Blisters, Pruritus and Rashes due to Systemic Condn Flashcards
(275 cards)
1
Q
What is erythema nodusum
A
Skin condn where red, tender nodules forms on the skins and less commonly the thighs and forearms
2
Q
What can eryhema nodusum be classified as
A
A type of panniculitis - infl disorder affecting s/c fat
3
Q
Epidemiology of erythema nodusum
A
Ages 20-45, peak 20-30
3-6x more common in F than M
Often associated w/ recent illness or infection
4
Q
Causes of erythema nodosum
A
NODOSUM
No - idiopathic D - drugs O - OCP/ pregnancy S - sarcoidosis U - ulcerative colitis (IBD)/ Crohns Micro
5
Q
Drugs causing erythema nodosum
A
Sulphonamides Salicylates NSAIDs Dapsone Bromides Gold salts
6
Q
Micro (pathogens) casing erythema nododum
A
TB
Strep
Toxoplasmosis
7
Q
Px of erythema nodosum
A
Sx of underlying disease
2-50 red lumps
Fever, joint pain and feeling unwell
8
Q
Natural hx of erythema nodosum
A
Hot and painful, bright red when first appears
Later becomes purple and fades through colour changes of a bruise
9
Q
Dx of erythema nodosum
A
Throat swab Sputum ot gastric washing FBC, ESR, CRP ASO titre (strep) CXR (TB and sarcoidosis)
10
Q
What is cutaneous vasculitis
A
Group of disorder in which there are inflamed blood vessels in the skin
11
Q
Skin changes in cutaneous vasculitis
A
Capilaritis
Pigmented purpura
Characterised bu petechiae resolving w/ haemosiderin deposition
12
Q
What skin changes are typiccalya associated w/ small vessel vasculitis
A
Palpabal epurpura
13
Q
What skin changes are medium vasculitis usually associated w/
A
Nodules
Livedo reticularis
14
Q
Causes of cutaneous vasculitis
A
Infection CTD Malignant Drugs - abx Idiopathic - IgA vasculitis (HSP)
15
Q
CTD causing cutaneous vasculitis
A
SLE and related condns RhA SScl Sjorgen Dermatomyositis
16
Q
Malignancy causing cutaneous vasculitis
A
Haematological
Myleoproliferative
Lymphoma
Myeloma and MGUS
17
Q
Dx of cutaneous vasculitis
A
Clinical picture
Skin bx
Screening for underlying
18
Q
Pyoderma gangerosum
A
Condn causing rapid;y enlarging, very painful ulcers
19
Q
Feature of pyoderma gangrenosum
A
Ragged
Purple
Undermined edge
20
Q
Causes of pyoderma gangrenosum
A
IBD Myeloproliferative disease RhA Drugs Monoclonal gammopathy Idiopathic
21
Q
Dx of pyoderma gangrenosum
A
Clinical picture Swabs Bx to excl other causes of ulcer Associated systemic disease Response bro oral steroids
22
Q
Necrobiosis lipoidica
A
Granulomatous skin disorder which can affect skin of insulin dependent diabetics, although it can occur in non diabetic subjects as well
23
Q
Features of necrobiosis lipoidica
A
Tender, yellowish, brown patches develop slowly on the lower legs over several months
Slow healing
24
Q
How do the patches in necrobiosis lipoidoca change over time
A
Round, oval or an irregular shape
Centre of patch becomes shiny, pale, thinned w/ prominent blood vessels (telangiectasia)
25
What can a minor injury to an established lesion in necrobiosis lipoidica cause
Ulceration of the lesion
26
What can localised granuloma annulare be associated with
Autoimmune thyroiditis
27
What can extensive GA be associated with
DM, hyperlipidaemia
| More rarely w/ lymphoma, HIV infection and solid tumours
28
What type of GA is most common in children
Localised
29
What type of GA presents in adults
Generalised
30
Px of generalised GA
Widespread skin-coloured, pinkish or slightly mauve-coloured patches
DIssemnated type is composed of small papules
31
What is erythema multiforme
A HS reaction usually triggered by infections, most commonly HSV
Usually a/c and self-limiting
32
Px of erythema multifrome
Target-like lesions
| May be mucous membrane involvement
33
What can erythema multiform be divide dinto
