Cutaneous Manifestations of Systemic Disease

Question 1

jaundice

Answer 1

liver disease

scleral yellowing

diffuse yellowness of the skin

Question 2

gynecomastia

Answer 2

liver disease

arises because of relatively higher levels of circulating estrogen

usually the liver clears the estrogen but when the liver is damaged that doesn’t happen

Question 3

Kaput Medusa

Answer 3

liver disease

increased portal pressure and results in engorged periorbital veins

Question 4

spider angiomas

Answer 4

liver disease

can happen de novo, ut in liver disease, patients have high levels of estrogen which leads to broken blood vessels with podlike extensions

in patients with severe disease, this spreads throughout the body

Question 5

lichen planus

Answer 5

liver disease

viral hepatitis serology because of association

prototypical skin lesion is purple, puritic, polygona, papules, placques

can have oral mucosal lesions in some cases

some reticulations is common, sometimes can be the sole manifestation

overgrowth of nail plate, typical

Question 6

hemochromatosis

Answer 6

liver disease

patients develop hyperpigmentation from disease causing increased melanin deposits

autosomal dominant

diabetes, arthritis, iron overload (primary process)

Question 7

Kayser-Fleisher Ring

Answer 7

Wilson’s Disease (liver disease)

autosomal recessive, copper metabolism defect

Question 8

cryoglobulinemia

Answer 8

Hep C (liver disease)

variety of causes - acquired condition of autoantibodies

these cause vasculitis, which has many different manifestations

ischemic changes in severe cases

Question 9

puritis

Answer 9

renal disease

itching of the skin, no primary lesions - lesions here are self-inflicted from scratching

theory is that kidney filters out itch-causing agents, so when they fail this happens

dialysis will improve itch

Question 10

calciphylaxis

Answer 10

renal disease

end result of derangement in calcium and phosphate metabolism

from calcium that has precipitated out

patients have pain, get septic and die quickly without proper management

Question 11

uremic frost

Answer 11

renal disease

result of urea and uric acid precipitating once the sweat dries on top of the skin

Question 12

cyanosis

Answer 12

pulmonary disease

blue lips and reddish-blue hands, especially tips of fingers

Question 13

clubbing

Answer 13

pulmonary disease

long-standing pulmonary disease

Schamroth’s windis is missing in clubbing

can be idiopathic or familial

Question 14

lupus pernio

Answer 14

sarcoidosis (pulmonary disease)

sarcoidal involvement of the skin around the nose

priminent papular placque

harbinger that a patient has sarcoidosis

need biopsy to prove

Question 15

Lofgren’s Syndrome

Answer 15

sarcoidosis (pulmonary disease)

associated with hilar adenopathy that is subclinical and bilateral

peniculitis - inflammation of subcutaneous fat

typically involving anterior and peritubular areas of the leg

not sarcoidosis involving the skin

good prognosis

Question 16

causes of erythema nodosum

Answer 16

Behcet disease

Estrogens

Drugs

Recent infection (pneumococcus)

Enteropathies (IBD)

Sarcoid

Tuberculosis

Question 17

lupus valgaris

Answer 17

cutaneous TB (pulmonary disease)

dissemination of TB onto the skin from the lungs

can be reactivation or reinfection

Question 18

erythema induratum

Answer 18

pulmonary disease

nodular vasculitis - reactive panniculitis from past or present TB infection

typically posterior calf or side

indication of tuberculosis in the lungs

Question 19

scrofuloderma

Answer 19

lung disease

direct extension of TB lymphadenitis

biopsy for diagnosis

Question 20

Osler’s nodes

Answer 20

cardiovascular disease

sign of dissemination of bacterial lesions in cardiac valves into the skin

painful, palpable red lesions usually on fingers/toes

they are caused by immune complexes

Question 21

Janeway’s Lesions

Answer 21

cardiovascular disease

non-painful, macular lesions, usually onpalms/soles

they are caused by septic emboli, more common in Staph aureus endocarditis

Question 22

splinter hemorrhages

Answer 22

endocarditis (cardiovascular disease)

small clots in the vessels of the nail plate

can happen randomly as well

Question 23

eruptive xanthoma

Answer 23

cardiovascular disease

lipid metabolism disorder, can happen anywhere

Question 24

xanthomas

Answer 24

cardiovascular disease

tendinous xanthomas, nothing morthan cholesterol or lipid deposition in the skin

can be palmar, tendinous, or tuberous

Question 25

xanthelasma

Answer 25

**cardiovascular disease/billiary cirrhosis** yellowish bumps around eyelids normal lipids, cholesterol from skin cells usually, not lipid metabolism disorder but can be associated with high LDL or cholesterol

