skin manifestations of systemic diseases

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the relationship between skin and systemic disorders manifestations.


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nice job

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it is an execellent lecture

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Presentation Transcript



Skin Manifestations of Systemic Disease : 

Skin Manifestations of Systemic Disease Skin signs of internal malignancy Skin signs of internal disease other than malignancy Drug eruptions

Skin signs of internal malignancy : 

Skin signs of internal malignancy cutaneous metastases paraneoplastic syndromes heritable "cancer syndromes"

Sister Mary Joseph nodule : 

Sister Mary Joseph nodule Umbilical metastasis; poor prognosis precedes or follows diagnosis of CA CA sites (decreasing order of frequency): colon, ovary, pancreas, endometrium, breast, small bowel

Paraneoplastic Syndromes : 

Paraneoplastic Syndromes The skin often presents a clue that an internal malignancy is present. The combination of a malignancy and associated signs and symptoms that are seemingly unrelated to the actual tumor is called a "paraneoplastic" syndrome

Erythema gyratum repens : 

Erythema gyratum repens "Wood-grain" pattern Wavy, erythematous, urticarial bands with scale Slowly migrate Breast, stomach, bladder, prostate, cervix; occasionally no CA

Glucagonoma syndrome -- necrolytic migratory erythema : 

Glucagonoma syndrome -- necrolytic migratory erythema Alpha cell tumor of the pancreas; occasionally no neoplasm found abdomen, thighs and buttocks Patchy erythema with flaccid vesicles and bullae Glossitis, angular cheilitis, normocytic anemia, low amino acid levels in seum

Sweet’s syndrome (acute febrile neutrophilic dermatosis) : 

Sweet’s syndrome (acute febrile neutrophilic dermatosis) Painful red plaques and papules - face, neck, upper chest, arms, legs Usually females (4:1); fever, leukocytosis prominent Associations, benign: URIs, strep, RA, Crohns, sarcoidosis, Behcet’s, pregnancy Association, malignant: AML, myelodysplasis, lymphoma--may follow by months to years

Trousseau’s sign : 

Trousseau’s sign Superficial migratory thrombophlebitis and neoplasia 75% of CA in pancreas, stomach, lung, prostate, hematopoietic Hypercoagulable state; thrombophlebitis resistant to therapy .

heritable "cancer syndromes : 

heritable "cancer syndromes Peutz-Jehger Multiple hamartomatous polyps in small bowel (most common), stomach and colon; low risk of bowel malignancy multiple lentigines (freckle-like) of lips, nose, oral mucosa, fingertips and nail beds non-intestinal malignancies increased: lung, ovary, endometrium pancreas, myeloma

Skin signs of internal disease : 

Skin signs of internal disease Pyoderma gangrenosum Cullen’s sign Xanthomas Acanthosis nigricans (AN) Erythema nodosum

Pyoderma gangrenosum : 

Pyoderma gangrenosum Rapidly expanding ulcer with bluish undermined border; often lower extremities; begin as sterile pustules 50% no disease association 1% to 10% of patients with active ulcerative colitis; often (but not always) parallels disease Other associations: Crohn’s, chronic active hepatitis, rheumatoid arthritis, HIV infection; acute and chronic granulocytic leukemia (bullous PG) Associated with underlying malignancy (leukemia, etc.)

Cullen’s sign : 

Cullen’s sign Periumbilical purpura associated with acute pancreatitis Hematomas dissect along fascial plans from the retroperitoneal site of bleeding to the periumbilical area Turner’s sign--purpura of the left flank; same cause

Xanthomas : 

Xanthomas A sign of systemic metabolic abnormality or a local cellular dysfunction Xanthomas may be the first sign of one the hyperlipoproteinemias, rare but serious metabolic diseases Xanthelasma : xanthomas of eyelids that may or may not be associated with hyperlipidemia

Acanthosis nigricans (AN) : 

Acanthosis nigricans (AN) Velvety thickening and darkening (hyperpigmentation) of the skin, especially on the nape of the neck, axillae and other body folds   Causes hereditary acquired, : obesity; drugs; "malignant"acanthosis nigricans; Diabetes Mellitus hyperinsulinemia is a common denominator

Erythema nodosum : 

Erythema nodosum Deep erythematous painful nodules, symmetrically on the lower legs; female predominance; a hypersensitivity panniculitis Fever, chills, malaise, leukocytosis Disease associations: streptococcal infections, drugs (OCPs, sulfonamides, iodides), pregnancy, TB, deep mycoses, acute sarcoidosis, inflammatory bowel disease

Skin Manifestations of other Systemic Diseases : 

Skin Manifestations of other Systemic Diseases Gastrointestinal Disease Diabetes mellitus Liver disease Kidney Diseases Other disorders Sarcoidosis Leucocytoclastic vasculitis in SLE

Gastrointestinal Disease : 

Gastrointestinal Disease Inflammatory Bowel Disease Pyoderma gangrenosum Erythema nodosum Aphthous stomatitis. Mucosal nodularity (cobblestoning). Pyostomatitis vegetans (erythematous thickened mucosa)

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Gastrointestinal disorders Cutaneous disorders Inflammatory bowel disease Ulcerative colitis Neutrophilic tissue reactions Crohn’s disease Pyoderma gangrenosum Bowel – bypass syndrome Sweet’s syndrome Pustular vasculitis Erythema nodosum Aphthous stomatitis

Nutritional and Metabolic disorders : 

