Cutaneous Manifestations of Internal Disease Ronald Buckley,
D.O. Dermatology Department Lakeview Medical Center
Suffolk,Virginia April 02 2011 Slide 2 Course Objectives: Cutaneous
findings may provide valuable clues to the diagnosis of underlying
internal disease. During this presentation, a limited number of
internal diseases manifestations on the skin will be reviewed.
Slide 3 Course Objectives At the conclusion of this talk, the
audience will recognize the cutaneous manifestations of internal
diseases involving: integument disorders, blistering diseases,
internal cancers, cardiovascular disease, pulmonary disease,
rheumatic disease, gastrointestinal, and metabolic disease. Goals
Help the primary care physician to establish the proper diagnosis
and management. Determine the need for referral to the appropriate
specialist. Slide 4 Overview 1.Common Benign Cutaneous Disorders
2.Blistering Diseases 3.Internal Cancers 4.Cardiovascular Disease
5.Pulmonary Disease 6.Rheumatic Disease 7.Gastrointestinal Disease
8.Metabolic Disease Slide 5 Common Benign Cutaneous Disorders
Seborrheic Dermatitis Chronic and common inflammatory disease.
Location: scalp, face, chest and intertriginous areas. Clinical
appearance: erythematous, often greasy, scaling patches and plaques
favor hair bearing areas. Scalp pruritus is common. Internal
Association: HIV/AIDS and Langerhan Cell Histiocytosis
(Letterer-Siwe, Hand Schuller-Christian and eosinophilic
granuloma). Slide 6 Seborrheic Dermatitis Slide 7 Slide 8 Common
Benign Cutaneous Disorders Seborrheic Dermatitis Differential
Diagnosis: eczema, psoriasis, tinea infection, zinc deficiency and
lupus erythematosus. Treatment: shampoos, sulfacetamide, azeleic
acid, coal tar, topical steroids and topical or oral antifungal.
Slide 9 Tinea Facei Slide 10 Common Benign Cutaneous Disorders
Seborrheic keratoses Extremely common benign tumor. Location:
Anywhere but most commonly on the trunk. Clinical appearance: warty
plaques and stuck on appearance, greasy with pseudohorn cysts.
Slide 11 Seborrheic keratoses Slide 12 Common Benign Cutaneous
Disorders Seborrheic keratoses Internal Association: underlying
adenocarcinoma of GI tract if they appear suddenly in great numbers
(sign of Leser- Trelat). Differential Diagnosis: Malignant
Melanoma. Treatment: reassurance, cryotherapy, curettage or
excision. Slide 13 Common Benign Cutaneous Disorders Urticaria and
Angioedema Transient lesions most often triggered by medication
(PCN, Sulfa, ASA) or food (nuts, eggs, milk, shellfish), and less
so by infection. Location: Localized, regional, or generalized.
Clinical appearance: edematous papules and plaques with oval,
annular, polycyclic, serpiginous, and bizarre shapes. Slide 14
Urticaria Slide 15 Slide 16 Common Benign Cutaneous Disorders
Urticaria and Angioedema Internal Association: Urticarial
vasculitis-type II immune complex reaction. Urticarial plaques that
persists for 24-72 hrs. Associated with purpura, scaling, and
hyperpigmentation. Differential diagnosis: erythema multiforme,
SLE, bullous pemphigoid, mastocytosis. Treatment: elimination of
known causes, antihistamines, systemic steroids, sulfasalazine and
cyclosporine. Slide 17 Urticarial Vasculitis Slide 18 Angioedema
Slide 19 Common Benign Cutaneous Disorders Erythema multiforme
Relatively common- hypersensitive, acute and often recurrent
inflammatory process. Location: backs of hands and feet, extensor
surfaces of forearms and arms and less commonly on the trunk.
Clinical Appearance: targetoid, morbilliform, plaques, vesicles or
bullae. Slide 20 Erythema multiforme Slide 21 Common Benign
Cutaneous Disorders Erythema multiforme Internal Association: HSV,
mycoplasma, connective tissue diseases and drugs. Differential
diagnosis: urticaria, drug eruption bullous pemphigoid. Treatment:
oral antiviral for herpes infection; discontinuation of offending
medication; oral prednisone and supportive care. Slide 22 Common
Benign Cutaneous Disorders Vitiligo Type of acquired leukoderma.
Autoimmune disease. Location: focal (periorificially -mouth,orbits,
vagina, anus), segmental and generalized. Clinical appearance:
Depigmented macules and patches. Slide 23 Vitiligo Slide 24 Slide
25 Common Benign Cutaneous Disorders Vitiligo Internal Association:
thyroid dz, diabetes mellitus, pernicious anemia or Addisons dz.
Differential Diagnosis: pityriasis alba, tinea versicolor,
postinflammatory hypopigmentation, hypopigmented mycosis fungoides.
