Dermatology - Cutaneous Signs of Systemic Disease
From Iusmicm
(Difference between revisions)
(Created page with '==Cutaneous Signs of Systemic Disease== ===Rheumatology=== ====Lupus erythematosus==== =====Acute lupus erythematosus===== *Cutaneous symptoms: **NB: lupus erythematous lesion…') |
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**Distribution is along photon exposure | **Distribution is along photon exposure | ||
**Look for a malar rash | **Look for a malar rash | ||
+ | **Violaceous = purple lesion; often means there are lymphocytes in the epidermis. | ||
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**Scaling, follicular plugging | **Scaling, follicular plugging | ||
**'''Scarring that leads to alopecia''' | **'''Scarring that leads to alopecia''' | ||
+ | **Hypopigmentation on the inside and hyperpigmentation on the outside. | ||
**http://www.skinsight.com/images/dx/webAdult/discoidLupusErythematosus_970_lg.jpg | **http://www.skinsight.com/images/dx/webAdult/discoidLupusErythematosus_970_lg.jpg | ||
**http://www.aocd.org/images_ddd/Lupus_discoid_2_low.jpg | **http://www.aocd.org/images_ddd/Lupus_discoid_2_low.jpg | ||
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**Gottron's papules over joints | **Gottron's papules over joints | ||
**Periungual erythema and "shaggy" cuticles | **Periungual erythema and "shaggy" cuticles | ||
- | **Periorbital heliotrope eruption | + | **Periorbital '''heliotrope eruption''': erythema / violaceous around the eyes |
- | ** | + | ***Spares the upper lip |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_09.png |
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====Scleroderma==== | ====Scleroderma==== | ||
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**Called "localized scleroderma" | **Called "localized scleroderma" | ||
**Light macules / papules | **Light macules / papules | ||
+ | **Hard to see; feels like hard scar tissue | ||
+ | **Shows atrophy of the epidermis | ||
**Scarring alopecia | **Scarring alopecia | ||
**Follows a dermatome? | **Follows a dermatome? | ||
- | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_11.png | |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_12.png |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | |
**http://medicalimages.allrefer.com/large/sclerodactyly.jpg | **http://medicalimages.allrefer.com/large/sclerodactyly.jpg | ||
**http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Scleroderma_Systemic-1.jpg | **http://trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Scleroderma_Systemic-1.jpg | ||
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*Systemic symptoms: | *Systemic symptoms: | ||
+ | **Usually started in hands | ||
+ | **Rounded off digits | ||
**Increased deposition of collage in the heart / lungs / kidneys / GI tract / joints / skin | **Increased deposition of collage in the heart / lungs / kidneys / GI tract / joints / skin | ||
**http://2.bp.blogspot.com/_CJ4JyVtxylg/TT8ZFkSDHLI/AAAAAAAAAVo/D9YZRdCpQ40/s1600/19507.jpg | **http://2.bp.blogspot.com/_CJ4JyVtxylg/TT8ZFkSDHLI/AAAAAAAAAVo/D9YZRdCpQ40/s1600/19507.jpg | ||
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**'''Palpable purpura''' | **'''Palpable purpura''' | ||
**Biopsy to diagnose vasculitis | **Biopsy to diagnose vasculitis | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_13.png |
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***Microthrombi are formed because of the activation of clotting on the deposits of immune complexes. | ***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.) | ***Endothelial damage occurs because of the inflammation that leads to enzyme release (neuts, basophils, etc.) | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_15.png |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_16.png |
**http://upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Immune22.gif/230px-Immune22.gif | **http://upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Immune22.gif/230px-Immune22.gif | ||
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#Maculopapular rash | #Maculopapular rash | ||
#Biopsy of a skin lesion showing neutrophils around an arteriole or venule | #Biopsy of a skin lesion showing neutrophils around an arteriole or venule | ||
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_17.png | |
====Aphthous ulcer==== | ====Aphthous ulcer==== | ||
*Come in minor and major forms | *Come in minor and major forms | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | *Little eronsions on the oral mucosa |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | *Minor are not usually a sign of systemic disease |
+ | *Think LE and HIV | ||
+ | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_18.png | ||
+ | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_19.png | ||
====Behcet's==== | ====Behcet's==== | ||
*Results in erythema nodosum | *Results in erythema nodosum | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | *Think HIV |
+ | *Erythema nodosum: type 3 hypersensitivity in the fat tissue | ||
+ | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_20.png | ||
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====Hypothyroidism (Myxedema)==== | ====Hypothyroidism (Myxedema)==== | ||
*Myxedema: "Swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands" | *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. | ||
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**Loss of lateral eyebrows | **Loss of lateral eyebrows | ||
**Dry, course, brittle hair | **Dry, course, brittle hair | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_22.png |
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*Cutaneous symptoms: | *Cutaneous symptoms: | ||
**Lots of hair | **Lots of hair | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_23.png |
*Systemic symptoms: | *Systemic symptoms: | ||
+ | **may be an endocrine tumor | ||
====Diabetes Mellitus==== | ====Diabetes Mellitus==== | ||
*Cutaneous symptoms: | *Cutaneous symptoms: | ||
**Necrobiosis lipoidica: well-demarcated areas of epidermal atrophy | **Necrobiosis lipoidica: well-demarcated areas of epidermal atrophy | ||
- | + | ***Yellowing ulcerations | |
- | + | ||
***Telangiectasias | ***Telangiectasias | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | ***Anterior lower legs |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_24.png |
- | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_25.png | |
- | + | ||
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**Fingernail infections | **Fingernail infections | ||
**Intra-scapular papules | **Intra-scapular papules | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_27.png |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_28.png |
*Systemic symptoms: | *Systemic symptoms: | ||
