Cutaneous Manifestations of Systemic Disease

Question 1

What is the difference between a dermal and epidermal rash?

Answer 1

Epidermal - wet/weepy/flaky/dry, this is the majority of rashes

Dermal - skin feels smooth but elevated, due to granulomas or proteins or vasculitis under the skin

Question 2

What are the 4 types of epidermal rash?

Answer 2

Eczema - flaky, scaly, dry skin
Psoriasis - thickened skin, flaky, red
Lichenoid - purplish rash, lymphocytes eating skin
Vesiculobullous - blistering

The latter two can be autoimmune

Question 3

What are the 2 types of dermal rash?

Answer 3

Vasculopathic - urticaria, vasculitis

Granulomatous - brown/purple colour, raised

Question 4

What are the skin manifestations of Cushings?

Answer 4

Stria, acne, bruising

Question 5

What are the skin manifestations of Addisons?

Answer 5

Hyperpigmentation (in buccal mucosa and palmar crease)

Question 6

What are the skin manifestations of hypothyroidism?

Answer 6

Periorbital oedema, loss of outer third of eyebrow, dryness

Question 7

What are the skin manifestations of hyperthyroid?

Answer 7

Acropachy, fat infiltration around eye, pretibial myxoedema

Question 8

What is porphyria?

Answer 8

• Skin sensitivity
• Hirsutism
• Blood filled blisters and scarring
• Milia

These are due to build up of porphyrins in the skin.
It is usually a sign of liver disease as the enzyme that breaks this compound down is produced in the liver.

Question 9

Why do you get milia?

Answer 9

Severe blistering from porphyria that has ripped through the sweat glands, causing formation of hard keratin white cysts

Question 10

What are the skin manifestations of hyperlipidemia?

Answer 10

Xanthelasma
Tendon xanthomas
Eruptive xanthomas (high triglycerides)

Question 11

What are the skin manifestations of diabetes?

Answer 11

Acanthosis nigricans - due to IGF

Necrobiosis lipoidica - granulamotous skin infiltration

Question 12

What conditions cause pyoderma gangrenosum?

Answer 12

Leukemia, myeloma, IBD, vasculitis

pustular, sterile necrotic blue black

Question 13

What is Sweets syndrome?

Answer 13

Red rashers when systemically unwell, marker of haematological malignancy

Question 14

What is cutaneous T cell lymphoma?

Answer 14

Lymphoma presenting as patchy plaques (looks like psoriasis) - can be used for staging.

Treat with phototherapy but this doesn’t alter prognosis just appearance, as the cancer is pushed back into the body

Question 15

What is the name of a rash due to a virus?

Answer 15

Exanthem

Question 16

What conditions cause morbilliform rashes?

Answer 16

Measles/rubella

Question 17

What conditions causes vesicular rashes?

Answer 17

Chickenpox/shingles

Question 18

What are the skin manifestations of syphillis?

Answer 18

1. Primary painless chancre
2. Copper brown rash on palms/soles and snail track ulcer
3. Gummata

Question 19

What are the skin manifestations of Lyme disease?

Answer 19

Borellia spp.

1. Ring rash ‘erythema migrans’
2. Severe neuro/joint/cardio problems

Question 20

What rashes are associated with IBD?

Answer 20

Erythema nodosum

Pyoderma gangrenosum

Question 21

What is pathergy?

Answer 21

Exaggerated skin injury from a minor trauma

Question 22

What are the skin manifestations of sarcoidosis?

Answer 22

Granulomatous inflammation

Lupus pernia - facial rash

Question 23

What are the skin manifestations of SLE?

Answer 23

Malar, photosensitive rash
Discoid rash
Nail fold changes
Livedo reticularis

Question 24

What are the skin manifestations of RA?

Answer 24

Nodules
Nailfold infarcts
Vasculitic leg ulcers

Question 25

What are the skin manifestations of systemic sclerosis?

Answer 25

Skin thinking and claw hands 'sclerodactly' Raynauds Telangectasia Nailfold changes

Question 26

What are some paraneoplastic skin manifestations?

Answer 26

Acanthosis nigricans | Dermatomyositis

Question 27

What are the skin manifestations of scurvy?

Answer 27

Ruptured haemorrhages around the skin follicles and corkscrew hairs Bleeding gums

Question 28

What is pellagra?

Answer 28

Dermatitis, diarrhoea and dementia, due to vitamin B3 deficiency Patients have very bad photosensitive rashes

Question 29

What is pseudoxanthoma elasticum?

Answer 29

Mutation of elastin fibres causing skin that looks like a plucked chicken Angiod streaks in the back of the eyes Arterial aneurysms

Question 30

What are the skin manifestations of neurofibromatosis type 1?

Answer 30

Cafe au lait spots Neurofibromas Lisch nodules

Question 31

What are the skin manifestations of neurofibromatosis type 2?

Answer 31

Cafe au lait spots Schwannomas Juvenile cataracts

Question 32

How is pyoderma gangrenosum treated?

Answer 32

Give steroids

Question 33

In which disease do you see blue-red nodular lesions on the nose and hands?

Answer 33

Sarcoidosis - this is a description of lupus pernio

Question 34

In which disease do you see ash-leaf hypopigmentation?

Answer 34

Tuberous sclerosis

Question 35

What do you get in vitamin B1 deficiency?

Answer 35

Beriberi - neuropathy and cardiomyopathy

Question 36

What do you get in vitamin B6 deficiency?

Answer 36

Neuropathy and eruptions of dermatitis

Question 37

In which condition do you get bleeding gums, easy bruising and frank purpura?

Answer 37

Scurvy from vitamin C deficiency