Major and minor forms
34
Causes of erythema multiforme
Viral infection
| Drugs
35
Viral infection causing erythema multiform
```
Para poxvirus
VZV
Adenovirus
Hepatitis
HIV
CMV
Viral vaccine
```
36
Drugs causing erythema multiforme
```
Barbituates
NSAIDs
Penicillin
Sulphonamides
Phenothiazines
Anticonvulsnats
```
37
Dx of erythema multiforme
Clinical dx
Skin bx
Screen for underlying cause
38
Xathoma
Skin lesions caused by accumulation of fat in macrophages in the skin and rarely s/c layer of skin
39
What might xanthoma be indicative fo
Lipid metabolism holism disorders
40
Congenital conditions causing xanthomas
Primary billiard cirrhosis (autoimmune)
Familial hyperlipidamie
May also be idiopathic
41
Acquired causes of xanthoma
DM
Cholestasis
Hypothyroidism
C/c renal failure
42
How are xanthoma classified
According to where they re found on the body and how they develop e.g. palmar xanthoma, tendon xanthoma, xanthelasma
43
Causes of eruptive xanthoma
Familial triglyceridaemia
| Lipoprotein lipase deficiency
44
Xanthelesma palpebrum
Most common type of xanthoma, arise symmetrically on upper and lower eyelids
May or may not be associated w/ hyperlipidaemia
45
Tuberuous xanthoma
Firm, painless, red-yellow nodules that develop around the pressure areas such as knees, elbows, heels and buttocks
46
What is tuberous xanthoma usually associated w/
Hypercholesterolaemia
47
Tendinous xanthoma
Slowly, enlarging s/c nodules related to a tendon or ligament
48
What is tendinous xanthoma associated w/
Severe hypercholesterolaemia and elevated LDL levels
49
What is eruptive xanthoma seen in
DM pts
50
What areas of the body are affected by eruption;tive xanthoma
Buttocks
Shoulder
Arms - extensor aspect
51
What does xanthoma disseminatum affect
Internal organs
| Self-limiting
52
Skin changes during pregnancy
```
Striae
Skin tags
Changes in hair growth
Acne breakouts
Spider veins and VV
Darkening of areas of your skin
Darkening of moles and freckles
```
53
When does pruritic urticariated papules and plaques of pregnancy occur
3rd trimester of primiparous women
54
Primiparous
Women who have been pregnant and given birth
55
Features of pruritic, urticraiated papules and plaques of pregnancy
Doesn't recur w/ future pregnancies
| Spares umbilicus
56
Treatment of pruritic, urticariated papules and plaques of pregnancy
Topical steroids
| Antihistamines
57
Do pruritic urticated papules and plaques of pregnancy pose a risk to newborn
No
58
Pemphigoid gestations
Abrupt onset of urticarial plaques and blisters usually in 2nd trimester
59
Features of pemphigoid gestations
Recurs in future
Takes weeks-months to resolve postpartum
Histologically similar to bullies pemphigoid (C3, IgG)
60
Treatment of pemphigoid gestations
Oral steroids
61
Intrahepatic cholestatis of pregnancy (ICP) presentation
Pruritus (palms and soles)
Dark urine
Jaundice
62
When does Intrahepatic cholestatis of pregnancy px
2nd or 3rd trimester
63
Does Intrahepatic cholestatis of pregnancy resolve on delivery
Yes
64
Does Intrahepatic cholestatis of pregnancy carry any risks to the newborn
Yes - higher risk of premature or stillbirth
65
Pathology of Intrahepatic cholestatis of pregnancy
Bile acids from liver unable to flow properly and build up in the body
66
Treatment of ICP
Urseodeoxycholic acid
67
Neurophyiology of pruritus
Complex and not fully understood
Itch transmitted by C fibres
Spinothalamic tracts --> thalamus ---> sensory cortex
68
Differntials of generalised itch w/out rash
```
Renal pruritus
Cholestatic pruritus
Endocrine - thyroid, DM
Paraneoplastic
Haematological
HIV
Pregnancy related
Drug related
```
69
Ddx of generalised itch w/ rash
```
Scabies
Eczema
Urticaria/ dermographism
Paraneoplastic
