The Skin In Systemic Disease Flashcards
(117 cards)
1
Q
What is erythema nodosum?
A
A type of panniculitis presenting as tender red nodules on the anterior shins
Less commonly affects thighs and forearms
2
Q
How does pyoderma gangrenosum (PG) present?
A
As a rapidly enlarging, very painful ulcer
It is one of a group of autoinflammatory disorders known as neutrophilic dermatoses
3
Q
What should be considered when evaluating generalized pruritus?
A
The exclusion of an underlying systemic disorder
Conditions may include haematologic, renal, liver, and endocrine disorders
4
Q
List some haematologic disorders that may be associated with pyoderma gangrenosum.
A
- Monoclonal gammopathy
- Myelogenous leukemia
- Hairy cell leukemia
- Myelodysplasia
5
Q
What are some gastrointestinal disorders associated with pyoderma gangrenosum?
A
- Ulcerative colitis
- Crohn’s disease
6
Q
What is PAPA syndrome?
A
A rare genetic autoinflammatory disorder characterized by Pyogenic Arthritis, Pyoderma gangrenosum, and Acne
Also known as PAPGA syndrome
7
Q
What are cutaneous manifestations of hypothyroidism?
A
- Eczema craquelé
- Carotenoderma
- Loss of hair in the outer third of eyebrows
- Ridged and brittle nails
- Myxedema
8
Q
What is acanthosis nigricans (AN) a risk factor for?
A
The presence of diabetes
Healthy patients with characteristic signs of AN should undergo further investigations
9
Q
What are some skin conditions associated with diabetes?
A
- Bullous diabeticorum
- Diabetic dermopathy
- Disseminated granuloma annulare
- Necrobiosis lipoidica diabeticorum
- Scleroedema of Buschke
- Eruptive xanthoma
10
Q
What are the cutaneous manifestations of hyperthyroidism?
A
- Pretibial myxedema
- Urticaria
- Pruritus
- Distorted and overgrown nails
11
Q
What is cutaneous tuberculosis (TB)?
A
An uncommon form of extrapulmonary TB resulting from a skin infection with Mycobacterium tuberculosis
Lupus vulgaris is the most common presentation
12
Q
What are the main subtypes of inflammatory bowel disease (IBD)?
A
- Crohn’s disease
- Ulcerative colitis
13
Q
What skin lesions are associated with inflammatory bowel disease (IBD)?
A
- Oral and perioral lesions
- Erythema nodosum
- Pyoderma gangrenosum
- Sweet’s syndrome
14
Q
What are common causes of cutaneous vasculitis?
A
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Sjögren syndrome
- Sarcoidosis
15
Q
What are some cutaneous manifestations of chronic renal failure?
A
- Pruritus
- Nodular prurigo
- Calcinosis and calciphylaxis
- Perforating collagenosis
- Porphyria cutanea tarda
16
Q
What are paraneoplastic cutaneous manifestations?
A
Distinctive cutaneous findings related to internal malignancies
Must be recognized to search for underlying neoplasm
17
Q
True or False: Cutaneous metastasis refers to the growth of cancer cells in the skin originating from internal cancer.
A
True
18
Q
What are specific lesions associated with sarcoidosis?
A
- Lupus pernio
- Skin plaques, papules, and papulonodules
- Erythroderma
- Nail sarcoidosis
19
Q
Fill in the blank: Eosinophilic granulomatosis with polyangiitis is also known as _______.
A
Churg-Strauss syndrome
Thought to be a multifactorial autoimmune disease
20
Q
What is Behçet disease characterized by?
A
Recurrent painful oral and genital ulcers and a variety of skin lesions
It is a multi-system condition that may affect many organs
21
Q
What is Erythema induratum also known as?
A
Bazin disease
Erythema induratum is the most common form of tuberculid, a hypersensitivity reaction related to tuberculosis.
22
Q
Who is mainly affected by Erythema induratum?
A
Young to middle-aged females
This condition primarily affects this demographic.
23
Q
Where do lesions of Erythema induratum typically present?
A
On the backs of the legs
Lesions are tender or painful violaceous nodules and plaques.
24
Q
What is Erythema nodosum (EN) a type of?
A
Panniculitis
EN is an inflammatory disorder affecting subcutaneous fat.
25
Where do EN lesions most commonly appear?
Anterior lower legs
## Footnote
They can also affect the arms and, rarely, the face and neck.
26
Do lesions of Erythema nodosum ulcerate?
