Skin Manifestations of Systemic Diseases PDF

Skin Manifestations of Systemic Diseases Dr. Murtadha Hashim Raheem M.B.Ch.B.F.I.B.M.S ‫بورد ( دكتوراه ) اختصاص االمراض الجلديةوالتناسلية‬ Email: [email protected] [email protected] Facebook : murtadha hashim DIABETES MELLI...

Skin Manifestations of Systemic Diseases Dr. Murtadha Hashim Raheem M.B.Ch.B.F.I.B.M.S ‫بورد ( دكتوراه ) اختصاص االمراض الجلديةوالتناسلية‬ Email: [email protected] [email protected] Facebook : murtadha hashim DIABETES MELLITUS Most of pt develop skin manifestations such as: Acanthosis Nigricans Necrobiosis Lipoidica Bullous Diabeticorum Diabetic Dermopathy Neuropathic ulcer  ACANTHOSIS NIGRICANS Clinically, presents as brown to gray-black papillomatous cutaneous thickening in the flexural areas, including the posterolateral neck, axillae, groin, and abdominal folds Causes: obesity & insulin resistance & PCOS & addison’s disease and hypothyroidism Malignancy (esp. GIT, Lung & Breast CA) Medications ( nicotinic acid, testosterone, OCPand steroids) Treatment: Tight blood glucose control, treatment of underlying malignancy, weight control, and discontinuation of offending agent. Topical treatment with calcipotriol, salicylic acid may be beneficial.  Necrobiosis Lipoidica Mean age of onset is around 30 years, pathogenesis of this skin disease is unclear Complication : Ulceration and SCC Initially, NL often presents as red –brown papules and nodules ,Over time, the lesions flatten, and a central yellow or orange area becomes atrophic, and commonly telangiectasias are visible. T h e o r i e s include: 1. immune-mediated vasculitis 2. abnormal collagen deposition 3. microangiopathy Treatment : disappointing and variable response 1. Topical or short-term systemic steroids 2. Systemic aspirin: 300mg/day 3. Topical retinoids and topical PUVA 4. Ulcer prevention : No impact of tight glucose control on likelihood of developing NLD.  Bullous Diabeticorum Blisters occur spontaneously in diabetic patients. Unclear pathogenesis ( microangiopathy ? increase skin fragility ? ) BD is characterized by the abrupt onset of bullae on the lower extremities, usually the toes, feet, and also hand Treatment: Spontaneous healing in two to five weeks  Diabetic D e r m o p a t h y (shin spot) first characterized and proposed as a cutaneous marker for diabetes. Possibly related to diabetic neuropathy and vasculopathy There are bilateral asymptomatic red-brown atrophic macules on shins Clear within 1-2 years with slight residual atrophy or hypopigmentation.  Infecti on Diabetics are more prone to infections, especially fungal infections. studies show that leukocyte chemotaxis, adherence, and phagocytosis are impaired in patients with diabetes, especially during hyperglycemia and diabetic acidosis among the main causes of the infections. The infections associated with diabetes are mainly itchy and is accompanied by pain. Candidisis Glucose-inducible proteins promote adhesion of Candida albicans to buccal or vaginal epithelium. This adhesion, in turn, impairs phagocytosis, giving the organism an advantage over the host. Clinically present as : macerated red erythematous patches and thin plaques with satellite vesiculopustules Candidal intertrigo (groins, interdigital, and inframammary), paronychia, vulvovaginitis, and balanoposthitis may be the presenting manifestations of undiagnosed diabetes. May require oral therapy with weekly fluconazole, especially if recurrent..  Thyroid 2- Hyperthyroidism 1. Hypothyroidism Warm, moist, smooth skin Flushing Dry skin Palmar erythema Cold, mottled skin (hyperkeratotic - scaly) Diffuse scalp hair thinning Carotenemia Onycholysis Macroglossia Pretibial myxedema Thyroid Loss of lateral third of eyebrows Coarse brittle hair acropachy Hypothyroidism Hyperthyroidism Adrenal glands C U S H I N G SYN D ROME striae moon f a c i e Acanthosis nigricans b u f f a l o hump Hirsutism A D D I S O N DISEASE John F K e n n e y  Coutanous manifestations in renal disease : 1Pruritus: the most common cutaneous manifestation of ESRD. 2Half and half (Lindsay's) nails result from edema of the nail bed and capillary network and give the proximal half of the nail an opaque white appearance. 