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Dermatological manifestation of systemic diseases

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Dermatological manifestation of systemic diseases

  1. 1. DERMATOLOGICAL MANIFESTATIONS OF SYSTEMIC DISEASES guide: dr.rahul nagar candidate: dr.smit chopra
  2. 2. CONNECTIVE TISSUE DISORDERS
  3. 3. LUPUS ERYTHEMATOSUS Discoid lupus erythematous Subacute cutaneous lupus erethematosus Systemic lupus erythematosus
  4. 4. DISCOID LUPUS ERYTHEMATOSUS • Most patients have limited disease to head and neck (localised DLE) but rarely may present as disseminated disease potentially affecting any area of skin (Disseminated DLE) • It presents as rash (erythematous patches) with adherent scale over it, • Raynaud’s phenomenon found in 14% of cases
  5. 5. Localised DLE- • Face is most commonly affected area f/b scalp, ears, arms, legs, and trunks to a lesser extent • Discoid erythematous rash appear most commonly over the cheeks, bridge of the nose, ears , scalp and side of the neck • Alopecia occurs in 1/3rd of the patients
  6. 6. Disseminated DLE • Characteristic lesions of DLE may occur in widespread pattern on trunk and limbs • This occur almost always in women and they are cigarette smokers • This variety tends to be persistent , resistant to therapy and associated with psychological upset
  7. 7. SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS • Lesions usually occur above the waist particularly around neck, on the trunk and on the outer aspects of arm. • Predominantly affects adult age group • Skin lesions comprises of non scarring papulosquamous (two thirds) and annular polycystic lesions (one third)
  8. 8. SYSTEMIC LUPUS ERYTHEMATOSUS
  9. 9. Skin manifestation occurs approximately in 80% of the cases
  10. 10. • Cutaneous erythema on light exposed area is the most common feature • Butterfly blush with fine scaling on butterfly area of the cheeks is frequently found • Epidermal necrosis may occur in some cases • Alopecia occurs in around 50% of cases , hair becomes coarse dry and fragile called ‘lupus hair’ • Persistent non itching urticaria like wheals are common • Livedo reticularis(a mottled or bluish red discoloration, which blanches on pressure and is not affected by temperature changes) may develop over outer aspects of arms
  11. 11. SCLERODERMA • At first lesions are indurated and faintly purplish later they lose their colour especially in centre and appear as thickened waxy areas with smooth and shiny surface , hairs are usually absent over these surfaces • Morphea i.e patches of hardened skin, appears over face, hands, and feet which lacks sweat gland and ability to make skin folds • Skin induration initially affects the fingers (sclerodactyly) and extend proximally • Raynauds phenomenon is a common finding • Infarction and dry gangrene of fingers may occur sometimes due to severe vasospasm
  12. 12. DERMATOMYOSITIS A purplish-red or heliotrope erythema occurs on the face, especially involving the eyelids, the upper cheeks, forehead and temples Oedema of the eyelids and periorbital tissues may occur Small erythematous or violaceous, flat papules (Gottron’s papules) occur over the knuckles, on the dorsa of the finger and around the nail folds .
  13. 13. RHEUMATOID ARTHRITIS Rheumatoid nodules these are subcutaneous nodules affecting the extensor surfaces of the forearms, back of hand, occipital region, auricular region more commonly Cutaneous small vessel vasculitis may lead to purpura, bruise or ulcerative lesions over the skin. Pyodermagangrenosum sterile pustules which rapidly evolve over painful ulcers charactrized by raised edges with erythematous purple covering
  14. 14. INFECTIOUS DISEASE
  15. 15. TUBERCULOSIS MODE OF INOCULATION DISEASE DIRECT INOCULATION Tubercular chancre(primary inoculation) CONTIGUOUS SPREAD Scrofuloderma MULTIBACILLARY AUTOINOCULATION Orofacial tuberculosis HEMATOGENOUS SPREAD Acute military tuberculosis, Tuberculous gumma(abcess)
  16. 16. MODE OF INOCULATION DISEASE DIRECT INOCULATION Warty tuberculosis (verruca cutis) PAUCIBACILLARY HEMATOGENOUS SPREAD Lupus vulgaris, Lichen scrofulosorum, Nodular tuberculid, Erethema induratum
  17. 17. PRIMARY INOCULATION Tubercular chancre skin lesion may vary from brownish papule ,nodule to an ulcer with undermined edge. On diascopy it shows apple jelly nodules Warty tuberculosis (verruca cutis) leisions occur on area exposed to trauma.Starts with a small indurated warty papule. Irregular extension may cause finger like
  18. 18. SCROFULODERMA At first bluish-red nodule overlying the infected gland forms which breaks down to form undermined ulceration with granulating tissue at the base
  19. 19. LUPUS VULGARIS Plaque form
  20. 20. Vegetative form Tumor like form
  21. 21. LEPROSY CLINICAL TYPE PERCATAGE DISTRIBUTION Tuberculoid (TT) 8 Borderline tuberculoid (BT) 41.33 Borderline (BB) 5.3 Borderline lepromatous (BL) 26.66 Lepromatous (LL) 18.66
  22. 22. HIV seborrhoea dermatitis psoriasis herpes simplex viral warts mollusca oral and vaginal candidiasis scabies squamous cell carcinoma kaposis sarcoma
  23. 23. ENDOCRINE DISORDERS