No
## Footnote
EN lesions heal spontaneously within 8 weeks without scarring.
27
What appearance do EN lesions have as they heal?
Erythema contusiformis
## Footnote
This appearance resembles bruising.
28
What is Cutaneous polyarteritis nodosa (PAN)?
A rare form of vasculitis
## Footnote
PAN affects small and medium-sized arteries of the dermis and subcutaneous tissue.
29
When does Cutaneous polyarteritis nodosa often start?
In childhood or adolescence
## Footnote
This condition tends to have periods of activity and remission.
30
What do lesions of Cutaneous polyarteritis nodosa present as?
Plaques or tender nodules
## Footnote
They are most often found on pressure points on the thighs and lower legs.
31
What is Behçet disease characterized by?
Recurrent oral and genital ulceration, cutaneous lesions, and systemic problems
## Footnote
It is a rare multi-system disease causing inflammation of blood vessels.
32
What types of cutaneous lesions can occur in Behçet disease?
* Papulopustular and nodular lesions
* Folliculitis
* Pyoderma gangrenosum
* Superficial thrombophlebitis
* Palpable purpura
* Erythema nodosum
* Sweet syndrome
## Footnote
These lesions represent various reactions to the disease.
33
How is erythema nodosum primarily diagnosed?
Clinically
## Footnote
Diagnosis can be confirmed through laboratory testing and histopathology.
34
When might a skin biopsy be helpful in diagnosing erythema nodosum?
In worsening cases or extensive differential diagnosis
## Footnote
A biopsy may also assist in changing the management approach.
35
What histopathologic presentation is classic for erythema nodosum?
Septal panniculitis with a mixed cellular infiltrate
## Footnote
This infiltrate includes lymphocytes, histiocytes, giant cells, and occasional eosinophils, with an absence of vasculitis.
36
What proportion of erythema nodosum cases are idiopathic?
One-third of cases
## Footnote
The exact cause is often unknown.
37
Name three inflammatory conditions that can cause erythema nodosum.
* Inflammatory bowel disease (IBD)
* Sarcoidosis
* Rheumatological disease
## Footnote
These conditions can trigger the inflammatory response leading to EN.
38
What infectious agents are associated with erythema nodosum?
* Streptococcal infections
* Tuberculosis
* Atypical mycobacterial infections
* Yersinia
* Gastrointestinal infections
* Mycoplasma
* Leprosy
## Footnote
Streptococcal infections account for 10-30% of adult cases.
39
List two types of malignancies that can be causes of erythema nodosum.
* Leukaemia
* Lymphoma
## Footnote
Malignancies can provoke an immune response leading to EN.
40
What pharmacological agents may lead to erythema nodosum?
* Sulphonamides
* HBV vaccine
* Isotretinoin
* Oral contraceptives
* SSRIs
## Footnote
These medications are known to cause drug-induced erythema nodosum.
41
What miscellaneous factors can trigger erythema nodosum?
* Pregnancy
* Autoimmune conditions
## Footnote
These factors may contribute to the development of EN.
42
Describe the typical distribution of lesions in erythema nodosum.
Lesions appear symmetrically, predominantly on lower legs
## Footnote
Sites include shins, knees, and ankles, with smaller lesions on extensor surfaces of upper limbs.
43
What is the size range and appearance of erythema nodosum lesions?
1–5 cm in diameter, tender, erythematous nodules and plaques
## Footnote
Lesions are warm and may be more easily palpated than seen.
44
How long do erythema nodosum lesions typically last?
Approximately 3–6 weeks
## Footnote
Over time, they turn purple and fade like a bruise.
45
What systemic symptoms might accompany erythema nodosum?
* Fever
* Malaise
* Arthralgia
## Footnote
Some patients may feel well, while others experience these symptoms.
46
True or False: Joint symptoms in erythema nodosum can persist for months.
True
## Footnote
Joint symptoms usually resolve eventually.
47
What tests should be considered in clinical presentation suggesting EN?
* Full blood count (FBC)
* Chest x-ray
* Tuberculin skin test or interferon gamma release assay (IGRA)
* Viral hepatitis panel
* Anti-streptolysin O and/or anti-DNase B titers
* β-HCG in women
## Footnote
These tests help in diagnosing various conditions and assessing overall health status.
48
What additional tests should be performed in patients experiencing diarrhea?
* Fecal white blood cells (WBC)
* Stool culture for bacteria, ova, and parasites
## Footnote
These tests help identify the cause of diarrhea and determine appropriate treatment.