Bullous disease
Psoriases - main cause
Pregnancy related
Drug eruptions
```
70
Who is renal pruritus seen in
Seen in pst w/ c/c renal failure (mainly advanced)
| Peaks 2nd nights w/out dialysis,
71
Mx of renal pruritus
Improves after dialysis
Subtotal parthyroidectomy
Phototherapy and antihistamines
72
Is renal pruritus dependent on raised serum urea
No
73
When does cholestatic pruritus occur
In any liver disease - usually intrahepatic cholestasis
74
Where is cholestatic worse
Worse on hands, feet and body and body regions constricted by clothing
Also worse at night
75
Treatment of cholestatic pruritus
Treat underling cause
| Dugs - cholestyramine, ursodeoxycholic acid, rifampicin
76
MOA of cholestyramine
Binds to bile acids preventing re-absorption
77
MOA of ursodeoxycholic acid
Regulates cholesterol via absorption rates
78
Enodrcine causes of pruritus
Thyroid disease - more h-common in hyper > hypo
DM - associated w/ poor glycaemic control, can be part of diabetic neuropathy
May also be candida infection in DM pts
79
Haematological causes of pruritus
IDA
Haemochromatosis
PV - aquagenic
CLL
80
HIV asd a cause of pruritus
Can px w/ generalised itch
Secondary dermatoses are more common: candidiasis, Kaposi sarcoma, 2' to lymphoma, eosinophilic folliculitis, drug reaction
81
Infections seen in hIV pts causing itch
Hepatitis A, B, C, E
Swimmer's itch
Helminths
82
Skin involvement in cutaneous T-cell lymphoma
Mycosis fungicides
Dry, peeling, itchy skin
Erythroderma
Thickened skin on sole and palms
83
Rashes due to scratching
Excoriation
Nodular prurigo - butterfly sign
Lichen simples chronic - caused by constant rubbing and scratching
84
Butterfly sign in nodular prurigo
No lesions on back where pt cannot reach
85
Tyepes of cutaneous drug reaction
```
Exanthematous
Pustular
Urticaria, angiodema, anaphylaxis
Fixed drug eruption
Drug HS syndrome
Pigmentation
Pseudoprohyria
Necrosis
```
86
Types of blisters (sizing)
Bullae - >0.5cm elevated circumscribed fluid filled sac
| Vesicles - <0.5cm elevated circumscribed fluid filled sac
87
Hx for drug-induced rashes
Sites e.g. single dermatome, where cream apples, light exposed areas
Onset & timing e.g. insect bite, had this before
Charters
Exacerbating 7 relieving factors
Any recent illness
Any new exposures
Allergies
88
How does erythema multiforme start
Target plaques and papules predominantly starts aurally distributed
89
Features of Erythema multiforme major
Major has fever & >1 mm involved (mouth, eye, genitals, GI tract/ anus, trachea/ bronchi)
90
SJS
Steven Johnsons Syndrome
91
TEN
Toxic Epidermal Necrolysis
92
SJS and TEN
Macules or blisters developing into sheets of skin detachment
SJS: 10-30%
TEN: >30%
Typically associated w/ prodormoal illness
93
Drugs that may cause a reaction ----> SJS/ TEN
```
Sulphonamides
Imidiazole
Naproxen
Ibuprofen
Anticonvsulanst e.g carbamazepine, phenytoin, valproic acid
```
94
+ve Nikolsky sign
Rubbing red skin then formation of blisters
95
How is SJS/TEN graded
SCORTEN
| 7 parameters of disease severity used to predict in-hosp mortality
96
When do pustular drug orectaiosn start
1-3 week(s) after drug
| May cause desquamation after initial reaction
97
Where do pustular drug reactions occur
Face
| Flexures
98
Ix findings of pustular drug reactions
Raised neutrophils
| Sterile pus
99
When do pustular drug reactions resolve
<15 days
100
Features of fixed drug eruption
Solitary erythematous plaques, bullae or erosion
Occurs 30mins - 8hrs
If exposed to same drugs --> same site in hrs
Area becomes hyper pigmented
101
When do fixed drug eruption resolve
In a few weeks
102
When does drug hypersensitivity syndrome occur
2/12 later
103
What does DRESS syndrome consist of
