Duke PA Cutaneous Manifestations of Systemic Disease
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| Autoimmune disorders with cutaneous signs | SLE, dermatomyositis, scleroderma, vasculitides
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| endocrine disorders with cutaneous signs | diabetes
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| immune disorders with cutaneous signs | dermatitis herpetiformis, urticaria/angioedema, sarcoidosis
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| metabolic disorders with cutaneous signs | xanthelasma
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| >__% of patients with SLE have skin findings | 85
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| subset of patients with __ have cutaneous, but not systemic disease | lupus erythematosus
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| 3 categories of skin manifestations of SLE | acute cutaneous, subacute cutaneous, chronic cutaneous (discoid lupus)
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| aka discoid lupus | chronic cutaneous lupus
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| other dermatologic manifestations of SLE | alopecia and oral ulcers
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| __ is very common in those with lupus, sun exposure may trigger acute lesions | photosensitivity
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| 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)
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| scaly plaques are more commonly associated with __LE | subacute cutaneous LE
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| discoid lesions are more commonly associated with __ LE | chronic cutaneous LE
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| __% of patients with SCLE have SLE | 50
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| typically start as small erythematous papules with scale, associated with anti-Ro and anti-La antibodies, | annular or papular (psoriaform) lesions associated with SCLE
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| __% of SLE patients have discoid lesions | 25
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| non-specific lesions/rashes associated with SLE | lupus profundus (lupus panniculitis), vasculitic lesions (purpura), livedo reticularis, urticaria
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| 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
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| considered pathognomonic of dermatomyositis | Gottron's papules
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| 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
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| macular rash over posterior shoulders/neck. seen in dermatomyositis | shawl sign
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| macular photosensitivity rash over anterior neck, can aslo occur on face or scalp. associated with dermatomyositis | V sign
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| nail findings of dermatomyositis | periungual erythema, telangiectasias, cuticle overgrowth
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| systemic sclerosis | scleroderma
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| localized scleroderma | morphea, linear scleroderma
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| localized plaques or linear, band-like distribution, most common in women, peak age of onset 20-50, rarely progresses to systemic disease | localized scleroderma
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| sclerodactyly, Raynaud's phenom, sclerosis of face, scalp, trunk, periungual and mat-like telangiectasia, pigmentation abnormalities, calcinosis cutis | systemic scleroderma
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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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| 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
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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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| treatement 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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| 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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| localized swelling of the skin and mucous membranes | urticaria
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| urticaria that extends into subcutaneous tissues | angioedema
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| 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
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| 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
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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 | H-1 and H-2 blockers ahve synergisitic effect, doxepin, glucocorticoids, epinephrine
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| __ generation H-1 blockers are more effective in acute urticaria | first
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| __ generation H-1 blockers are more effective in chronic urticaria | second
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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 corticorsteroids, identify exacerbating/causitive factors, around the clock use of antihistamines
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| chronic skin disorder associated with celiac disease | dermatitis herpetiformis
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| physiology of dermatitis herpetiformis | IgA deposits in the skin, these are antibodies made in response to glutens
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| 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
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| skin findings of __ are: pitting edema (usually dependant, improves overnight), varicose veins, stasis dermatitis, hyperpigmentation (mottled blue, purple), skin fibrosis, venous ulcers | venous insufficiency
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| 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
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| treatment for stasis dermatitis | compression, oral antibiotics, topical steroids
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| 1/3 of patients with venous insufficiency will develop __ | venous ulcers
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| venous ulcers are usually located __ | above medial malleolus
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| 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
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| __ is always present with venous ulcers | bacterial superinfection
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| chronic multisystem granulomatous disease (more common in AA females) | sarcoidosis
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| with sarcoidosis skin involvement occures in __% of patients | 25
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| most common lesions of sarcoidosis | macules/papules-brown yellow or purple, occur mostly on face, extremities
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| 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
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| classic sarcoid lesion, infiltrating violaceous plaque, occurs on nose, cheeks, ears, lips | lupus pernio
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| lesions tend to occur on old scars (tattoos) | sarcoid
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| 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
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| mild erythema multiforme | no bullae, lesions on upper extremities, face
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| major/severe erythema multiforme | one or more mucous membranes involved, epidermal detachment of <10% of total body surface area
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| considered dermatologic emergencies | Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
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| definition of __ is widespread bullae on trunk, face, and mucous membrane involvement with epidermal datachments | Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
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| treatment for mild erythema multiforme | symptomatic analgesics, topical steroids
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| treatment for major erythema multiforme | often associated with drugs. discontinue the offending agent
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| treatment for Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis | medical emergency, monitor fluid/electrolytes, systemic steroids
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