MED: Common Skin Disorders & Manifestations of Systemic Disorders

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Common Skin Disorders & Manifestations of Systemic Disorders
Jessica Margaux Mercado
Flashcards by Jessica Margaux Mercado, updated more than 1 year ago
Jessica Margaux Mercado
Created by Jessica Margaux Mercado over 8 years ago
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papulosquamous, proliferative, inflamatory skin disease (common skin disorder) PSORIASIS skin sheds every 5 days 2% of pop, peak: late 20s Koebner reaction extradermal: edema, liver damage, arthropathy, nail pitting, corneal nodules
salmon pink plaque topped by silvery white scale on extensor surfaces (scalp, elbows, knees); can be round/gultate/ geographical/ circinate; (+) Auspitz (common skin disorder, be specific) PLAQUE TYPE PSORIASIS
pinkish, glazed, clearly demarcated, non-scaly; (groin, perianal, genital, inframammary folds); usually mistaken as dermatophytic or candida (type of psoriasis) FLEXURAL PSORIASIS
well-demarcated, scaling, erythematous, pustules are white/yellow/green/brown; common in palms and soles (type of psoriasis) PUSTULAR PSORIASIS
more complicated; life-threatening; can lead to death (type of psoriasis) VON ZUMBUSCH PSORIASIS
Psoriasis Management? Reassurance, social support, emolients, salicylic acid, coal tar, UVB, calcipotriol, photochemotherapy (Psoralen w/ UVR), Acitretin, cytotoxic drugs (methotrexate, cyclosporine)
Acute: vesicular, can rupture to leave a raw, weeping surface; Subacute: diffuse, irritating, pruritic, sometimes painful; Chronic: lichenification (common skin disorder) ECZEMA/DERMATITIS
presents at infancy, resolves by 12y/o; area of predilection: cheek; (+) Prick test to common allergens; itch rash cycle (type of eczema/dermatitis) ATOPIC ECZEMA may be prevented by breastfeeding; family history of atopy
age 2 and above; at flexural, antecubital, popliteal areas (type of eczema/dermatitis) CHILDHOOD ATOPIC DERMATITIS
Atopic Eczema Management? Emolients, topical corticosteroids, antihistamines, immunosuppressants
erythema, vesiculation, fissuring; commonly affects hands; can manifest even in 1st exposure (type of eczema/dermatitis) IRRITANT CONTACT DERMATITIS occupational hazard detergents, bleach, soaps
sharp cut-off where contact ends; previous sensitization, autosenzitation; most vulnerable: thin, moist skin; (+) Patch Test: marked prolonged response (type of eczema/dermatitis) ALLERGIC CONTACT DERMATITIS dyes, nickel, chromates, lanolin, rubber, resins, topical antibiotics (Neomycin), antiseptics (Betadine)
scaly, rusty, red, pruritic eruption on oily areas of skin (T-zone, flexures, scalp, nasolabial, eyebrows) (type of eczema/dermatitis) SEBORRHEIC DERMATITIS unkown etiology; aggravated by stress; may be due to fungal infection
papulopustular inflammatory condition affecting face and trunk; mild: comedo, open/closed; severe: pustular, scarring, cystic (common skin disorder) ACNE VULGARIS 90% adolescents, hormonal overproduction of sebum = blockage = comedone (1˚ lesion); Proprionibacterium acnes
Acne Vulgaris Management? dispel myths, non-soap cleansers, benzoyl peroxide, eryhthromycin, tetracycline, clindamycin, isotretinoin
chronic inflammatory eruption on cheeks, nose, chin; erythema, papules, pustules, cyst, telangectasia; complication: nose deformity (common skin disorder) ACNE ROSACEA fair-skinned, middle-aged women; hot drinks, stress, sunlight, spicy food, cheese, alcohol, topical steroids
Acne Rosacea Management? Topical Metronidazole
small, polygonal, flat-topped, violaceous papules; very pruritic; areas: wrist, lower extremities; Wickham striae; post-inflammatory hyperpigmentation (common skin disorder) LICHEN PLANUS sulfonamides, sulfonylureas, methyldopa, thiazides, beta-blockers, antimalarials, gold salts, penicillamine
Lichen Planus Management? potent topical/systemic steroids and antihistamines
