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MBBS VI Medicine > Teaching Clinic - Dermatological manifestations of systemic diseases > Flashcards

Teaching Clinic - Dermatological manifestations of systemic diseases Flashcards

- Dermatomyositis - SLE - Chronic painful nodules: panniculitis, medium vessel vasculitis +/- panniculitis - Erythema nodosum - Erythema induratum - Systemic sclerosis - Vascular diseases - Diabetes: acute manifestations and chronic skin disease - cutaneous manifestation of neoplasia - generalized pruritis of systemic disease

1
Q

Dermatomyositis

Definition
Differentiation between polymyositis, dermatomyositis and amyopathic dermatomyositis

A
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2
Q

Dermatomyositis

Extent of muscle involvement

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3
Q

Dermatomyositis

Extent of cutaneous involvement

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4
Q

Dermatomyositis

Extra-cutaneous manifestations

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5
Q

Dermatomyositis

Clinical subsets, autoAb implicated in each clinical subset

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6
Q

Dermatomyositis

Investigations and diagnosis

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7
Q

Dermatomyositis

Management

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8
Q

Dermatomyositis

Commonly associated malignancies

A

Rule out NPC until proven otherwise

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9
Q

Name features

A

 Heliotrope rash around eyelids

 Gottron’s papules along downing line

 Cuticle: small vessel dilatation/ telangiectasia

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10
Q

Cutaneous lupus erythematosus (CLE)

Differentiating features between acute, subacute and chronic CLE

A
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11
Q

Subacute cutaneous lupus erythematosus

Clinical features

A

Types:
 Annular SCLE (urticarial-like eruption)
 Papulosquamous SCLE (erythematous scaly plaques with psoriasiform appearance)
 Toxic EM-like (Rowell’s syndrome)

Clinical features:
 Highly photosensitive
 Affected areas = sun-exposed aspects: face, V of neck, upper chest and upper back, shoulders, extensors of arms and forearms
 Non-scarring
 Scaly psoriasiform annular erythematous plaques and papules
 Borders may show crusting, vesiculation
 Follicular plugging and hyperkeratosis are not prominent

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12
Q

Name feature
Ddx

A

Annular SCLE (urticarial-like)

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13
Q

Name feature

A

Annular SCLE (urticarial-like)

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14
Q

Name feature

Ddx

A

Papulosquamous SCLE

Ddx:
 Psoriasis
 Lichen planus

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15
Q

Drug-induced SCLE

Common causative drugs

A
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16
Q

Cutaneous lupus erythematosus

Diagnosis

A

Diagnosis: mainly rely on clinical context
- Serum immune markers → Usually only anti-Ro/La, strongly a/w SCLE
- Skin bx at affected sites → lupus band test

Immunology:
- ANA+ in 70-80% of SCLE (ANA –ve can still be lupus)
- SCLE has a high prevalence of positivity to anti-Ro and anti-La: Anti-Ro is positive in 50-70%, especially the annular variant; Anti-La is positive in 30-40%
- Since anti-Ro autoantibodies are associated with Sjögren’s syndrome (dry eyes, dry mouth) as well as SCLE, some patients have features of both condition

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17
Q

Cutaneous lupus erythematosus

Management

A
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18
Q

Acute cutaneous lupus erythematosus

Subtypes
Clinical presentation
Ddx

A
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19
Q

Subacute cutaneous lupus erythematosus

Subtypes
Clinical presentation
Ddx

A
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20
Q

Chronic cutaneous lupus erythematosus

Subtypes
Clinical presentation
Ddx

A
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21
Q

Panniculitis

Definition
D/dx

A
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22
Q

Panniculitis

Histopathological classification

A

Subcutaneous fat lobule/septal wall

Look at vasculature structure: destroyed or not (vasculitis or not)

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23
Q

Septal panniculitis

Types with vasculitis and without vasculitis

A
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24
Q

Lobular panniculitis without vasculitis

Subtypes

A
25
Q

Septal panniculitis without vasculitis/ Erythema nodosum

  • Pathogenesis
  • Causes
A
26
Q

Erythema nodosum

Clinical presentation

A
27
Q

Erythema nodosum

Investigation and diagnosis

A
28
Q

Erythema nodosum

Treatment

A
29
Q

Erythema induratum/ Lobular panniculitis with vasculitis

  • Pathogenesis
  • Clinical presentation
A
30
Q

Erythema induratum

Investigation and diagnosis

A
31
Q

Erythema induratum

Treatment

A
32
Q

Chronic cutaneous lupus erythematosis: Discoid luous erythematosis

  • Risk factors
A
33
Q

Name feature

A

Discoird lupus lesion with dyspigmentation

Hypertrophic lesions develop with significant hyperkeratosis

34
Q

Name feature

A

Discoid lupus erythematosus
Scarring alopecia

(always check beind ear for scarring alopecia)

35
Q

Name feature

A

Lupus panniculitis: depressed area due to inflammatory lesion

36
Q

Medium vessel vasculitis

Types with cutaneous involvement
Causes

A

Types:
- Polyarteritis nodosa: systemic necrotizing ANCA-negative vasculitis affecting medium-sized arteries
- Livedo vasculitis(cutaneous only)

Causes:
□ Idiopathic: majority
□ Secondary: streptococcal infection, HBV, HCV infection, IBD, hairy cell leukaemia

