Transcript 3-systemic diseases

Dermatological Manifestations of
Systemic Diseases
By
Dr. Saad Al Mohizea
Skin manifestations of
Diabetes mellitus:
1.- skin manifestations due
to vascular
abnormalities:
A- wet gangrene of the
foot
B- Diabetic Bullae
C- Diabetic dermopathy”
shin spots”:
D- Erysiepilas- like
erythema
• 2. Diabetic neuropathy
(peripheral)
-Autonomic neuropathy
3. Cutaneous infections:
A- Staphylococcus aureus
B- Non- clostridial
gangrene
C- Candidiasis
4. Various skin disorders associated
with diabetes mellitus:
• A- Diabetic bullae
• B- Pruritus
• C- Granuloma annulare
Skin problems associated with
diabetes mellitus
• Necrobiosis lipoidica
– Rare, insulin dependent DM
– One or more tender yellowish brown patches
develop slowly on the lower legs over several
months
– Round, oval or an irregular shape
– The centre of the patch becomes shiny, pale,
thinned
– Prominent blood vessels (telangiectasia)
– Often painless
• D- Necrobiosis lipoidica
• Treatment: control of diabetes
doesn’t help in disappearance
of the lesions.
– Intralesional steroids.
– Systemic aspirin: 300mg/day
and dipyridamole 75 mg/day.
– Nicotineamide
– Ticlopidine as antiplatelet
– pentoxyfylline.
– Preilesional heparin injection
- Oral cyclosporin
- Photochemotherapy (PUVA)
Hyperlipidemia
• Xanthomata
– 4 forms : tendinous subcutaneous nodule
found in fascia, ligament and extensor tendon
of hand, knee and elbow
– Planar : yellow, soft, macule or plaque found
on the upper eyelids
– Tuberous : yellow to reddish nodule at
extensor surface of elbows, knees and
knuckles
– Eruptive : sudden, multiple reddish yellow
papule extensor of extremities, buttock
PLANAR XANTHOMA
ERUPTIVE XANTHOMA
Pituitary disorders:
• 1. Acromegaly
– Skin is oily and wet due to
hyperhidrosis with wet hands
on hand shaking.
– The lower lip is thickened,
protruded with wide spaced
teeth.
– Large and furrowed tongue.
– Increased skin pigmentation.
– Hirsutism.
2. Hypopitutirism: “Sheehan
syndrome”;
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Suprarenal syndrome:
Cushing syndrome:
endogenous or
exogenous
Deposition of fat over the
clavicles and back of the
neck” Buffalo hump”
Puffy, rounded
erythematosus face with
telangiectasia “Moon
face”
Trunkal obesity with
slender wasting limbs.
Striae distensae .
Hirsutism, acneform rash,
androgenetic alopecia.
Addisonian-like
pigmentation
Easy bruising of the skin
on simple trauma.
Striae distensae
• Aetiology:
• Idiopathic
• pregnancy: Striae
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gravidarum
Endocrine: cushing
Iatrogenic: systemic
or potent topical
steroids, anabolic
drugs or androgens.
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Hypocorticism
”Addison,s disease”:
Generalized
hyperpigmentation that
is more prominent in
light exposed areas,
scars, genitalia, palmar
and finger creases, and
under the nails. The
pigmentation
characteristically affects
the mucous
membranes.
Loss of pubic and
axillary hair in females.
Improvement of acne.
IV- Thyroid diseases:
• Hyperthyroidism:
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• red,soft, moist and hot skin.
• addisonian hyperpigmentation
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i.e. not affect the mucous
membranes.
Diffuse thinning of scalp hair
Rapid nail growth and
onycholysis.
Generalised pruritus and
urticaria.
Palmar erythema and facial
flushing.
Hyperhidrosis or increased
sweating.
• Pretibial myxoedema:
appears as small red or
skin colored coalescing
Nodules
• Thyroid acropatchy
Endocrinologic Diseases
• Hypothyroidism
Macroglossia
• Hypothyroidism:
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Buffy face with coarse
features.
The skin is pale,
thickened, cold, finely
scaling and wrinkled.
Coarse sparse hair of
the scalp with loss of
the lateral third of the
eyebrows.
Brittle and striated hair.
Poor wound healing.
Decreased or absent
sweating.
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Gastrointestinal tract and the
skin
Crohn,s disease
”regional ileitis”
Perianal abscess and fisulae.
Erythema nodosum
Erythema multiforme
Aphthous-like stomatitis and
glossitis.
Cutaneous vasculitis.
Epidermolysis bullousa
acquisita.
Metastatic Crohn,s disease
as numerous eroded
cutaneous granulomas at
sites distant from the
affected intestine.
Pyoderma gangrenosum.
Pyoderma gangrenosum
• Aetiology:
• Idiopathic in 50% of the cases.
• Inflammatory bowel disease-
Crohn,s disease and ulcerative
colitis.
• Connective tissue diseasesRheumatoid arthritis, SLE or Behc,et
disease.
