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Dermatology Diploma > Skin & Systemic Disease > Flashcards

Skin & Systemic Disease Flashcards

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1
Q

In Diabetes Mellitus, what condition is this called?

Describe it.

A

Diabetic Dermopathy

Atrophic macules and patches on the shins.

(Possibly due to trauma)

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2
Q

In Diabetes Mellitus, what condition is this called?

A

Diabetic Bullae

Tense non-inlammatory bullae on the lower limbs.

Unknown why it happens.

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3
Q

In Diabetes Mellitus, what condition is this called?

Describe it.

A

Necrobiosis Lipoidica

  • Very common. Yellow atrophic plaques on the anterior shins.
  • Collagen degeneration with a granulomatous response.
  • SCC can develop from chronic lesions.
  • Can Ulcerate.
  • TREATMENT: Very resistant. Can try potent topical steroids, intralesional steroids, topical PUVA or narrow band UVB. Occasionally tacrolimus.
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4
Q

In Diabetes Mellitus, what condition is this called?

Describe it.

A

Acanthosis Nigricans

  • Common in high BMI and insulin resistance.
  • Pathology: IGF propagates epidermal growth.
  • More common in pigmented skin.
  • Treatment: Pigmanorm or topical retinoids.
  • Pigmanorm( hydroquinone 5%, tretinoin 0.1g, hydrocortisone 1g)
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5
Q

In Diabetes, What condition is this?

A

Partial Lipodystrophy

Atrophy of subcutaneous tissue secondary to insulin use.

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6
Q

In Diabetes, what condition is this called?

A

Scleredema of Buschke

  • Only seen in diabetes
  • Induration of the skin in the upper back and nape of neck.
  • Due to deposits of glycosaminoglycans.
  • Skin feels woody and hard to touch.
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7
Q

In thyroid disease, what is this called?

Is it common?

What form of thyroid disease is it associated with?

A

Thyroid Acropachy

  1. Not Common
  2. Grave’s Disease
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8
Q

In Thyroid disease, What is this?

What form of thyroid disease is it associated with?

Does it reverse with treatment?

A

Pretibial Myxoedema

  • Associated with Grave’s Disease
  • Peau dórange appearance
  • Treatment: intralesional steroids or steroids under occlusion.
  • It does not reverse with treatment.
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9
Q

What can happen to eyebrows in thyroid disease?

A

The lateral third of the eyebrow may be lost.

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10
Q

What cutaneous features do we see in Cushings Disease?

A
  • Subcutaneous fat redistribution - mood face, buffalo hump.
  • Skin atrophy - global atrophy of epidermis and dermis.
  • Cutaneous infections - candidiasis, pityriasis versicolor.
  • Appendageal effects - steroid-related acne, hirsutism.
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11
Q

What are some cutaneous manifestations in addison’s disease?

A

The Excess ACTH stimulates melanin production by melanocytes

  • Pigmentation in mucosal surfaces, palmar creases, nail beds and in scars.
  • Vitiligo
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12
Q

In IBD, what is this?

What are some other non-IBD causes for it?

A

Erythema Nodosum

  • idiopathic - most common
  • Streptococcal infections - upper respiratory tract.
  • Drugs - oestrogens, COCP, pinicillin, iodides, sulphonamides.
  • Sarcoidosis
  • Behcet’s disease
  • Sweet’s syndrome
  • Pregnancy
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13
Q

What investigations should be done in Erythema Nodosum?

A
  • Thorough drug history
  • Infection screen - viral and bacterial cultures, stool cultures, urine, Sputum, Serum ACE levels & Calcium, CXR and Heaf test.
  • Skin Biopsy - needs ot be a deep incisional biopsy - not a punch biopsy - subcutis needs to be obtained where a panniculitis is seen.
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14
Q

What is the treatment for Erythema Nodosum?

A
  • Treat the underlying cause.
  • Rest and NSAIDs
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15
Q

What is this?

A

Leucocytoclastic Vasculitis

(Seen in both UC and Crohns)

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16
Q

What condition is this in IBD and where on the body is it usually found?

What investigations should you do?

A

Pyoderma gangrenosum

  • Lower limbs
  • Investigations: look for inflammatory bowel disease, rheumatoid arthritis or malignancy.
    • Biopsy - primarily to exclude other causes.
  • DO NOT HAVE SURGEONS DEBRIDE - it will only make it worse.
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17
Q

What is the most common skin manifestation in Coeliac disease?

A

Dermatitis Herpetiformis

  • Intensly itchy
  • Most common on buttocks, scalp and extensor surfaces.
  • Biopsy shows neutrophil microabscesses in the dermal papilla.
    • IMF has granular IgA deposition.
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18
Q

Whats a cutaneous sign of liver cirrhosis?

A

Palmar erythema

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19
Q

What are some signs of Hepatitis C infection?

Study These Flashcards
A
  • Lichen Planus
  • Small vessel vasculitis
  • Cryoglobuinaemia
  • Pruritus
  • Porhyria Cutanea Tarda

(Picture on the other page is lichen planus)

(This picture - Porphyria Cutanea Tarda - blisters and erosions and milia on sun-exposed areas.)

20
Q

In patients with sarcoidosis, what fraction have affected skin?

