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34 Cards in this Set
- Front
- Back
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What skin conditions are seen in Diabetes Mellitus?
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- Acanthosis Nigricans
- Diabetic Dermopathy - Necrobiosis Lipoidica Diabeticorum - Diabetic Bullae |
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What skin condition is a sign of insulin resistance (as in type 2 DM)?
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Acanthosis Nigricans - velvety hyperpigmented thickening of skin; commonly in skin folds of posterior neck, axillae, and groin
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If you see this brown, velvety plaque on skin, what should you suspect?
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Acanthosis Nigricans
- Sign of insulin resistance (type II DM) - Also in familial syndromes and associated with cancer (malignancies more common when there is oral or palmar involvement = Tripe palms) |
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What are the characteristics of Diabetic Dermopathy?
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- Brown, atrophic macules and plaques on shins
- Trauma may play a role in pathogenesis - Marker of poor diabetes control - 30% of those w/ long-standing diabetes |
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In a diabetic, what do these brown atrophic macules / plaques suggest?
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Poor diabetic control (Diabetic Dermopathy)
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What are the characteristics of Necrobiosis Lipoidica Diabeticorum?
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- Yellow-orange, atrophic patches / plaques on shins of diabetic patients
- Multiple, bilateral lesions - Progressively expand and may lead to ulceration (especially males) - Not always in DM patients (11-65%) |
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What do these plaques suggest?
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Necrobiosis Lipoidica Diabeticorum - likely to ulcerate in males w/ diabetes, treatment difficult
(can appear in people w/o DM) |
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What are the blisters that occur in people with diabetes? Where do they appear?
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- Diabetic Bullae - spontaneously arise on hands, legs, and feet (typically self-resolve over a couple weeks)
** No immunoreactants in blisters ** |
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What are the symptoms associated with Hyperthyroidism?
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- Fine, velvety, smooth skin
- Warm and moist d/t increased sweating - Hyperpigmentation (local or general) - Pruritus - Hair: fine, thin hair; mild, diffuse alopecia - Nails: onycholysis (detachment of nail from bed) |
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What are the symptoms associated with Hypothyroidism?
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- Dry, rough, coarse skin; keratoderma of hands and feet
- Cold and pale - Yellow discoloration from carotenemia - Generalized boggy and edematous skin (myxedema): rare - Hair: dull, coarse, brittle, slow growing; alopecia of lateral 1/3 of eyebrows - Nails: thin, brittle, slow growing |
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How do thyroid disorders affect the hair?
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- Hyper: fine, thin hair; mild, diffuse alopecia
- Hypo: dull, coarse, brittle, slow growing; alopecia of lateral 1/3 of eyebrows |
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How do thyroid disorders affect the nails?
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- Hyper: onycholysis (nail falls off of nail bed)
- Hypo: thin, brittle, slow growing |
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What skin condition is associated with Grave's Disease + Hyperthyroidism? Characteristics?
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Pretibial Myxedema
- Cutaneous infiltration of skin w/ MUCIN - Peau d'orange skin - brown/red, firm |
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What skin condition is associated with Renal Failure / Dialysis patients?
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Calciphylaxis d/t Hyperparathyroidism
- Uncommon, worrisome, ischemic ulceration of skin - Cause: intra-arterial calcification - Painful, irregular (retiform) purpura w/ induration |
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What skin condition is associated with Addison's Disease? Characteristics?
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- Hyperpigmentation - diffuse, sun-exposed sites, including mucous membranes, hair, nails, etc
- Lose ambisexual hair in post-pubertal women - Fibrosis and calcification of cartilage (ear) - rare - Cause: primary adrenocortical insufficiency (autoimmune 80%) |
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What skin conditions are associated with Cushing's Disease? Characteristics?
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- Moon (round) facies
- Buffalo hump (fat pad) - Acne / hirsutism - Truncal obesity w/ thin limbs - Stretch marks - Easy bruisability - Slow wound healing - Cause: overproduction of ACTH or cortisol |
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What skin conditions are associated with Lupus Erythematosus? Characteristics?
