Cutaneous Signs Of Systemic Disease

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Diabetes dermopathy

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Common 30% of DM pts; brwon atrophic macules on shins; marker for poor diabetic control; No effective treatment; resemble scars

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Bullous diabeticorum (diabetic bullae)

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.5% of pts; acral in location; NO immunoreactants in blisters; no effective treatment to prevent; M:F 2:1; typically self resolve but can reoccur; spontanously arise in hands, legs, and feet

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Necrobiosis Iipoidica

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Yellow-orange atrophic plaques; multiple/bilateral; usually shins; .03 % of DM patients (can get it w/o DM too) Especially likely to ulcerate;

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Acanthosis Nigricans

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Common in Type II DM; marker for INSULIN resistance; Brown Velvety Hyperpigmented thickening of the skin; presnet on post neck, axillae and occasionally the groin; intertriginous/flexures; also on hands; can be due to other reasons-familial, malignancy, obesity, endocrinopathy, cushings, hypothyroidism

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Common associations with Diabetes

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Cellulitis, MRSA infxns, Peripheral arterial disease, various gangrene (ischemia and infection), Neuropathic ulcers (cant feel the pressure)

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Hyperthyroidism

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Leads to fine, velvety, smooth skin; Warm and moist d/t increased sweating; Hyperpigmentation-localized or generalized; Pruritus; fine thin hair; Mild diffuse alopecia; Onycholysis; pretibial myxedema can develop on the shins, representing deposition of hyaluronic acid in the skin

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Hypothyroidism

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Dry rough coarse skin; keratoderma of hands and feet; cold and pale, yellow discoloration from carotenemia; Hair is DULL coarse brittle slow growing alopecia of the LATERAL 1/3 of the eyebrows!!!

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Pretibial myxedema

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Occurs in those with Grave's disease; cutaneous infiltration of skin of shins with MUCIN (can cause bumps); peau d'orange; colored to brown red, firm; Associated with 1-5% of graves disease cases; Can occur during Graves' of following treatment; hyperthyroidism

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Other effects of Graves' disease

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Acropachy (abnormal bone formation); Exophtalmos-abnormal protrusion of the eyeball or eyeballs

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Calciphylaxis in Hyperparathyroidism

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An uncommon worrisome ischemic ulceration of the skin d/t intra-arterial calcification; usually in renal failure/dialysis pathient with abnormal 2ndary hyperparathyrodism; Painful, irregular retiform purpura with induration can lead to necrosis

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Addison's disease

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adrenocartical insufficiency; autoimmune; Hyperpigmentation; diffuse, sun-exposed, sites of trauma/scars, axillae, perineum, nipples, palmar creased; loss of ambisexual hair; nail pigmentation (stripes in nails); mucosal pigmentation; calcification of auricular cartilage

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Cushings disease

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Acne/hirsutism; striae distensae; easy bruisability; slow wound healing; hirsutism and steroid acne may be seen

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Systemic Lupus Erythematosus

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Multisystem disorder; malar erythema, discoid lesions, oral ulcers, photosensitivity; F>M 6:1; Young adults>old; dark skin >caucasian (3:1); diffuse alopeia and bullous lupus

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Subacute Cutaneous lupus erythematosus

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Pink scaly plaques are present on sun-exposed areas of the face, upper chest, and arms; Annular configuration; tx with topical steroids

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Dermatomyositis

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Purple flower; Heliotrope rash (eyelids); photosensitive "poikiloderma" (thin skin w/ alot of broken blood vessels on trunk and extremities/dermatitis Gottron's papules (pint-purple flat-topped papules) or shawl sign (chest shoulders back); Nailfold capillary changes; Positive ANA (+/-) Positive anti-Jo-1 antibody; Elevated CRP; Prox muscle weakness; ASSOCIATED with OVARIAN cancer (GU and colon cancer); INterstitial lung disease; muscle weaknes

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Sarcoidosis

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Easy to biopsy; multisystem; Non caseating granulomonas; usually asympotomatic; pleomorphic erythema nodosum, calcifications, clubbing of fingers; Red brown Papular and maculopapular rashes, plaques and nodular lesions; annular; ulcer, subcutaneous, scarring alopecia, mucosal; in African american men

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Cutaneous sarcoidosis main points

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Brown red papules and plaques; unusual variants (ichthyotic); a "great pretender"; favor the periorbital area (granulomatous); Annular and mucousal plaques

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Hep C and Skin

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Porphyria and cutanea tarda; mixed cryoglobulinemia with or without vasculitis; necrolytic acral erythema; pruritus; Lichen planus

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Porphyria cutanea tarda

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Defect in uroporphyrin that decarboxylase which breaks down heme proteins; Enzyme system is "stressed" by chronic hepatitis C infection of the liver also EtOH and drugs; Hypertrichosis of the face; Fragility, bullae and scars on the hands

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Dermatitis Herpetiformis

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Consequence of gluten sentitivity; Some degree of enteropathy of small bowel; may be patchy and subtle; Itchy blisters (anti-tissue transglutaminase antibodies attach to skin); PRURITIC; scratched off which lead to erosions extensor surfaces common; Treat with avoiding gluten or Dapsone for skin relief

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Neurofibromatosis

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benign, plexiform; Multiple cafe au lait macules; "deep bag of worms" feeling (plexiform neurofibromas); AXILLARY and Inguinal Freckling; soft rubbery papules generally where malignant peripheral nerve sheath tumors occur; hyperpigmented: tumors: optic glioma, CNS tumors-->malignant peripheral nerve sheath tumors; pheochromocytoma; juvenile myelomonocytic leukemia

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Facial Angiofibromas-Tuberous sclerosus

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Tuberous sclerosus-Facial angiofibromas (telangiectatic papules that develop on the central face), periungual fibromas (Lesions found around the nail folds) , ash leaf macules, shagreen patches (pebbly leathery plaques on lower back); dominant; benign tumor formation in multiple organ systems; Hypomelanotic macules can be present in early childhood (wood's lamp often needed)

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Discoid lupus erythematousus

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Associated with SLE in only a small minority of cases while the majority are skin limited; hyperkeratotic violaceous plaques are characteristicaly on the head and neck, especially the scalp and the ears; these plaques heal with atrophic scars

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Sturge Webber syndrome

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Congenital devo disorder of unknown cause; Capillary malformation (port wine stain) present at birth on the forehead; V1 distribution; underlying calcifications of the cerebral cortex can cause seizures; Glaucomas may be present

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PHACE syndrome

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Congenital; Posterior fossa brain malformation, Hemangiomas of the face, Arterical cerebrovascular anomalies, Cv anomoniles and Eye anomalies; often misdiagnosed as sturge webber