Skin presentation of systemic disease

Question 1

What are some skin manifestations of diabetes?

Answer 1

Small and large vessel angiopathy
Xanthomata
Xanthelasma
Erysepelas (Caused by hyperglycaemia leading to infection)
Necrobiosis lipidoica
Acanthosis nigricans

Question 2

What is necrobiosis lipidoica?

Answer 2

A granulomatous inflammatory reaction around destroyed collagen, usually found in diabetes

Question 3

What condition is shown?

Answer 3

Erysipelas

Question 4

What condition is shown?

Answer 4

Necrobiosis lipidoica

Question 5

What condition is shown?

Answer 5

Xanthelasma

Question 6

What condition is shown?

Answer 6

Acanthosis nigricans

Question 7

What cells contain thyroid hormone receptors in the skin?

Answer 7

Keratinocytes, fibroblasts, arrector pili muscle cells, hair follicle cells, smooth muscle cells, sebaceous gland cells, vascular endothelial cells

Question 8

What are the effects of thyroid hormone on the skin?

Answer 8

• Promotes fibroblast activity
• Regulates epidermal differentiation
• Essential for hair formation and sebum production

Question 9

What are some skin presentations of hyperthyroidism?

Answer 9

• Warm, moist smooth skin
• Facial flushing, palmar erythema
• Fine, thin hair. Diffuse alopecia (increased hair turnover time)
• Hyperhidrosis
• 5% - nail changes (concave, distal onycholysis)
• Pruritus
• Graves disease – pretibial myxoedema also present
• Urticaria / angioedema (uncommon – linked to thyroid autoimmunity)

Question 10

What condition is shown?

Answer 10

Pre-tibial myxoedema - Fibroblasts stimulated by autoantibodies to produce high amounts of GAGs, which accumulates in the dermis

Question 11

What are some skin presentations of hypothyroidism?

Answer 11

• Cold, dry pale skin
• Xerosis – may resemble acquired ichthyosis
• Carotenaemia - The conversion of beta-carotene (provitamin A) to vitamin A (retinol) is accelerated by thyroxine.
• Dry, coarse brittle hair, diffuse alopecia
• Loss of lateral 1/3 eyebrow (madarosis)
• Thickened brittle nails
• Generalised myxoedema
• Peri-orbital oedema
• Facial puffiness

Question 12

What causes myxoedema?

Answer 12

Dermal accumulation of mucopolysaccharides, mainly hyaluronic acid, which disappears with correction of T4 level

Question 13

What are some skin changes in Addison’s disease?

Answer 13

• Diffuse hyperpigmentation
• Palmar crease pigmentation
• Buccal pigmentation

Question 14

What are some skin presentations of tumours with MSH-like activity (E.g. pituitary tumours)?

Answer 14

Hyperpigmentation

Question 15

What are some skin presentations of tumours with androgenic activity (E.g. ovarian tumours)?

Answer 15

Virilisation
Hirsutism
Acne
Baldness

Question 16

What are some skin presentations of chronic discoid lupus?

Answer 16

• Photosensitivity
• Erythematous indurated plaques on exposed sites
• Follicular plugging
• Heal with scarring / permanent alopecia

Question 17

What are some skin presentations of subacute cutaneous lupus?

Answer 17

• Annular erythematous scaly plaques
• Symmetrical
• No plugging or scarring
• Photosensitive

Question 18

What are some skin presentations of SLE?

Answer 18

• UV sensitivity
• Nail fold capillaries prominent
• May have widespread DLE type rash

Question 19

What condition is shown?

Answer 19

Subacute cutaneous lupus

Question 20

What are some skin presentations of systemic sclerosis?

Answer 20

• Pinched mouth – radial furrows
• Beaked nose
• Matt - like facial telangectasia
• Sclerodactyly
• Periungual telangiectasia / ragged cuticles
• Raynaud’s phenomenon in 85%

Question 21

What condition is shown?

Answer 21

Sclerodactyl

Question 22

What condition is shown?

Answer 22

Calcinosis

Question 23

What are some skin presentations of dermatomyositis?

Answer 23

• Photosensitivity rash like that of L.E.
• Heliotrope oedema of eyelids
• Linear finger rash with Gottron’s papules

Question 24

What are some causes of erythema multiforme?

Answer 24

Viral (E.g. Herpes simplex)
Other infection (E.g. TB, Strep. sp, mycoplasma)
Drugs (E.g. sulphonamide)
Malignancy
Autoimmune disease

Question 25

How does erythema multiforme present on the skin?

Answer 25

Target lesions on the knees, elbows, palms, soles and mucosae

Question 26

What condition is shown?

Answer 26

Erythema multiforme

Question 27

What condition is shown?

Answer 27

Erythema nodosum

Question 28

How will erythema nodosum present on the skin?

Answer 28

- Red, tender, diffuse nodules, may be assoc. with joint pains, fever - Over Shins ; sometimes other sites - Slow resolution - like bruise, 6-8 weeks

Question 29

What are some causes of erythema nodosum?

Answer 29

- Infections – Strep, TB, EB, fungal - Drugs – OCP, sulphonamides - Inflammatory bowel disease - Sarcoidosis

Question 30

What are some causes of livedo reticularis?

Answer 30

–Cardiac failure –Vascular emboli –Drugs –Throbocythaemia –Cryoglobulins –Arteritis (PAN, SLE, RA, DM, lymphoma) –Infections

Question 31

What condition is shown?

Answer 31

Mycosis fungoides - Caused by cutaneous T-cell lymphoma

Question 32

What condition is shown?

Answer 32

Sister Mary Joseph nodules - Metastatic deposits

Question 33

What skin presentation can be caused by cholestatic jaundice?

Answer 33

Pruritus

Question 34

What skin presentation can be caused by IVC obstruction?

Answer 34

Visible venous dilation around the chest

Question 35

What are some skin manifestations of occult malignancy?

Answer 35

- Dermatomyositis - Generalised Erythroderma (Red skin) - Annular Erythemas - e.g. - Erythema Gyratum Repens (”wood grain” effect) - Acanthosis Nigricans - Acquired Ichthyosis (“Fish scale” skin) - Generalised pruritus (lymphoma)

Question 36

What are some skin presentations of HIV?

Answer 36

- Kaposis sarcoma - Seborrhoeic eczema / folliculitis (50%) - Skin infections (E.g. herpes, molluscum, candida, staph. etc) - New onset / worsening psoriasis - Dry skin / pruritus