091914 skin signs of systemic disease

Question 1

diabetic dermopathy prevalance

Answer 1

common-30%-in long standing diabetes

Question 2

diabetic dermopathy occurs where

Answer 2

lower legs

Question 3

what does diabetic dermopathy look like

Answer 3

atrophic, pink and hyperpigmented macules and plaques (looks like scars)

Question 4

diabetic dermopathy is a marker for

Answer 4

poor diabetic control

Question 5

bullous diabeticorum

Answer 5

tense blisters
rarer-0.5% of pts w/ diabetes mellitus

long standing diabetes mellitus w/ other complications

acral in location, often recurrent

no effective treatment to prevent

Question 6

necrobiosis lipoidica

Answer 6

rare-only 0.03% of pts with diabetes mellitus
not all have diabetes

yellow atrophic plaques w/ telangiectasia

usually shins

tx is difficult

Question 7

acanthosis nigricans

Answer 7

common in TYPE II DIABETES

marker for insulin resistance

velvety hyperpigmented thickening of skin

intertiginous or flexures. less on extensor surfaces or face

with or without skin tags

Question 8

is acanthosis nigricans seen only in diabetes?

Answer 8

no, can have:

AN1-familial
AN2-malignancy
AN3-endocrine, obsesity, insulin resistance

Question 9

common associations of diabetes mellitus on skin

Answer 9

tinea
candidiasis
cellulitis
MRSA infections
neuropathic ulcers
peripheral arterial disease (ischemia)
various gangrene (ischemia and infection)

Question 10

signs of hyperthyroidism from skin

Answer 10

fine velvety smooth skin
warm and moist skin (sweating)
hyperpigmentation
pruritis
fine and thin hair
onycholysis (nail lifts off from nail bed)

Question 11

signs of hypothyroidism from skin

Answer 11

dry rough skin
cold and pale skin
yellow skin
thick scale on feet
coarse, brittle, slow growing hair
ALOPECIA OF LATERAL THIRD OF EYEBROWS

thin, brittle slow growing nails

Question 12

pretibial myxedema

Answer 12

occurs in some with Grave’s diesase (1-5%)

cutaneous infiltration of skin of shins w/ mucin

peau d orange, bumpy and firm

Question 13

Addison’s disease

Answer 13

primary adrenocortical insufficiency (autoimmune in 80%)

Question 14

what skin manifestations do you see in Addison’s disease

Answer 14

hyperpigmentation in sun exposed areas, mucous membranes, skin creases, sites of trauma
nail pigmentation (striate)-brown streaks in nail
mucosal pigmentation
the above are non-specific for Addisons

loss of ambisexual hair in post pubertal women

fibrosis and calcification of cartilage (ear) is rare

Question 15

Cushing’s syndrome signs

Answer 15

moon facies
dorsicervical fat pad (buffalo hump)
truncal obesity
spindly limbs
striae distensae
easy bruisability
slow wound healing
acne, hirsutism

Question 16

porphyria cutaneous tarda

Answer 16

porphyria-inherited and acquired disorders of heme synthesis pathway, resulting in accumulation of porphyrins

PCT is the most common porphyria. fragility. vesicles that heal with scarring on sun-exposed areas (face, hands). hypertrichosis (abnormal hair growth) may be present on temples and may have malar cheeks.

Question 17

systemic lupus erythematosus

Answer 17

80% of these pts have problems with skin

may have pink scaly patch on malar region of face

may have diffuse alopecia, oral ulcers, Raynaud phenomenon

photosensitivity

Question 18

discoid (Chronic) lupus erythematosus

Answer 18

majority of cases of this disease is skin limited

hyperkeratotic, violaceous plaques on head and neck. heal with atrophic scars

atrophic scarring with telangiectasis, follicular scales, and too much or too little pigment–can lose hair due to scars

Question 19

subacute cutaneous lupus erythematosus

Answer 19

can be skin limited or associated w/ internal disease

pink, scaly plaques on sun exposed areas. sometimes annular.

Question 20

acute cutaneous lupus erythematosus

Answer 20

resolves WITHOUT SCARRING

often brought on by sun

malar rash
strongly associated with SLE

Question 21

dermatomyositis skin findings

Answer 21

photosensitive dermatosis

heliotrope rash-pink/purple discoloration of upper eyelids, often w/ edema

pink, scaly patches and plaques may be present on sun exposed areas (called shawl sign if on chest, shoulders, back).

poikiloderma rash on trunk and extremities

Gottron’s papules: pink/purple, papules on elbows, knees, dorsal surfaces of hands and foot

nailfold capillary changes

Question 22

dermatomyositis is associated with what cancer?

Answer 22

OVARIAN

and others

Question 23

sarcoidosis

Answer 23

caused by noncaseating (non necrotic) granulomas in multiple organs, including pulmonary in 90% of cases and skin in 25% of cases

in skin can be pleomorphic. a great pretender-looks like lot of things

most common: red brown macules and papules on the face, typically around eyes and nose

erythema nodosum may be associated

Question 24

if you see sarcoidosis, what should you do?

Answer 24

look for systemic disease

Question 25

diascopy is

Answer 25

taking a slide and applying pressure to skin to see the color better

used in cutaneous sarcoidosis

Question 26

Lofgren’s syndrome

Answer 26

very common
a sarcoidosis syndrome
associated with hilar adenopathy and erythema nodosum

Question 27

dermatitis herpetiformis

Answer 27

autoimmune blistering disease due to sensitivity to gluten

INTENSELY PRURITIC papulo-vesicles (herpetiformis, meaning vesicles like herpes), which are scratched off so that only erosions and excoriations are present