Question 26

cholesterol emboli

Answer 26

**cardiovascular disease** can happen spontaneously claudication symptoms of the lower extremities cholesterol emboli can cuase dots in the feet usually resolves spontaneously can also happen after an angioplasty

Question 27

stasis dermatitis

Answer 27

**venous disease (cardiovascular disease)** poor venous blood flow, inability of the veins to squeeze blood back to the heart leakage of RBCs back into the skin with enough inflammation, can get skin breakdown and ulceration brown discoloration because of extravasation of RBCs into the skin - permanent discoloration

Question 28

moon facies

Answer 28

**adrenal/pituitary disease** caused by increase in relative amounts of cortisol - often due to pituitary tumors also exogenous corticosteroids

Question 29

buffalo hump

Answer 29

**adrenal/pituitary disease** lipodystrophy changes where fat normally distributes

Question 30

striae

Answer 30

**adrenal/pituitary disease** happens in overweight or pregnant individuals

Question 31

acanthosis nigricans

Answer 31

**adrenal/pituitary disease** **diabetes mellitus** insulin insensitivity from hypercortisolism velvety appearance, due to high levels of insulin

Question 32

hirsutism

Answer 32

**pituitary/adrenal disease** women with male pattern of excess hair growth can be triggered by increase in cortisol hypercortisolism and hyperandrogenism from adrenal

Question 33

acne

Answer 33

**pituitary/adrenal disease** hypercortisolism and hyperadnrogenism from adrenal often accompanied with puberty

Question 34

diabetic ulcer

Answer 34

**diabetes mellitus** poorly controlled diabetes, peripheral neuropathy trauma and then skin breakdown can lead to osteomyelitis and bone infection need to be debrided

Question 35

diabetic dermopathy

Answer 35

rare, skin becomes more fragile fine blisters on lower legs slight trauma may play a role

Question 36

insulin lipodystrophy

Answer 36

**diabetes mellitus** for patients that get multiple insulin injections, can get atrophy of skin

Question 37

necrobiosis lipoidica

Answer 37

**diabetes mellitus** granulomatous skin disorder typical appearance is orangish yellow scales almost as if you can see through the top of the skin idiopathic, by far more common in diabetes biopsy dependent

Question 38

granuloma annulare

Answer 38

**diabetes mellitus** can occur anywhere on the body annular appearance with heaped up border know that this is a common granulomatous skin disorder

Question 39

necrolytic migratory erythema

Answer 39

**(glucagonoma) diabetes mellitus** excessive glucagon production and high blood sugars non-specific dermatosis usually around groin and mouth requires diagnosis of islet cell tumors

Question 40

Grave's Disease

Answer 40

anautoimmune disease most commonly affects the thyroid, frequently causing it to enlarge to twice its size or more (goiter), become overactive, with related hyperthyroid symptoms

Question 41

exophthalmos

Answer 41

**Grave's Disease** hypertrophy of subcutaneous tissues and bony structures can lead to proptosis (inability to move eyes)

Question 42

pretibial myxedema

Answer 42

**Grave's Disease** autoantibodies stimulate thyroid production and leads to plaques more severe forms can lead to hypertrophy and thickening of skin

Question 43

goiter

Answer 43

**hypothyroidism** in patients who can't produce enough thyroid hormone, and the gland keeps growing to attempt to do so

Question 44

thin hair

Answer 44

**hypothyroidism** if left untreated

Question 45

generalized myxedema

Answer 45

**hypothyroidism** coarse facial features, edema, ptosis comatose, bradycardic, hypotensive - **medical emergency!**

Question 46

vertiligo

Answer 46

hypothyroidism destruction of melanocytes very commonly associated with endocrine disorders

Question 47

alopecia areata

Answer 47

**hypothyroidism** discrete form of nonscarring hair loss get it in the head and arms associated with thyroid disease

Question 48

cutaneous Crohn's Disease

Answer 48

**GI disease** rare, disseminate to the skin requires biopsy

Question 49

pyosomatitis vegetans

Answer 49

**GI disease** reactive process in patients with Chron's or Ulcerative colitis micropustules and vesicles skin breakdown and ulceration of lips and oral mucosa

Question 50

pyoderma gangrenosum

Answer 50

**GI disease** in association with Chron's and ulcerative colitis start off as a little pimple and then expands over days or months needs to be treated medically, not with surgery ulceration with very heaped up border sometimes a lot more subtly - Dx of exclusion

Question 51

causes of pyoderma gangrenosum

Answer 51

Chron's ulcerative colitis Hep C Rheumatoid arthritis Hematologic malignancy (dorsal hands/wrists) idiopathic

