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Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

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Page 1: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Cutaneous Manifestations of Systemic Disease

Holly Edmonds, MDChief Resident

Department of Dermatology

Page 2: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Brief Review of terminology…

Page 3: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Zits???

Page 4: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Red Rash???

Page 5: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

“Nasty… just call the derm service and get a consult!”

Page 6: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

You have to learn the language!

Page 7: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Description of a skin lesion:

Type

Shape

Arrangment

Distribution

OH!!! DATS what that rash is!!!

Page 8: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

TYPE

Primary lesion

Secondary lesion

Color

Palpation

Page 9: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

MACULE/PATCH

Page 10: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 11: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

PLAQUE

Page 12: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 13: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

PAPULE

Page 14: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 15: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

NODULE

Page 16: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 17: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

VESICLE/BULLA

Page 18: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 19: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 20: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

PUSTULE

Page 21: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 22: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

WHEAL

Page 23: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 24: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SCALE

Page 25: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 26: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

CRUST

Page 27: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 28: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

LICHENIFICATION

Page 29: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 30: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

EROSION

Page 31: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 32: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ULCER

Page 33: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 34: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ATROPHY

Page 35: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 36: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

EXCORIATION

Page 37: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 38: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

FISSURE

Page 39: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 40: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SCAR

Page 41: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 42: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Color

Page 43: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Color

http://dermnetnz.org/common/image.php?path=/lesions/img/blue3.jpg
http://dermnetnz.org/common/image.php?path=/dermal-infiltrative/img/s/xanthelas1.jpg
Page 44: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Color

Page 45: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Palpation

Consistency – Firm, Soft, Fluctuant, Boardlike

Temperature deviation (hot or cold)

Mobility

Presence of tenderness

Page 46: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Margination

Ill-defined

vs.

Well-defined

Page 47: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SHAPE

Page 48: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SHAPE

Page 49: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SHAPE

Page 50: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SHAPE

Page 51: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SHAPE

Page 52: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ARRANGEMENT

Page 53: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ARRANGEMENT

Page 54: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ARRANGEMENT

Page 55: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ARRANGEMENT

Page 56: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

ARRANGEMENT

Page 57: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

DISTRIBUTION

Page 58: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

DISTRIBUTION

http://www.dermnet.com/image.cfm?passedArrayIndex=9&moduleID=5&moduleGroupID=66
Page 59: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

DISTRIBUTION

Page 60: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

DISTRIBUTION

Page 61: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

DISTRIBUTION

Page 62: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Cutaneous Manifestations

Diabetes Mellitus Renal DiseaseGastrointestinal disordersRheumatologic diseaseHepatitis CThyroid diseaseParaneoplastic diseaseNutritional disease

Page 63: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetes Mellitus

Acanthosis Nigricans

Diabetic Dermopathy

Bullosis Diabeticorum

Necrobiosis Lipoidica

Diabetic Foot Ulcers

Page 64: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Acanthosis Nigricans

African Americans and Hispanics > Caucasians

Associated with obesity, insulin resistance

Hyperpigmented velvety plaques of the flexures

Genetic sensitivity of the skin to hyperinsulinemia

Malignant form a/w gastric ACA

Page 65: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Acanthosis Nigricans

Page 66: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Acanthosis Nigricans

Page 67: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetic Dermopathy

AKA “shin spots” or pigmented pretibial papules

Most common cutaneous manifestation of diabetes

Benign asymptomatic red brown macules on shins

No treatment needed

Page 68: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetic Dermopathy

Page 69: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Bullosis Diabeticorum

Rapid onset painless, tense blisters on hands and feet

Trauma and microvascular disease may play a role

Spontaneous healing in 2-5 weeks

Page 70: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Bullosis Diabeticorum

Page 71: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Necrobiosis Lipoidica

20-35% of patients with NLD have diabetes, only about 1-3% of diabetics have NLDStart as red-brown papules and progress to well defined yellow-brown atrophic plaques with irregular violaceous borders and telangiectasias. Shins #1 site. Ulceration in 35%. Glucose control will not clear NLD

Page 72: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Necrobiosis Lipoidica Diabeticorum

Page 73: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetic Eruptive Xanthomas