self-limiting, non-recurrent, scaling reddish-brown discrete maculopaular eruption; Herald patch: shoulder or back; Christmas-tree like: trunk, upper thighs, arms; Colarette scaling (common skin disorder) PITYRIASIS ROSEA unkown etiology, often mistaken for fungal infection; children & young adults, rainy months; clears w/in 6-8wks w/o treatment
Pityriasis rosea Management? Avoid precipitating factors (avoid too cold/hot baths, gold salts, penicillamine), antihistamines, topical steroids, emolients
very pruritic, transient/evanescent, sharply defined, erythematous or white weals w/ erythematous rim (common skin disorder) URTICARIA triggers: infection, drugs, food, parasites, physical exertion/stress, solar exposure, cold urticaria Treatment: antihistamine
"burrows", excoriations; nocturnal pruritis or discomfort; Circle of Hebra; areas: fingerwebs, wrists, antecubital fossae, axilla, areola, abdomen, gentialia, areas w/ thin skin (common skin disorder) SCABIES indigent communities, summer
Scabies Management? PERMETHRIN, precipitated sulfur; *Crotamiton (high failure rate, neurotoxic esp to children and pregnant)
chronic, granulomatous; leonine facies, saddle nose (common skin disorder) HANSEN'S DISEASE
few, well-defined, hypopigmented, hypoesthetic macules/patches w/ raised erythematous/purple border enlarging peripherally (type of Hansen's) TUBERCULOID LEPROSY milder, CMI is good Dapsone + Rifampicin, 1yr
symmetric, skin-colored/slightly erythematous papules/nodules on nose, earlobes, face, arms, buttocks, trunk, and lower extremities; Leonine facies (type of Hansen's) LEPROMATOUS LEPROSY severe, CMI is weak Dapsone + Rifampicin + Clofazimine, 2yr
painful to touch, nodular lesions usually on anterior shins (systemic manifestations) ERYTHEMA NODOSUM females, 20-50y/o
Possible causes of Erythema Nodosum? Sarcoidosis, Crohn's, ulcerative colitis, Behcet's, drugs (sulfonamides, OCP, dapsone), bacterial infection (Strep), fungal (histoplasma), viral, lepto
Erythema Nodosum Management? identify trigger, rest and elevation of affected extremity, Indomethacin, Potassium Iodide
target lesions or circular w/ central blistering; usually on limbs, symmetric (systemic manifestations) ERYTHEMA MULTIFORME
Possible causes of Erythema Multiforme? drugs (barbiturates, sulfonamides, PCN, salicylates), systemic infection (HSV), Vit deficiency (Niacin, A, C), Collagen disorders
enlarging, coalescing macules w/ crinkled surface; sheet-like loss of epidermis; extensive necrosis; (+) Nikolsky (systemic manifestations) SJS, TEN idiopathic, drug-induced; widespread apoptosis of keratinocytes (cell-mediated cytotoxicity)
SJS Management? early diagnosis and withdrawal of drug, ICU, IV fluids, systemic glucocorticoids, IV Ig
evanescent pink rash/rings on trunk or proximal extremities (systemic manifestations) ERYTHEMA MARGINATUM Rheumatic Fever
starts as a papule, become vesicular and pustular; painful ulcers on back, thigh, buttocks w/ bluish edge (specific disease w/ skin manifestation) PYODERMA GANGRENOSUM (Ulcerative Colitis, Crohn's, AML, Hodgkin's)
hardened, raised, shiny area on shins, center has yellowish tint, surrounding: pink; telangectasia (lips, nose, eyes, fingers, oral cavities); gradual formation, slow healing (specific disease w/ skin manifestation) NECROBIOSIS LIPOIDICA DIABETICORUM (DM)
smooth, discolored, annular, pustular patches w/ intact skin surface; no ulceration, no damage to epidermis; usually on hands (specific disease w/ skin manifestation) GRANULOMA ANNULARE (severe DM, HIV)
pruritic, symmetrical clusters of urticarial lesions, evolve to vesicles & bullae; very itchy; found at gluteal area, extensor aspect of elbows, knees, and upper back (specific disease w/ skin manifestation) DERMATITIS HERPETIFORMIS (Celiac Disease) Treatment: Dapsone, Gluten-free diet
infiltrative dermopathy: erythematous, edematous swellings above lateral malleoli = thickened edema of legs & feet (specific disease w/ skin manifestation) PRETIBIAL MYXEDEMA (Hyperthyroidism, Grave's)
