skin manifestations in systemic diseases

Question 1

types of skin manifestations associated with diabetes

Answer 1

metabolic
venous
bullous
miscellaneous
diabetic foot
necrobiotic

Question 2

acanthosis nigricans

Answer 2

• Velvety hyperpigmentation of the skin folds
• Hyperkeratotic with multiple skin tags

Question 3

associatiions of acanthosis nigricans

Answer 3

hereditary
endocrine causes of insulin resistance
Obesity
Drug induced
Malignant

Question 4

C/P of eruptive xanthomas

Answer 4

• Papules are dome shaped, discrete, initially red, then yellow center with red halo, they appear suddenly
• Lesions may be scattered, discrete, in a localized region [e.g., elbows, knees, buttocks] or appear as tight clusters

Question 5

cause of eruptive xanthomas

Answer 5

• A sign of a very rare familial lipoprotein lipase deficiency, and diabetes out of control.

Question 6

management of eruptive xanthomas

Answer 6

React very favorably to a low-calorie and low-fat diet.

Question 7

changes associated with diabetic foot syndrome

Answer 7

neuropathic ulcers
presence of calluses is pathognomonic
non painful ulcerations commonly found under the metatarsal head and the toes

Question 8

other skin changes associated with diabetes

Answer 8

diabetic dermopathy - brown atrophic macules and patches on the leg possibly precipitated by trauma
bullous diabeticorum - bullae arises on a non erythematous base and oozes red erosions when erupted

Question 9

Necrobiosis lipoidica:

Answer 9

• Yellow atrophic patches, most often on the shins.
• An erythematous rim may indicate activity at the
  border.
• Ulcerations common.

Question 10

granuloma annulare

Answer 10

• Merged, pearly papules forming a well- demarcated ring with central regression.
• Commonly on the dorsa of the hands, feet, elbows, and knees

Question 11

necrosis of the finger tips or the toes in diabetes

Answer 11

Acral dry gangrene

Question 12

association of necrobiosis lipoidica and diabetes

Answer 12

not all pts who have necrobiosis lipoidica have diabetes
control of diabetes s not associated with healing or presentation of necrobiosis lipoidica

Question 13

what are the skin diseases associated with diabetes

Answer 13

ØPsoriasis
ØVitiligo
ØLichen planus
ØHidradenitis suppurativa

Question 14

common skin infections associated with diabetes

Answer 14

primary - furnuclees and carbuncles
secondary - staph aureus infection
cellulitis
dermatophytoses
candidiasis

Question 15

skin manifestations associated with DM medications

Answer 15

insulin : local reaction - lipodystrophy , urticarial lesion at the site of the reaction

systemic insulin allergy : urticaria

oral hypoglycaemic agents : Exanthematous eruptions, urticaria, erythema multiforme, photosensitivity

Question 16

when are skin tags and acanthosis nigricans observed

Answer 16

in the pre-diabetic stage

Question 17

long standing diabetes and poor glycemic control skin changes

Answer 17

Bullosis diabeticorum, diabetic dermopathy and scleroedema diabeticorum ( thickening of the skin )

Question 18

additional investigations for patients presenting with diabetic dermopathy

Answer 18

examined for retinopathy and nephropathy

Question 19

cutaneous changes in hyperthyroidism vs hypothyroidism

Answer 19

hyperthyroidism :
* Fine, velvety, smooth skin
Warm and moist due to increased sweating
* Hyper-pigmentation
* Localized or generalized Pruritus

hypothyroidism :
* Dry, rough, coarse skin Cold and pale
* Boggy and edematous skin (myxedema).
* Yellow discoloration as a result of carotenemia.
* Easy bruising (capillary fragility)

Question 20

cutaneous disease associated with hyperthyroidism vs hypothyroidism

Answer 20

hyperthyroidism :
* Pretibial myxedema, thyroid acropachy ( associated with clubbing and is seen in graves)
* Urticaria, dermato-graphism
* Increased incidence of vitiligo

hypothyroidism :
* Ichthyosis and palmoplantar keratoderma
* Eruptive and/or tuberous xanthomas

Question 21

type of alopecia associated with hypo and hyperthyroidism

Answer 21

hyperthyroidism - alopecia areata
hypothyroidism - alopecia in the lateral third of the eyebrow

Question 22

skin manifestations of liver cirrhosis

Answer 22

• Spider angiomas, telangiectasias
• Palmar erythema
• Sparse axillary, pubic and pectoral hair
• Gynecomastia
• Pruritus, Jaundice

Question 23

skin manifestations in hepatitis C and B

Answer 23

• Lichen planus – particularly erosive oral
  disease
• Erythema multiforme
• Erythema nodosum

Question 24

Hemochromatosis skin manifestations

Answer 24

also called bronze diabetes
presents with generalized hyper-pigmentation

Question 25

cutaneous findings in end stage renal disease

Answer 25

* Oedema * Pallor * Xerosis * Pruritus * Calciphylaxis * Uremic frost

Question 26

what is the aetiology calciphlaxis

Answer 26

progressive cutaneous necrosis associated with small- and medium-sized vessel calcification and thrombosis.

Question 27

when does calciphlaxis occur and what are the disease association ?

Answer 27

after the initiation of dialysis associated with DM, end stage renal disease and secondary hyperparathyroidism

Question 28

what does calciphlaxis look like

Answer 28

Usually in lower extremities, pre-infarctive lesions show mottling or livedo reticularis pattern, dusky red then changes into black leathery ulcer that is extremley painful

Question 29

granulomatous lesions in sarcoidosis

Answer 29

papules, translucent yellow-red with apple jelly appearance on diascopy

Question 30

most common non specific lesion in skin in early sarcoidosis

Answer 30

eryhthema nodosum presence suggests a good prognosis

Question 31

what is lofgren syndrome

Answer 31

specific to sarcoidosis , includes the triad of fever, erythema nodosum, and bilateral hilar adenopathy

Question 32

granulomatous lesions of sarcoidosis

Answer 32

lupus pernio seen on the nose and cheeks diascopy positive apple jelly apperancee

Question 33

diascopy finding in erythema nodosum

Answer 33

paniculitis

Question 34

erythema nodosum and the diseases associated with it

Answer 34

painful red nodules on the lower leg nodular upon palpitation SORE SHINS C streptococci ocp rickets r behcet sulfonamide hansen disease ( leprosy ) ibd nhl sarcoidosis cutaneous TB