Skin in Systemic Disease Flashcards
(53 cards)
When does pruritis require further investigation?
In the absence of a rash to exclude an underlying systemic disorder.
When can we resolve pruritis very easily?
When it develops as a result of a new medication starting - just change or stop the medication.
A pt presents with generalised pruritis and other symptoms suggesting an underlying haematological cause. Which haematological causes are there for pruritis?
- Iron deficiency anaemia
- Myeloproliferative disorders
- Leukaemia
- Lymphoma
- Multiple myeloma
- MGUS
A pt with CKD presents with generalised pruritis. How can renal disorders cause pruritis?
Renal insufficiency -> more urea in the blood -> Uraemia -> pruritis
A long term alcoholic presents to the GP with generalised pruritis. How can hepatobiliary disease cause generalised pruritis?
Cholestasis -> build up of conjugated bilirubin -> levels increase in the blood -> hyperbilirubinaemia -> pruritis
Which endocrine disorders can be associated with generalised pruritis?
Both hyper- and hypo-thyroidism
How should generalised pruritis with an underlying systemic caus ebe managed?
Treat the underlying cause, and manage symptoms e.g. with antihistamines
What is erythema nodosum?
An acute, reactive inflammation of the subcutaneous fat.
Where is erythema nodosum seen, and what does it look like?
Symmetrical tender hot erythematous nodules over the extensor surfaces of the legs.
What are the systemic causes of erythema nodosum?
How can we remember these?
Infections IBD Sarcoidosis Malignancy Pregnancy Behcet syndrome Drugs
NODOSUM acronym: N o cause found O bstetric (pregnancy) D rugs O ncological S arcoidosis U lcerative colitis, Crohn's, Bechet syndrome M icrobiological/infection
Which drugs can cause erythema nodosum?
Oral contraceptive pill Tetracycline abx Sulphur based drugs Bromides Iodides
Which infections are common causes of erythema nodosum?
Bacterial - Streptococcus, Salmonella, Campylobacter
Viral - EBV
TB
Fungal infections also
How should erythema nodosum be managed?
Treat the underlying cause if possible.
Wait for spontaneous resolution.
Symptomatic management with NSAIDs, bed rest, support stocking.
If severe, systemic corticosteroids may be needed.
What is vasculitis?
Inflammation of the blood vessels
How does small vessel vasculitis present?
As palpable purpuric papules and plaques, often on the lower legs
What are the systemic causes of cutaneous vasculitis?
Infection Connective tissue disorders Malignancy Drugs Idiopathic
Which malignancies are associated with cutaneous vasculitis?
Haematological malignanices - myeloproliferative/lymphoma/MGUS/multiple myeloma
Which drugs are associated with cutaneous vasculitis?
Antibiotics
Antihypertensives
Which connective tissue disorders are associated with cutaneous vasculitis?
- SLE
- RA
- Systemic sclerosis
- Sjogren syndrome
- Dermatomyositis
- Wegener granulomatosis/polyarteritis nodosa/Churg-Strauss syndrome
What investigations are routinely done as part of a vasculitis screen?
Bloods - FBC, U and Es, Creatinine, LFTs. ANA, ANCA, ENA, Rheumatoid factor.
Blood film
Urinalysis and urine phase contrast microscopy
Skin biopsy
What investigations are done as part of a vasculitis screen as and when appropriate?
Hep B and C serology Throat swab Blood cultures MSU HIV serology
A pt presents with cutaneous vasculitis and is very unwell, potentially spetic. How should we proceed?
Treat as meningococcaemia until proven otherwise
What cutaneous manifestations can happen in chronic liver disease?
Spider naevi Palmar erythema Pruritis Jaundice Macula purpura
How can hepatitis C manifest cutaneously?
- Cutaneous vasculitis
- Polyarteritis nodosa
- Lichen planus
