Dermatologic Manifestations of systemic disease
Leser-Trelat (paraneoplastic syndrome)
Abrupt increase in size or number of seborrheic keratoses that can occur before, during, or after diagnosis of gastric/colon adenocarcinoma, breast carcinoma, and lymphoma.
Hypertrichosis lanuginosa acquisita
Appearance of lanugo hairs in generalized areas of skin in association w/ cancers. predominantly in females
Nephrogenic Fibrosing Dermpoathy
Assoc. w/ exposure to gadolinium-containing contrast agents during MRI in patients w/ advanced renal disease Thickened hard immobile joint contracture w/ difficulty walking. 5% mortality
Peutz-Jegher's
Autosomal dominant condition w/ possibly malignant intestinal polyps and mucocutaneous pigmentation.
Perforating folliculitis control itching
Dermal material is eliminated transepidermally causing scaly papules in hair-bearing areas that may be pruritic asso. w/ renal failure condition? treatment?
Xanthomas
Develop due to intracellular and dermal lipid deposition. May be due to lipid disorder or paraproteinemia
Necrobiosis lipoidica
Disorder of collagen degeneration w/ granuloma formation and fat deposition commonly seen w/ DM but can occur w/o diabetes. Asymptomatic shiny red-brown patches on shins
Eruptive xanthomas
Erythematous to yellow/orange papules seen in severe chylomicronemia and hypertrigliceridemia (high triglcyerides) on hands, extremities, buttocks that regress when lipid state is stabilized
tendinous xanthoma on achilles tendon
Familial Hypercholesterolemia most commonly has a skin manifestation as what/where?
Gardner syndrome
Familial polyposis of colon. Autosomal dominant. Mutation in APC gene. Epidermoid cysts seen. Congenital Hyperpigmentation of retinal pigment epithelium (CHRPE)
Tuberous/Tuboeruptive xanthomas
Fatty growths that indicated underlying disorder of lipid/cholesterol metabolism. Pink/yellow papules or nodules on extensor surfaces. Slower to resolve w/ therapy.
Tendinous Xanthomas
Firm smooth nodular lipid deposits that can affect achilles, extensor tendons of hands/knees/elbows. Assoc. w/ underlying lipid disorder
Tripe Palm
Form of palmoplantar keratoderma. Velvety thickened skins of palms w/ ridged and rugose appearance. May herald malignancy of stomach, GU or lungs
Acquired Ichthyosis
Generalized scaling of skin most commonly seen w/ hodgkin's lymphoma "fish-like scales"
Necrolytic Migratory Erythema
Glucagon-producing tumor of pancreas often have what skin manifestation?
Acanthosis Nigricans treat DM - Keratolytic agents like lactic acid cream
Hyperpigmented velvety papules/plaques seen in association w/ DM. Commonly in axilla, inguinal, neck folds assoc. w/ skin tags condition? treat?
Acrokeratosis Paraneoplastica
Lesions on hands, occurs w/ malignancies of upper respiratory or digestive tracts. very rare.
Paget's disease
Malignant intraepithelial condition of nipple and skin around the nipple. Occurs almost exclusively in women w/ breast cancer.
Calciphylaxis renal disease wound care aggressive. normalize serum calcium
Microvascular occlusion w/ deposition of calcium salts in skin due to dysregulation of its metabolism. Dermatologic emergency. Super painful violaceous patches w/ necrosis. high mortality rate from sepsis condition? assoc. w/ what? treatment
Diabetic Dermopathy
Most common skin finding in patients w/ diabetes - shin spots in up to 50% of diabetics
Chlamydia
Most common trigger of reactive arthritis
Tuberous Sclerosis
Mutating hamartin or tuberin genes resulting in epilepsy, intellectual disability and angiofibromas.
Diabetic Ulcer
Occurs over pressure points on feet that have been diabetic for many years. Can often result in loss of limb. often associated w/ thick callus
Bullous Diabeticorum
Painless rapid developing blisters in small percentage of diabetics. Appear like bullous pemphigoid.
Familial dysbetalipoporteinemia
Palmar xanthomas are associated w/ what?
renal disease perforating disorders
Perforating folliculitis Elastosis perforans serpiginosa Reactive perforating collagenosis Kyrle's disease all are assoc. what what type of systemic disease?
Zinc deficiency
Periorificial, intertirignous, and acroal distribution of eczematous lesions
Kyrle's disease
Predominant material is extruded keratin, can have elastic and collagen as well. Almost always on lower extremity. Assoc. w/ kidney disease
Wilson Disease zinc
Rare autosomal recessive disease causing copper accumulation in tissues that presents in first or second decade of life presenting w/ nausea, vomiting, stomach ache or neurologic abnormlaties condition? treatment?
Marasmus
Results from total calorie starvation. Most commonly in infants that are malnourished.
Kwashiorkor
Severe from of protein malnutrition. Hyperpigmented patches/plaques that desquamate leaving raw surface often in friction areas. Flag sign - alternating bands of light and dark hair.
Sarcoidosis
Skin lesions occurring in tattoos. Condition?
Elastosis Perforans Serpiginosa
Transepidermal elimination of abnormal elastic fibers assoc. w/ renal disease, osteogenesis imperfecta, down's syndrome. Flesh colored to red umbilicated papules often occuring on extermities, face, trunk.
Reactive perforating collagenosis
Transepithelial elimination of altered collagen related to superficial trauma. Initially small papule that enlarges, spontaneously regresses, leaving scarring w/ brown adherent crust seen w/ kidney disease.
Pellagra
Vitamin B3 deficiency assoc. w/ 4 D's - dermatitis, dementia, diarrhea, and death.
Scurvy
Vitamin C deficiency - corkscrew hairs, perifollicular hemorrahge, gingival hypertrophy w/ bleeding gums
Perforating disorders Calciphylaxis Nephrogenic Fiborsing Dermopathy Pruritis
What are 4 major skin manifestations of renal disease
Eruptive Tuberous/Tuboeruptive Tendinous Plane
What are the types of xanthomas
Acanthosis Nigricans Diabetic dermopathy Diabetic ulcers Skin tags Necrobiosis Lipoidica Diabeticorum Bullous Diabeticorum
What are the various skin manifestations of DM
Chest abdomen, pelvis Most commonly - ovarian cancer
What cancers should be screened for after diagnosis w/ dermatomyositis
Arthritis, erythema nodosum, bilateral hilar lymphadenopathy Sarcoidosis
What is lofgren syndrome? Where is it seen?
Plane xanthomas
Xanthelasma is what type of xanthoma
Plane xanthomas
Yellow/orange patches or slightly raised papules or plaques that form due to increased lipid deposition due to elevated serum lipid. common in ages 40-60 commonly around eyelids
Type 1 - autosomal dominant mutation of tumor suppressor gene on chromosome 17 - cafe au lait, neurofibromas and axillary/groin freckling type 2 - acoustic neuromas, less common, mutation of TSG on 22. fewer cafe au lait.
differentiate neurofibromatosis type 1 and type 2
Xeroderma pigmentosum
rare autosomal recessive disorder of nucleotide excision repair - can't repair sun damaged keratinocytes. Extreme photosensitivity and high skin cancer rate.
Paget disease
what can mimic nipple eczema
If patients scratch they create more lesions
whats the koebner phenomenon