49
When should a gastrointestinal (GI) referral be considered?
If there is bloody diarrhea, fecal WBC, and negative cultures
## Footnote
A GI referral can help in further evaluation and management of serious gastrointestinal conditions.
50
What may indicate the need for a malignancy workup?
Certain cases based on patient history and physical exam
## Footnote
A thorough assessment is crucial to rule out cancer or other serious conditions.
51
What is the first line therapy for EN management?
* Limit physical exercise
* Bed rest and elevation of the legs
* Cool compresses
* NSAIDs such as naproxen 500 mg daily
* Potassium iodide 360–900 mg/day
## Footnote
First line therapy focuses on immediate symptomatic relief and reducing inflammation.
52
What are the components of second line therapy for prolonged cases of EN?
* Intralesional corticosteroids
* Systemic corticosteroids (after ruling out infection, sepsis, and malignancy)
* Systemic tetracyclines (e.g., doxycycline 100 mg once daily or lymecycline 408 mg once daily)
## Footnote
Second line therapy is used when first line treatments are insufficient.
53
What is the third line therapy for recalcitrant, chronic, or recurring EN?
* Colchicine
* Hydroxychloroquine
* Dapsone
## Footnote
Third line therapy involves more aggressive treatment options for persistent cases.
54
What should be monitored in patients undergoing treatment with potassium iodide?
Thyroid stimulating hormone (TSH) levels
## Footnote
Patients on potassium iodide for 1 month or more should have their TSH levels checked monthly due to potential thyroid complications.
55
True or False: Systemic corticosteroids can be used as a second line therapy for EN without any prior evaluations.
False
## Footnote
Systemic corticosteroids can only be used if infection, sepsis, and malignancy have been ruled out.
56
Fill in the blank: _______ can aid in pain relief for EN patients.
NSAIDs such as naproxen 500 mg daily
## Footnote
Non-steroidal anti-inflammatory drugs are commonly used for pain management.
57
What is confluent and reticulated papillomatosis?
An uncommon skin condition characterized by multiple hyperpigmented, scaly macules or papillomatous papules ranging in size from 1–5 mm.
## Footnote
Lesions can be asymptomatic or mildly itchy and occur on the upper trunk, neck, and axillae, sparing mucosal surfaces and nails.
58
What are the common characteristics of candidiasis?
Caused by the yeast candida; can infect mucosa, skin, or deep tissues when host defenses are lowered.
## Footnote
Superficial skin fold infection is known as candidal intertrigo, presenting as erythematous and macerated plaques with peripheral scaling.
59
Define acanthosis nigricans.
A common condition characterized by hyperkeratotic, velvety, and hyperpigmented plaques on the skin, which may or may not be pruritic.
## Footnote
Skin tags are also common, and it usually indicates an underlying condition or disease.
60
What causes erythrasma?
Caused by the bacteria Corynebacterium minutissimum.
## Footnote
Lesions present as well-defined pink or brown patches with fine scaling and superficial fissures, typically affecting skin folds.
61
What is Addison's disease?
A metabolic disorder affecting the adrenal glands, resulting in insufficient production of cortisol and aldosterone.
## Footnote
Commonly caused by autoimmune disorders, chronic infection, or underlying disease.
62
What systemic symptoms are associated with Addison's disease?
Fatigue, weakness, weight loss, nausea, abdominal pain, diarrhea, vomiting, and mood disturbances.
## Footnote
Cutaneous signs can include hyperpigmentation, typically in sun-exposed or intertriginous sites.
63
Fill in the blank: Erythrasma typically affects the skin folds, including the axillae, groin, and between the _______.
toes
## Footnote
Other areas like the intergluteal fold, submammary, and periumbilical skin may also be affected.
64
True or False: Acanthosis nigricans lesions commonly appear on mucosal surfaces.
False
## Footnote
Acanthosis nigricans lesions are more common in intertriginous sites like the neck and axillae.
65
What is the typical presentation of candidal intertrigo?
Erythematous and macerated plaques with peripheral scaling.
## Footnote
Papules and pustules may also be present along the edge of the rash.
66
List the common sites for confluent and reticulated papillomatosis lesions.
* Upper trunk
* Neck
* Axillae
## Footnote
These lesions spare mucosal surfaces and nails.
67
What dermatological examination findings are associated with acanthosis nigricans (AN)?
Bilateral axillary hyperpigmentation, brown velvety plaques, hyperkeratosis, and skin tags
## Footnote
Acanthosis nigricans is characterized by dark, velvety patches on the skin.
