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Flashcards in Skin Manifestation of Systemic Disorders Deck (22)
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1
Q

Pyoderma Gangrenosum

  • cause
  • what is this?
  • PE
  • MC sites
  • tx
A

Cause:

  • Chronic Ulcerative Colitis**
  • chronic active hepatitis
  • Rheumatoid Arthritis
  • Crohns Dz
  • Hematologic malignancies

What:

  • rapidly evolving, chronic, and severely debilitating ulcerative skin dz
  • tissue becomes necrotic
  • deep ulcers on the legs

PE:

  • painful hemorrhagic pustules or painful nodule surrounded by erythematous halo.
  • ulcer formation w/ dusky red or purple borders, irregular and raised, boggy with perforations that drain pus

MC sites:
-lower extremities, buttocks, abdomen.

Tx:

  • treat underlying dz
  • high dose systemic corticosteroids
  • systemic immunosuppression
  • -sulfazalazine (intense inflamm)
  • -cyclosporine (immunosuppression)
  • -Infliximab
2
Q

What skin conditions are associated with DM?

A

Acanthosis Nigricans

Necrobosis Lipoidica Diabeticorum

Granuloma annulare

Thrush

Intertrigo

3
Q

Acanthosis Nigricans:

  • characteristics
  • associated with ?
  • PE
  • MC sites
  • Tx
A

Characteristics:
-velvety thickening and hyperpigmentation of the skin.

Associated with:

  • endocrine disorders such as DM
  • obesity
  • internal malignancy (GI MC)

PE:
-hyperpigmentation, velvety skin, skin line accentuation, surface becomes wrinkled or creased.

MC sites: axilla, neck, groin, antecubital fossae.

Tx:

  • Treat associated disorder
  • usually none required.
4
Q

Necrobiosis lipoidica Diabeticorum (NLD)

  • describe this lesion
  • tx
A

Lesion:

  • oval, violaceous patch that expands slowly
  • advancing border is red and the central area turns yellow-brown
  • telangiectasias
  • ulceration possible.

Tx:
-refer to derm..

5
Q

Granuloma Annular:

  • describe this lesion
  • MC sites
  • tx
A

Description:

  • smooth, shiny firm ring of fleshed colored papules and plaques (1-5cm)
  • annular with central depression
  • central clearing

MC sites: dorsum of hands and feet, extremities, and trunk

Tx:

  • topical steroids, but usually clear on their own
  • intralesional injections of steroids
6
Q

Intertrigo:

  • what is this?
  • what makes this worse?
  • associated with?
  • MC sites
  • PE
  • Tx
A

What: irritation in the skin folds

Worse with heat and moisture

Associated with DM, HIV, obesity

MC sites: axilla, groins, gluteal folds, overlapping abdominal panniculus

PE:
-erythema, +/- pruritis, tenderness, erythematous plaques

Tx:

  • keep cool and dry
  • tx based on cause:
  • -antifungal/antibacterial poweders
  • zinc oxide ointment
  • topical steroids MUST BE AVOIDED!!!
7
Q

ThrusH:

  • cause
  • describe the lesion
  • associations
  • tx
A

cause: yeast infection, usually candida

Lesion:
-white plaques or red erosions areas in the moral mucosa

Associations:
-DM, HIV, immunosuppression

Tx:
-antifungal (fluconazole, itraconazole)

**the average person should not get this frequently, if they do you should start thinking about HIV, DM… etc.

8
Q

Lupus: Chronic Cutaneous (Discoid)

  • describe this lesion
  • tx
A

lesion: ;scarring, dispigmented, scaly plaques on the face.
tx: potent topical steroids +/- antimalarials (hydroxychloroquine)

9
Q

Lupus: Subacute cutaneous

  • cause
  • describe these lesions
  • tx
A

Cause: may be drug induced.

Lesion: polycyclic scaly plaques in sun exposed areas
**NOT on the face

Tx: antimalarials (hydroxychloroquine) or other immunosuppressants.

10
Q

Systemic Lupus Erythematosus:

  • describe that lesion
  • characteristics
  • tx
A

Lesion:
-butterfly facial erythema with is nonscarring

Characteristics

  • photosensitivity
  • oral ulcers
  • discoid lupus

Tx:
-antimalarials and immunosuppression.

11
Q

Dermatomyositis:

  • describe these lesion
  • characteristics of disordder
  • association
  • tx
A

Lesion:

  • erythema, heliotrope eyelid rash
  • gottrons papules: on the knuckles, periungual telangiectasia, poikiloderma (red, white, brown)
  • calcinosis cutis

Characteristics:
-weakness of proximal muscles
-

90% of the time they have an underlying maignancy associated (adenocarcinoma)

Tx:prednisone daily and methotrexate.

