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D40 Dermatology
Skin Manifestations of Systemic Disease Toronto Notes 2019
Skin Manifestations of Systemic Disease
Table 23. Skin Manifestations of Internal Conditions
Raynaud’s Phenomenon DDx
COLD HAND
Cryoglobulins/Cryofibrinogens Obstruction/Occupational
Lupus erythematosus, other connective tissue disease
DM/Drugs
Hematologic problems (polycythemia, leukemia, etc.)
Arterial problems (atherosclerosis) Neurologic problems (vascular tone)
Disease of unknown origin (idiopathic)
Acanthosis Nigricans
An asymptomatic dark thickened velvety hyperpigmentation of flexural skin most commonly around the neck. Associated with DM, obesity, and other endocrine disorders, and malignancy. It is a cutaneous marker of tissue insulin resistance
Disease
AUTOIMMUNE DISORDERS Behçet’s Disease Buerger’s Disease Dermatomyositis
Polyarteritis Nodosa
Reactive Arthritis Rheumatic Fever Scleroderma
SLE
Crohn’s Disease/UC
ENDOCRINE DISORDERS Addison’s Disease Cushing’s Syndrome Diabetes Mellitus
Hyperthyroidism Hypothyroidism
HIV-RELATED Infections
Inflammatory Dermatoses Malignancies
MALIGNANCY
Adenocarcinoma
Gastrointestinal Cervix/anus/rectum
Carcinoma
Breast
GI
Thyroid Breast/lung/ovary
Lymphoma/Leukemia
Hodgkin’s Acute leukemia
Multiple Myeloma
OTHERS Liver Disease
Renal Disease
Pruritic Urticarial Papules and Plaques of Pregnancy
Cryoglobulinemia
Related Dermatoses
Painful aphthous ulcers in oral cavity ± genital mucous membranes, erythema nodosum, acneiform papules Superficial migratory thrombophlebitis, pallor, cyanosis, gangrene, ulcerations, digital resorptions
Periorbital and extensor violaceous erythema, heliotrope with edema, Gottron’s papules (violaceous flat- topped papules with atrophy), periungual erythema, telangiectasia, calcinosis cutis
Subcutaneous nodules, stellate purpura, erythema, gangrene, splinter hemorrhages, livedo reticularis, ulceration
Keratoderma blennorrhagica (on feet), balanitis circinata (on male penis) Petechiae, urticaria, erythema nodosum, rheumatic nodules, evanescent rash
Raynaud’s, nonpitting edema, waxy/shiny/tense atrophic skin (morphea), ulcers, cutaneous calcification, periungual telangiectasia, acrosclerosis, salt-and-pepper pigmentation
Malar erythema, discoid rash (erythematous papules or plaques with keratotic scale, follicular plugging, atrophic scarring on face, hands, and arms), hemorrhagic bullae, palpable purpura, urticarial purpura, patchy/ diffuse alopecia, mucosal ulcers, photosensitivity
Pyoderma gangrenosum, erythema nodosum, Sweet’s syndrome
Generalized hyperpigmentation or limited to skin folds, buccal mucosa, and scars
Moon facies, purple striae, acne, hyperpigmentation, hirsutism, atrophic skin with telangiectasia
Infections (e.g. boils, carbuncles, candidiasis, S. aureus, dermatophytoses, tinea pedis and cruris, infectious eczematoid dermatitis), pruritus, eruptive xanthomas, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic foot, diabetic bullae, acanthosis nigricans, calciphylaxis
Moist, warm skin, seborrhea, acne, nail atrophy, hyperpigmentation, toxic alopecia, pretibial myxedema, acropachy, onycholysis
Cool, dry, scaly, thickened, hyperpigmented skin; toxic alopecia with dry, coarse hair, brittle nails, myxedema, loss of lateral 1/3 eyebrows
Viral (e.g. HSV, HZV, HPV, CMV, Molluscum contagiosum, oral hairy leukoplakia), bacterial (impetigo, acneiform folliculitis, dental caries, cellulitis, bacillary epithelioid angiomatosis, syphilis), fungal (candidiasis, histoplasmosis, cryptococcus, blastomycosis)
Seborrhea, psoriasis, pityriasis rosea, vasculitis Kaposi’s sarcoma, lymphoma, BCC, SCC, MM
Peutz-Jeghers: pigmented macules on lips/oral mucosa Paget’s disease: eroding scaling plaques of perineum
Paget’s disease, eczematous and crusting lesions of the skin of the nipple and usually areola of the breast Palmoplantar keratoderma: thickened skin of palms/soles
Sipple’s syndrome: multiple mucosal neuromas
Dermatomyositis: heliotrope erythema of eyelids and violaceous plaques over knuckles
Ataxia Telangiectasia: telangiectasia on pinna, bulbar conjunctiva Ichthyosis: generalized scaling especially on extremities, Sweet’s syndrome Bloom’s syndrome: butterfly erythema on face, associated with short stature
Amyloidosis: large, smooth tongue with waxy papules on eyelids, nasolabial folds and lips, as well as facial petechiae
Pruritus, hyperpigmentation, spider nevi, palmar erythema, white nails (Terry’s nails), porphyria cutanea tarda, xanthomas, hair loss, jaundice
Pruritus, pigmentation, half and half nails, perforating dermatosis, calciphylaxis
Erythematous papules or urticarial plaques in distribution of striae distensae: buttocks, thighs, upper inner arms, and lower back
Palpable purpura in cold-exposed areas, Raynaud’s, cold urticaria, acral hemorrhagic necrosis, bleeding disorders, associated with hepatitis C infection