Drug rash
Eosinophilia
Systemic sx
104
DRESS px
Fever
Papaules, facial oedema +/- exfoliative dermatitis
Lymphadenopathy
105
Haematological findings in DRESS
Eosinophilia
| Atypical lymphocytes
106
Organ involvement in DRESS
Hepatitis
Carditis
Interstitial nephritis
Interstitial pneumonitis
107
Causes of drug-induced pigmentation
Amiodarone - slate grey
Antimalarial (>4/12) - brown or blue-black
Oestrogen/ progesterone - hyperpigmneted patches (melasma)
108
Drug related necrosis and warfarin
Seen days 3-5
| Prone if hereditary deficiency of protein C. S or antithrombin III
109
Px of pseudoporphyria
Photosensitive, bulbous rash on hands and feet
110
Features of pseudoporphyria
Heals w/ scars and milia
| Histologically different from porphyria & porphyrin studies are -ve
111
Drug reaction mimics of pemphigus vulgaris
Captopril
P;eniclllamine
Ampicillin
112
Drug reactions mimics of bullous pemphigoid
```
Furosemide
Bumetanide
Spiro
Penicillamine
Amoxi
Cipro
```
113
Drug reaction mimics of lineal IgA disease
Vancomycin
114
Ix for drug induced rashes
Blood tests - akin autoimmune, raised IgE, serum + blister fluid IMF
Swab - viral, bacterial
Bx
115
What are welling for when we perform a bx for blisters
Levl of split - sub-corneal, into-epidermal & sub-epidermal
| What is depositing at that layer e.g. IgA, IgG, C3
116
IMF as an ix for blistering disorders
Determines which layer of the basement membrane is splitting e.g. desmosome for pemphigus
117
Which layer of skin are the blisters in pemphigus vulgaris found
Within the epidermis floor, lined by basal cells
118
What types of cells are found in blister fluid for pemphigus vulgaris
Acantholytic
119
Which layer of skin are the blisters in pemphigoid found
Sub epidermal
120
Which layer are the blisters in dermatitis herpetiformis found
Sub epidermal
121
Infiltrates in underlying dermis for pemphigoid vs dermatitis herpetiformis
Eosinophil for pemphigoid
| Neutrophil fro dermatitis herpetiformis
122
IMF results for diff blistering disorders
Intercellular IgG & C3 - pemphigus
Basement membrane IgG & C3 - pemphigoid
Dermal papillary IgA - DH
123
Mx for drug-induced rashes
Stop drug
Antihistamine (sedating)
Steroids - top or po
124
Mx for drug-induced rashes causing anaphylaxis
CHAOS
```
Chlorphenamine IM/IV
Hydrocortisone IM/ IV
Adrenaline
Oxygen
Salbutamol
IV fluids
```
125
Exanthematous drug rectaion
Measles-like rash (morbilliform, maculopapular)
EBV + amoxi or ampicillin = rash
3-5 darts after stopping drug
126
Examples of blistering disorders
Bullous pemphigoid
Pemphigus vulgarise
Dermatitis herpetiformis
127
Types of blisters (level of split)
Sub-epidermal
| Intra-epidermal
128
Where is the basement membrane found
Interface between dermis and epidermis
129
Features of blisters in pemphigoid
Thick walled and tense
| Occur at hemidesmosome
130
Features of blisters in pemphigus
Thin walled and flaccid
| Occur at desmosome
131
Epidemiology of pemphigoid
Acquired blistering disease
Most common autoimmune bullouse disease
Peak incidence 8th decade
132
Hx of pts w/ pemphigoid
Itchy rash - weeks to months
| Blisters
133
Examination of pts w/ pemphigoid
Eczematous or urticariated rash
Tense blisters (vesicles and bullae)
Localised or widespread
Mucous membrane involvement 1/3 - 1/2
134
Difference in distribution of lesions in PV and pemphigoid
Pemphigoid is more likely to a facet limbs
135
Ix for pemphigoid
```
Bx - histology, direct IMF
indirect IF (circulating bp abs in 70%)
```
136
What kind of sample needs to be taken for pemphigoid IMF
Perilesional skin - band of IgG +/- C3 along bm
137
Treatment for pemphigoid
Orla steroids (30-40mg) (+bisphosphonates, PPi)
May use doxycycline
