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Dermatology > Systemic Disease > Flashcards

Systemic Disease Flashcards

1
Q

Name some genetic diseases which may have some skin manifestations?

A

Tuberous Sclerosis

Neurofibromatosis

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2
Q

Name some endocrine and metabolic diseases which may have some skin manifestations?

A 
Diabetes
Thyroid disease
Addison's Disease
Tumours with endocrine effect
Porphyrias
Cushing's syndrome
Parathyroid disease
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3
Q

Name some skin signs that may be present in diabetes?

A
  1. Infection
  2. Ulcers
  3. Xanthomata
  4. Necrobiosis Lipoidica
  5. Acanthosis nigricans
  6. Diabetic dermopathy – brown atrophic lesions legs
  7. Therapy - Effects of Insulin, Oral treatments
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4
Q

What is erysipelas and what causes it?

A

Acute infection of the upper dermis and superficial lymphatics typically with a skin rash and is usually caused by a streptococcal infection (Strep. pyogenes which is a beta-haemolytic group A strep is the most common cause)

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5
Q

What is xanthomata?

A

Deposition of yellowish cholesterol-rich material that can appear anywhere in the body in various disease states

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6
Q

Most patients with necrobiosis lipoidica will have what condition?

A

Diabetes mellitus (can also be associated with rheumatoid arthritis)

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7
Q

Thyroid hormone does what in the skin?

A
  1. Promotes fibroblast activity
  2. Regulates epidermal differentiation
  3. Essential for hair formation and sebum production
  4. Effects on skin perfusion
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8
Q

What effects might hyperthyroidism have on the skin?

A 
Warm, moist smooth skin
Facial flushing, palmar erythema
Fine, thin hair. Diffuse alopecia
Hyperhidrosis
5%  - nail changes 
2%  - hyperpigmentation
Pruritus
Graves disease – pretibial myxoedema also present
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9
Q

Explain the pathophysiology of pretibial myxoedema?

A

Fibroblasts stimulated by autoantibodies to produce high amounts of glycosaminoglycans which accumulates in the dermis

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10
Q

What effects might hypothyroidism have on the skin?

A

Cold, dry pale skin
Xerosis – may resemble acquired ichthyosis
Carotenaemia - ↓ capacity of liver to synth. Vit A
Dry, coarse brittle hair, diffuse alopecia
Loss of lateral 1/3 eyebrow
Thickened brittle nails
Generalised myxoedema – disappears with correction of
T4 level
Autoimmune causes may be assoc. with alopecia areata, PA ETC.

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11
Q

What is Addison’s disease?

A

Primary adrenocortical insufficiency

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12
Q

What are some of the signs/symptoms of Addison’s disease?

A

Diffuse hyperpigmentation
Palmar crease pigmentation
Buccal pigmentation

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13
Q

Why is there an increase in pigmentation in Addison’s disease?

A

Absence of normal glucorticoid feedback to pituitary leads to increased ACTH + MSH production leading to increased melanogenesis

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14
Q

Name a tumour which may cause hirsutism?

A

Ovarian tumour

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15
Q

What syndrome may cause hirsutism?

A

Polycystic ovarian syndrome

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16
Q

What is the treatment of discoid lupus erythematous?

A

Sun avoidance
Potent/very potent steroids
Oral antimalarials

17
Q

What are the skin features of systemic lupus erythematous (SLE)?

A
  1. Butterfly rash - present in 85%
  2. UV sensitivity
  3. Nail fold capillaries prominent
  4. May have widespread DLE type rash
18
Q

Is SLE more common in males or females?

A

Females (7:1 ratio)

19
Q

What is systemic sclerosis?

A

Thickening of the skin caused by accumulation of collagen

20
Q

What are the skin features of systemic sclerosis?

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

Dysphagia

21
Q

Is systemic sclerosis more common in males of females?

A

Females (4:1 ratio)

22
Q

Which autoantibodies may be present in systemic sclerosis?

A

Anti-nuclear antibody (+ANA)

Anti-centromere antibody

23
Q

What are the skin features of dermatomyositis?

A

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

24
Q

Which autoantibody may present in dermatomyositis?

A

+ANA

25
Q

What are the systemic features of dermatomyositis?

A 
Myositis - Creatine Kinase raised
Muscle weakness
Proximal muscles most involved
If severe  => Respiratory problems
N.B. In patients > 40 yrs look for underlying neoplasm – present in approx 30%
26
Q

What condition is known as having target lesions?

A

Erythema multiforme

27
Q

Which drug type most commonly causes erythema multiforme?

A

Sulphonamide

28
Q

Which viral disease may cause erythema multiforme?

A

Herpes simplex

29
Q

Which bacterial diseases may cause erythema multiforme?

A

Tuberculosis

Streptococcus

30
Q

Other than drugs, viral, or bacterial causes what else may cause erythema multiforme?

A

Sarcoidosis
SLE
Malignancy

31
Q

What are the clinical features of erythema nodosum?

A

Red, tender, diffuse nodules, may be assoc. with joint pains, fever

Over Shins ; sometimes other sites
Slow resolution - like bruise,6-8 weeks

32
Q

What are the causes of erythema nodosum?

A

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

33
Q

What are the clinical features of cutaneous vasculitis?

A

Non-blanching, purpuric rash ± bullae and necrosis.
Lower legs usually worst
May be systemic: renal, GI, eyes, joints

34
Q

What are the causes of cutaneous vasculitis?

A 
Many causes (vasculitis screen)
Drugs
Infective
Autoimmune
Neoplastic
35
Q

What is lived reticularis?

A

Mottled cyanotic network exacerbated by cold

36
Q

What are the causes of lived reticularis?

A 
Many secondary causes:
Cardiac failure
Vascular emboli
Drugs
Throbocythaemia
Cryoglobulins
Arteritis (PAN, SLE, RA, DM, lymphoma)
Infections
37
Q

What is the most common form. of cutaneous T-cell lymphoma?

A

Mycosis fungoides

38
Q

What disease is described of fish scale?

A

Ichthyosis vulgaris

39
Q

What skin disorders are associated with HIV infection?

A

Kaposis sarcoma – initial presentation in up to 25%. Often multiple
Seborrhoeic eczema / folliculitis – seen in at least 50%
Skin infections – herpes, molluscum, candida, staph. etc
New onset / worsening psoriasis
Dry skin / pruritus

Dermatology (16 decks)

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