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Derm Systemic 1


Autoimmune disorders with cutaneous signs SLE, dermatomyositis, scleroderma, vasculitides
endocrine disorders with cutaneous signs diabetes
immune disorders with cutaneous signs dermatitis herpetiformis, urticaria/angioedema, sarcoidosis
metabolic disorders with cutaneous signs xanthelasma
>__% of patients with SLE have skin findings 85
subset of patients with __ have cutaneous, but not systemic disease lupus erythematosus
3 categories of skin manifestations of SLE acute cutaneous, subacute cutaneous, chronic cutaneous (discoid lupus)
aka discoid lupus chronic cutaneous lupus
other dermatologic manifestations of SLE alopecia and oral ulcers
__ is very common in those with lupus, sun exposure may trigger acute lesions photosensitivity
localized or generalized face, scalp, upper extremities (malar or butterfly rash), papules, papular urticaria, scaly plaques, discoid lesions, bullae, palmar erythema acute cutaneous LE (ACLE)
scaly plaques are more commonly associated with __LE subacute cutaneous LE
discoid lesions are more commonly associated with __ LE chronic cutaneous LE
__% of patients with SCLE have SLE 50
typically start as small erythematous papules with scale, associated with anti-Ro and anti-La antibodies, annular or papular (psoriaform) lesions associated with SCLE
__% of SLE patients have discoid lesions 25
non-specific lesions/rashes associated with SLE lupus profundus (lupus panniculitis), vasculitic lesions (purpura), livedo reticularis, urticaria
one of the idiopathic inflammatory myopathies; heliotrope is classic cutaneous lesion Dermatomyosistis
considered pathognomonic of dermatomyositis Gottron's papules
slightly raised pink, dusky red or violaceous papules over the dorsal sides of the MCP/PIP and or DIP joints, can occur over wrists elbows or knees (pathognomonic for dermatomyositis) Gottron's papules
macular rash over posterior shoulders/neck. seen in dermatomyositis shawl sign
macular photosensitivity rash over anterior neck, can aslo occur on face or scalp. associated with dermatomyositis V sign
nail findings of dermatomyositis periungual erythema, telangiectasias, cuticle overgrowth
systemic sclerosis scleroderma
localized scleroderma morphea, linear scleroderma
localized plaques or linear, band-like distribution, most common in women, peak age of onset 20-50, rarely progresses to systemic disease localized scleroderma
sclerodactyly, Raynaud's phenom, sclerosis of face, scalp, trunk, periungual and mat-like telangiectasia, pigmentation abnormalities, calcinosis cutis systemic scleroderma
erythematous or violaceous macular rash of eyelides, peri-orbital area, often accompanied by edema; DM Heliotrope
scleroderma epidemiology F>M; 20-50 yrs
systemic,immunologic,genetic disease manifesting in skin and/or joints psoriasis
psoriasis lesions: Red scaling papules coalesce to round-oval plaques
psoriasis epidemiology 2.1% of US adults (4.5M); 1M psoriatic arthritis; 200K new cases/yr
Psoriasis most common sites scalp, elbows, legs, knees
Psoriasis common findings Chronic plaque; Erythroderma; Pustular; Guttate; Intertriginous
Most common type of psoriasis plaque psoriasis: erythematous oval plaques, distinct borders, w/silver-white scale
Drugs that exacerbate psoriasis Lithium; Beta-blockers; Antimalarials; Systemic steroids
Factors that flare psoriasis: Strep infxn; Injury or trauma; Drugs; Low humidity; Emotional stress; Overtreatment
Guttate psoriasis Small papules of short duration (weeks to months); Usually children and young adults; often after strep
Most common type of psoriatic arthritis asymmetrical arthritis
Psoriasis etiology T-cell-mediated hyperproliferation of epidermis -> inflammation of epidermis / dermis -> keratinocyte hyperproliferation
Psoriasis: associated conditions CVD, depression, lymphoma
Silvery scaling plaques on extensor sensors. Ausptiz sign, Koebner phenomena; sausage fingers Psoriasis
Rat bite erosions on X-ray Psoriatic arthritis
Psoriasis: 5 variants = plaque, pustular, guttate, inverse, erythrodermoid
psoriasis tx topical steroids & vit D; coal tar / ASA preps; topical retinoid prn; for severe: cyclosporine, MTX, PUVA
von Zombusch syndrome pustular psoriasis: emergency; diffuse pustules coalesce => lakes of pus; fever, malaise, high WBC
erythrodermoid psoriasis = generalized, over most of skin; hypermetabolic state requiring hospitalization
psoriasis mgmt Acitretin (0.5mg/kg; teratogen) vs MTX / Csteroid vs retinoids.
psoriasis tx categories Topical (tar & CS, vit D & A/retinoid); phototherapy (UVB); MTX; cyclosporin A; Biologics (alefacept / efalizumab)
pemphigus vulgaris etio bullous autoimmune dz; IgG Ab => acantholysis => loss of cell-cell adhesion
pemphigus vulgaris S/S oral mucosa lesions precede skin by 6-12 mos; pain (no itch); Nikolsky sx
pemphigus vulgaris tx systemic tx: prednisone + immunosuppressives, azathioprine +/- MTX
Created by: Adam Barnard Adam Barnard