Cutaneous manifestations of systemic disease

Question 1

Cutaneous manifestations of liver diseases

Answer 1

• Primarily stem from a state of excess estrogen from impaired metabolism
• Develop: spider angioma (central red arteriole w/ branching vasodilated capillaries), palmar erythema
• Similar findings can also be seen in pregnancy (also increased estrogen)

Question 2

Cutaneous manifestations of renal diseases

Answer 2

• Due to underlying uremia and atypical metabolism and clearance of other chemicals (Ca, PO4)
• Develop: pruritus, nail changes
• Patients w/ pruritus can present w/ secondary changes related to scratching
• Patients develop “lindsay’s nails” (red/white streaks in nails) due to edema of the nail bed

Question 3

Cutaneous manifestations of CV diseases

Answer 3

• Present w/ stasis dermatitis (misdiagnosed as bilateral lower extremity cellulitis), related to chronic lower extremity edema
• Caused venous insufficiency that is related to standing occupation, obesity, and exacerbated by CHF
• Patients also develop erythema, hyper pigmentation, xerosis, pruritus, ulcerations

Question 4

Cutaneous manifestations of pulmonary diseases

Answer 4

-Patients w/ chronic pulmonary diseases develop clubbing of the fingernails (but non-specific finding)

Question 5

Cutaneous manifestations of GI diseases

Answer 5

• Pyoderma gangrenosum: inflammatory non-infectious ulcers
• Dx of exclusion
• Ulcer w/ undermined border (demarcated), gray color, can worsen or be caused by trauma
• About half is associated w/ IBD, inflammatory arthropathy

Question 6

Cutaneous manifestations of endocrine diseases

Answer 6

• Acanthosis nigricans: velvety darkening of the skin posterior neck, armpits, occasionally face and hands
• Associated w/ diabetes, obesity, familial, malignancy
• Hyperpigmentation of palmar creases and gums can be due to Addison’s disease (destruction of adrenal gland)
• Due to lack of glucocorticoids, ACTH is produced to compensate. Through this process MSH is produced and stimulates the production of melanin

Question 7

Cutaneous manifestations of infectious diseases 1

Answer 7

• Janeway lesions (on fingers): painless septic emboli of bacterial endocarditis
• Can be accompanied by Olser nodes (tender immune complex deposition on hands) and/or splinter hemorrhages (under fingernails)

Question 8

Cutaneous manifestations of infectious diseases 2

Answer 8

• Erythema nodosum: non-specific panniculitis (inflammation of fat). Can cause bruise-like lesions
• Most frequently associated w/ strep throat infections in children. But can be related to many other infections/disorders/medications (coccidiodomycosis, sarcoidosis)

Question 9

Cutaneous manifestations of autoimmunity diseases 1

Answer 9

• Butterfly rash (gets worse in sun), SOB, mouth ulcers, and arthralgias
• Fingers turn colors in the cold (white-> blue-> red)
• These findings are consistent with lupus (do both ANA and dsDNA Ab tests to confirm)

Question 10

Cutaneous manifestations of autoimmunity diseases 2

Answer 10

• Dermatomyositis: connective tissue disease in both kids and adults
• Manifests as pruitus, redness around eyes, chest, and hands (gottrons papules), fatigue and muscle weakness
• Should screen for malignancy as DM can be paraneoplastic

Question 11

Cutaneous manifestations of malignancy diseases 1

Answer 11

• Like infectious diseases, can comes from direct involvement or underlying tissue involvement
• Past history of breast cancer, now has hard bump on abdomen
• Most likely is metastatic adenocarcinoma of the breast (can be colon, lung, ect)

Question 12

Cutaneous manifestations of malignancy diseases 2

Answer 12

• Persistent elevated glucose, fatigue, weight loss and a rash (mostly in skin folds)
• Glucogon level significantly elevated
• Dx is necrolytic migratory erythema in the setting of glucagonoma (tumor of alpha cells from pancreas)

Question 13

Cutaneous manifestations of immunodeficiency diseases 1

Answer 13

• Rash on face (white, crusty), scalp and chest, along with weight loss, and fatigue
• Dx is seborrheic dermatitis
• Test for HIV (HIV patients present w/ pronounced versions of common things)

Question 14

Cutaneous manifestations of immunodeficiency diseases 1

Answer 14

• HIV patient has red and tender papular/plaque-like rash on extremities and palate
• Dx is AIDS-related kaposi’s sarcoma (HHV8)
• Can be seen any anyone who are ICd due to medication/disease

Question 15

Cutaneous manifestations of nutritional deficiency diseases 1

Answer 15

• Bleeding of gums and strange spots around the hair on arms (perifollicular hemorrhage)
• Dx is scurvy due to vit C deficiency