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