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Flashcards in Skin and Systemic Disease Deck (37)
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1

Name two cutaneous manifestation of GI genetic diseases

• Hereditary haemorrhagic telangiectasia
• Blue rubber bleb naevus -> GI haemorrhage

2

What is hereditary haemorrhage telangiectasia?

Autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin and mucous membranes

3

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)

4

Name a cutaneous manifestation of vitamin deficiency

Vitamin deficiency
• Gingival hypertrophy
• Bleeding gums

5

What are cutaneous manifestations of diabetes?

• Acanthosis nigricans
• Diabetic bullae
• Diabetic dermopathy
• Eruptive xanthomas
• Necrobiosis lipoidica

6

What is diabetic dermopathy?

Lots of small papules which join to form almost plaque-like lesions

7

What is acanthosis nigricans?

Hyperprigmentation of skin folds (commonly around neck) - can be benign or malignant

8

Describe Necrobiosis lipoidica

Tender yellowish brown patches develop slowly on the lower legs over several months

9

What are cutaneous manifestations of thyroid disorders?

• Hyperthyroid -> thyroid acropachy
• Hypothyroid -> pre-tibial myxoedema

10

What skin conditions are caused by autoimmunity?

• Cutaneous lupus
• Cutaneous vasculitis
• Alopecia
• Vitiligo

11

What are the features of cutaneous lupus?

Butterfly rash
• Plaques with clear margins
• Photosensitivity
• Negative antibodies
• Disc-like lesions and raised on the outside

12

What are the features of cutaneous vasculitis?

Small vessel vasculitis (small haemorrhages)
• Lacey pattern - no change with temperature if pathological

13

What are the features of alopecia?

• Alopecia areata
• T-lymphocyte, cytokine rejection of hair
- Totalis
- Universalis

14

What are the differential diagnoses of alopecia?

• Scarring alopecia (hair doesn't grow back)
• Androgenic alopecia

15

What are the features of vitiligo?

• Segmental
• Generalised
• Destruction of melanocytes
• Associated with other autoimmune conditions

16

Give examples of common malignancies which cause cutaneous manifestation

Carcinoid Syndrome
Ectopic ACTH
Pagets disease
Paraneoplastic pemphigus
Acquired hypertrichosis
Erythema Gyratum Repens
Bazex Syndrome
Leser Trelat

17

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

18

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

19

Describe the cutaneous manifestation of pagets + extra-mammary pagets (malignancy)

Paget's disease
• Eczematous plaque (nipple/areolar)
• Extension of underlying ductal

Extra-mammary pagets
• Usually axilla or ano-genital areas
• Intraepitheial adenoma

20

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

21

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)

22

Describe the cutaneous manifestation of Erythema Gyratum Repens (malignancy)

• Concentric erythematous lesions
• Associated with Lung ca > Oesophageal, Breast
• Very rarely with -Mycobacteial infection, Pregnancy

23

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

24

Describe the cutaneous manifestation of Leser-Trelat (malignancy)

• Eruptive seborrhoeic keratosis (brown warty nodules)
• GI adenocarcinomas

25

What are two skin conditions associated with cancer?

• Acanthosis Nigricans
• Dermatomyositis

26

Describe the clinical features of Acanthosis Nigricans

Brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds.

27

When can Acanthosis Nigricans occur?

Can preceed malignancy (gastric adenocarcinoma).
Concern if:

• Older patient, rapid onset
• Involves lips
• Weight loss

28

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
• Photosensitive
• Asso with -Ovarian, breast, lung ca

29

What is the shawl sign?

Widespread, flat, reddened area that appears on the upper back, shoulders and back of neck

30

What signs may be associated with malignancy?

• Bullous pemphgoid
• Sweets Syndrome
• Pyoderma gangrenosum
• Acquired ichthyosis
• Cryoglobulinaemia