pigmented, rough, thickened skin in axilla or groin w/ warty lesions; velvety plaques on back in obese (specific disease w/ skin manifestation) ACANTHOSIS NIGRICANS (Neoplasia: stomach CA)
heliotrope inflamm changes, edema of eyelids & periorbital area; erythema of face, neck, upper trunk, usually sun-exposed areas; hands: Gottron's papule = flat-topped violacrous papules over knuckles (specific disease w/ skin manifestation) DERMATOMYOSITIS (Neoplasia: stomach, breast, lung, ovarian, cervical; Rheuma: CT disease, paraneoplastic syndrome)
dry, scaly skin; sparing of flexural areas e.g. popliteal (specific disease w/ skin manifestation) ACQUIRED ICTHYOSIS (Neoplasia: lympoma)
successive crops of tender nodules affecting blood vessels throughout the body (specific disease w/ skin manifestation) THROMBOPHLEBITIS MIGRANS (Neoplasia: pancreatic carcinoma)
painful groups of vesicles on an inflamed base, unilateral w/ dermatomal distribution (specific disease w/ skin manifestation) HERPES ZOSTER
reddening of skin on palmar aspect of hands, usually over hypothenar eminence (specific disease w/ skin manifestation) PALMAR ERYTHEMA (liver disease)
telangectasis found slightly beneath skin surface, often containing central red spot and reddish extension which radiate (specific disease w/ skin manifestation) SPIDER NEVI (liver disease)
diffuse bluish plaque w/ small papules w/in the swelling affecting the nose; sometimes spreads to cheek (specific disease w/ skin manifestation) LUPUS PERNIO (Sarcoidosis)
Café-au-lait macules, axillary freckling, violaceous dermal neurofibroma, subcutaneous nodules (specific disease w/ skin manifestation) NEUROFIBROMATOSIS autosomal dominant; no treatment
tense bullae & erosions on normal appearing skin; slowly heals to form pink atrophic scars, milia on dorsa of hands, feet, nose, forehead, scalp; hypertrichosis on face (specific disease w/ skin manifestation) PORPHYRIA CUTANEA TARDA enzymatic defect in heme biosynthetic pathway; on sun exposed areas
small, red papule; gradually enlarges to form ring w/ raised border (specific disease w/ skin manifestation) ERYTHEMA CHRONICUM MIGRANS (Lyme Disease)
Lyme Disease Treatment? Tetracycline (Lymecycline), PCN, 3rd gen Cephalosporin (Cefotaxime)
yellow plaque, commonly found on eyelids (specific disease w/ skin manifestation) XANTHOMATOSIS (Hyperlipidemia) Tendon Xanthomata: familial hyperchol Eruptive Xanthomata: hyperlipidemia
periorificial, acral eczematous and erosive dermatitis; may be some alopecia and diarrhea (specific disease w/ skin manifestation) ACRODERMATITIS ENTEROHEPATICA autosomal recessive Zn deficiency; babies after weaning, elderly
painful oral and genital ulcerations and eye and joint conditions; iritis, keratitis, hyopyon, retinal vein occlusion, arthritis, CNS, complications (specific disease w/ skin manifestation) BECHET'S DISEASE wastebasket diagnosis recurrent progressive systemic disease of unknown etiology
Bechet's Disease Management? Steroids, Colchicine, Cytotoxic drugs (Azathioprine)
initial: flesh-colored papule/plaque w/ superficial dilated blood vessels over surface; classic lesion: ulceration & central necrosis, pearly rolled border; "rodent ulcer": dirty-looking ulcerations BASAL CELL CARCINOMA elderly, fair-skinned > 40y/o; face, nasal, periorbital; malignant but curable
Basal Cell Carcinoma Management? Surgical excision Cryotherapy Radiotherapy Moh's micrographic surgery
hyperkeratotic, crusted, indurated, may ulcerate; may look like psoriatic lesion; from damaged/chronically irritated skin, sun exposure, HPV SQUAMOUS CELL CARCINOMA fair-skinned >60y/o; HPV 6,11,16,18,30; grows more quickly, can be invasive, can metastasize
Squamous Cell Carcinoma Management? wide excision radiotherapy quadrivalent vaccine (9-26y/o)
pigmented lesion with: rapid enlargement, bleeding, variegated pigmentation, ulceration, indistinct border, persistent itching, small satellite lesions around principal lesion MALIGNANT MELANOMA fair-skinned w/ chronic UV exposure, may arise in pre-existing mole; prognosis: limbs>trunk>face
