Transcript - Abdel Hamid Derm Atlas

Medical problems in dermamatology
Inflammatory bowel disease
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Cutaneous manifestastions
@ Erythema nodosum, erythema multiformis @ Pyoderma gangrenosa,
sweet’s syndrome, other neutrophilic dermatosis @ Small vessel
vasculitis, cutaneous polyarthritis nodosa @ Fistula & abscesses in
perianal region @ Pruritis ani, vulvi &scrota @ acquired acrodermatitis
enteropathica,
Oral associations:
@ Apthous ulcers @ granulomatous chelitis, angular chelitis @ gingival /
mucosal swelling @ Cobblestoning of buccal mucosas.
Secondary systemic amyloid may be associated with longstanding
inflammatory bowel disease & presents with petichiae & ecchymosis.
However, primary macular amyloidosis has nothing to do with inflammatory
bowel disease but only present with macular hyperpigmwentation.
Inflammatory bowel disease
(continue)
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The main forms of inflammatory bowel disease are Crohn’s disease &
ulcerative colitis, The main difference between them is the location& nature
of inflammatory changes. Crohn’s disease can affect any part of G.I.T. from
mouth to anus, although majority of cases start in the terminal ileum.
Ulcerative colitis , in contrast, is restricted to the colon & the rectum..
Microscopically, ulcerative colitis is restricted to the mucosa ( epithelial
lining of the gut), while Crohn’s disease affects the whole bowel wall.
Both diseases may present with vomiting, diarrhea, rectal bleeding, weight
loss, severe internal cramps, muscle spasm in region of pelvis & various
complaints & diseases like arthritis, pyoderma gangrenosa, cutaneous
manifestations, primary sclerosing cholangitis.
Pancreatitis
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Cutaneous features:
@ Grey –Turner’s sign: This is a cutaeous sign of acute hemorrhagic
pancreatitis & carries grave prognosis, Other causes of Grey- Turner ‘s sign
include blunt abdominal trrauma, ruptured aortic aneurysm & ruptured
ectopic pregnancy.It is bluish dicolaration OF THE FLANKs
Pancreatitis (Continue)
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@Cullen’s sign: Black blue bruising around the umbilicus.
@Pancreatic panniculitis:
Tender fluctant nodules on
the lower legs
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@ Jaundice, @ livedo reticularis @
urticaria @ Throbophlebitis migrans: pancreatic malignancy associated
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Rheumatoid arthritis
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Cutaneous manifestations
@Neutrophilic dermatosis: Pyoderma gangrenosa, rheumatoid neutrophilic
dermatoses, sweet’s syndrome, neutrophilic panniculitis;
@ Palisading granuloma: rheumatoid nodules & papules, palisaded
neutrophilic & granulomatous dermatitis, interstitial granulomatous
dermatitis
@ Vascular: small, medium & large vessel vasculitis, capilaritis,
bywater’lesions:
It is a cutaneous manifestation of rheumatoid arthritis. They are cutaneous
infarcts related to small vessel rheumatoid vasculitis,. In addition ,they also
may present under the nails as painless red brown lesions mimking the
splinter hemorrhages of subacute bacterial endocarditis
@ Purpura.
@palmer erythema
@ Thin skin @ Drug reaction to therapy
Palmer erythema
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Causes:
@ Familial variant @ Chronic liver disease, alcohol abuse @ pregnancy
@ connective tissue disorders e,g. lupus, rheumatoid arthritis, sarcoid
@Thyrotoxicosis @ Polycythemia @ Leukemia @ Inflammatory
dermatosis e,g. eczema, psoriasis, erythroderma @ Chemotherapy, antiepileptic merdications @ HTLVI infection @ Paraneoplastic: especially
brain malignancies.
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Chronic liver disease
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Cutaneous feature:
@ Palmer erythema @ Clubbing of the nails, leukoplakia, spider
angiomas, @ Diffuse pigmentation @ Loss of axillary & pubic hair
@Gynecomastia @ Xanthelasma , if obstructed elements.
Facial flushing
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Causes:
@ Physiological: emotional or sexual arousal. @ Menopausal @
Rosacea. @ Carcinoid syndrome @ Hyperthyroidism @
Pheochromocytoma @ Autonomic dysfunction, migraine, neurological
lesions @ Systemic mastocytosis @ neoplasm.
Drugs related flushing:
@ ACE inhibitors @ Calcium channel blockers @ Alcohol @ nitrates @
Opiods @ Calcitronin
Carcinod syndrome:
Carcinoid syndrome occurs when a neuroendocrine carcinoid tumor
metastasize to the liver & release serotenin & other mediators into the blood
streem. Patients may develop a pellagra like photodistributed skin rash &
the flushed areas may have violaceous hue. Bronchospasm, diarrhea &
cardiac murmur can be seen. The disese is investigated by testing urine for
metabolities such as 5-HIAA
Generalized pruritus
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Causes:
@ Scabies @ Liver disease @ Malignancy @ Hematological: leukemia,
lymphoma, myeloma @ Drug reactions @ Renal failure (late sign) @
Iron, B12 or floater deficiency @ Hyperthyroidism, hypothyroidism @
Psychogenic neuropathy
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Lignocaine toxiciity
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The maximum safe dose of plain lignocaine in an adult is 3 mg/ Kg, with
adrenaline up to 7 mg/kg may be used , In children and the elderly these
doses should be halved, !% lignocaine has 1O mg/ml
If a 7O Kg adult may be given up to 7 mg/kg of lignocaine with adrenaline.
This equates to 49O n.g. ,or 49 mls of 1% solution
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Macular petechial rash
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It consists of flattened purple
macules less than 3 mm in
diameter
Causes:
@ Thrombocytopenia @
Abnormal platelet function
disorders @ Scurvy @ venous
eczema @ Pigmented purpuric
eruption e.g. Schamberg’s
Macular purpura: Larger flat red
purple lesions with a diameterr of
5-9 mm. Vasculitis tends to
present with palpable purpura..
Vitamin K defeciency results in
ecchymoses
Palpable purpuric rash
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Causes:
@ Primary vasculitis
@ Immune related vasculitis: idiopathic, sepsis related, drug associated,
secondary to connective tissue disorders.
@ Non-vasculitis: Erthema multiformis, PLEVA, pigmented purpuric eruption
Ecchymoses are flat round-oval purpuric lesion often over 1 cm in size, they
normally result from minor traumas on a background of dermal fragility,
platlet dysfunction or an anticoagulated state.