Malabsorption Gluten-sensitive enteropathy Alcoholic liver disease Acrodermatitis enteropathica Dermatogenic enteropathy Pancreatic panniculitis Porphyria cutanea tarda Dermatitis herpetiformis Nutritional and Metabolic disorders

Infections : 

Infections Hepatitis B and C Helicobacter pylori Porphyria cutanea tarda Erosive or oral lichen planus Sweet's syndrome

Malignancies : 

Malignancies Glucagonoma Carcinoid Esophageal carcinoma   Nonspecific cutaneous signs of gastrointestinal malignancy Necrolytic migratory erythema Flushing Bazex's syndrome Palmar-plantar hyperkeratosis Koilyonychia Glossitis Acanthosis nigricans Erythema nodosum Metastatic skin lesions (eg adenocarcinoma of colon Sister Mary Joseph's nodules)

Malignancies : 

Malignancies Gastrointestinal polyposis syndromes and gastrointestinal cancer Peutz-Jeghers syndrome

Gastrointestinal hemorrhage : 

Gastrointestinal hemorrhage Vascular disorders Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) Kaposi's sarcoma Necrotizing angiitis Pseudoxanthoma elasticum Ehlers-Danlos syndrome Degos, disease Henoch-Schönlein purpura

Dermatologic Manifestationsof liver disease : 

Dermatologic Manifestationsof liver disease Vascular a. Spider telangiectasia, b. Palmer erythema, c. Corkscrew scleral vessels, d. Caput medusae, e. Plethoric facies, f. Flushing, g. Unilateral nevoid telangiectasia. Jaundice, Pruritus, Urticaria, Nail changes – Koilonychia, Clubbing. Hyperpigmentation, Skin cancer, Lichenoid dermatitis,

Skin manifestations of Renal diseases : 

Skin manifestations of Renal diseases Uremic pruritus :generalized or localized Excoriations, lesions of lichen simplex chronicus, and prurigo nodularis. Mediated by various chemical mediators neurotransmitters: (pentapeptide enkephalins, proteases, serotonin, and histamine..)

Skin manifestations of Renal diseases : 

Skin manifestations of Renal diseases 2-Xerosis : the dry or roughened skin texture A direct relation between xerosis and stratum corneum water content. A thicker though fractured stratum corneum leads to increase transepidermal water loss. 3-Cutaneous pigmentation:pallor, brown-to-slate-gray discoloration, yellowish (sallow) hue, and brownish hyperpigmentation in sun-exposed areas. Due to increased levels of melanocyte stimulating hormone (MSH)

Skin manifestations of Renal diseases : 

Skin manifestations of Renal diseases 4-Calciphylaxis: a life-threatening condition of progressive cutaneous necrosis due to small- and medium-sized vessel calcification. A complication of secondary hyperparathyroidism in chronic renal failure. Firm, bilaterally symmetric non-ulcerating painful preinfarctive ischemic plaques that appear as mottling or violaceous discoloration on the extremities developing into necrotic areas. ---_Flaccid or hemorrhagic bullae may form over ischemic tissue

Diabetes mellitus : 

Diabetes mellitus Vascular microangiopathies and rubeosis Recurrent skin infections :, either due to fungi (e.g. genital candidiasis) or bacteria (e.g. folliculitis). Blisters on the feet Wet gangrenes Peripheral neuropathy and trophic skin changes Brown macules sometimes develop on the shin Plaques with dark red or purple edges, atrophic centres, and surface telangectasia (Necrobiosis lipoidica diabeticorum ).

Drug eruptions : 

Drug eruptions Urticaria Morbilliform Fixed drug eruption Erythema multiforme Stevens-Johnson Syndrome Toxic epidermal necrolysis

Urticaria (hives) : 

Urticaria (hives) Drugs (e.g., penicillins) are a common cause of urticaria, but urticaria can be precipitated by other internal and external factors Primary lesion is a wheal, a flesh-colored to pink, well circumscribed plaque caused by dermal edema; itchy! Individual lesions last only a few hours, never more than 24 hours When caused by drugs, may be IgE mediated, triggering mast cell granule release; or drug may directly cause mast cell granule release

Morbilliform eruption (exanthematous drug eruption, maculopapular drug eruption): : 

Morbilliform eruption (exanthematous drug eruption, maculopapular drug eruption): "morbilliform" refers to a resemblance to the rash of measles (morbilli is Latin for measles); measles is a rare disease now, but morbilliform eruptions are common a morbilliform eruption is symmetrically distributed on the trunk and proximal extremities, and consists of bright pink macules and slightly raised papules ("maculopapular")

Fixed drug eruption : 

Fixed drug eruption Fixed" in that it occurs at same sites with each episode OTC drugs containing phenolphthalein, pseudoephedrine, etc. common culprits tetracyclines, barbiturates, phenothiazines, sulfonamides oval, itchy or burning dusky red plaque

Erythema multiforme : 

Erythema multiforme A form of cutaneous reaction to an underlying condition. In 50% of cases, a cause can’t be identified Common causes: Drugs (sulfonamides, phenytoin, barbiturates, penicillin, etc.); infections (esp. herpes simplex and Mycoplasma); inflammatory bowel disease Eruption usually lasts for a week or two, then spontaneously remits the "target" lesion is approximately 1cm dull-red macule or papule with a central area of blistering or hemorrhage

Toxic epidermal necrolysis (TEN) : 

Toxic epidermal necrolysis (TEN) it is unclear whether TEN is a severe form of erythema multiforme or a distinct disease 80% of cases have a strong association with a specific drug (list is similar to that for erythema multiforme) TEN is a medical emergency, on the order of a total body burn

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