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Derm Systemic 2

Derm

QuestionAnswer
the hallmark of vasculitis palpable purpura
well defined raised petechiae and macules, may have a central area of hemorrhage, can become confluent, primarily on lower extremities but can extend to buttocks. can become ulcerative, necrotic in severe cases. Associated with vasculitis palpable purpura
cutaneous disorders associated with diabetes acanthosis nigricans, diabetic dermaopathy, diabetic bullae, necrobiosis lipoidica, infections, lesions secondary to peripheral neuropathy, lesions secondary to peripheral vascular disease
skin infections associated with diabetes abscesses, furuncles, and carbuncles, cellulitis, erythrasma, candidiasis, malignant otitis externa, mucormycosis
thickened hyperpigmented velvety plaques that develop on neck, axillae, other body folds. associated with obesity and insulin resistance acanthosis nigricans
Most common cutaneous manifestation of DM: diabetic dermopathy (incidence 10-60%)
Characterized by atrophic, small (<1 cm), brown lesions on lower extremities (2/2 microangiopathy) = diabetic dermopathy
appear spontaneously, usually on hands or feet, patho-unclear but they appear to be associated with peripheral neuropathy in diabetics diabetic bullae
three types of diabetic bullae sterile (heals w/o scarring), hemorrhagic (heals with scarring), non-scarring (triggered by sun exposure)
flesh colored or reddish brown papules that evolve into waxy plaques (center becomes yellow and atrophic, telangiectasis my appear, mostly seen on shins usually bilateral) Necrobiosis Lipodica Diabeticorum
pathophysiology of necrobiosis lipodica diabeticorum degeneration of collegen in dermis and subutaneous fat
treatment for necrobiosis lipodica diabeticorum topical or intralesional steroid
can result from neuropathic or ischemic causes from diabetes. often surrounded by callus formation, may extend through subcutaneous tissue to bone-->osteomyelitis diabetic ulcers
thickened hyperpigmented velvety plaques that develop on neck, axillae, other body folds; assoc w/obesity and insulin resistance acanthosis nigricans
appear spontaneously, usually on hands or feet, patho-unclear but they appear to be associated with peripheral neuropathy in diabetics diabetic bullae
three types of diabetic bullae sterile (heals w/o scarring), hemorrhagic (heals with scarring), non-scarring (triggered by sun exposure)
reddish brown papules, evolve into waxy plaques (center becomes yellow and atrophic, telangiectasis appear, seen on shins usually bilateral) Necrobiosis Lipodica Diabeticorum
2/2 neuropathic / ischemic causes from DM; often surrounded by callus formation, may extend thru subQ tissue to bone => osteomyelitis diabetic ulcers
uncommon benign skin disorders of papules and plaques in annular distribution, self limiting (more common in women, hands, feet, knees and elbows) usually associated with diabetes granuloma annulare
yellow plaques occuring near medial canthus of eyelid, upperlid>lower lid (50% associated with elevated lipid levels) xanthelasma
Pruritic raised erythematous plaques Urticaria
localized swelling of skin & mucous membranes w/pruritis; usually resolve in 24 hr, may last up to 6 weeks; urticaria
Urticaria triggers: foods, drugs, infxn (viral hep, mono), stress, latex, environmental (sun, bugs)
urticaria that extends into subcutaneous tissues angioedema
urticaria >6 wks duration; trigger is undetermined in 85% of cases; (poss 2/2 autoimmune or chronic dz) chronic urticaria
wheal is the characteristic lesion of urticaria
edematous papule or plaque, transient, very pruritic wheal (urticaria)
treatment of urticaria Remove cause if possible; H-1 and H-2 blockers have synergistic effect, doxepin, glucocorticoids, epinephrine
clinical evaluation of chronic urticaria complete H&P, CBC, LFT's, TFT's, RFT's, ESR or CRP, biopsy in cases of vasculitis (referral to allergist/rheumatologist may be appropriate)
treatment principles of chronic urticaria avoid use of systemic corticosteroids, identify exacerbating/causative factors, around the clock use of antihistamines
urticaria: tx: H1 blockers efficacy: 1st gen H1 (Benadryl, hydroxyzine, Allegra, Zyrtec) better in acute urticaria; 2d gen H1 (famotidine, cimetidine)better in chronic
urticaria/angioedema most common when 3rd-4th decade
necrobiosis (NLD) incidence: 2% of diabetics; female > male
Erythema nodosum: epi 18-30 year olds; F>M; poss assoc w/leukemia
Erythema nodosum: lesion large erythematous (subQ), firm, hard nodules, LE; very painful
Hx URI then palpable purpuric rash to buttocks, posterior thighs HSP (Hx post Strep A infection)
Created by: Abarnard
 

 



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