Treatment: sunscreen, topical steroids, tacrolimus or pimecrolimus,
phototherapy, skin grafting and depigmentation. Slide 26 Common
Benign Cutaneous Disorders Erythema nodosum Most common type of
panniculitis. Location: lower legs (most common in females), knees,
arms, rarely face and neck. Clinical Appearance: painful,
indurated, tender, red to violaceous nodules. Internal Association:
Infectious ( streptococcal pharyngitis), drug sensitivity
(sulfonamide,oral contraceptives), inflammatory bowel dz and
sarcoidosis. Slide 27 Erythema Nodousm Slide 28 Erythema Nodosum
Slide 29 Common Benign Cutaneous Disorders Erythema nodosum
Differential diagnosis: nodular vasculitis and other panniculitis.
Treatment: elimination of known triggers, bed rest, NSAIDs,
colchicine, and supersaturated iodide. Slide 30 Life Threatening
Cutaneous Disorder Exfoliative Dermatitis (Erythroderma)
Potentially a life-threatening reaction pattern involving the skin.
Location: generalized. Clinical appearance: generalized and
confluent redness and scaling of the skin with associated systemic
toxicity, generalized lymphadenopathy, pruritus, malaise, chills,
and fever. Causes: most commonly are preexisting skin diseases:
Psoriasis, atopic dermatitis and drug hypersensitivity. Slide 31
Exfoliative dermatitis Slide 32 Slide 33 Life Threatening Cutaneous
Disorder Exfoliative Dermatitis (Erythroderma) Internal
Association: Cutaneous T Cell Lymphoma (less commonly), leukemia
and pityriasis rubra pilaris. Differential diagnosis: lichen
planus, pemphigus foliaceus, ichthyosiform erythroderma, acute
graft- versus-host disease. Treatment: hospitalized in single room
with attention to the patient need for temperature control. Water
baths with bath oils followed by application of bland emollients.
Slide 34 Life Threatening Cutaneous Disorder Exfoliative Dermatitis
(Erythroderma) Treatment: Oral and topical corticosteroids for
remission induction only. Supportive (cardiac, fluid, electrolyte,
protein replacement). Slide 35 Blistering Disorders Pemphigus
vulgaris Serious acute or chronic debilitating blistering
autoimmune disease of the skin and mucous membrane. Often fatal
unless treated with immunosuppresive agents. Location: mouth or
generalized. Predilection for the scalp, face chest, axillae,
groin, umbilicus. Clinical appearance: Vesicles and bullae,
flaccid, easily ruptured, and weeping, arising on normal skin.
Extensive erosions that bleed easily with crusting. Nikolskys sign.
Slide 36 Blistering Disorders Pemphigus Vulgaris Diagnosis: Bx of
the skin and mucous membrane, DIF (IgG/C3) and circulating auto-
antibodies(IgG). DDX: BP, Steven-Johnson, EBA Tx: Immunosuppressive
agents, systemic corticosteroids, plasmapheresis, topical
corticosteroids and antibiotics, rituximab and IVIg. Slide 37
Pemphigus Vulgaris Slide 38 Slide 39 Blistering Disorders Bullous
pemphigoid Chronic autoimmune mediated bullous eruption in patients
over 60 yrs of age. Location: Generalized or localized and randomly
distributed. Rarely involve oral mucosa. Clinical appearance: Large
tense firm-topped bullae. May arise in normal or erythematous skin
and often pruritic. Slide 40 Bullous Pemphigoid Slide 41 Blistering
Disorders Bullous pemphigoid Diagnosis: Clinical, confirmed by
histopathology and immunopathology (IgG at DEJ) Differential
Diagnosis: bullous SLE, EBA, cicatricial pemphigoid and DH.
