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DU PA Derm Syst Dz
Duke PA Cutaneous Manifestations of Systemic Disease
| Question | Answer |
|---|---|
| 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
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