• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Skin Manifestations Of Systemic Diseases
 

Skin Manifestations Of Systemic Diseases

on

  • 7,313 views

skin manifestations of systemic diseases

skin manifestations of systemic diseases

Statistics

Views

Total Views
7,313
Views on SlideShare
7,310
Embed Views
3

Actions

Likes
8
Downloads
0
Comments
0

1 Embed 3

http://www.slideshare.net 3

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Skin Manifestations Of Systemic Diseases Skin Manifestations Of Systemic Diseases Presentation Transcript

    • SKIN MANIFESTATIONS OF SYSTEMIC DISEASES BY Professor M.YOUSRY ABDEL_MAWLA
    • 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
      • cutaneous metastases
      • paraneoplastic syndromes
      • heritable "cancer syndromes"
    • 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
      • 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
      • "Wood-grain" pattern
      • Wavy, erythematous, urticarial bands with scale
      • Slowly migrate
      • Breast, stomach, bladder, prostate, cervix; occasionally no CA
    • 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 )
      • 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
      • Superficial migratory thrombophlebitis and neoplasia
      • 75% of CA in pancreas, stomach, lung, prostate, hematopoietic
      • Hypercoagulable state; thrombophlebitis resistant to therapy .
    • 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
      • Pyoderma gangrenosum
      • Cullen’s sign
      • Xanthomas
      • Acanthosis nigricans (AN)
      • Erythema nodosum
    • 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
      • 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
      • 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)
      • 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
      • 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
      • Gastrointestinal Disease
      • Diabetes mellitus
      • Liver disease
      • Kidney Diseases
      • Other disorders
      • Sarcoidosis
      • Leucocytoclastic vasculitis in SLE
    • Gastrointestinal Disease
      • Inflammatory Bowel Disease
      • Pyoderma gangrenosum
      • Erythema nodosum
      • Aphthous stomatitis .
      • Mucosal nodularity (cobblestoning).
      • Pyostomatitis vegetans (erythematous thickened mucosa)
      • 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
      • Malabsorption
      • Gluten-sensitive enteropathy
      • Alcoholic liver disease
      • Acrodermatitis enteropathica
      • Dermatogenic enteropathy
      • Pancreatic panniculitis
      • Porphyria cutanea tarda
      • Dermatitis herpetiformis
      Nutritional and Metabolic disorders
    • Infections
      • Hepatitis B and C
      • Helicobacter pylori
      • Porphyria cutanea tarda
      • Erosive or oral lichen planus
      • Sweet's syndrome
    • 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
      • Gastrointestinal polyposis syndromes and gastrointestinal cancer
      • Peutz-Jeghers syndrome
    • 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 Manifestations of 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
      • 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
      • 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
      • 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
      • 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
      • Urticaria
      • Morbilliform
      • Fixed drug eruption
      • Erythema multiforme
      • Stevens-Johnson Syndrome
      • Toxic epidermal necrolysis
    • 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" 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" 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
      • 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)
      • 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
    • THANK YOU