  24. 24. THYROID DISORDERS Cutaneous features of hyperthyroidism • SKIN- palmar erythema ,facial flushing ,increased skin temp.,increased sweating, hyper pigmentation , pretibial myxoedema • NAILS- soft nails ,koilonychia,distal onycholysis (plummer’s nail) • HAIR- fine thin hair ,diffuse alopecia
  25. 25. Cutaneous features of Hypothyroidism • SKIN-Pale, cold, scaly and wrinkled skin, Ivory- yellow skin colour, Xerosis, Absence of sweating, puffy oedema of hands, face and eyelids • NAILS- Brittle and striated nails • HAIR- Coarse sparse scalp hair, Loss of pubic, axillary and facial hair, Loss of lateral eyebrows (madarosis)
  26. 26. ADRENAL DISORDERS Cutaneous manifestation of cushing’s syndrome • Truncal obesity (classically deposits of fat over the clavicles and back of the neck, the ‘buffalo hump’) • Facial fullness and plethora (‘moon facies’) • Slender limbs • Skin atrophy • Fragility, bruising and poor healing leading to Striae (typically white and red) • Hirsuties,Acneiform lesions • Male-pattern baldness in women
  27. 27. Cutaneous manifestation of Addison’s disease • Hyperpigmentation of the skin, due to increased secretion of pituitary MSH and ACTH as a response to low adrenal corticosteroid levels, is the cardinal dermatological feature • Patterns of addisonian pigmentation - 1. Light-exposed areas i.e.face, dorsa of hands, 2. Areas subject to friction—elbows, knees, waistline 3. Accentuation of normally high pigmentation areas—genital, perineum, axillae, areolae, umbilicus 4. Palmar creases 5. Tongue and mucous membranes
  28. 28. DIABETES MELLITUS Periungual talengectasia- A microangiopathic complication seen in upto 49% of diabetics Acanthosis nigricans- a verrucous hyper pigmented plaques seen over axilla , nape of neck which is due to hyperinsulinemia
  29. 29. Granuloma annulare- annular leisions with raised skin colour having symmetrical distribution on arms,neck and upper half of the trunk Necrobiosis lipodica- sharply demarcated slightly depressed yellow waxy plaques with erythematous raised border
  30. 30. Insulin reactions (Lipodystrophy)- soft nodules resembling lipoma are formed, these are local response to lipogenic action of insulin, preventable by rotating injection sites
  31. 31. GASTROINTESTINAL DISEASES
  32. 32. LIVER CIRRHOSIS Skin lesions associated with chronic liver disease •Spiderangiomas , telangiectasis •Palmar erythema •Dilated abdominal/chest veins (including periumbilical caput medusae) •Jaundice •Increased melanin pigmentation •Thin ‘paper-money’ skin •Loss of secondary sexual hair in males
  33. 33. ACUTE PANCREATITIS Grey Turner sign (Turner sign)—tracks from the pararenal space to the edge of the quadratus lumborum muscle then through a defect in the fascia to the subcutaneous tissues of the flank (left sided in pancreatitis)
  34. 34. Bryant’s sign—tracks to the scrotum to produce the ‘blue scrotum’ sign. Cullen’s sign—tracks into the falciparum ligament then through the connective tissues of the round ligament to the periumbilical area
  35. 35. NUTRITIONAL AND METABOLIC DISORDERS
  36. 36. IRON DEFICIENCY DISORDER • Paleness of skin, palm creases and conjuctiva • Painful cracks at corner of mouth (angular cheilitis) • Shiny smooth tongue (atrophic glossitis) • Spoon shaped nails (koilonychiya) • Dry and brittle hair
  37. 37. VITAMIN B COMPLEX DEFICIENCIES VitB3 (niacin)deficiency - Pellagra • Red skin with large blebs or blisters that exfoliates • Erethema over the dorm of hands • Scaling over the sun exposed area of the skin • Dry ,scaly and hyperkeratotic darkly pigmented skin • Site- mostly over face, neck ,arms, hands and feet
  38. 38. B12 Deficiency - • Skin hyperpigmentation with accentuation in flexural areas ,palms ,soles and oral cavity • Angular stomatitis , glossitis(hunters glossitis), xerostomia • Vitiligo
  39. 39. VITAMIN C DEFICIENCY SCURVY • Perifollicular hemmorage with blood pigment discolouration especially on the trunk and lower limbs (purpuric rash) • Swollen bleeding gums • Epistaxis may occur sometimes
  40. 40. SYSTEMIC AMYLOIDOSIS Myeloma associated cutaneous amyloidosis (AL amyloid) Secondary systemic amyloidosis (AA amyloid) Dialysis associated amyloidosis
  41. 41. Myeloma associated cutaneous amyloidosis (AL amyloid) • Almost 40% of patients with AL amyloidosis have skin manifestation • leisions tend to aggregate around mucocutaneous junctions like orbit, lips and genital skin • purpura is also a common finding which results from vascular fragility due to amyloid deposition in blood vessels
  42. 42. Secondary systemic amyloidosis (AA amyloid) • The amyloids are composed of fibrils of a protein designated as AA • AA protein is an acute phase reactant • secondary amyloidosis occurs as a complication of many chronic inflammatory diseases • Skin lesions are wage and are non specific • Most common are renal manifestation leading to nephrotic syndrome
  43. 43. Dialysis associated amyloidosis • cutaneous involvement is rare • manifests as hyper pigmentation ,lichenoid eruptions,or nodules that demonstrate amyloid deposition on HPE examination
  44. 44. TAKE HOME MESSAGE CUTANEOUS MANIFESTATIONS CAN HELP IN EARLY DIAGNOSIS AND INTERVENTION OF MANY HIDDEN SYSTEMIC DISEASES IT ALSO HELPS IN UNDERSTANDING THE PROGNOSIS AND MANAGING THE DISEASE
  45. 45. THANK YOU