21
Q

What organ is most commonly affected in sarcoidosis?

22
Q

What are the cutaneous patterns sarcoidosis can manifest like?

Study These Flashcards
A
  • Papules
  • Plaques
  • Hypopigmented patches
  • Subcutaneous Nodules (including Erythema Nodosum)
  • Annular
  • Ulcerative
  • Scar sarcoid
23
Q

What pattern of lupus is this?

Tell me a bit about it

Study These Flashcards
A

Lupus Pernio

  • Nodules & plaques
  • Form on the nose, ears, cheeks.
  • 75% have chronic lung involvement
  • It is resistant to treatment
  • Scarring
24
Q

What pattern of sarcoid is this?

Study These Flashcards
A

Annular Sarcoid

25
What pattern of sarcoid is this?
Paular and Nodular Sarcoid
26
What ungual (nail) signs can be seen in sarcoidosis?
* Clubbing * Subungual hyperkeratosis * Onycholysis
27
What is the hallmark feature of sarcoid?
**Naked Granulomas** "Dermal epithelioid granulomas without an inflammatory infiltrate."
28
What are some other investigations for Sarcoid?
* **Chest X-Ray** usually shows **pulmonary infiltrates** + **Bi-Hilar Lymphadenopathy**. * **ANA** is usually positive (**30%**) * **Serum ACE** is raised in **60%**. * **Lymphopenia** and **Hypercalcaemia** can also be present.
29
What is the treatment of sarcoidosis?
* **Corticosteroids** (topically, intralesionally or sometimes systemically.) * **Calcineurin inhibitors** (**Tacrolimus**) & **Hydrocychloroquine** can be useful adjuncts. * **Immunosuppression** - methotrexate - this usually requires an MDT approach.
30
What is this?
**Lupus Vulgaris** (The Commonest form of **Cutaneous TB**) An apple jelly appearance under dermoscopy.
31
What is the triad of Wegner's Granulomatosis? What cutaneous manifestations can occur with it?
1. Systemic vasculitis 2. Necrotising Granulomatous Inflammation of the repistory tract 3. Glomerulonephritis Skin lesions can be * Nodules * Petechiae * Purpura * Pyoderma-gangrenosum-like lesions.
32
What is this and what conditions is it associatied with if secondary/acquired? (Hence to always test for)
Acquired/Secondary Ichthyosis * Lymphoma * HIV
33
What is this called? What is it associated with?
**Migratory Erythemas** Associated with malignancy so ALWAYS do a full malignancy screen.
34
What is this?
**Heliotropic exfoliative plaques** affecting the **eyelids** and **cheeks** (**Classic of Dermatomyositis**)
35
What are the two types of dermatomyositis? What is malignancies is adult dermatomyositis associated with?
**Juvenile and Adult Dermatomyositis** * **ONLY Adult dermatomyositis** is associated with malignancy (10-50%) * **Commonest** malignancies are: * **Genitourinary (Especially Ovarian)** * **Breat** * **Lung** * **Gastric**
36
What malignancies are associated with acanthosis nigricans?
* **Adenocarcinoma of the stomach (most common)** * Gastrointestinal * Genitourinary
37
What is this? What is it associated with?
**Calciphylaxis** Calcium is deposited in the **small vessels** in the **skin** resulting in **necrosis**. It occurs in **renal failure patients** undergoing **dialysis**. **Calcium**/**phosphate imablances**. It can also occur in patients with a **hypercoagulable state**.
38
What is this?
**Reactive Perforating Collagenosis** * Seen in **dialysis patients**. * Grouped with a **central core**. * **Collagen** is being pushed out of the skin
39
What is this condition and what is it associated with?
**Palmoplantar Keratoderma** Associated with **lymphomas** and **certain adenocarcinomas**.
40
What condition is this?
**Paraneoplastic Pemphigus** * Severe **Erosive Gum Disease** * Associated with **lymphomas** and **Castleman's disease**. * Very **Resistant** to Treatment.
41
What is this condition? What must be done when seen?
**Sweet's Syndrome** * **Erythematous plaques** with **pustules** on the **face** and **upper arms**. * Associated **fever** and **neutrophilia**. * **Biopsy** shows - **nuetrophils**. * Search for **malignancy is mandatory.**
42
What is interesting about itch being a cause for malignancy?
The itch may predate the malignancy by many eyars.
43
What is the difference between primary and secondary itch?
Primary - due to a dermatological condition (Eczema) Secondary - due to an underlying cause
44
What are some causes of pruritus without dermatosis?
**ITCH** * **I**ron deficiency/**I**nternal Malignancy * **T**hyroid problems * **C**hronic RENAL and LIVER disease. * **H**IV * **H**aematological disorders * Hodgkins or non-Hodgkins lymphoma * Leukaemia * Myeloma * Polycythaemia
45
How do you treat pruritus?
1. Identify the underlying cause 2. Emollients 3. Steroids 4. Antihistamines - hydroxyzine. 5. Low dose doxepin and amitryptiline at night. 6. **Liver disease itch** --\> Naltrexone 7. **CKD** --\> UVB or Gabapentin/Pregabalin

Dermatology Diploma (39 decks)

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