• Blood disease: Leukemia, multiple
myeloma, polycythemia or
monoclonal gammopathy.
• Treatment:
– Dealing with underlying cause.
– Systemic steroids in high dose
like 60-80 mg oral prednisolone
daily and then reduce gradually.
• Azathioprime, Dapsone, or
cyclosporine
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Ulcerative colitis: identical to
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Malabsorption: specific or nonspecific features.
Non- specific features: Pallor,
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Crohn,s disease but pyoderma
gangrenosum and erythema nodosum
are more common in ulcerative colitis.
dry skin, oedema, acquired
icthyosis, Pigmentary
disorders, glossitis, mouth
ulcers.
Specific features due to
certain factor deficiency:
e.g. – Follicular hyperkeratosis
--------------- Vit. A deficiency.
Echymosis and scurvy ----------------- Vit. C deficiency.
Acrodermatitis enteropathica --------- Zinc deficiency.
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Liver diseases:
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Pruritus: generalized itching
especially in the presence of
biliary obstruction or
jaundice.
Urticaria especially in
infectious hepatitis.
Jaundice.
Spider naevi: small
telangeictatic blood vessels
especially on the face and
upper chest.
Palmar erythema.
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Diffuse hyperpigmentation.
Thinning of the hair and
sometime loss of sexual hair
in the axillae and pubic areas.
Gynaecomastia.
Acneform-lesions.
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Porhyria cutanea tarda.
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Xanthoma: collection of lipid
in the dermal tissue especially
in primary biliary cirrhosis.
Behcet disease
• Recurrent aphthous oral
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ulcerations more than
three times per a year is
a must plus two of the
following:
Genital ulceration or
other skin manifestations
Erythema-nodosum like
lesions, pseudofolliculitis,
papulopustular lesions or
acneform rash.
Eye lesions: anterior or
posterior uveitis
• Positive pathergy test
Generalised pruritus
• Generalised pruritus in the absence of a
rash requires investigation and exclusion
of an underlying systemic disorder
• it is important to distinguish these from an
underlying
• primary skin disease such as scabies or
eczema
Erythema nodusom
sarcoidosis
?
DM
Cutaneous markers of internal
malignancy
• I.Genetically
•
determined syndromes:
Gardners syndrome,
Howel-Evans
syndrome, Torre-Muir
syndrome.
II. II. Skin signs of
exposure to carcinogen:
e.g. – Nicotine staining,
X-ray damage
Paraneoplastic dermatoses
• 1. Acanthosis
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nigricans
2. Dermatomyositis
3. Erythema gyratum
repens
4. Erythema nodosum
and erythema
multiforme
• 5. Acquired icthyosis
• 6. Pruritus
• 7. Bullous eruptions
• 8. Pyoderma gangrenosum
• 9. Erythroderma
• 10. Flushing of the face
• 11. Urticaria
12. Acquired hypertrichosis
lanuginosa
• 13. Disseminated herpes zoster
• 14. Migratoratory superficial
thrombophlebitis
• 15. Hypertrophic osteoarthropathy
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and Finger clubbing
16. Tripe palms
• 17. The sign of Leser-Telat
• 18. Necrolytic migratory erythema
• IV. Direct metastases to
the skin e.g. Carcinoma of
the breast or lymphoma.
Sign of Leser-Trelat
• Sudden appearance of multiple seborrheic
keratoses
• Association with internal malignancy is
unproven
•18.
Necrolytic
migratory
erythema
Nephrogenic fibrosing
dermopathy
• fibrotic disease of the skin and internal
organs that develops in patients with renal
insufficiency after exposure to gadoliniumbased contrast agents. It is similar to, yet
distinct from, scleroderma.
• pain and pruritus.
• Most patients are on hemodialysis or
peritoneal dialysis or have had a renal
transplantation.
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Cutaneous small vessel
vasculitis
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mainly cutaneous post-capillary venules,
50% of cases ‘idiopathic’,
15% due to infection,
15% related to inflammatory diseases
(such as collagen vascular disorders),
• 15% due to medications
• 5% are associated with malignancy
Leukocytoclastic vasculitis
• may be localized to the skin or may
manifest in other organs. The internal
organs affected most commonly include
the joints, the gastrointestinal tract, and
the kidneys. The prognosis is good in the
absence of internal involvement.
Physical
• The most common manifestation of
cutaneous vasculitis is palpable purpura,
but other manifestations may develop.
• They may coalesce to form plaques; in
some instances, they may ulcerate.
• Legs is most common location
• Urticarial lesions
• Livedo reticularis
• Nodular lesions
• Ulceration
• treatment of cause.
Rx
• colchicine or dapsone
• antihistamines
• NSAIDS
• severe visceral involvement may
require high doses of
corticosteroids with or without an
immunosuppressive agent
• severe or debilitating disease
might also be treated with
biologic agents such as rituximab
or intravenous immunoglobulin
vasculitis