Skin signs of Systemic disease

Question 1

CTCL

-most common type

Answer 1

cutaneous T-cell lymphoma

-most common: Mycosis Fungoides (misleading name because nothing to do with fungal)

Question 2

mycosis fungoides

• how does it present
• histology

Answer 2

• non-specific rash with pahses of patch, plaque, and nodules.
• late involvement with blood is Sezary syndrome. poor prognosis, 1-3 years survival.
• cerebriform lymphocytes in histology

Question 3

what skin conditions do you see in diabetes?

• 2 common
• 2 rare

Answer 3

1. diabetic dermopathy (usu lower legs)
2. acanthosis nigricans
3. bullous diabeticorum (rare)
4. necrobiosis lipoidica (rare)

Question 4

diabetic dermopathy–what do you see?

Answer 4

• lower legs affected
• hyperpigmented macules/plaques that look like scars

Question 5

acanthosis nigricans:

-what is it a marker for?

Answer 5

3 types/causes:

1. familial
2. malignancy
3. endocrine problem (DM2, cushings, etc)

Question 6

pretibial myxedema

-what is this

Answer 6

• “peau d’ organe”
• cutaneous infiltration of shin skin with Mucin
• occurs in 1-5% of grave’s hyperthyroidism

Question 7

what skin condition can happen with grave’s disease?

Answer 7

-pretibial myxedema

Question 8

Addison’s disease

-skin manifestations

Answer 8

1. hyperpigmentation (MSH effect of ACTH)

(-MSH: melanocyte stimulating hormone)

• skin
• nail pigmentation
• mucosal pigmentation
  2. also, fibrosis/calcification of ear (rare but distinctive)

Question 9

suspect what if pt’s ear has fibrosis and calcification?

Answer 9

-rare but distinctive finding of Addison’s

Question 10

Cushing’s disease

-what skin findings

Answer 10

• Striae
• Acne
• Buffalo hump

Question 11

Lupus

-what to know about spectrum of disease, related to skin findings?

Answer 11

• Lupus has many forms of presentation
• Some have only skin symptoms (Chronic Cutaneous lupus)

Question 12

skin findings of lupus (4)

Answer 12

1. malar rash
2. discoid lesions
3. oral ulcers
4. photosensitivity

Question 13

acute cutaneous lupus e. (ACLE)

Answer 13

• acute–resolves in hours to days without scarring
• generalized rash, including malar rash
• often triggered by sunlight

Question 14

chronic cutaneous lupus e.

Answer 14

“Discoid” LE, with discoid lesions

• most common form of chronic cutaneous LE
• leaves scars

Question 15

what percent of chronic cutaneous lupus e. patients develop SLE?

Answer 15

• only 5%
• so don’t expect systemic signs or lab findings when you see cutaneous lupus

Question 16

dermatomyositis

-in addition to heliotrope rash, what kind of rash do you see?

Answer 16

• poikiloderma rash (photosensitive)
• on trunk and extremities

Question 17

what to suspect if pt has dermatomyositis?

Answer 17

• ovarian cancer in women!
• silent onset, so do transvaginal US.

Question 18

sarcoidosis

-skin findings

Answer 18

• ‘cutaneous sarcoidosis’
• characteristic brown red papules/plaques
• also be aware of Lofgren’s syndrome

Question 19

Lofgren’s syndrome

-clinical findings (triad of symptoms)

Answer 19

• very common presentation of sarcoidosis
  1. hilar adenopathy
  2. erthema nodosum
  3. arthritis

Question 20

porphyria cutanea tarda

-skin findings

Answer 20

• enzyme defect in heme breakdown
• fragile blisters from trauma/sun on hands especially

Question 21

inflammatory bowel disease

-skin findings

Answer 21

• pyoderma gangrenosum:
• sterile, rapid ulceration caused by neutrophilic infiltration

Question 22

pyoderma gangrenosum

Answer 22

• associated with IBD
• sterile, rapid ulceration caused by neutrophilic infiltration

Question 23

of skin disorders, this is known as extremely pruritic. few vesicles left intact

Answer 23

dermatitis herpetiformis

Question 24

how to tx dermatitis herpetiformis

Answer 24

1. gluten free diet
2. dapsone–relief of itch