Dermatology Flashcards
what are the diagnostic criteria for lupus?
Mucocutaneous:
- acute - photodistributed/sun-exposed rash
- chronic - alopecia
- Oral ulcers
- Alopecia
Synovitis serositis (pleuritis, pericarditis) Renal disease Neurological disorder Haemolytic anaemia, thrombocytopenia, leukopenia
Immunological: ANA anti-dsDNA, anti-Sm, antiphospholipid Low complement Direct coombs test
What are the findings in cutaneous (discoid) lupus erythematosus?
discoid lupus erythematous
SCLE
What are the cutaneous findings in systemic lupus erythematosus?
Alopecia Photodistributed rash Cutaneous vasculitis (manifesting as purpura) Chilblains Livedo reticularis Subacute cutaneous lupus
In a newborn suspected of lupus, what test do you order? what are you testing for?
ECG - risk of heart block
A _ is indicated as a test in SLE for renal function
urinalysis
what are some symptoms of dermatomyositis?
Photosensitive erythema - usually scalp and periocular Shawl sign Heliotrope rash Gottron's papules Ragged cuticles
Which antibody in dermatomyositis is associated with gottrons papules?
Anti Jo-1
Which antibody in dermatomyositis is associated with interstitial lung disease and digital ulcers/ischemia?
Anti-MDA5
Which antibody in dermatomyositis is associated with malignancy in adults?
Anti-p155
Which antibody in dermatomyositis is associated with necrotising myopathy?
anti-SRP
name 2 other antibodies in dermatomyositis
Anti-SAE - +/- amyopathic
Anti-p140 - juvenile, associated with malignancy
what test are carried out if dermatomyositis is suspected?
Muscle biopsy - main test Autoantibody profile Skin biopsy LFT - ALT often increased Screening for internal malignancy
State 3 conditions that can be associated with dermatomyositis
interstitial lung disease
digital ischemia
malignancy
___Is a manifestation of small vessel vasculitis
purpura
State 4 manifestations of medium vessel vasculitis
digital necrosis
retiform purpura and linear ulcers
Subcutaneous nodules along blood vessels
Livedo reticularis
What are the symptoms and signs of IgA Vasculitis?
Skin - purpura on buttocks/legs
Arthralgias
GI - abdominal pain, meleana
IgA associated glomerulonephritis (hematuria, proteinuria)
What are the symptoms/signs of Granulomatosis with Polyangiitis (GPA)
Upper respiratory tract - sinusitis, otitis media
Lower respiratory tract - hemoptysis, cough, dyspnea
Small vessel manifestation - purpura
Medium vessel manifestations
Pauci-immune glomerulonephritis
__ is a systemic disorder most commonly affecting the lungs. Histology involves non-caseating epithelioid granulomas
sarcoidosis
what are some symptoms of sarcoidosis
Dry cough, dyspnea
Lupus pernio - skin lesions on face
Erythema nodosum - inflammation of subcutaneous fat in legs
KEY findings = Hilar lymphadenopathy - CXR
Papules on skin
UGLIER = (uveitis), Granulomas, lupus pernio, interstitial fibrosis, erythema nodosum (RA)
what is included in the diagnostic criteria for DRESS?
Fever
Lymphadenopathy ⩾ 2 sites, > 1cm
Circulating atypical lymphocytes
Peripheral hypereosinophilia
Internal organs involved - Liver most common(hepatitis)
Negative ANA, Hepatitis / mycoplasma, chlamydia
Skin involvement:
>50% BSA
Cutaneous eruption suggestive of DRESS e.g. facial oedema
Biopsy suggestive of DRESS
how do you treat dress?
stop drugs, start corticosteroids
What accounts for most fatalities in DRESS
fulminant liver failure
signs and symptoms of shnitzler syndrome?
recurrent urticarial rash - resolves with brownish hyperpigmentation.
Recurrent fever above 40°C
Bone or joint pain (especially over the ilium or tibia)
Raised monoclonal IgM
Organomegaly - Lymphadenopathy, hepatomegaly or splenomegaly
Neutrophilia
Elevated acute phase reactants or abnormal bone imaging
What is the treatment for schnitzler syndrome?
