of patch becomes shiny, pale, thinned, with telangiectasia
minor injury to patch can cause ulceration
slow to heal

Question 16

What does granuloma annulare look like?

Answer 16

smooth skin-coloured plaques
thickened
ring-shaped or annular
affects children, teenagers or young adults

Question 17

What can localised granuloma annulare be associated with?

Answer 17

autoimmune thyroiditis

Question 18

Who does localised granuloma annulare most commonly affect and what is the clinical picture?

Answer 18

children
one or more skin coloured bumps occur in rings in skin over joints (particularly knuckles, ankles and elbows)

Question 19

Who does generalised granuloma annulare most commonly affect and what is the clinical picture?

Answer 19

adults
widespread skin coloured, pinkish or slightly mauve coloured patches
disseminated type is composed of small papules

Question 20

What is erythema multiforme?

Answer 20

hypersensitivity reaction usually triggered by infections (most commonly HSV)

Question 21

How does erythema multiforme present?

Answer 21

target-like lesions
may be mucous membrane involvement
acute and self-limiting
divided into major and minor forms

Question 22

Erythema multiforme causes

Answer 22

viral infection
parapoxvirus, herpes varicella zoster, adenovirus, hepatitis, HIV, cytomegalovirus, viral vaccine

drugs: barbiturates, NSAIDs, penicillin, sulphonamides, phenothiazines, anticonvulsants

Question 23

What is a xanthoma?

Answer 23

skin lesion caused by accumulation of fat in macrophages immune cells in the skin and rarely in the layer of fat under the skin

Question 24

What can cause xanthoma?

Answer 24

(can be indicative of lipid metabolism disorders)
primary biliary cirrhosis
idiopathic
familial hyperlipidaemia
acquired hyperlipidaemia (diabetes, cholestasis, hypothyroidism, chronic renal failure)

Question 25

Where does xanthelasma palpebrarum occur?

Answer 25

symmetrically on upper and lower eyelids
most common type of xanthoma

Question 26

Where do tuberous xanthomas occur, what do they look like and what can they be associated with?

Answer 26

firm, painless, red-yellow nodules
develop around pressure areas (eg. knees, elbows, heels and buttocks)
usually associated with hypercholesterolaemia

Question 27

Where do tendinous xanthomas occur, what do they look like and what are they associated with?

Answer 27

slowly enlarging subcutaneous nodules related to a tendon or ligament
associated with severe hypercholesterolaemia and elevated LDL levels

Question 28

What skin changed can occur during pregnancy?

Answer 28

stretch marks (striae)
skin tags
changes in hair growth
acne breakouts
spider veins and varicose veins
darkening of areas of skin (melasma)
darkening of moles and freckles

Question 29

Describe pruritic urticated papules and plaques of pregnancy

Answer 29

3rd trimester
primiparous
does not recur in future pregnancies
spares umbilicus
resolves after delivery
no risk to newborn

Question 30

What is PUPPP?

Answer 30

pruritic urticated papules and plaques of pregnancy

Question 31

PUPPP treatment

Answer 31

topical steroids
antihistamines

Question 32

Describe pemphigoid gestationis

Answer 32

does not spare umbilicus
abrupt onset of urticarial plaques and blisters
2nd trimester (mostly)
recurs in future
takes weeks-months to resolve post partum
histologically similar to bullous pemphigoid (C3, IgG)

Question 33

Pemphigoid gestationis treatment

Answer 33

oral steroids

Question 34

Describe intrahepatic cholestasis of pregnancy

Answer 34

frank jaundice
pruritis (palms and soles - excoriations, nodular prurigo)
2nd or 3rd trimester
resolves on delivery
risk of premature labour

Question 35

How is intrahepatic cholestasis of pregnancy treated?

Answer 35

Ursodeoxycholic acid (helps lower bile salt levels)