Question 52

dermatitis herpetiformis

Answer 52

**celiac disease (GI disease)** most people with celiac don't have this, but most patients with this have celiac

Question 53

acrodermatitis enteropathica

Answer 53

**zinc deficiency** can be seen in kids and adults if supplemented, goes away in a few days

Question 54

scurvy

Answer 54

**vitamin C deficiency** gingival bleeding, perifollicular hemorrhage and corckscrew hairs

Question 55

pellagra

Answer 55

**niacin deficiency** diarrhea, dermatitis, dementia, death usually in alcoholics circular distribution

Question 56

Bitot's spots

Answer 56

**vitamin A deficiency** debris of conjunctival tissue

Question 57

phrynoderma

Answer 57

**vitamin A deficiency** toad's skin plugging of follicles around elbows and thighs

Question 58

Cowden syndrome

Answer 58

autosomal dominant PTEN gene breast, endometrial, thyroid, kidney, colorectal cancers facial trichilemmomas

Question 59

Hereditary non-polyposis colorectal cancer (Lynch syndrome)

Answer 59

autosomal dominant DNA mismatch repair defects colorectal, endometrial, ovarian, gastric, urinary tract sebaceous adenoma/carcinoma

Question 60

Paget's disease

Answer 60

**mammary lesions** - breast cancer **extra-mammary lesions** - underlying geritourinary cancer different from the bone

Question 61

Sweet's syndrome

Answer 61

**acute febril neutrophilic dermatosis** typically seen in setting of fever, neutrophilia, acute leukemia, URI, G-CSF, or idiotpathic high fever and development of edematous papules and plaques

Question 62

sign of Leser-Trelat

Answer 62

**GI malignancy** more likely to be GI cancer if develops quickly over a short time

Question 63

acquired ichthyosis, keratoderma

Answer 63

**Hodgkin disease** commonly seen, not associated with anything underlying may be seen in a patient with Hodgkin's disease

Question 64

erythema gyratum repens

Answer 64

**lung, esophageal cancer** wood grain appearance in the skin with diffuse plaques lung and esophageal cancer suggested

Question 65

What are the skin findings of liver disease?

Answer 65

jaundice hynecomastia dilated abdominal wll veins (Kaput Medusa) spide rangiomas lichen planus hemochromatosis Wilson's disease cryoglobulinemia

Question 67

What are the skin findings of reneal disease?

Answer 67

puritis calciphylaxis uremic frost

Question 69

What are the skin findings of pulmonary disease?

Answer 69

cyanosis clubbing yellow nails sarcoidosis findings (lupus pernio and Lofgren's syndrome) TB findings (lupus vulgaris, erythema induratum, scrofuloderma)

Question 71

What are skin findings of sarcoidosis?

Answer 71

lupus pernio Logren's syndrome (erythema nodosum and hilar adenopathy)

Question 73

What are skin findings of tuberculosis?

Answer 73

lupus vulgaris (cutaneous dissemination of TB) erythema induratum (cutaneous reaction to TB) scrofuloderma

Question 75

What are skin findings of cardiovascular/peripheral vascular disease?

Answer 75

endocarditis findings xanthomas xanthelasma cholesterol emboli stasis dermatitis

Question 77

What are skin findings of endocarditis?

Answer 77

Janeway lesions (non-tender) Osler nodes (tender) splinter hemorrhages

Question 79

What are skin findings of adrenal/pituitary disorder?

Answer 79

moon facies buffalo hump striae acanthosis nigricans hirsutism acne

Question 81

What are skin findings of diabetes mellitus?

Answer 81

acanthosis nigricans diabetic ulcer diabetic dermopathy insulin lipodystrophy necrobiosis lipoidica granuloma annulare necrolytic migratory erythema (glucagonoma)

Question 83

What are the skin findings of thyroid disease?

Answer 83

1) Grave's Disease - exophthalmos, peritibial myxedema 2) hypothyroidism - goiter, brittle/thin hair, generalized myxedema 3) skin diseases - vitiligo, alopecia areata

Question 85

What are skin findings associated with gastrointestinal disease?

Answer 85

cutaneous Chron's disease pyostomatitis vegetans pyoderma gangrenosum dermatitis herpetiformis

Question 87

What are skin findings associated with nutritional disease?

Answer 87

acrodermatitis enteropathica (zinc deficiency) scurvy (ascorbic acid deficiency) pellagra (niacin deficiency) phyrnoderma (vitamin A deficiency)

Question 89

What are skin findings associated with cancer, cancer syndromes, and paraneoplastic diseases?

Answer 89

Cowden's Lynch/Muir-Torre syndrome Paget's disease Sweet's syndrome Sign of Leser-Trelat (erputive sseborrheic keratoses acquired ichthyosis/keratoderma erythema gyratum repens cutaneous metastases of hematologic and solid organ malignancies