Mild - colchicine
Severe - anakinra
____ is a multiorgan disease affecting 10-80% of allogeneic HSCTs. It can cause a rash including face and acral involvement as well as GI effects (diarrhea, abdominal pain) and Liver effects (elevated bilirubin/jaundice, elevated LFTs)
Graft versus host disease
describe the pathophysiology of graft versus host disease
donor-derived T-lymphocyte activity against antigens in an immunocompromised recipient
Itching without a rash is known as___.
pruritus
name some causes of pruritus
Hematological causes: lymphoma, polycythemia - FBC, LDH, Ureamia - renal profile Cholestasis - test LFTs Iron deficiency or iron overload - test ferritin HIV/Hepatitis A/B/C Cancer Drugs - opiates Psychogenic Pruritus of old age (XR chest to check for lymphadenopathy)
____ ___ develops from constant rubbing or scratching in pruritus
nodular prurigo
___ ___ is a manifestation of plasma cell dyscrasia
systemic amyloidosis
What symptoms, excluding skin findings, are common in systemic amyloidosis?
Weight loss, Fatigue
**parasthesias - e.g carpal tunnel syndrome
**Dyspnea - restrictive cardiomyopathy - can progress to heart failure
Syncopal attacks
**hypertrophy of muscles - e.g macroglossia
Which investigations are carried out for systemic amyloidosis?
Biopsy of abdominal fat/rectal mucosa
SAP scan
State cutaneous manifestations of systemic amyloidosis
Racoon sign - periocular purpura
Papules can also occur in other places - face, neck, scalp, anogenital region, digits
Skin involvement ONLY in 25% of cases
What are the symptoms of scurvy?
Spongy gingiva with bleeding and erosion
Skin - petechiae, ecchymosis, follicular hyperkeratosis
Corkscrew hairs with perifollicular hemorrhage
___ results from protein deficiency
kwashiokor
state some skin changes seen in kwashiokor
Superficial DEQUAMATION
Sparse, dry hair
Soft, thin nails
Cheilitis
state some systemic features seen in kwashiokor
Hepatomegaly Bacterial / fungal infections Diarrhoea Loss of muscle mass Oedema Failure to thrive
In a Zinc deficiency, what triad is usually seen? When not acquired, what is the genetic cause of deficiency?
Dermatitis, Diarrhoea, Depression
Genetic - SLC39A4
In what locations is dermatitis commonly seen in a zinc deficiency and what are some common cutaneous manifestations?
Perineal, perioral, acral
Erythema, Scale-crusts, Erosions, Alopecia, Stomatitis, Conjunctivitis
state a role of zinc in the body
Wound healing, antioxidant
Severe deficiency of what vitamin leads to pellagra? What 4 “Ds” are seen in pellagra?
Vitamin B3 (niacin) Diarrhea, Dermatitis, Dementia, Death
State some cutaneous manifestations of vitamin B3 deficiency
Photodistributed erythema/hyperpigmentation - classically dorsal surface of hands and on face
“Casal’s necklace”
Glossitis and cheilitis
Painful fissures of palms and soles
Flushing, diarrhea, difficulty breathing, hypotension are all signs of ____ ___ where 5HT is released into the bloodstream
Carcinoid syndrome
Flushing only present in 25% of cases
What is the difference between SJS and TEN?
SJS affects < 10% of the body. TEN affects > 30. Overlap in between
What are the symptoms in SJS/TEN
Prodromal - flu like symptoms
Skin lesions - macules, erythema, blisters, atypical targetoid
Blisters merge and sheets of skin detach
nikolsky +ve
What is the main cause of SJS and TEN
drugs
What are the main complications of SJS/TEN?
Death - 30%
Dehydration
Blindness
eroded GI tract - ulceration, perforation
interstitial pneumonitis, renal tubular necrosis
Multiple organ failure - liver and heart failure
hypothermia/hyperthermia, neutropenia
What are some differentials for SJS/TEN?
