Dermatology - Cutaneous Signs of Systemic Disease

From Iusmicm

(Difference between revisions)

Current revision as of 16:54, 22 October 2011

[edit] Cutaneous Signs of Systemic Disease

[edit] Rheumatology

[edit] Lupus erythematosus

[edit] Acute lupus erythematosus

Cutaneous symptoms:
- NB: lupus erythematous lesions are blanchable
- Distribution is along photon exposure
- Look for a malar rash
- Violaceous = purple lesion; often means there are lymphocytes in the epidermis.

Systemic symptoms:
- circulating antibodies
- immunoglobulin deposition in skin and other organs

[edit] Chronic (discoid) lupus erythematosus

Cutaneous symptoms:
- Erythema with telangiectasis
- Scaling, follicular plugging
- Scarring that leads to alopecia
- Hypopigmentation on the inside and hyperpigmentation on the outside.

Systemic symptoms:
- Discoid LE usually remains localized to the skin
- 5% will develop systemic symptoms like immunoglobulin

[edit] Dermatomyositis

Cutaneous symptoms:
- Gottron's papules over joints
- Periungual erythema and "shaggy" cuticles
- Periorbital heliotrope eruption: erythema / violaceous around the eyes
  - Spares the upper lip

[edit] Scleroderma

Cutaneous symptoms:
- Called "localized scleroderma"
- Light macules / papules
- Hard to see; feels like hard scar tissue
- Shows atrophy of the epidermis
- Scarring alopecia

**Follows a dermatome?

Systemic symptoms:
- Usually started in hands
- Rounded off digits
- Increased deposition of collage in the heart / lungs / kidneys / GI tract / joints / skin

[edit] Vasculitis

Cutaneous symptoms:
- Palpable purpura

**Biopsy to diagnose vasculitis

Systemic symptoms:
- Henoch-Schonlein purpura associated with renal or bowel involvement
- Type 3 Ab reaction (immune complex) against the endothelium of the vasculature
  - Antibodies bind to an antigen and form a complex
  - The complex activates platelets (clotting) and the complement pathway (inflammation)
    - C3a and C5a are important complement factors that lead to inflammation
    - Vasoactive amines increase permeability and lead to erythema
  - Microthrombi are formed because of the activation of clotting on the deposits of immune complexes.
  - Endothelial damage occurs because of the inflammation that leads to enzyme release (neuts, basophils, etc.)

Hypersensitivity vasculitis:
- Has 5 criteria; 3 or more required for dx:

Age >16
Use of a possible offending drug in temporal relation to the symptoms
Palpable purpura
Maculopapular rash
Biopsy of a skin lesion showing neutrophils around an arteriole or venule

[edit] Aphthous ulcer

Come in minor and major forms
Little eronsions on the oral mucosa
Minor are not usually a sign of systemic disease
Think LE and HIV

[edit] Behcet's

Results in erythema nodosum
Think HIV
Erythema nodosum: type 3 hypersensitivity in the fat tissue

[edit] Endocrinology

[edit] Hypothyroidism (Myxedema)

Myxedema: "Swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands"
- Lateral eyebrow loss in myxedema is classic board question.
- Mucopolysaccharides in the skin.

Cutaneous symptoms:
- Puffy skin
- Yellowish tint
- Loss of lateral eyebrows
- Dry, course, brittle hair

Systemic symptoms:
- Typical hypothyroid stuff

[edit] Hirsutism

Excess androgen production
- Can be from ovary, adrenals, or drug-induced
- Mind the racial differences and normal variation

Cutaneous symptoms:
- Lots of hair

Systemic symptoms:
- may be an endocrine tumor

[edit] Diabetes Mellitus

Cutaneous symptoms:
- Necrobiosis lipoidica: well-demarcated areas of epidermal atrophy
  - Yellowing ulcerations
  - Telangiectasias
  - Anterior lower legs

[edit] Pulmonary

[edit] Sarcoidosis

Cutaneous symptoms:
- Nasal / facial papules / plaques
- Fingernail infections
- Intra-scapular papules

Systemic symptoms:
- Think lung issues
- Distal digit bone deterioration

[edit] Gastroenterology

[edit] Metabolic Disorders

[edit] Hyperlipidemia

Cutaneous symptoms:
- Xanthomas: firm, flesh-colored to yellowish, papules / plaques
  - At the eye, a xanthoma is called a xanthelasma
- Xanthelasmas usually DO NOT indicate an underlying lipid issue

[edit] Porphyria cutanea tarda

Cutaneous symptoms:
- Blisters / bullae and scarring on dorsum of hand
- Hypertrichosis
  - Can be dx by demonstrating fluorescent serum

Systemic issues:
- Liver disease
- Acquired porphyria

[edit] Chronic liver diasease

Cutaneous symptoms:
- Spider telangiectasias
- Palmar erythema
- Jaundice

[edit] Inflammatory bowel disease

Cutaneous symptoms:
- Ulcerations characterized by their rolled violaceous border
- Called pyoderma gangrenosum: 50% have an underlying disease (think IBD, LE)
  - DO NOT DEBRIDE!

[edit] Hematology / Oncology

[edit] Leukemia

Cutaneous symptoms:
- Leukemia cutis: purpuric or flesh-colored papules and plaques
- Characteristically round
- 10-50% of monocytic leukemia pts manifest leukemia cutis
- 6-20% of lymphocytic and granulocytic leukemias manifest leukemia cutis

[edit] Lymphoma

Cutaneous symptoms:
- Lymphoma cutis: cutaneous collections of T cells
  - appears as macules / pathces, plaques, OR nodules
  - Can be present for years, then start evolving into plaques and nodules.
  - Mycosis fungoides type...?

[edit] Bone marrow transplantation

Cutaneous symptoms:
- GVHD:
  - Acute: Light erythema macules that spread down the head along the cheeks
  - Chronic: pink macules at the joints / tips of hands, depigmentation plaques

[edit] Psychiatry

[edit] Factitial

Cutaneous symptoms:
- Look for odd borders, weird patterns, strange distributions, et cetera.

[edit] Neurotic excoriations

Cutaneous symptoms:
- Excoriations made by pt's own manipulation: an uncontrolled cycle of re-damaging the skin.

[edit] Cases

[edit] Case 1

[edit] Case 2

Discoid lupus erythematosus

[edit] Casse 3

Spider telangiectasias
Jaundice
Palmar erythema
Liver failure

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