Seen in uncontrolled diabetes, hypertriglyceridemia

Sudden crops on firm, non-tender yellow papules with a red rim on extensors

Control glucose and lipid reduction will reduce lesions

Page 74: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetic Eruptive Xanthomas

Page 75: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetic Neurotropic Ulcers

Peripheral neuropathy leads to unnoticed trauma

Vascular complications may lead to ulcers and complicate ulcer healing

Risk of amputation goes up 8x once these develop

Page 76: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Diabetic Neurotropic Ulcers

Page 77: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Renal disease

Pruritis

Perforating dermatosis

Calciphylaxis

Nephrogenic Fibrosing Dermopathy

Page 78: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pruritis

Most common cutaneous manifestation of renal disease

Seen in both peritoneal and hemodialysis patients

Unknown mechanism, unsatisfactory therapy- UVB helps the most

Page 79: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pruritis

Page 80: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Perforating Disorder

Acquired Perforating Dermatosis of ESRD

Umbilicated papules/nodules with central hyperkeratotic core

Page 81: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Perforating dermatosis

Page 82: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Perforating dermatosis

Page 83: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Calciphylaxis

Painful purpuric plaques and retiform purpura

More proximal lesions = poorer prognosis

Page 84: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Calciphylaxis

Page 85: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Nephrogenic Fibrosing Dermopathy

Woody, indurated plaques with peau d’orange appearance

Usually spares the face, palms, soles

Associated with gadolinium contrast for MRIs

Page 86: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Nephrogenic Fibrosing Dermopathy

Page 87: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Gastrointestinal disorders

Henoch Schonlein Purpura

Dermatitis Herpetiformis

Inflammatory Bowel Disease

Page 88: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Henoch Schonlein Purpura

Palpable purpura, urticaria, necrotic ulcers on buttocks, distal legs

Symmetric

IgA vasculitis

GI symptoms + arthritis, long term concern for hypertension and renal involvement

Usually under 20, following an URI

Page 89: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

HSP

Page 90: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

HSP

Page 91: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Dermatitis Herpetiformis

Symmetric, grouped vesicles on extensors

Very pruritic!

All patients have gluten-sensitive enteropathy, only 20% symptomatic

Associated with HLA-DQ2, Hashiomoto’s thyroiditis, lymphoma, IDDM

Cutaneous findings are due to autoantibodies to epidermal transglutaminase

Treatment- rapidly responsive to dapsone

Page 92: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Dermatitis Herpetiformis

Page 93: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Inflammatory Bowel Disease

Crohn’s and Ulcerative Colitis

Page 94: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Oral Crohn’s

• Linear ulcerations, cobblestoned oral

mucosa

• UC may have aphthous ulcers that develop as

IBD flares

Page 95: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Metastatic Crohn’s• See fissures and

fistulas with Crohn’s

• Metastatic Crohn’s are

nodules, plaques and ulcerations

usually in intertriginous

areas which can mimic erythema

nodosum

Page 96: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Erythema Nodosum• Tender red nodules on

anterior lower legs, precedes or occurs with

IBD flares, UC more common

• Most EN is idiopathic, also can be related to oral

contraceptives or abx, preceding strep or mycobacterial infxn

Page 97: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pyoderma Gangrenosum

• More common in UC• Papules, pustules, hemorrhagic blisters enlarge and ulcerate with dusky

undermined edges• Frequently on legs or around stoma sites• Treat with steroids, often gets better as IBD gets better

Page 98: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Rheumatologic Disorders

Lupus Erythematosis

Dermatomyositis

Reiter’s Disease

Page 99: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Lupus Erythematosis

Classification:– Systemic Cutaneous Lupus (SLE)– Subacute Cutaneous Lupus (SCLE)– Discoid Lupus (DLE)– Neonatal Lupus

Page 100: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SLE

+ANA

+Sm and dsDNA

Butterfly Rash

Poikiloderma

Photodistrubited erythematous, papular scaling eruption sparing knuckles.

