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Flashcards in 31. Signs of Systemic Disease Deck (66)
1

Common (30%) in long standing diabetes

Diabetic dermopathy

2

50 yo man with uncontrolled diabetes comes in with this on his legs, how would you describe the lesions?

Atrophic, pink and hyperpigmented macules and (looks like scars)

 

3

Longstanding diabetic comes in with these ickies on his leg... what are they? Are they common

Bullous diabeticorum
• Rarer- 0.5% of patients with DM
• Male: Female 2:1

4

Location of Bullous diabeticorum and Tx?

• Longstanding DM with 
other complications
• Acral in location
• Often recurrent
• No effective treatment to 
prevent

5

Diabetic presents with these all over here shins... Gross, what is this?

Necrobiosis lipoidica
• Rare- only 0.03% of patients 
with DM
• DM in only 11-65% (not all 
 

6

How would you describe this lesion: necrobiosis lipoidica?

Yellow atrophic plaques Multiple/bilateral, Usually shins
• Especially likely to ulcerate 
in males with diabetes
 

7

Treatment for Necrobiosis lipoidica

Treatment difficult

8

9

Young woman comes in worried about this discoloration on her neck and armpits. What disease do we expect her to have?

Common in TYPE II DM
• Marker for insulin resistance
• Velvety hyperpigmented
thickening of the skin 
• Intertriginous/flexures
• Less extensor surfaces/face
• +/- skin tags

10

What is this shit?

acanthosis nigrans skin tags

11

What are some other reasons for ancanthosis nigrans besides DM Type II

• AN 1- familial
• AN 2-malignancy (especially gastric and lung)
• AN 3- related to obesity, insulin resistance and 
endocrinopathy (Type II DM, PCOS 
>acromegaly, Cushing’s, hypothyroidism)

12

AN 3 is releated to:

related to obesity, insulin resistance and 
endocrinopathy (Type II DM, PCOS 
>acromegaly, Cushing’s, hypothyroidism)

13

What type of AN is related to malignancy (especially gastric and lung)

 

AN 2

14

Common associations of Diabetes millitis?

Yeast, tinea, cellulitis, MRSA infections, neuropathic ulcers

 

15

What vascular diseases are associated with diabetes millitus?

Peripheral artieral disease and gangrenes

16

Young lady comes in with a nail infection and mild diffuse alopecia. Her skin is fine and smooth due to increased sweating and has hyperpigmentation with itching. DDx?

HYperthyroidism

17

Your performing a physical exam on an young woman and notice she has dry, cold, rough skin with scales on her feet. She has a dry cough and thin brittle nails and is misisng the lateral thid of the eyebrows. Dx?

Hypothyroidism
 

18

Occurs in some with Grave’s disease- about 1-5% (not in all with hyperthyroidism)
• Cutaneous infiltration of skin of shins (rare other sites) with MUCIN 
• “Peau d’orange” (like the skin of an orange), skin colored to brown red, firm
• Can occur during Grave’s or following treatment of same

Pretibial myxedema

19

Primary adrenocortical insufficiency--inability to make cortisol. 80% of the ime is autoimmune-aBs are found

*especially post TB, vascular, neoplastic, genetic)

Addisons
 

20

Symptoms of Addisons

Hyperpigmentation: MSH like effect of ACTH

diffuse, sun exposed, sites of trauma/scars, axillae, perineum, nipples, palmar creases, nevi, mucous membranes, hair, nails

Loss of ambisexual hair in post-pubertal woman

fibrosis and calcification of ear (rare)

21

Symtpsoms of Cushings

 Moon (round ) facies
 Dorsicervical fat pad (“buffalo
 hump”)
 Truncal obesity
 Spindly limbs
 Striae distensae
 Easy bruisability
 Slow wound healing
 Acne and hirsutism

22

23

Etiology of Addisons

Overproduction of Cortisol by Adrenal Gland

24

Multisystem disorder that can have big affect on the skin. Has several recognizable 'subsets' and is often diagnosed by appearance, timing and pathology

Lupus Erythematous

25

Why is Lupus considered a Spectrum of Disease?

• Overall, about 80% of systemic lupus (SLE) patients 
have problems with skin
• Some lupus patients (chronic cutaneous lupus) ONLY 
have problems with their skin

26

What skin related SLE systoms do we suspect to see?

Skin related
• Malar (cheek) erythema*
• Discoid (chronic/thick) lesions*
• Oral ulcers*
• Photosensitivity (sun sensitivity)*

27

What are the multisystem involvements seen in SLE

Multisystem 
• Arthritis
• Serositis
• Nephropathy
• CNS disorder
• Hematologic disorder
• Immunologic
• Abnormal ANA

28

Does SLE target any specific group of people?

 

Females > Males (6:1 for SLE)

Young > Old

African American > Caucasian

29

Pt comes in with ACLE, what regions are we expecting to see

• Generalized or 
photodistributed, 
exanthematous (rashy) 
eruption
• Often brought on by the 
sun but not always
• “Malar rash” = “butterfly 
rash”
• Strongly associated with 
SLE

30

Young girls comes to the office dt what her mother suspected was sunburn. It looked erythematous and there is a malar rash over her face. Whats the Dx and what can you tell the mom to expect?

 

Acute = resolves quickly 
in hours to days 
WITHOUT scarring
• Female:male = 8:1

31

Most common type of Chronic Cutaneous Lupus Erythematosus

Discoid

32

15-30% of SLE pts have some of these lesions 

discoid CCLE
 

33

____% of those with CCLE will devo Systemic SLE (especially if lesions are widespread

5%
 

34

Discoid CCLE is typically seen:

• Usually face/ ears/ scalp/ 
arms but can be 
generalized
• Mucosal (lips and mouth) 
involvement in 25%
 

35

• Atrophic (thin) scarring with telangiectasias (blood vessels), follicular scales, and too much or too little pigment. 
• Leaves scars! This is why it is challenging especially 
if scarring alopecia

Chronic cutaneous (discoid) lupus 
erythematosus

36

Differential Dx

Chronic cutaneous (discoid) lupus 
erythematosus

37

Dx:

Discoid Lups: Leaves scars! 