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- 80% of systemic lupus erythematous have problems w/ skin (some only have problems w/ skin - chronic cutaneous lupus)
- Malar (cheek) erythema - Discoid (chronic/thick) lesions - Oral ulcers - Photosensitivity - Diffuse alopecia - Bullous lupus (blisters) - Other sx: arthritis, serositis, nephropathy, CNS disorder, hematologic disorder, immunologic - Abnormal ANA - More common in females of childbearing age and AA, other dark skin |
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Who is most likely to get Subacute Cutaneous Lupus Erythematous? Characteristics?
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- 7-27% of lupus patients, mostly white females w/ onset in 40s
- Annular (ring like) plaques common - Sun exposed sites, but spares mid face - Very photosensitive |
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What is the cause of neonatal lupus?
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SSA/B antibodies crossing the placenta
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What skin condition is associated with:
- Heliotrope rash (eyelids) - Photosensitive poikiloderma - Gottron's papules - Proximal muscle weakness - Abnormal EMG and MRI of muscles |
Dermatomyositis
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What should you be worried about in patients who have Dermatomyositis?
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10-50% of adults have associated neoplasm
- GU, OVARIAN, colon most common - Also breast, lung, pancreatic, and lymphoma *** ALWAYS consider Ovarian in women w/ DM *** Also, interstitial lung disease may be fatal (associated w/ anti-Jo-1 Abs) |
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What condition should be a red flag to screen for ovarian cancer?
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Dermatomyositis
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What systems are at most risk for disease in Sarcoidosis?
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- Pulmonary (90%) - most common, can be asymptomatic
- Skin (20-35%) - easy to biopsy - Many others |
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What skin conditions are associated with Sarcoidosis? Characteristics?
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- Most common at onset of disease
- Look for systemic disease Great Pretender - Brown-red papules and plaques are characteristic - Occasionally unusual variant (ichthyotic) - Periorbital granulomatous papules - Annular and papular plaques Lofgren's Syndrome (very common): - Erythema nodosum - Hilar adenopathy - Fever - Iritis, arthritis |
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What condition should be suspected with Erythema Nodosum, Hilar Adenopathy, and Fever?
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Sarcoidosis
- These 3 symptoms are called "Lofgren's Syndrome" |
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What skin conditions are associated with Hepatitis C? Characteristics?
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Porphyria Cutanea Tarda
- Defect in UROD - breaks down heme proteins - Enzyme is stressed by chronic hep. C infxn of liver - Also can be caused by drugs, alcohol, and iron overload (hemachromatosis) Symptoms: - Hypertrichosis of face - Fragile bullae and scars on hands |
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What skin conditions are associated with Inflammatory Bowel Disease (Crohn's and Ulcerative Colitis)? Characteristics?
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Pyoderma Gangrenosum
- Sterile, rapid ulceration of skin - Neutrophilic infiltration - Dusky border Also: - Inflammatory arthritis hematologic problems, and maliganncies |
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What skin conditions are associated with Celiac Disease? Characteristics?
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Dermatitis Herpetiformis
- Consequence of gluten sensitivity - Much less common than prevalence of celiac disease - Anti-tissue TRANSGLUTAMINASE Abs attach to skin - Very pruritic: leads to excoriations (from papules/vesicles) - Especially on extensor surfaces |
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How do you treat Dermatitis Herpetiformis (from gluten intolerance)?
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- Avoid gluten
- Dapsone relieves itching but no effect on gut or production of auto-Abs |
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What skin conditions are associated with Neurofibromatosis? Characteristics?
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- Multiple Cafe au Lait Macules (CALM)
- Neurofibromas - deep bag of worms feeling, hyperpigmented |
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What skin conditions are associated with Peutz-Jehgers Syndrome? Associated with?
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- Periorificial lentiginosis (brown-black macules on skin by mouth, lips, buccal mucosa, nails, digits, palms and soles
Associated with: - Hamartomatous polyps of sm > lg intestine (obstruction and adenocarcinoma) - Increased ovarian, breast and pancreatic carcinoma |
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What skin conditions are associated with Systemic Amyloidosis? Characteristics?
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- Deposition of AL light chains
- Macroglossia and ridging or purpura |
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What skin conditions are associated with hematologic malignancies?? Characteristics?
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- Leukemia cutis: leukemic cells in skin
- Sweet's syndrome: benign sterile neutrophilic eruption (often in leukemia) |
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What skin conditions are associated with Glucagonoma? Characteristics?
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Necrolytic Migratory Erythema (NME)
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