Nicotinamine
+/- azathioprine
138
Why may doxycycline be used in pemphigoid
Steroid-sparing agent for anti-infl
139
Prognosis of pemphigoid
Pt relapse/ remitting
Can last for 5 yrs
Morbidity/ mortality related to treatment
140
Pathogenesis of pemphigus vulgaris
Acquired autoimmune blisters
IgG to desmosomal antigens
Target = demsoglein 3, codes for cadherin
141
Hx of pts w/ pemphigus
Age 40-60 yrs (median 7th decade)
Oral ulcers - preceding rash (months)
"Sore" rash rather than itchy
142
Examination features of pemphigus
Mouth ulcers
Erosion of skin
Fragile/ flaccid blisters
+/- involvement of other mms
143
Mm involvement seen in pemphigus
```
Laryngeal
Pharyngeal
Nasal
Oesophageal
Urethral
Vulval
```
Mucosal surfaces erosions seen rather than bullae
144
Sites of pemphigus vulgaris
```
Scalp
Face
Chest
Axillae
Groin
Umbilicus
Back if bed ridden
```
145
Acantholysis
Loss of normal cell-cell adhesion
146
Direct IMF for PV
'Chicken wire' or 'crazy paving appearnce'
147
Ix for PV
Bx - histology (intra-epidermal split), direct IMF, acantholysis
Indirect IF
Titre proportional to activity
148
Treatment of PV
High dose oral steroids
Azathioprine
Plasmapheresis
IV Ig
149
Prognosis of PV
Mortality of 5-15%. Associated w/ tx, infection, fluid and electrolyte imbalance
150
Rare variants of PV
Follaceous
| Paraneoplastic
151
Features of follaceous PV
Desmoglein antibody causes upper epidermal pacantholysis, not mms
Benign course
152
Where does follaceous PV present
Scalp, face, chest, upper back - similar distribution as Seb K
153
What do pt's dermatitis herpetiformis also have
Gluten sensitive enteropathy (coeliac) - usually 2' gluten enterooptahy
154
What is dermatitis herpetiformis associated w/
Other autoimmune condns - DM, thyroid, pernicious anaemia, SLE
155
Pathogenesis of dermatitis herpetiformis
Deposition of IgA and epidermal transglutaminase complexes in the papillary dermis
156
Hx of pts w/ DH
```
Age of onset 20-60
Have an intensely, itchy rash
Small blisters (herpetiform) - vesicles
```
157
Examination of pts w/ DH
```
Erythematous papules + blisters
Excoriations
Extensor aspects - knees, elbows, buttocks (grouped vesicles)
May be more widespread
MM not involved
```
158
Ix for DH
```
Bx
Histology - sub-epidermal
Direct IMF (sample from uninvolved skin)
Indirect IMF for skin autoantibodies
Distal duodenal bx
Antiendomysial and tTG (+ve)
```
159
Direct IMF results for DH
Granular deposits IgA in dermal papillae
160
Treatment of DH
Gluten free diet - rash resolves after 2-3yrs on diet
Dapsone
Sulphonamides
161
Dapsone side effects
```
Headaches
Depression
Lethargy
Haemolytic anaemia - severe in G6PD deficiency
Neuropathy
```
162
What needs to be checked before prescribing dapsone
G6PD levels for deficiency
163
Sulphonamides side effects
```
Bone marrow suppression (esp neutrophils)
Nausea
Depression
Rashes
Hepatitis
Interstitial pneumonitis
```
164
Azathioprine side effects
GI disturbance - nausea, vomiting, diarrhoea
Bone marrow suppression
Liver damage
165
Blood tests to monitor azathioprine
LFT
FBC
U&E
166
Prurigo of pregnancy
Discrete erythematous or skin coloured papules, excoriated
| Occurs in any stage of pregnancy
167
Treatment of prurigo of pregnancy
MInld to moderate steroids
1% menthol in aq cream arm
Antihistamines
168
Which antihistamines should be used in prurigo of pregnancy
Cetirizine
| Loratidine
169
What level of the skin does UVA rays reach
Dermis
| Causes skin damage e by damage to the dermis
170
Which level of the skin do UVB rays reach
Absorbed by the epidermis
| Causes erythema, oedema and skin ageing
171
Which form of UV radiation is responsible for Vit D synthesis
UVB
| Also more potent than UVA
172
Fitzpatrick I features