Page 101: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SLE

Page 102: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SLE

Page 103: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SLE

Page 104: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Dermatomyositis

Poikiloderma favoring scalp, periocular (Heliotrope rash), and extensor skin sites Nailfold telangiectasiasGottron’s papules

Page 105: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Dermatomyositis

http://dermnetnz.org/common/image.php?path=/immune/img/dm3.jpg
Page 106: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Dermatomyositis(periungal telangiectasias, gottrons

papules)

Page 107: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Reiter’s Disease

Urethritis, arthritis, ocular findings, and oral ulcers in addition to psoriasiform skin lesions. Keratoderma blenorrhagicum (feet)Balanitis circinata (penis)

Page 108: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Reiter’s DiseaseKeratoderma Blenorrhagicum

Page 109: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Reiter’s Disease(balanitis circinata)

Page 110: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Hepatitis C virus

Porphyria Cutanea Tarda

Lichen Planus

Pruritis

Page 111: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Porphyria Cutanea Tarda

Vesicles and bullae on sun-exposed areas, scarring with milia

Hypertrichosis

Fragile skin with sclerodermoid changes

Page 112: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

PCT

Page 113: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

PCT(hypertrichosis)

Page 114: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Lichen Planus

Purple, pruritic, polygonal papules

Koebner phenomenon

Wickham’s striae

50% with mucosal involvement

Page 115: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Lichen Planus

Page 116: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Mucosal Lichen Planus

Page 117: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pruritis

Excoriations, lichenification, and prurigo nodularis

Page 118: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Prurigo Nodularis

Page 119: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pruritis

Page 120: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Thyroid disease

Graves disease

Hyperthyroidism

Hypothyroidism

Page 121: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Graves Disease

Thyroid dermopathy (pretibial myxedema)

Symmetric, non-pitting yellow-brown waxy papules/plaques

Due to increased hyaluronic acis in dermis

Page 122: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Thyroid Dermopathy

Page 123: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Hyperthyroidism

Warm, moist skin

Flushing, palmar erythema

Associated with reversible alopecia and vitiligo

Page 124: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Vitiligo

Page 125: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Hypothyroidism

Dry, cool skin

Generalized myxedema

Yellow hue from carotenemia

Purpura from delayed wound healing

Alopecia, madarosis

Page 126: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Carotenemia

Page 127: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Paraneoplastic Disorders

Acanthosis Nigricans

Dermatomyositis

Cushing’s Disease

Sign of Lesser-Trelat

Paraneoplastic Pemphigus

Hypertrichosis Lanuginosa

Page 128: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Acanthosis Nigricans

Page 129: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Dermatomyositis

http://dermnetnz.org/common/image.php?path=/immune/img/dm3.jpg
Page 130: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Cushing’s syndrome(buffalo hump and striae)

Page 131: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Sign of Lesser-Trelat

Page 132: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Paraneoplastic Pemphigus

http://162.129.70.33/images/pemphigus_2_010526.jpg
Page 133: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Erythema Gyratum Repens(associated with cancers above diaphragm)

Page 134: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Hypertricosis Lanuginosa Acquisita

Page 135: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Nutritional Disorders

1. Marasmus

2. Kwashiorkor

3. Pellagra

4. Scurvy

5. Zinc deficiency

Page 136: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Marasmus

Marasmus = protein/calorie malnutrition.

Cutaneous Manifestations:– Emaciation with thin, lax, and wrinkled skin.– Fine scaling with hyperpigmentation.– Follicular hyperkeratosis– Purpura– Thin hair and nails.

Page 137: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Marasmus

Page 138: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Marasmus

Page 139: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Kwashiorkor

Decreased protein intake

Dyschromia (irregular pigment)

Hypopigmentation.

Superficial desquamation with areas of erosion (flaky paint)

Petechia/purpura

Thin hair/nails

Page 140: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Kwashiorkor

Page 141: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Kwashiorkor

Page 142: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pellagra

Niacin deficiency (Vit B3)

Triad of dermatitis, diarrhea, dementia

Photosensitive eruption around neck known as “Casal’s necklace”

Page 143: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pellagra

Page 144: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pellagra

Casal’s neckace

Page 145: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Scurvy

Vitamin C deficiency

Follicular hyperkeratosis with corkscrew hairs

Perifollicular hemorrhage

Gingival hypertrophy with erosive bleeding gums.