Melanoma Management? Interferon Wide excision w/ skin grafting
Casal necklace: symmetric photosensitive eruption on face, neck and upper chest; Gauntlet: extensor arms, back of hands PELLAGRA
starts as erythema and swelling after sun exposure, accompanied by itching and burning or pain; skin becomes thickened, scaly, hyperpigmented w/ copper or mahogany hue PELLAGRA
dull erythema of bridge of nose w/ fine yellow, powdery scales over follicular orifices (sulfur scales) PELLAGRA
vesicular or bulous erruptions (type of pellagra) WET PELLAGRA
pustular and bullous dermatitis w/ acral and periorificial distribution; patchy, red, dry, scaling w/ exudation and crusting on face, groin, flexor areas ACRODERMATITIS ENTEROHEPATICA autosomal recessive; mutation in SLC39A4 = Zn transporter ZIP4
periungual areas are erythematous and scaling, sometimes have superficial, flaccid pustules; angular chellitis, stomatitis; nail dystrophy, generalized alopecia; diarrhea, lethargy, irritibalitiy, whining, crying, Candidiasis, Staph ACRODERMATITIS ENTEROHEPATICA
hypopigmented on dark skin, erythematous/ purple on fair; first appear on friction areas (flexures, groin, buttocks, elbows); hyperpigmented patches w/ slightly raised edges, peeling, desquamation KWASHIORKOR
"crazy pavement", "crackled skin", "mosaic skin", "enamel paint", "flaky patient" KWASHIORKOR
hair: hypopigmented, reddish-yellow to gray or even white, dry, lusterless, crackled; (+) Flag Sign: alternating bands of pale and dark hair; nails are soft and thin; KWASHIORKOR
failure to thrive, edema, lethargy, irritability, apathy, abdominal distention, hypoglycemia, anemia, hypoprotenemia KWASHIORKOR
multiple, intensely pruritic, small papules and vesicles on thenar and hypothenar eminences of hands, soles, sides of fingers and toes DYSHIDROTIC ECZEMA
round or oblong, yellow fibrinous base ulcers; lower medial aspect of leg VENOUS ULCERS
early eruptions: symmetrical, more or less generalized, superficial, non-destructive, exanthematic, transient, macular later: maculopapular or papular, polymorphous SECONDARY SYPHILIS; SYHPILID face, shoulders, flanks, palms and soles, anal or genital regions
exanthemic erythema; round indistinct nonconfluent macules; appear first on sides of trunk, about the navel, and on inner surface of extremities MACULAR ERUPTIONS (SECONDARY SYPHILIS; SYHPILID)
raw ham or coppery shade and round; slightly raised; deep, firm, palpable; Ollendorf's sign: papule tender to touch of blunt probe; healing lesions leave hyperpigmented spots PAPULAR ERUPTIONS (SECONDARY SYPHILIS; SYHPILID)
adherent scales covering lesions more or less dominate (syphilid) PAPULOSQUAMOUS SYPHILID (SECONDARY SYPHILIS; SYHPILID)
minute scale-capped papules; at the ostia of hair follicles; conical, elsewhere domed (syhpilid) FOLLICULAR/LICHENOID (SECONDARY SYPHILIS; SYHPILID)
mimics sarcoidosis; usually in cheeks or angles of mouth; "nickels and dimes" ANNULAR SYPHILID (SECONDARY SYPHILIS; SYHPILID)
large central papule, group of minute satellite papules (syphilid) CORYMBOSE SYMPHILID (SECONDARY SYPHILIS; SYHPILID) late in secondary stage
widely scattered over trunk and extremities, involve face; arise from red infiltrated base (syphilid) PUSTULAR SYPHILID (SECONDARY SYPHILIS; SYHPILID) rare
papular lesions, relatively broad and flat; located on fold of moist skin, esp genitalia and anus (syphilid) CONDYLOMATA LATA (SECONDARY SYPHILIS; SYHPILID)
mucus patches; macerated, flat, grayish, roudned erosions covered by delicate, soggy membrane; occur on tonsils, tongue, pharynx, gums, lips, buccal areas, genitalia SECONDARY SYPHILIS highly infectious
butterfly rash over cheeks and bridge of nose; skin sores or flaky red spots on arms, hands, neck, head area; scaly red/purple raised rash; Raynaud's; temporary hair loss SLE type II & III HSN; women 15-35
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