Flashcards in Skin and Systemic Disease Deck (37)
Name two cutaneous manifestation of GI genetic diseases
• Hereditary haemorrhagic telangiectasia
• Blue rubber bleb naevus -> GI haemorrhage
What is hereditary haemorrhage telangiectasia?
Autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin and mucous membranes
Name two cutaneous manifestation of GI inflammatory / autoimmune diseases
• Erythema nodosum
• Pyoderma gangrenosum (causes tissue to become necrotic, causing deep ulcers that usually occur on the legs)
Name a cutaneous manifestation of vitamin deficiency
• Gingival hypertrophy
• Bleeding gums
What are cutaneous manifestations of diabetes?
• Acanthosis nigricans
• Diabetic bullae
• Diabetic dermopathy
• Eruptive xanthomas
• Necrobiosis lipoidica
What is diabetic dermopathy?
Lots of small papules which join to form almost plaque-like lesions
What is acanthosis nigricans?
Hyperprigmentation of skin folds (commonly around neck) - can be benign or malignant
Describe Necrobiosis lipoidica
Tender yellowish brown patches develop slowly on the lower legs over several months
What are cutaneous manifestations of thyroid disorders?
• Hyperthyroid -> thyroid acropachy
• Hypothyroid -> pre-tibial myxoedema
What skin conditions are caused by autoimmunity?
• Cutaneous lupus
• Cutaneous vasculitis
What are the features of cutaneous lupus?
• Plaques with clear margins
• Negative antibodies
• Disc-like lesions and raised on the outside
What are the features of cutaneous vasculitis?
Small vessel vasculitis (small haemorrhages)
• Lacey pattern - no change with temperature if pathological
What are the features of alopecia?
• Alopecia areata
• T-lymphocyte, cytokine rejection of hair
What are the differential diagnoses of alopecia?
• Scarring alopecia (hair doesn't grow back)
• Androgenic alopecia
What are the features of vitiligo?
• Destruction of melanocytes
• Associated with other autoimmune conditions
Give examples of common malignancies which cause cutaneous manifestation
Erythema Gyratum Repens
Describe the cutaneous manifestation of carcinoid syndrome (malignancy)
• Episodic flushing, mins-hours
- No sweating (unlike menopause)
• Facial telangiectasia
• GI carcinoid = liver mets
• Bronchial, ovarian = can occur with no liver mets
Describe the cutaneous manifestation of ectopic ACTH syndrome (malignancy)
• Tumour production of ACTH leads to generalised hyperpigmentation
• ACTH -> Inc. MSH -> release of melanin from melanocytes
Describe the cutaneous manifestation of pagets + extra-mammary pagets (malignancy)
• Eczematous plaque (nipple/areolar)
• Extension of underlying ductal
• Usually axilla or ano-genital areas
• Intraepitheial adenoma
Describe the cutaneous manifestation of paraneoplastic pemphigus (malignancy)
• Erosive stomatitis, rash
• Auto-antibodies driven
• Non-hogkins, castleman's disease
• Blisters which had ruptured -> erosions or ulcers
• Often mucosal involvement
Describe the cutaneous manifestation of acquired hypertrichosis lanuginosa (malignancy)
• Acute onset of lanugo* hairs all across face & body
• Colorectal ca > lung > breast - usually advanced
*baby hairs (very fine)
Describe the cutaneous manifestation of Erythema Gyratum Repens (malignancy)
• Concentric erythematous lesions
• Associated with Lung ca > Oesophageal, Breast
• Very rarely with -Mycobacteial infection, Pregnancy
Describe the cutaneous manifestation of Bazex Syndrome (malignancy)
• Symmetrical hyperkeratosis of extremities – acrokeratosis neoplastica
• Resembles psoriasis, non-specific fx on skin biopsy
• SCC: Bronchial, oropharyngeal, Gastric, colon, biliary adenocarcinomas
Describe the cutaneous manifestation of Leser-Trelat (malignancy)
• Eruptive seborrhoeic keratosis (brown warty nodules)
• GI adenocarcinomas
What are two skin conditions associated with cancer?
• Acanthosis Nigricans
Describe the clinical features of Acanthosis Nigricans
Brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds.
When can Acanthosis Nigricans occur?
Can preceed malignancy (gastric adenocarcinoma).
• Older patient, rapid onset
• Involves lips
• Weight loss
Describe the clinical features of Dermatomyositis
Inflammatory myopathy + rash
• Periorbital heliotrope rash
• Gottrons papules: red maculo-papular lesions over bony prominences (i.e. back of fingers)
• Shawl sign
• Asso with -Ovarian, breast, lung ca
What is the shawl sign?
Widespread, flat, reddened area that appears on the upper back, shoulders and back of neck