Page 146: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Scurvy

Page 147: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Zinc Deficiency

Acquired

-deficient intake, high fiber intake, malabsorption

Inherited (acrodermatitis enteropathica) zinc deficiency

-defect in intestinal absorption of zinc

Dermatitis, diarrhea, alopecia

Periorificial and acral distribution

Page 148: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Acrodermatitis Enteropathica

Page 149: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Acrodermatitis Enteropathica

Page 150: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

A couple of randoms you should know…

Page 151: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Sarcoidosis

Multisystem granulomatous disease

Skin affected in 20-35%

Page 152: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 153: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 154: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Neurofibromatosis

Von Reckinghausen’s disease

Autosomal dominant

Neurofibromin gene, Chr 17

Page 155: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 156: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 157: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
http://dermnetnz.org/common/image.php?path=/systemic/img/nf4.jpg
Page 158: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Tuberous Sclerosis

Autosomal Dominant

Hamartin and Tuberin (TSC 1 and 2)

MR, Seizures (variable)

Page 159: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 160: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
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Page 163: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 164: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 165: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

QUIZ TIME!!!

Page 166: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Very itchy.

Page 167: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Lichen Planus (HCV)

Page 168: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Anterior lower leg

Page 169: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Necrobiosis Lipoidica (DM)

Page 170: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

?

Page 171: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Pyoderma Gangrenosum (IBD)

Page 172: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

?

Page 173: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Porphyria Cutanea Tarda

Page 174: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

?

Page 175: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

SLE

Page 176: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

?

Page 177: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Basal Cell Carcinoma

Page 178: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
Page 179: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology

Nodulocystic Acne

Page 180: Cutaneous Manifestations of Systemic Disease Holly Edmonds, MD Chief Resident Department of Dermatology
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Xanthelasma

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Herpes Labialis

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Nevus Sebaceous


S2k - European Dermatology Forum Guideline for the ... · S2k - European Dermatology Forum Guideline for the Treatment of Cutaneous Lupus Erythematosus . guided by the European Dermatology

HIV infection(AIDS) Dr. Yingguo Ding Dept. of Dermatology First Affiliated Hospital Sexually transmitted disease - Cutaneous manifestations and management

nd Skin & Body · Best Poster Award Young Researchers Forum • Clinical Dermatology & its Therapies • Pediatric Dermatology • Cutaneous Conditions • Plastic and Cosmetic Surgery

Refinements in Surgical Technique Murad Alam, MD Chief, Section of Cutaneous & Aesthetic Surgery Departments of Dermatology, Otolaryngology, and Surgery

Case Report of a Primary Cutaneous …...Journal of Dermatology and Clinical Research Cite this article: Kwon G, Ofodile O, Knezevich S, Compton N (2015) Case Report of a Primary Cutaneous

2012 Dermatology Fellowship Examination Written FINAL · • Vesicular cutaneous lupus erythematosus in Collies and Shetland sheepdogs. End of Section B . Veterinary Dermatology Paper

Oxidants and Antioxidants in Cutaneous Biology (Current Problems in Dermatology) by Jens Thiele

Cutaneous Disorders of the Newborn - c.ymcdn.com · Bolognia JL, Jorizzo JL, Scheaffer JV eds. Dermatology. 3rd Edition. Saunders; 2012. NLE

Practice Gaps in Cutaneous (Small- Vessel) Vasculitis F004... · ©2015 MFMER | 3440206-1 Practice Gaps in Cutaneous (Small-Vessel) Vasculitis David A. Wetter, M.D. Professor of Dermatology,

Skin Manifestations of Connective Tissue Diseases Prof. Khalid M. AlGhamdi Professor and Consultant Dermatology and Cutaneous Laser Surgery King Saud University

Update on Cutaneous Reactions to and Therapy U031... · 1 U031‐Update on Cutaneous Reactions to Targeted and Immune Therapy Anisha B. Patel, M.D. Assistant Professor, Dermatology

Inpatient Consultative Dermatology and Severe Cutaneous ... · causality in Stevens –Johnson syndrome and toxic epidermal necrolysis: comparison with case –control analysis. Clinical

Medical Dermatology Society...A Mashup of Instructive Cases Presenting With Subacute Cutaneous LE (SCLE) Skin Lesions Medical Dermatology Society Denver, Colorado March 20, 2014 Rick