3Metastatic Calcification Deposition of calcium within tissue secondary to abnormal calcium and or phosphate metabolism. uremic frost uremia leads to high levels of urea secreted in the sweat, the evaporation of which may result in tiny crystallized yellow- white urea deposits on the skin. Muehrcke’s lines which may be a sign of hypoalbuminaemia (nephrotic syndrome). Connective tissue diseases:.1Discoid lupus erthmatosus chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp ( cause scarring Alpoecia) , maninly in sun exposed areas. red, inflamed plaque with a adherent scales with Central atrophy & hyperpigmented periphery Management : Mild to moderate limited disease can be treated : with topical steroids or calcineurin inhibitors. widespread disease or disease that is disfiguring :Oral antimalarials such as hydroxychloroquine other options for systemic therapy: Methotrexate, prednisone Sunscreens, hats, and sun protective clothing should be regularly used. 2 - Systemic lupus erythematosus (SLE) Joint pain + dermatological complain. Treatment is generally systemic :- Hydroxychloroquine, prednisone, methotrexate, biologic agents ,also Sun protection is important. Gastrointestinal diseases  Inflammatory Bowel Disease (IBD) -1Pyoderma gangrenosum:- it is an inflamed nodule or pustule that breakes down centrally to form a rapid enlarging painful ulcer with violeceous border May last months to years Spontaneous healing may occur TX: By systemic steroid 2 - A p h t h o u s ulcer : - u l c e r f o r m e d in mucos m e m b r a n e s 3- Erythema nodosum :- is a type of panniculitis, an inflammatory disorder affecting subcutaneous fat. Erythema nodosum results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees Skin manifestations and Liver disease Common cutaneous manifestations o f liver disorders include: 1. Jaundice 2. Telangiectasias 3. Spider naevus 4. Palmar e r y t h e m a 5. c a p u t medosa 6. T e r r y nails 7. Nail c l u b b i n g 8. Lichen planus 9. xanthoma Jaundice Spider naevus: These stellate telangiectases do look rather like spiders, with legs radiating -2.from a central, often palpable, feeding vessel Palmar erythema: manifested as diffuse or splotchy erythema on the thenar and -3.hypothenar eminences and tips of the fingers Terry's nails — Terry's nails are characterized by leukonychia that involves more than the proximal two-thirds of the nail plate, whereas the distal third appears red Capital medusae: It is a pathognomonic sign of -5 portal hypertension characterized by the presence.of enforced, tortuous paraumbilical veins 7-Nail clubbing:  Xanthomas : Deposits of fatty material in the skin and subcutaneous tissues (xanthomas) may provide the first clue to important disorders of lipid metabolism Cutaneous manifestations of internal malignancies Paraneoplatic syndrome 1- Acanthosis nigicans Associate d malignancy: A d e n o c a r c i n o m a o f t h e stomach. : PYODERMA GANGRENOSUM-2 large spreading purulent ulcers, with cyanotic over hanging.borders Hematological malignancy: AML most frequent; multiple myeloma second Myeloma solid tumors, Non hodgkins lymphoma, 3. TRIPE PALMS Cutaneous manifestation: Hyperkeratosis in a wrinkled or ridged pattern on the palms and the dorsal surface of the large joints. Associated malignancy: Squamous cell carcinoma of the lung. 4. Paraneoplastic Pemphigus Lymphoproliferative…… Polymorphic skin lesions (erythema multiforme like, lichenoid or polycyclic lesions) and painful, indolent mucosal (especially oral) lesions. THANK YOU