68
How does acanthosis nigricans presentation differ between darker and lighter skin phenotypes?
Higher frequency of acanthosis on the neck in darker skin phenotypes; skin may appear more hyperpigmented and leathery
## Footnote
This reflects variations in skin type responses to insulin resistance.
69
How can a diagnosis of acanthosis nigricans typically be made?
Clinically and by taking a thorough patient history
## Footnote
A skin biopsy may be performed in cases of diagnostic uncertainty.
70
What are the major pathologic features of acanthosis nigricans?
Hyperkeratosis and epidermal papillomatosis; acanthosis is relatively mild
## Footnote
Inflammation is not a prominent feature in histological findings.
71
What common medical disorders are linked with acanthosis nigricans?
Diabetes mellitus and obesity
## Footnote
Acanthosis nigricans is often associated with insulin resistance.
72
What role does hyperinsulinemia play in acanthosis nigricans?
It is suggested to play a key role in the pathogenesis of AN
## Footnote
The connection with insulin resistance disorders indicates a metabolic cause.
73
What is a common cause of drug-induced acanthosis nigricans?
Drugs that induce hyperinsulinemia, such as systemic glucocorticoids, injected insulin, oral contraceptives, niacin, and protease inhibitors
## Footnote
These medications may increase insulin levels, leading to skin changes.
74
Which autoimmune conditions are associated with autoimmune acanthosis nigricans?
* Systemic lupus erythematosus (SLE)
* Sjögren syndrome
* Scleroderma
* Hashimoto’s
## Footnote
Autoimmune mechanisms can contribute to the development of AN.
75
What malignancy is most commonly associated with acanthosis nigricans?
Abdominal adenocarcinomas
## Footnote
Acanthosis nigricans may occur due to paraneoplastic syndromes from tumors.
76
List features that suggest underlying malignancy in a patient with acanthosis nigricans.
* Rapid onset of skin lesions
* Additional paraneoplastic findings
* Extensive involvement
* Lesions in atypical sites
* Unexplained weight loss
* Older adult
## Footnote
These features warrant further investigation for malignancy.
77
What aspects of patient history are important in the work-up of acanthosis nigricans?
* Age of onset
* History of underlying endocrinopathy
* Family history of AN
* Possible drug exposure
## Footnote
These factors help determine the etiology of AN.
78
What physical examination findings are relevant in evaluating acanthosis nigricans?
* Height and weight for BMI
* Growth rate in children
* Signs of underlying endocrinopathy
* Blood pressure assessment
## Footnote
These findings can indicate obesity or other health issues related to AN.
79
What laboratory investigations should be conducted for patients with acanthosis nigricans?
Additional laboratory studies based on history and physical examination findings
## Footnote
Non-obese adults with new-onset AN should also undergo age-appropriate cancer screening.
80
What is the management approach for diabetic skin conditions?
Management of the underlying disease or cause
## Footnote
This includes treating the cutaneous lesions with specific agents.
81
Name three types of keratolytic agents used in treating diabetic skin lesions.
* Salicylic acid
* Glycolic acid
* Trichloroacetic acid
82
What are two examples of topical retinoids?
* Adapalene gel
* Tretinoin cream
83
What are bullous diabeticorum?
Tense bullae that occur on the lower extremities and often heal spontaneously
## Footnote
Also known as diabetic bullae.
84
How many types of diabetic bullae are there?
2 types
## Footnote
They are intraepidermal bullae and subepidermal bullae.
85
Who is more likely to develop diabetic bullae?
Individuals with long-standing diabetes or multiple diabetic complications
86
What characterizes diabetic dermopathy?
Light brown or reddish, oval or round, slightly indented scaly patches, often bilateral on the pretibial area
87
What is the significance of having 4 or more lesions in diabetic dermopathy?
It is almost always limited to patients with diabetes
88
How do diabetic dermopathy lesions respond to improved blood glucose control?
They tend to resolve after a few years
89
What is disseminated granuloma annulare?
Characterized by annular, erythematous patches composed of small papules
90
Where are lesions of disseminated granuloma annulare typically found?
Intertriginous areas, e.g., axillae and groin
91
What is a common symptom of disseminated granuloma annulare?
Pruritus
92
What characterizes necrobiosis lipoidica diabeticorum?
Red papules or plaques on the pretibial area that enlarge into yellowish-brown atrophic patches with a red rim
93
What symptoms may necrobiosis lipoidica lesions present?