37
Q

Medium vessel vasculitis/ Polyarteritis nodosa

Clinical features

A
38
Q

Medium vessel vasculitis/ Polyarteritis nodosa

Diagnosis
Management

A
39
Q

Name feature

A

Erythema nodosum

40
Q

Panniculitis

History taking questions
P/E
Ix

A
41
Q

Name feature

A

Cutaneous TB

42
Q

Name feature

A

tuberculosis verrucosa cutis (TBC: direct inoculation of bacilli into skin, e.g. direct contact in swimming pool)

43
Q

First line investigations for chronic recurrent painful nodules

A
44
Q

Cutaneous manifestations of DM

Pathogenesis

A

Insulin and skin:
 Insulin regulates glucose deposition into skin cells
 Affects growth and differentiation of keratinocytes
 promotes comedone formation
 Affects dermal fibroblastic function and therefore dermal collagen formation

45
Q

Cutaneous manifestations of DM

List all manifestations

A

Infections:
- Staphylococcal pyodermas
- Candidiasis
- Erythrasma
- Epidermophytosis

Xanthomatosis:
- Eruptive xanthomas
- Xanthelasma
- Tuberous xanothoma

Chronic degenerative changes
- Diabetic dermopathy
- Erythema and necrosis/ gangrene: rubeosis faciei (facial erythema)
- Bullous lesions
- Scleredema adultorum (of Buschke): skin induration in back and neck. Not painful, itchy.
- Thickened skin and stiff joints/ Skin and joint contactures

Other cutaneous conditions:
- Necrobiosis lipoidica diabeticorum (NLD)
- Granuloma annulare (GA)
- Acanthosis nigricans
- Perforating disease (Kyrle’s disease)

Cutaneous reaction to diabetic treatment

46
Q

Name feature

Treatment

A
47
Q

Name feature

A

Diabetic dermopathy = commonest cause of brown patch in LL in short case:
- Atrophic brownish patches in lower limbs
- Asymptomatic Appears and disappear over 12 to 18 months
- Constant appearances of new lesions, create a stationary impression
- Men/women: 2/1
- No telangiectasia/ yellow lesions

48
Q

Name feature

Cause
Treatment

A

Necrobiosis lipoidica diabeticorum (NLD)

Clinical presentation:
 Erythematous papules that coalesce into large plaques in the pretibial area
 Yellow atrophic center with telangiectasia (can see through the macule)
 Could be multiple
 1/3 ulcerated
 50% of DM cases have neuropathy or retinopathy
 10-20% spontaneously resolution

Treatment:
 ?Benefit of tight control
 Topical potent/ intralesional steroid
 Antiplatelet agents (aspirin, dipyridamole)
 Fibrinolytic therapy (nicotinic acid derivative)

49
Q

Name feature

Treatment

A
50
Q

Name feature

Causes

A

Acanthosis nigricans (AN: common):
- Papilloma with hyperpigmentation in axilla, inguinal, inframammary folds and neck
- Severe form could also involve the palms, sole and mucosal area
- Severe form linked to malignant disease
- Benign form associated with insulin resistance (hyperinsulinaemia) Insulin acts on IGF receptors

Other endocrinopathies associated:
- Acromegaly
- DM
- Obesity
- Cushing’s disease
- Polycystic ovary disease

Malignant:
- Lung, breast, uterus, ovarian, GI
- Associated with more extensive disease and could also involve the mucosa
- Associated with Leser-Trelat sign

51
Q

Cutaneous reaction to DM treatment

A
52
Q

Cutaneous manifestations of neoplasm

A
  1. Acanthosis nigricans
  2. Acquired icthyosis = extreme dryness of skin
  3. Amyloidosis
  4. Clubbing
  5. Coagulopathies/ bruising
  6. Cryoglobinemia
  7. Cushingoid features
  8. Dermatomyositis
  9. Erythema gyratum repens = annular rash that comes and goes
  10. Hypertrichosis lanuginose = increased hair growth, associated with CA pancreas
  11. Leser-Trelat = brownish plaque on face
  12. Pemphigus = associated with thymoma
  13. Necrolytic migratory erythema = also associated with CA pancreas
53
Q

Generalized pruritis of systemic disease

Major Ddx
Causes

A

Need to ddx from
(1) scabies (tend to spare face)
(2) mild asteatotic eczema
(3) dermatographism

Causes:
- Thyroid disease
- Parathyroid diseases
- Hepatic disease especially obstructive jaundice
- Lymphoma
- Uraemia (e.g. DM)
- Iron deficiency
- Myeloproliferative diseases

54
Q
A

Livedo reticularis caused by polyarteritis nodosa (medium vessel vasculitis)
Tender nodules, 5-10mm in diameter usually smaller than erythema nodosum

55
Q

Dx and histology

A

Eryhema nodoum: septal panniculitis without vasculitis
Resolves into bruises

56
Q

dx?

A

Varicose veins
Venous eczema (dry scaling itchy skin)

57
Q
A

Erythrasma: superficial infection due to corynebacterium minutissimum
Wood lamp skin examination done: UVA radiation
Presents as well defined brownish patches in the intertriginuous areas (axilla, toe web)
Tx: 2 weeks course of erythromycin

58
Q

Dx?

A

Diabetic dermopathy
Brownish papule and patches
No yellowish appearance
No blood vessels

MBBS VI Medicine (92 decks)

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