Teaching Clinic - Dermatological manifestations of systemic diseases Flashcards
- Dermatomyositis - SLE - Chronic painful nodules: panniculitis, medium vessel vasculitis +/- panniculitis - Erythema nodosum - Erythema induratum - Systemic sclerosis - Vascular diseases - Diabetes: acute manifestations and chronic skin disease - cutaneous manifestation of neoplasia - generalized pruritis of systemic disease
Dermatomyositis
Definition
Differentiation between polymyositis, dermatomyositis and amyopathic dermatomyositis
Dermatomyositis
Extent of muscle involvement
Dermatomyositis
Extent of cutaneous involvement
Dermatomyositis
Extra-cutaneous manifestations
Dermatomyositis
Clinical subsets, autoAb implicated in each clinical subset
Dermatomyositis
Investigations and diagnosis
Dermatomyositis
Management
Dermatomyositis
Commonly associated malignancies
Rule out NPC until proven otherwise
Name features
Heliotrope rash around eyelids
Gottron’s papules along downing line
Cuticle: small vessel dilatation/ telangiectasia
Cutaneous lupus erythematosus (CLE)
Differentiating features between acute, subacute and chronic CLE
Subacute cutaneous lupus erythematosus
Clinical features
Types:
Annular SCLE (urticarial-like eruption)
Papulosquamous SCLE (erythematous scaly plaques with psoriasiform appearance)
Toxic EM-like (Rowell’s syndrome)
Clinical features:
Highly photosensitive
Affected areas = sun-exposed aspects: face, V of neck, upper chest and upper back, shoulders, extensors of arms and forearms
Non-scarring
Scaly psoriasiform annular erythematous plaques and papules
Borders may show crusting, vesiculation
Follicular plugging and hyperkeratosis are not prominent
Name feature
Ddx
Annular SCLE (urticarial-like)
Name feature
Annular SCLE (urticarial-like)
Name feature
Ddx
Papulosquamous SCLE
Ddx:
Psoriasis
Lichen planus
Drug-induced SCLE
Common causative drugs
Cutaneous lupus erythematosus
Diagnosis
Diagnosis: mainly rely on clinical context
- Serum immune markers → Usually only anti-Ro/La, strongly a/w SCLE
- Skin bx at affected sites → lupus band test
Immunology:
- ANA+ in 70-80% of SCLE (ANA –ve can still be lupus)
- SCLE has a high prevalence of positivity to anti-Ro and anti-La: Anti-Ro is positive in 50-70%, especially the annular variant; Anti-La is positive in 30-40%
- Since anti-Ro autoantibodies are associated with Sjögren’s syndrome (dry eyes, dry mouth) as well as SCLE, some patients have features of both condition
Cutaneous lupus erythematosus
Management
Acute cutaneous lupus erythematosus
Subtypes
Clinical presentation
Ddx
Subacute cutaneous lupus erythematosus
Subtypes
Clinical presentation
Ddx
Chronic cutaneous lupus erythematosus
Subtypes
Clinical presentation
Ddx
Panniculitis
Definition
D/dx
Panniculitis
Histopathological classification
Subcutaneous fat lobule/septal wall
Look at vasculature structure: destroyed or not (vasculitis or not)
Septal panniculitis
Types with vasculitis and without vasculitis