12
Q
Scleroderma: 
-what are the CREST 
characteristics 
-other signs and sx
-prognosis 
-tx
A

CREST:

  • Calcinosis
  • Reynauds phenomenon
  • Esophageal dysmotility
  • sclerodactyly
  • telangiectasia

Other:
-flexion contractures, painful, edematous face (too much botox)

Prognosis:
-progressive systemic sclerosis

Tx:
-with systemic immunosuppression

13
Q

Xanthomas:

  • describe this lesion
  • assocations
  • MC sites
  • tx
A

Lesion:

  • lipid deposits in skin and tendons
  • yellow-brown, pinkish or orange macules, papules, plaques, nodules

Associations:

  • hyperlipidemia
  • biliary cirrhosis, DM, CRF

MC sites:
-upper and lower eyelids, inner canthus

Tx:
-laser exicison, electrodessication or topical application of trichloroacetic acid.

14
Q

Erythema Multiforme:

  • describe the lesions
  • cause
  • MC predisposing infection?
  • Tx
A

Lesions:

  • erythematous “targetoid” macules/patches
  • papules/plaques
  • vesicles/bullae
  • wheals
  • *MC on the extensor surfaces**

Cause: immune mediated, usually follow bad infection or drug exposure.
MC drugs are:
-sulfa (bactrim, dapsone)**
-anti-eleptic drugs (pheytoin, carbemazepine)
-abx: pcn, cephalosporins
-allopurinol

MC predisposing infection is herpes simplex

Tx:
steroids (heather said this)
-antiviral prophylaxis to control HSV
-early dx and cessation of suspected causitive drug.

15
Q

Describe each of the following in both erythema Multiforme Minor and Major

  • mucous membrane involvment
  • sx systemic or not?
  • Cause
A

MINOR:

  • little or NO mucous membrane involvement
  • few if any systemic sx
  • often do to HSV or medications.

MAJOR:

  • ALWAYS mucous membrane involvement
  • systemic sx such as fever
  • often due to medications, hepatitis, nephritis
16
Q

Steven Johnson Syndrome & Toxic epidermal necrolysis:

-what is this?

A

-mucocutaneous drug-induced or idiopathic rxn patters characterized by skin tenderness and erythema of skin and mucosa. followed by extensive cutaneous and mucosal epidermal necrosis and sloughing.

SJS is considered maximal variant of erythema multiform major

TEN is considered maximal variant of SJS.

17
Q

SJS & TEN:

  • associated with?
  • prodrome
  • progression
A

association:
- drugs**
- SLE
- HIV
- HLS-B12

Prodrome:

  • rash (morbilliform)
  • fever
  • mouth lesions
  • flu like sx 1-3d prior to mucocutaneous lesions.
  • mucocutaneous skin lesion
  • burning and itching

Progression:

  • necrotic epidermis, macular areas
  • sheet like loss of epidermis
  • flaccid blisters that spread with lateral pressure (Nickolsky sign)
  • with trauma, full thickness epidermal detachment yeilding exposed, red, oozing dermis resembling a 2nd degree burn.
18
Q

SJS and TEN:

-tx

A

early dx and cessation of suspected causative drug

  • supportive care in ICU
  • systemic steroids (controversial)
  • IVIG may halt progression with administered early
  • eye lesions with erythromycin ointment
  • transfer to burn unit if widespread sloughing.
19
Q

Drug rash

  • when does this occur?
  • MC with which drug?
  • describe this rash
  • tx
A

Can happen within 2days of onset of therapy to weeks after therapy is over.

MC with bactrim.

Rash is morbiliform rash.

Tx:

  • benadryl
  • IV/IM steroids
  • Steroid dose pack
  • try not to sweat at night, dont use covers.
20
Q

Lymes dz:

  • ticks that cause lymes?
  • describe the 2 stages of lymes:
  • -sx
  • -skin lesion
A

Ticks:
-Deer tick, Lone star tick, rocky mountain tick

Stage 1:

  • 1-30d post bite: flu-like, fatigue, HA, fever and chills, muscle and joint pain, nausea, vomiting, dizziness, and non-productive cough
  • skin lesion appear as small red circular rash

Stage 2:
-weeks or months post bite: severe HA and neck pain or stiffness, arthritis, if severe neurological sx

21
Q

What are meningeal signs?

A

nuchal rigidity and back pain

kernigs sign: flexion of hip 90 degrees with subsequent pain and limitation with extension of the leg

brudzinski sign: involuntary flexion of the knees and hips after passive flexion of the neck while pt is supine.

22
Q

Gonococcemia:

  • Cause
  • sx
  • MC at what age?
  • describe the skin lesion
  • tx
A

cause: neisseria gonorrhoeae

Sx: tenosynovitis (inflamm of tendon and its sheath)

  • arthralgias
  • dermatitis

Peak age in males is 20-24 and then females 15-19YO

skin lesions are acral hemorrhagic pustules

Tx:

  • hospitilization with IV abx:
  • -empiric tx with rocephin
  • -PCN G
  • -Augmentin
  • -Doxy and azithro