38

Newest subset of skin disease in lupus, described in 1979
• May also meet ARA criteria for SLE
• Usually positive for different ANA types than SLE
• Very photosensitive yet usually not on face

Subacute cutaneous lupus 
erythematosus

 

39

What is the pathology of Neonatal Lupus?

Due to SSA/B 
antibodies crossing the placenta

40

Young pt comes in with proximal weakness and Elevated CK. Abnormal myositis of biopsy and abnormal MRI of muscles. Dx. 

Dermatomyositis

41

Skin findings of Dermatomyositis

SKIN
“Heliotrope rash” (eyelids)
Photosensitive “poikiloderma”/ 
dermatitis
Gottron’s papules
Positive ANA (+/-)
Elevated CRP/ESR

 

42

What are these little ickies and who would we expect ot see them on?

Gottrons papules, Dermatomyositis

43

Young girl comes in with this rash on her face and muslce weakness, hard to get up stairs and get out of bed. What would we expect to see in her labs

Dermatomyositis

Positive ANA (+/-)
Elevated CRP/ESR

 

44

Describe this rash

Dermatomyositis: poikiloderma rash 
on trunk and extremities

45

Nailfold capillary changes are seen in : 

Dermatomyositis

46

What must we absolutely kepe on an eye on in a female pt with dermatomyositis?

Associated cancer in adults 10-50%
– GU, ovarian, colon most common
– Also breast, lung, pancreatic and lymphoma
– Always consider OVARIAN in women with DM
• DM may overlap with other CTDs
• Interstitial lung disease may be fatal

47

Sarcoidosis is characterized by what histologically?

Non-caseating granulomas

48

Sarcoidosis is a multisystem disease. What are two of the more commonly invovled organ systems?

Pulmonary 90% of time and can be asytomatic

Skin 20-35 and easy to biopsy

49

What skin presentation do we expect to see with sarcoidosis?

can be pleomorphic

common is red-brown macules and papules on face, typically around eye and nose

lesions can be small papules or larger plaques

(may have associdated erythema nodosum)

****If you have cutaneous sarcoidosis... do systemic workup!!!)

50

51

What is diascopy and when would we use this technique?

Placing glass slide over suspected sarcoidosis... will reveal the brown-red pigment better

(also helps to visualize telengactasia)

52

African American Pt comes in with fever and has brown-red papules and plaques around the eyes and nose. During a workup it's confirmed he has Hilar adenopathy, Erythema nodosum and joint stiffness. 

Dx?

Lofgren’s syndrome- very commom in sarcoidosis

(Spring; better prognosis- will often resolve 
Can make diagnosis without tissue)

 

53

Pt comes in with Causes fragile blisters from 
trauma and what he suspectes as sunburn.  During labs you note he has elevated ALT, AST and a history of Hep C. What explains the blistering on hands? 
 

Porphyria cutanea tarda

(Caused by defect uroporphyrin
decarboxylase which breaks 
down heme proteins)

 

54

What disease states or 'stressors' can cause porphyria cutanea tarda?

Enzyme system is “stressed” by 
chronic hepatitis C infection of 
the liver, but PCT can also be 
caused by some drugs, alcohol 
and iron overload in the liver 
(hemachromatosis)

 

55

Little boy is on platelet and RBC transfusions for a blood disorder. The Doctor is worried about iron overload because if he has a defect in this enZ it can lead to Porphyria cutanea tarda

Caused by defect uroporphyrin
decarboxylase which breaks 
down heme proteins

56

Besides Fragility and bullae and scars on the 
hands.. what else do we expect in pt with Porphyria cutanea tarda

Hypertrichosis of the face

57

• Crohns disease has specific skin involvements including: 

granulomas in the skin
• Involvement of oral mucosa 
with granulomatous
inflammation
• Fistulae to skin 

58

Non-specific association of Crohns disease?

• Erythema nodosum
• Pyoderma gangrenosum
• Nutritional problems
• Other

59

What is the association of IBD we see?

 

Pyoderma gangrenosum

60

Describe this lesion and its associated disease

IBD:

A sterile, rapid ulceration of 
the skin caused by 
neutrophilic infiltration 
• Characteristic undermined, 
dusky border

61

What diseases is pyoderma grangrenosum associated with?

inflammatory 
arthritis, hematologic 
problems and malignancies. 
Also idiopathic

62

This is a consequence of gluten sensitivity. What is it called?

Dermatisis Herpetiformis

63

Dermatitis herpetiforms reaction in the body?

Reaction to gluten in grains--> immune rxn to small bowel that laters the mucosa--> leasds to antiB formatio--> aBs can enter blood and attach to skin--> dermatitis herpetiformis

64

Common involvement of Dermatitis Herpetiformis

Extensor surface and above ass crack

RIDICULOUSLY pruitic!

65

Pt comes in with outbreak of lesions on her elblows and some on her lower back. Very itchy! They look simular to a herpes outbreak. What is the Tx you would recommend?

Pt has Dermatitis herpetiformis

Best treatment is complete avoidance of 
gluten - after 3 months, TTG antibody levels 
decrease, mucosa of gut normalizes and 
symptoms of DH abate

66

What is the reasoning behind using Dapsone as tx for pt with dermatitis herpetiformis?

Dapsone is also effective treatment for relief 
of DH (almost immediate for itching), but does 
not effect the gut or production of 
autoantibodies.