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DU PA Derm Syst Dz

Duke PA Cutaneous Manifestations of Systemic Disease

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, heliotrop is classic cutaneous lesion (erythematous or violaceous macular rash of eyelides, peri-orbital area, often accompanied by edema 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
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
considered by many to be most common cutaneous manifestations of DM. Pathophysiology:microangiography. Characterized by atrophic, small (<1 cm), brown lesions on lower extremities 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
treatement 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
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
localized swelling of the skin and mucous membranes urticaria
urticaria that extends into subcutaneous tissues angioedema
localized swelling of the skin and mucous membranes accompanied by pruritis. occurs once, individual lesions usually resolves in 24 hours. lasts days to 6 weeks, triggers:foods, drugs, infection, stress, latex, environmental agents acute urticaria
localized swelling of the skin and mucous membranes accompanied by pruritis. recurrent or constant, 6 weeks or greater duration, trigger is undetermined in 85% of cases (may be due to autoimmune or chronic disease) chronic urticaria
wheal is the characteristic lesion of urticaria
edematous papule or plaque, transient, very pruritic wheal (urticaria)
treatment of urticaria H-1 and H-2 blockers ahve synergisitic effect, doxepin, glucocorticoids, epinephrine
__ generation H-1 blockers are more effective in acute urticaria first
__ generation H-1 blockers are more effective in chronic urticaria second
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 corticorsteroids, identify exacerbating/causitive factors, around the clock use of antihistamines
chronic skin disorder associated with celiac disease dermatitis herpetiformis
physiology of dermatitis herpetiformis IgA deposits in the skin, these are antibodies made in response to glutens
characteristics of __ lesions are - erythematous papules/plaques studded with vesicles (location is classicaly on extensor surfaces of elbows, knees, also buttocks, scapular areas, scalp. they are symmetric and intensely pruritic(celiac) dermatitis herpetiformis
skin findings of __ are: pitting edema (usually dependant, improves overnight), varicose veins, stasis dermatitis, hyperpigmentation (mottled blue, purple), skin fibrosis, venous ulcers venous insufficiency
occurs on lower legs, ankles (pitting edema also often present), often mistaken for cellulitis, lesions (erythematous papules, scale, erosions, excriations), can be pruritic, irritant contact dermatitis stasis dermatitis
treatment for stasis dermatitis compression, oral antibiotics, topical steroids
1/3 of patients with venous insufficiency will develop __ venous ulcers
venous ulcers are usually located __ above medial malleolus
characteristics of __ are : usually located above medial malleolus associated with venous insufficiency, exquisitely painful, well demarcated, irregular shape, begin as a shallow erosion but can become quite deep (base often necrotic), venous ulcers
__ is always present with venous ulcers bacterial superinfection
chronic multisystem granulomatous disease (more common in AA females) sarcoidosis
with sarcoidosis skin involvement occures in __% of patients 25
most common lesions of sarcoidosis macules/papules-brown yellow or purple, occur mostly on face, extremities
lesions of sarcoidosis macules/papules-brown, yellow, or purple (face, extremities), nodules (brown purple, occur on face/trunk/extremities), plaques (annular or serpiginous, may be scaly. occur on buttocks/trunk/extremties) lupus pernio
classic sarcoid lesion, infiltrating violaceous plaque, occurs on nose, cheeks, ears, lips lupus pernio
lesions tend to occur on old scars (tattoos) sarcoid
characteristic lesion of __ is: macule--> papule with vesicle or bulla in center, this is known as a target (or iris) lesion. occurs on hands, forearms, feet, face, usually symmetric erythema multiforme
mild erythema multiforme no bullae, lesions on upper extremities, face
major/severe erythema multiforme one or more mucous membranes involved, epidermal detachment of <10% of total body surface area
considered dermatologic emergencies Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
definition of __ is widespread bullae on trunk, face, and mucous membrane involvement with epidermal datachments Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
treatment for mild erythema multiforme symptomatic analgesics, topical steroids
treatment for major erythema multiforme often associated with drugs. discontinue the offending agent
treatment for Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis medical emergency, monitor fluid/electrolytes, systemic steroids
Created by: bwyche