Burns easily, never tans
| Ivory/ white
173
Fitzpatrick II features
Burns easily, tans minimally w/ difficulty
| White
174
Fitzpatrick III features
Burns moderately, tans moderately and uniformly
| Beige
175
Fitzpatrick IV features
Rarely burns, tans profusely
| Light brown
176
Fitzpatrick V features
Never burns, tans profusely
| Dark brown
177
Factors increasing incidence of sunburn
```
Regions situated closer to the equator
Areas at high altitude
Skin exposure between 10am - 2pm
Clear skies
Envirpnemnetal reflection (from snow and ice)
```
178
Things to look out for in examination of pits w/ photosensitive skin disease
Sparing fo facial creases, behind ears, lower eyelids, beneath nose and chin
Erythema, blisters, wheals
179
How can we group photosensitive disease
```
Idiopathic
Genetic
Metabolic
Autoimune
Exogenous
Other diseases that a re exacerbated by sunlight
```
180
Pathogenesis of sunburn
Erythema and vasodilation of skin caused by excess exposure to UV(B)
UVB releases chemicals making skin tender, hot, blistering
181
What chemicals are released by UIVB isn sunburn
Leukotrienes
NO
Histamines
PGE2
182
Features of severe sunburn
```
Blistering
Dehydration
Infection
Electrolyte imbalance
Shock
```
183
What is sunburn typically followed by
Desquamation and pigmentation
184
Long term consequences of sunburn
Increased risk of skin cancer
Lentigo formation
Skin ageing
185
Polymorphic light eruption
Itchy, erythematous eruption
Spares habitually exposed ares (face, hands)
'Prickly heat'
186
Pathology behind polymorphic light eruption
Autoimmune infl response if the skin to UV radiation
187
Mx of polymorphic light eruption
Avoidance/ sunblock
If severe, steroids (po or top)
Prophylactic UVB/ UVA
188
Ddx of polymorphic light eruption
Lupus erythematous
189
Px of c/c actinic dermatitis
Pruritic, erythematous, thickened xeroderma
Sun exposed skin
Often hx of pre-existing eczema
190
Dx of c/c actinic dermatitis
Patch testing
| Photo patch testing
191
Epidemiology of c/c actinic dermatitis
Men > 50
192
Mx of c/c actinic dermatitis
Sun avoidance/ sun block
| As for eczema (emollient, top steroids)
193
Solar urticaria
Rare, physical urticaria within mins of UV light, lasts a few hrs
194
Px of solar urticaria
Raised, erythematous wheals
195
Mx of solar urticaria
Sun protection
Antihistamine
Desensitising phototherapy
196
Actinic prurigo
Photosensitivity causing v itchy papules on sun exposed areas
197
Epidemiology of actinic prurigo
Usually children <10
More common in darker skin types
Often over lips and sun exposed ares on face - worse in spring/ summer
198
Mx of actinic prurigo
Emollients
Topical steroids
Hydroxychloroquine
Desensitisation
199
Hydroa vacciniforme
Blisters form over sun exposed ares and heal w/ scarring 30-120 mins after exposure
Causes burning sensation or itching
200
Epidemiology of Hydroa vacciniforme
Children aged 3-15,
F>M
Resolves once teenagers, but left w/ scarring
201
Mx of hydrovacciniforme
Sun protection/ avoidance
Desemnistising phtotheroay
Rarely, hydroxychloroquine
202
Xeroderma pigmentosum
Rare, autosomal recessive defect in DNA repair
| Results in photosensitivity, skin ageing tendency to form skin cancer
203
What may xeroderma pigmentosum be associated w/
Neurological or ocular disease
204
Mx of xeroderma pigmentsoum
Sun avoidance/ protection
| Regular skin examination
205
Px of Porphyria Cutanea Tarda
Erythema, blisters, erosions, hypertrichosis
| Often over hands, face, neck, chest
206
What are the skin changes in PCT in response to
UV
Radiation
Minor trauma
207
Triggers of PCT
Alcohol
Oestrogen (cocp, liver disease, HRT)
Iron overload (oral iron/transfusions, hepatitis, haemochromatosis)