Editor's Notes

  • Good afternoon everyone today i will be presenting seminar on dermatological manifestation of systemic ds
  • There are 3 types of lupus
  • This shows a discoid erythematous rash over the face

    This is a scalp leision showing alopecia and alopecia is usually permanent. Scalp leision occurs in almost 1/3 rd of pt.

    This is a typical erethematous rash with adherent scale over it
  • These are lesions of disseminated dle these are actually classical dle leisions that may occur at any part of the skin
  • Now here we can see the leisions are occurring typically above the waist
  • This picture shows typical butterfly rash over cheecks
  • This shows characterstick lupus hair with alopecia

    This is levido reticularid
  • This is an early leision showing central paleness with waxy smooth and shiny surface

    This is frontopariteal morphea

    This is a typical scleroderma facies with decreased skin fold
  • This shows radial furrowing round the mouth and decreased oral apurture

    This shows infarction and dry gangrene of fingers
    Due to sevre vasospasm
  • This is a typical heliotrope erethema seen in dermatomyositis

    These are gotrons papule
  • This is rheumatoid nodule

    This is pyoderma gangrenosum

    This is cutaneous small vessel vasculitis
    Showing purpuric leision over the skin
  • Tubercular skin infection can be divided into multibacillary and paucibacillary types
  • Lupus vulgaris has 5 forms
    Plaque form, ulcerative form , vegitative form, tumor like form, papular and nodular form
  • Other types of tubercular skin leisions are lichen scrofulosorm. Tubercular gumma
  • Sensory loss
  • Here we can see a patient of seborrhoic dermatitis
    Showing itchy scaly patches over face
    Extensive forms may some times
    lead to erythroderma in aids pt.
  • This is a picture showing lady with hypothyroid features
  • ×