Staphylococcal scalded skin syndrome (SSSS)
Thermal burns
Cutaneous graft versus host disease
__ is generalized erythema affecting >90% of BSA
erythroderma
What are the causes of erythroderma?
Drug reactions
Lymphoma - sezary syndrome
Skin conditions - psoriasis, atopic eczema
Idiopathic (25-30%)
State some complications of erythroderma
thermoregulatory problems
Protein and fluid loss
Sepsis risk
Tachycardia, peripheral edema
Prurigo means __ __
itchy spots
xerosis means _ __
dryness
___ is a condition where calcium blocks the arteries. Patients can get Retiform purpura and ulcers.
calciphylaxis
describe some cutaneous signs of CKD
Conjunctival pallor, hair thinning (anemia)
Excoriatons, Prurigo - high urea in the blood
Calciphylaxis
Half and half nails
Manifestations corresponding to underlying cause of kidney disease such as:
SLE
ANCA-associated vasculitis
Viral warts, skin cancer (immunosuppression following kidney transplant)
Nephrogenic systemic fibrosis
Xerosis
Perforating disorder
Describe some cutaneous signs of Chronic Liver Disease
Muehrcke’s lines Terry’s nails (mostly white with distal dark band) Jaundice Spider telangiectasia Palmar erythema Porphyria cutaneous tarda Clubbing Excoriations, prurigo
_____ _____ can occur in the setting of Diabetes Mellitus . It is characterised by red-brown plaques with pale or atrophic centres. It is treated with __
Necrobioisis lipoidica
steroids
State some cutaneous manifestations of diabetes
Terrys nails Granuloma annulare Xerosis Xanthelesma & Xanthomata Neuropathic ulcers Acanthosis nigricans - dry dark patches of skin usually in armpits, neck, groin Skin infections
Eruptive xanthomas are common in __
hyperlipidemia
Pretibial myxoedema is seen in what endocrinological condition?
Graves disease
Hyperpigmentation of skin and gums is seen in what endocrinological disorder?
Addisons disease
Acne can be a sign of which endocrinological disorders?
cushings
acromegaly
pcos
Cutis gyrata verticis can be a sign of which disorder?
Acromegaly
List of cutaneous signs of systemic disease - in this case signs of Immunosuppression:
Severe seborrhoeic dermatitis Extensive viral warts CMV ulceration Eosinophilic folliculitis Norwegian scabies Bacillary angiomatosis Severe psoriasis Penicillinosis Tinea corporis & faciei Cryptococcosis Kaposi sarcoma
what are the symptoms of HIV infection?
Seroconversion stage can get many types of rashes - ERYTHEMA MULTIFORME UTICARIA, MORBILLIFORM RASH, oral/genital ulceration
persistent or atypical manifestations of common infections
Severe manifestation of common dermatoses - e.g. psoriasis, seborrheic dermatitis
Itch
Eosinophilic folliculitis
State some cutaneous manifestations of inflammatory bowel disease
Pyoderma gangrenosum Panniculitis (erythema nodosum) Orofacial granulomatosis - lips, face or insides of mouth swell Aphthous ulceration Hidradenitis suppuritiva Associated with psoriasis and pemphigoid
State some cutaneous manifestations of celiac disease
Dermatitis herpetiformis - itchy blisters of extensor surfaces
___ ___ causes inflamed nodes, abscesses, lumps in intertriginous zones, especially axillary anogenital and inframammary area
Hidradenitis suppurativa
State 3 causes of pyoderma gangrenosum
IBD, leukemia, seronegative arthritis
Groin metastases are common in __ carcinoma
prostatic
Which skin symptom can be a symptom of breast cancer?
Peau d’orange (breast location)
Name 5 skin infections that Staphylococcus aureus can cause:
Ecthyma
Impetigo
Cellulitis
Folliculitis ->abscess: furuncles, carbuncles
Staphylococcal scalded skin syndrome SSS
Can also superinfect other dermatoses (e.g. atopic eczema, HSV, leg ulcers)