+ | **Think lung issues | ||
**Distal digit bone deterioration | **Distal digit bone deterioration | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_26.png |
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**Xanthomas: firm, flesh-colored to yellowish, papules / plaques | **Xanthomas: firm, flesh-colored to yellowish, papules / plaques | ||
***At the eye, a xanthoma is called a '''xanthelasma''' | ***At the eye, a xanthoma is called a '''xanthelasma''' | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **'''Xanthelasmas''' usually DO NOT indicate an underlying lipid issue |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_30.png |
- | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_31.png | |
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=====Porphyria cutanea tarda===== | =====Porphyria cutanea tarda===== | ||
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**Blisters / bullae and scarring on '''dorsum of hand''' | **Blisters / bullae and scarring on '''dorsum of hand''' | ||
**Hypertrichosis | **Hypertrichosis | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | ***Can be dx by demonstrating fluorescent serum |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_32.png |
+ | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_33.png | ||
**http://www.primehealthchannel.com/wp-content/uploads/2011/02/Hypertrichosis-Images.jpg | **http://www.primehealthchannel.com/wp-content/uploads/2011/02/Hypertrichosis-Images.jpg | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_35.png |
- | *Systemic | + | *Systemic issues: |
+ | **Liver disease | ||
+ | **Acquired porphyria | ||
====Chronic liver diasease==== | ====Chronic liver diasease==== | ||
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**Palmar erythema | **Palmar erythema | ||
**Jaundice | **Jaundice | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_36.png |
- | + | ||
- | + | ||
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====Inflammatory bowel disease==== | ====Inflammatory bowel disease==== | ||
*Cutaneous symptoms: | *Cutaneous symptoms: | ||
**Ulcerations characterized by their '''rolled violaceous border''' | **Ulcerations characterized by their '''rolled violaceous border''' | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **Called '''pyoderma gangrenosum''': 50% have an underlying disease (think IBD, LE) |
+ | ***DO NOT DEBRIDE! | ||
+ | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_37.png | ||
+ | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_38.png | ||
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*Cutaneous symptoms: | *Cutaneous symptoms: | ||
**Leukemia cutis: purpuric or flesh-colored papules and plaques | **Leukemia cutis: purpuric or flesh-colored papules and plaques | ||
+ | **Characteristically round | ||
**10-50% of monocytic leukemia pts manifest leukemia cutis | **10-50% of monocytic leukemia pts manifest leukemia cutis | ||
**6-20% of lymphocytic and granulocytic leukemias manifest leukemia cutis | **6-20% of lymphocytic and granulocytic leukemias manifest leukemia cutis | ||
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_40.png |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_41.png |
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====Lymphoma==== | ====Lymphoma==== | ||
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**Lymphoma cutis: cutaneous collections of T cells | **Lymphoma cutis: cutaneous collections of T cells | ||
***appears as macules / pathces, plaques, OR nodules | ***appears as macules / pathces, plaques, OR nodules | ||
- | + | ***Can be present for years, then start evolving into plaques and nodules. | |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | ***Mycosis fungoides type...? |
- | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_42.png | |
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- | + | ||
====Bone marrow transplantation==== | ====Bone marrow transplantation==== | ||
*Cutaneous symptoms: | *Cutaneous symptoms: | ||
**GVHD: | **GVHD: | ||
- | *** | + | ***Acute: Light erythema macules that spread down the head along the cheeks |
- | *** | + | ***Chronic: pink macules at the joints / tips of hands, depigmentation plaques |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_43.png |
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====Factitial==== | ====Factitial==== | ||
*Cutaneous symptoms: | *Cutaneous symptoms: | ||
- | + | **Look for odd borders, weird patterns, strange distributions, et cetera. | |
**http://www.dermnet.com/dn2/allJPG3/factitial-dermatitis-4.jpg | **http://www.dermnet.com/dn2/allJPG3/factitial-dermatitis-4.jpg | ||
**http://www.dermnet.com/dn2/allJPG3/factitial-dermatitis-3.jpg | **http://www.dermnet.com/dn2/allJPG3/factitial-dermatitis-3.jpg | ||
**http://www.ghorayeb.com/files/Factitial_Ulcer_500x380.jpg | **http://www.ghorayeb.com/files/Factitial_Ulcer_500x380.jpg | ||
**http://www.ghorayeb.com/files/Factitial_Ulcer_500x380.jpg | **http://www.ghorayeb.com/files/Factitial_Ulcer_500x380.jpg | ||
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====Neurotic excoriations==== | ====Neurotic excoriations==== | ||
*Cutaneous symptoms: | *Cutaneous symptoms: | ||
- | **Excoriations made by pt's own manipulation | + | **Excoriations made by pt's own manipulation: an uncontrolled cycle of re-damaging the skin. |
- | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/ | + | **http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_45.png |
+ | |||
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+ | ===Cases=== | ||
====Case 1==== | ====Case 1==== | ||
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_48.png | |
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_49.png | |
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_50.png | |
====Case 2==== | ====Case 2==== | ||
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_52.png | |
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_53.png | |
+ | *Discoid lupus erythematosus | ||
- | + | ===Casse 3=== | |
- | + | *http://mypage.iu.edu/~pbaenzig/medschoolfiles/icm/dermatology/111019_Dermatology_04_Cutaneous_Signs_of_Systemic_Disease_Page_55.png | |
+ | *Spider telangiectasias | ||
+ | *Jaundice | ||
+ | *Palmar erythema | ||
+ | *Liver failure |
Current revision as of 16:54, 22 October 2011
Contents |
[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
- Necrobiosis lipoidica: well-demarcated areas of epidermal atrophy
[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
- Xanthomas: firm, flesh-colored to yellowish, papules / plaques
[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...?
- Lymphoma cutis: cutaneous collections of T cells
[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
- GVHD:
[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