Cutaneous Deposition Diseases - DermpathMD.comdermpathmd.com/Clinical Dermatology/Cutaneous... · Cutaneous Deposition Disorders Group of unrelated conditions characterized by the

ADVANCES IN DERMATOLOGY · Cutaneous Langerhans cell histiocytosis Actinomycosis Granuloma inguinale Lymphogranuloma venereum ... antibiotics require fairly long courses of therapy

Cutaneous Lupus Erythematosus - PIEL-L Latinoamericana · Cutaneous Lupus Erythematosus Issues in Diagnosis and Treatment Hobart W. Walling1 and Richard D. Sontheimer2 1 Private Dermatology

Cutaneous Fungal Infections Susan Massick, MD OSU Dermatology E-mail: [email protected]@osumc.edu Phone: (614) 293-1707

Our Dermatology Online Case Report CCutaneous epithelioid hemangioma mimicking ... · 2018. 9. 14. · Cutaneous epithelioid hemangioendothelioma presented as an ulcerated areolar

Cutaneous manifestations of systemic disease Mohammed Al-Haddab,MD,FRCPC,DABD Assistant Professor, Dept. of Dermatology College of Medicine, King Saud

Cutaneous Melanomawebapps.cap.org/apps/docs/committees/cancer/cancer... · Web viewRegional Medical Laboratory, Departments of Dermatology, Pathology and Surgery, University of Oklahoma,

1 Adult Cutaneous Fungal Infections 2: Yeasts Basic Dermatology Curriculum Last updated November 27, 2013

I938 C~ DerMaTOLOGY I I Cutaneous horn of the penis: Its

Cutaneous Manifestations of Internal Disease Ronald Buckley, D.O. Dermatology Department Lakeview Medical Center Suffolk,Virginia April 02 2011

Review of Year Year 2 SBM/Dermatology course Spring … · Review of Year Year 2 SBM/Dermatology course ... 10 Explain how the expression of pediatric cutaneous diseaseand normal

Clinical Issues in Cutaneous T-cell Lymphomacutaneouslymphoma.stanford.edu/documents/S011 Clin... · Clinical Issues in Cutaneous T-cell Lymphoma Youn H Kim, MD Department of Dermatology

HALLO, - PNAS · hallo, andg. paolodotto*§ *Department of Dermatology, HarvardMedical School andthe Cutaneous BiologyResearchCenter, Massachusetts GeneralHospital East, Charlestown,

Dermatology Update: 2017web.brrh.com/msl/IM2017/Saturday-IM -2017/Saturday... · Dermatology Update: 2017 “Abnormal” skin findings as clue to internal disease ... SUMMARY OF CUTANEOUS

Cutaneous Vasculitis: AAD 2018 C018... · Cutaneous Vasculitis: AAD 2018 Joseph L. Jorizzo, MD Professor, Former and Founding Chair Department of Dermatology Wake Forest School of

DERMATOLOGY DETAILS Dermatology Diagnostics: Cutaneous ...€¦ · Skin Surface In my experience, skin cytology is the diagnostic test most commonly missed in everyday referral cases

CRYOTHERAPY AND CUTANEOUS BIOPSIES FOR … AND CUTANEOUS BIOPSIES FOR SOME COMMON DERMATOLOGIC DIAGNOSES ... Bolognia JL, Jorizzo JL, Rapini RP. Dermatology 2nd Edition. Spain: Elsevier

Welcome to the Department of Dermatology & …hsc.usf.edu/NR/rdonlyres/77776C86-AB91-4FBC-AF48-1FC46BBADC8D/0/NP...Welcome to the Department of Dermatology & Cutaneous Surgery! Thank

JOURNAL OF CUTANEOUS MEDICINE AND SURGERY Offi cial ... · ADVERTISING OPPORTUNITIES WITH JOURNAL OF CUTANEOUS MEDICINE AND SURGERY Offi cial Publication of the Canadian Dermatology

"On-line Atlas" of Dermatology and Rheumatology Cutaneous Manifestations of Rheumatic Diseases

Perioperative Use of Antibiotics in Cutaneous Surgery Dermatology/Perioperative Antibiotics... · dermatology need to be developed . Bibliography Carmichael AJ, Flanagan PG, Holt

Cutaneous Viral Infections Alisha Plotner, MD Assistant Professor Division of Dermatology