Asymptomatic or tender, may ulcerate, and are often slow to heal
94
What is scleroedema of Buschke?
Characterized by the thickening of the skin over a period of months to years
95
What are eruptive xanthomas?
Red-yellow papules that appear over weeks to months, typically on extensor surfaces and buttocks
96
What is the typical size of eruptive xanthoma papules?
2–5 mm
97
On which body areas do eruptive xanthomas typically develop?
Extensor surfaces, e.g., buttocks or shoulders
98
True or False: Eruptive xanthomas can affect mucosal skin.
True
99
What is the classic presentation of zinc deficiency?
The triad of:
* peri-acral and periorificial dermatitis
* Diarrhea
* Alopecia
## Footnote
This triad is commonly used to identify zinc deficiency in clinical settings.
100
How is a diagnosis of zinc deficiency usually established?
By the presence of typical skin lesions and clinical symptoms, confirmed if the serum zinc level is low.
## Footnote
Clinical symptoms often guide the diagnosis before laboratory confirmation.
101
What are the two types of zinc deficiency?
Inherited and acquired/transient.
## Footnote
Inherited deficiency is due to mutations, while acquired deficiency can arise from various factors.
102
Why is external zinc supply necessary for humans?
Zinc is not synthesized within the human body.
## Footnote
This necessitates dietary intake to maintain adequate levels.
103
What is Acrodermatitis enteropathica?
A rare autosomal recessive genetic condition caused by mutations in SLC39A4, coding for the zinc transporter protein ZIP4.
## Footnote
Infants with this condition may not show symptoms while breastfed.
104
Why are infants with Acrodermatitis enteropathica usually asymptomatic while breastfeeding?
Breast milk has additional cofactors that enhance the absorption of zinc.
## Footnote
Symptoms typically manifest after weaning due to reduced zinc absorption.
105
What is a consequence of prematurity concerning zinc levels?
Preterm infants may have insufficient zinc due to increased metabolic rate and inadequate transplacental transfer during the third trimester.
## Footnote
This can lead to zinc deficiency if not addressed.
106
What genetic mutation can affect zinc levels in breast milk?
Mutations in SLC30A2, which encodes the zinc transporter (ZnT2).
## Footnote
This mutation leads to decreased zinc secretion from maternal serum to breast milk.
107
What percentage of the global population is at risk for zinc deficiency due to dietary inadequacy?
17.3%.
## Footnote
This highlights the widespread nature of zinc deficiency risks related to nutrition.
108
What conditions can cause malabsorption of zinc?
Cystic fibrosis, inflammatory bowel disease, pancreatic disease.
## Footnote
These conditions can impair the body's ability to absorb zinc from food.
109
What can cause increased urinary zinc excretion?
Nephrotic syndrome.
## Footnote
This condition can lead to significant losses of zinc through urine.
110
When do infants with acrodermatitis enteropathica typically become symptomatic?
Following weaning from breast milk or when exclusively formula fed.
## Footnote
This contrasts with acquired zinc deficiency, which typically presents within the first 6 months of life.
111
What role do zinc and magnesium play concerning alkaline phosphatase (ALP)?
They are important cofactors of the enzyme alkaline phosphatase (ALP).
## Footnote
Low ALP can indicate deficiencies in both zinc and magnesium.
112
What are typical serum zinc and ALP levels in zinc deficiency?
Serum zinc: undetectable, ALP: 45 (60-425 U/L).
## Footnote
These lab results help in diagnosing zinc deficiency.
113
What distinguishes inherited from acquired zinc deficiency?
Risk factors and age of presentation.
## Footnote
This distinction is crucial for appropriate diagnosis and management.
114
What might be considered for further investigation in suspected zinc deficiency?
Maternal serum zinc levels, breast milk zinc levels, maternal SLC30A2 mutations.
## Footnote
These investigations can provide insights into the source of deficiency.
115
How long does skin healing take following zinc supplementation?
1–2 weeks
## Footnote
Skin healing is significantly improved with adequate zinc levels.
116
What are the key roles of zinc in the body?
Neurological development and immune regulation
## Footnote
Early detection and management of zinc deficiency are crucial for these functions.
117
What complications can arise from prolonged and severe zinc deficiency in children?
* Recurrent infections
* Delayed wound healing
* Growth failure
* Behavioural disturbances
* Hypogonadism
* Impaired neurological development
## Footnote
These complications highlight the importance of zinc for children's health.