These all increase the production of porphyrins
208
Ix for PCT
```
Bx
Urinary porphyrins
Woods light (fluoresces coral pink)
Check Hb, Fe, LFTs, viral hepatitis screen
Fasting blood glucose
ANA
```
209
Mx of PCT
Avoid alcohol, oestrogen, iron
Sunblock/ sun avoidance
Venesection if necessary
Rarely, hydroxychloroquine
210
What does cutaneous LE px with
```
Mlar (butterfly) rash
Photosensitivity
Mouth ulcers
Urticaria
Hair thinning
```
211
Classification of Lupus Erythematosus
Cutaneous LE
Systemic LE
Drug-induced LE
212
Aside from the skin, what may systemic LE also affect
```
Joints
Kidneys
Lungs
Heart
Liver
Blood vessels (vasculitis)
```
May be associated w/ aPL antibodies
213
Which drugs can cause drug-induced LE
```
Hydralazine
Carbamazepine
Lithium
Phenytoin
Sulphonamides
Minocycline
```
214
Ix for LE
```
FBC
U+Es
ANA
Anti-dsDNA
Anti-Ro/La
aPLs
Skin bx w/ IMF
```
215
Mx of LE
```
Stop causative drugs
Smoking cessation
Sun protection/ avoidance
Topical steroids
Oral steroids
Immunosuppression
```
216
Phytophotodermatitis
Form of plant dermatitis
Reaction to organic psoralens found in lime, celery, wild carrot, hogweed
Subsequent exposure to sunlight causes irregular erythema and blistering
217
What are examples of conditions exacerbated by the sun
Darier's
HSV
Pellagra
Photoaggravated psoriasis
218
Pellagra
Deficiency in niacin
| Causes diarrhoea, dermatitis and dementia
219
What are examples of conditions that improve following sun exposure
```
Atopic eczema
Pityriasis lichenoides
Pityriasis rosea
Psoriasis
Pruritus/ of renal failure and liver disease
```
220
What is purpura
Non blanching rash due to haemorrhage from skin vessels
221
Macular vs palpable purpura
Macular is usually non-infl
| Palpable purpura is usually infl (e.g. vasculitis)
222
Causes of purpura
Platelet disorders
Vascular disorders
Coagulation disorder
223
Platelet disorders as a cause of purpura
TTP - usually causes petechiae
224
Vascular disorders as a cause of purpura
Blood vessel wall damage (vasculitis) - may be palpable
Deficient vascular support
Schamberg's disease
225
Deficiente vascular support as a cause of purpura
Senile purpura
| Corticosteroid-induced
226
Features of Schamberg's disease
Brown macule
| Red, cayenne pepper spots on legs
227
Coagulation disorders as a cause of prpura
DIC, HIT, warfarin induced necrosis
| Usually causes ecchymoses & external bleeding
228
Non-palpable purpura causes - petechiae
Thrombocytopenia
Abnormal platelet function
Increased intravascular venous pressures
Some infl skin diseases
229
Non-palpable purpura causes - echymoses
```
External trauma
DIC and infection
Coagulation defects
Skin weakness/ fragility
Waldenstrom hypergammaglobulinaemia
```
230
Does systemic vasculitis alway have cutaneous features
No
231
Causes of vasculitis
```
Idiopathic
Infection
Infl and autoimmune diseases
Drugs
Neoplastic
```
232
What types of vasculitis can be caused by infection
Henoch-Schonlein Purpura
| Septic vasculitis
233
Infl and autoimmune disease causing vasculitis
SLE, RhA, Crohn's, UC
| Rare causes - Churg-Strauss, Wegener's granulomatosis, polyarteritis nodosa (PAN)
234
Drugs that may cause vasculitis
```
Sulphonamides
Beta-lactams
Penicillin
Quinolones
NSAIDs
OCP
Thiazides
```
235
Neoplastic causes of vasculitis
```
Paraproteinaemia
Lymphoproliferative disorders (lymphoma, leukaemias)
```
236
Infections causing vasculitis
Can be any infection - often follows URTI
Bacterial esp meningocuus
Viral - hep B & C
237
Pattern seen in Henoch-Schonlein Purpura (IgA)
Skin vasculitis
Joint pain
Abdo pain
Presence of IgA
238
What type of vasculitis is livedo reticularis seen in
PAN
| Anti-cardiolipin antibodies or cholesterol emboli
239
