Dermatology - Cutaneous Signs of Systemic Disease

From Iusmicm

Contents 1 Cutaneous Signs of Systemic Disease 1.1 Rheumatology 1.1.1 Lupus erythematosus 1.1.1.1 Acute lupus erythematosus 1.1.1.2 Chronic (discoid) lupus erythematosus 1.1.2 Dermatomyositis 1.1.3 Scleroderma 1.1.4 Vasculitis 1.1.5 Aphthous ulcer 1.1.6 Behcet's 1.2 Endocrinology 1.2.1 Hypothyroidism (Myxedema) 1.2.2 Hirsutism 1.2.3 Diabetes Mellitus 1.3 Pulmonary 1.3.1 Sarcoidosis 1.4 Gastroenterology 1.4.1 Metabolic Disorders 1.4.1.1 Hyperlipidemia 1.4.1.2 Porphyria cutanea tarda 1.4.2 Chronic liver diasease 1.4.3 Inflammatory bowel disease 1.4.3.1 Pyoderma gangrenosum 1.5 Hematology / Oncology 1.5.1 Leukemia 1.5.2 Lymphoma 1.5.3 Bone marrow transplantation 1.6 Psychiatry 1.6.1 Factitial 1.6.2 Neurotic excoriations 1.7 Cases 1.7.1 Case 1 1.7.2 Case 2 1.8 Casse 3

Cutaneous Signs of Systemic Disease

Rheumatology

Lupus erythematosus

Acute lupus erythematosus

• Cutaneous symptoms:
  • NB: lupus erythematous lesions are blanchable
  • Distribution is along photon exposure
  • Look for a malar rash

• Systemic symptoms:
  • circulating antibodies
  • immunoglobulin deposition in skin and other organs
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Chronic (discoid) lupus erythematosus

• Cutaneous symptoms:
  • Erythema with telangiectasis
  • Scaling, follicular plugging
  • Scarring that leads to alopecia
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• Systemic symptoms:
  • Discoid LE usually remains localized to the skin
  • 5% will develop systemic symptoms like immunoglobulin

Dermatomyositis

• Cutaneous symptoms:
  • Gottron's papules over joints
  • Periungual erythema and "shaggy" cuticles
  • Periorbital heliotrope eruption
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• Systemic symptoms:

Scleroderma

• Cutaneous symptoms:
  • Called "localized scleroderma"
  • Light macules / papules
  • Scarring alopecia

**Follows a dermatome?

• • Rounded off digits
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• Systemic symptoms:
  • Increased deposition of collage in the heart / lungs / kidneys / GI tract / joints / skin
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Vasculitis

• Cutaneous symptoms:
  • Palpable purpura

**Biopsy to diagnose vasculitis

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• 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.)
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• Hypersensitivity vasculitis:
  • Has 5 criteria; 3 or more required for dx:

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

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Aphthous ulcer

• Come in minor and major forms
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Behcet's

• Results in erythema nodosum
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Endocrinology

Hypothyroidism (Myxedema)

• Myxedema: "Swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands"

• Cutaneous symptoms:
  • Puffy skin
  • Yellowish tint
  • Loss of lateral eyebrows
  • Dry, course, brittle hair
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• Systemic symptoms:
  • Typical hypothyroid stuff

Hirsutism

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

• Cutaneous symptoms:
  • Lots of hair
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• Systemic symptoms:

Diabetes Mellitus

• Cutaneous symptoms:
  • Necrobiosis lipoidica: well-demarcated areas of epidermal atrophy

***Characteristic histopathologic changes

• • • Ulcerations
    • Telangiectasias
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• Systemic symptoms:

Pulmonary

Sarcoidosis

• Cutaneous symptoms:
  • Nasal / facial papules / plaques
  • Fingernail infections
  • Intra-scapular papules
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• Systemic symptoms:
  • Distal digit bone deterioration
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Gastroenterology

Metabolic Disorders

Hyperlipidemia

• Cutaneous symptoms:
  • Xanthomas: firm, flesh-colored to yellowish, papules / plaques
    • At the eye, a xanthoma is called a xanthelasma
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• Systemic symptoms:

Porphyria cutanea tarda

• Cutaneous symptoms:
  • Blisters / bullae and scarring on dorsum of hand
  • Hypertrichosis
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• Systemic symptoms:

Chronic liver diasease

• Cutaneous symptoms:
  • Spider telangiectasias
  • Palmar erythema
  • Jaundice
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• Systemic symptoms:

Inflammatory bowel disease

• Cutaneous symptoms:
  • Ulcerations characterized by their rolled violaceous border
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• Systemic symptoms:

Pyoderma gangrenosum

• Cutaneous symptoms:
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• Systemic symptoms:

Hematology / Oncology

Leukemia

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

Lymphoma

• Cutaneous symptoms:
  • Lymphoma cutis: cutaneous collections of T cells
    • appears as macules / pathces, plaques, OR nodules

***Mycosis fungoides type

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• Systemic symptoms:

Bone marrow transplantation

• Cutaneous symptoms:
  • GVHD:
    • Alopecia (acute)
    • Skin depigmentation at the tips / joints of the fingers (chronic)
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• Systemic symptoms:

Psychiatry

Factitial

• Cutaneous symptoms:

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• Systemic symptoms:

Neurotic excoriations

• Cutaneous symptoms:
  • Excoriations made by pt's own manipulation
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• Systemic symptoms:

Cases

Case 1

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Case 2

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Casse 3

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