Examples of large vessel vasculitis
Temporal/ GCA
| Takayasu' arteritis
240
Examples of medium vessel vasculitis
PAN
| Kawasaki disease
241
Examples of small vessel vasculitis
Granulomatous vasculitis
Microscopic polyangitis (polyarteritis)
HSP (IgA)
242
Examples of granulomatous vasculitis
Wegener granulomatosis
| Churg-Strauss syndrome
243
Cutaneous px of larger vessel vasculitis
Claudication
Ulceration
Necrosis
244
Cutaneous px of small-medium vessel vasculitis
S/c nodules
Purpura
Fixed livedo reticularis
245
Cutaneous px of small vessel vasculitis
Palpable purpura
| Rarely, urticarial lesions (urticarial vasculitis)
246
Systemic manifestations of GCA
Associated w/ PMR
Headache
Jaw claudication
Blindness (amaurosis fugax)
247
Cutaneous involvement of GCA
Tender, swollen, nodular indurated temporal artery
248
Epidemiology of Takayasu arteritis
Usually occur in young women and Asian population
249
Features of Takayasu;s arteritis
Typically affects aorta and branches:
Unequal BP in upper limbs
Claudiaction on exertion
Renal artery stenosis
250
Mx of Takayasu's arteritis
Steroids
251
Epidemiology of PAN
More common in middle-aged men and its associated w/ Her B infections
252
Features of PAN
```
Livedo reticularis
Fever, malaise, arthralgi
HTN
Renal disease - haemoturia
Microaneurysm on angio*
Neuritis
```
253
Cutaneous features of PAN
5-10mm s/c nodules distributed segmentally
| May be painful, pulsatile or secondly ulcerated
254
Kawasaki disease epidemiology
Seen in children
255
Features of Kawasaki disease
```
High grade fever for at least 5/7
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Polymorphic rash followed by desquamation of palms and soles
```
256
Prognosis of Kawasaki disease
Most cases are benign but risk of coronary artery aneurysms
257
Mx of Kawasaki disease
High dose aspirin
IV Ig
Echo - screen for aneurysms
258
Epidemiology of HSP
Most common in children <10
| Can be triggered by URTI
259
Pathogenesis of HSP
IgA deposition in vessel walls
260
Cutaneous features of HSP
Symettricla, intermittent palpable purpura over buttocks and extensor extremities
261
Systemic features of HSP
Abdo pain
Haematuria
Arthralgia
262
Prognosis of HSP
Very good - eps in children
| BP and urinalysis monitored to detect renal involvement
263
Wegener's granulomatosis (granulomatosis w/ polyangitis)
Necrotising granulomatous infl of upper and lower resp tract
264
Resp features of Wegener's granulomatosis
Epistaxis
Sinusitis
Haemoptysis
265
Systemic features of Wegner's granulomatosis
URT/LRT involvement
Glomerulonephritis
Saddle-shop nose deformity
266
Cutaneous features of Wegener's granulomatosis
Painful, s/c nodules
Pyoderma gangrenous lesion
Palpable puerperal
267
Churg0Strauss syndrome (eosinophilic granulomatosis w/ polyangitis)
Triad of tissue eosinophilia, granulomatous inflammation and vasculitis
268
Features of Churg-Strauss
Asthma and allergic rhiniti9s - typically precedes vasculitis phase
C/c sinusitis
Mononerutos multiplex
Blood eosinophilia
269
Cutaneous stigmata of Churg-Struass
Palpable purpura
| Infiltrated nodules
270
Mx of Churg-Strauss syndrome
Steroids
271
Pathophysiology of cutaneous leukocytoclastic vasculitis
Circulating immune complexes deposited in walls of affect small vessels/ post-capillary venules in dermis
272
Epidemiology of cutaneous leukocytoclastic vasculitis
F > M (2.5: 1)
273
Skin lesions in cutaneous leukocytoclastic vasculitis
Palpable purpura on ankles/ LL or pressure points
| Urticaria or ulcers possible
274
ANCA associated vasculitis
Wegners (cANCA)
Churg-Strauss (pANCA)
Microscopic polyarteritis (pANCA)
275
Which vasculidities show low levels of complement
Mixed cryoglobulinaemia
Urticarial vasculitis
Lupus