Treatment: excellent prognosis with treatment; topical and systemic
corticosteroids, TCN, niacinamide, steroid sparing
immunosuppressants. Slide 42 Blistering Disorders Dermatitis
herpetiformis (DH) Intensely pruritic chronic and recurrent
eruption. Location: symmetrical groups on the elbows, knees, scalp,
and buttocks. Clinical appearance: tiny vesicles, papules, and
urticarial wheals. Slide 43 Dermatitis Herpetiformis Slide 44
Blistering Disorders Dermatitis herpetiformis (DH) Internal
association: small-bowel malabsorption. Gluten-sensitive
enteropathy. Diagnosis: Clinical, confirmed by histopathology and
immunopathology. Circulating IgA antibodies (antiendomysial
antibodies) in 70% pts. Differential Diagnosis: linear IgA
dermatosis, BP, contact dermatitis and bullous LE. Treatment:
dapsone, sulfapyridine, gluten-free diet. Slide 45 Blistering
Disorders Epidermolysis bullosa acquisita (EBA) Rare autoimmune
bullous disease. Location: hands, feet, elbows, knees and mucous
membrane. Clinical appearance: skin fragility, milia, scarring
alopecia, and nail dystrophy, tense blisters on inflammatory or
noninflammatory base. Slide 46 Epidermolysis bullosa acquisita
Slide 47 Slide 48 Blistering Disorders Epidermolysis bullosa
acquisita (EBA) Diagnosis: Clinical, confirmed by histopathology
and immunopathology. Differential Diagnosis: bullous pemphigoid
bullous LE. Treatment: Poor response to topical and systemic
therapy. Cyclosporine and high dose intravenous immunoglobulins may
be effective. Slide 49 Skin Disease and Internal Cancer Cutaneous
metastases Occur in less that 5% of patients with metastatic
cancer. Generally reflect the most prevalent cancer in the general
population (breast, lung, or GI tract) Clinical appearance:
skin-colored to violaceous nodules in close proximity to the
primary neoplasm. Location: most commonly seen on the head, neck
and trunk. DDx: cyst, adnexal tumor, neurofibroma and lipoma Slide
50 Metastatic Carcinoma Slide 51 Slide 52 Skin Disease and Internal
Cancer Mammary Pagets disease Unilateral breast cancer-nearly
always associated with underlying intraductal carcinoma. Clinical
appearance: eczematous plaque of the nipple and areola with exudate
that persists for longer than a few weeks. Resistant to topical
therapy. Differential Diagnosis: allergic or irritant contact
dermatitis, psoriasis, BCC, Bowens dz. Treatment: Referral to
oncologist, surgery, radiation, photodynamic therapy. Slide 53
Pagets Disease Slide 54 Skin Disease and Internal Cancer
Extramammary Pagets Disease Neoplasm of the anogenital and axillary
skin. Histologically and clinically similar to Pagets dz of the
breast. Often represents an intraepidermal extension of primary
adenocarcinoma of underlying adnexal (apocrine) carcinoma or
underlying cancer of GI tract or GU tract. Location: vulva,
scrotum, penis, perianal, perineal, axilla,umbilicus and sternum.
Clinical appearance: erythematous plaque +/- scaling, crusting, and
exudation. Borders sharply defined. Slide 55 Extramammary Pagets
Disease Slide 56 Skin Disease and Internal Cancer Extramammary
Pagets Disease. Differential Diagnosis: eczematous dermatitis,
intertriginous Candida infection, tinea corporis, erythrasma,
Bowens dx, HPV induced intraepithelial neoplasia, superficial
spreading melanoma. Treatment: surgical excision. Slide 57 Skin
Disease and Internal Cancer Acanthosis nigricans most likely
triggered by factors that stimulate epidermal keratinocyte and
dermal fibroblast proliferation. benign form- the factor likely
insulin or an insulin-like growth factor malignant AN- stimulating
factor secreted either by the tumor or in response to the tumor.
Slide 58 Acanthosis Nigricans Slide 59 Slide 60 Skin Disease and
Internal Cancer Acanthosis Nigricans Location: groin, axillae,
neck. Malignant form has sudden onset and more extensive
distribution- face and dorsal and palmar surfaces of hands.
Clinical appearance: smooth, velvet-like, hyperkeratotic plaques of
intertriginous areas. Internal association: Adenocarcinoma GI,
lung, breast. Most common causes are obesity, insulin-resistant
diabetes and medications. Slide 61 Tripe Palms Slide 62 Skin
Disease and Internal Cancer Acanthosis Nigricans Differential
diagnosis: confluent and reticulated papillomatosis, Dowling-Degos
dz. Treatment: treatment of underlying disorder, including removal
of malignant tumor. Slide 63 Skin Disease and Internal Cancer
Gardners syndrome Autosomal dominant cancer syndrome Characterized
by: Colonic polyposis Osteomas (maxilla, mandible, skull) Scoliosis
Epidermoid cysts Soft-tissue tumors (fibromas, desmoid tumors,
lipomas) Pigmented ocular fundus lesions Adenocarcinoma of colon
develops in 60% of pts by the age of 40. Slide 64 Epidermal
Inclusion Cyst Slide 65 Skin Disease and Internal Cancer Muir-Torre
Syndrome Autosomal dominant cancer syndrome. Characterized by at
least one sebaceous tumor (adenoma, sebaceoma, epithelioma, or
carcinoma) and one internal neoplasms, usually colorectal(47%),
GU(21%), breast CA(12%) and hematologic(9%) Clinical appearance:
small asymptomatic papules or nodules that resembles cysts or
benign growths to waxy papules located mainly of the face, trunk
and scalp. Slide 66 Sebaceous Adenoma Slide 67 Sebaceous Neoplasms
Slide 68 Skin Disease and Internal Cancer Cowdens Syndrome
Autosomal dominant. Mutations in tumor suppressor gene PTEN
Characterized by: Multiple tricholemmomas (resemble warts) around
the mouth, nose and ears. Breast and thyroid cancer Fibrocystic
disease of the breast Thyroid adenoma Mental retardation Slide 69
Skin Disease and Internal Cancer Hirsutism Appearance of excessive
coarse, male-type pattern, hair in woman. Associated androgen
excess (adrenal or ovarian tumor). Hypertrichosis Excessive growth
of vellus hairs in any hair-bearing areas Associated with
malignancy, metabolic disorders or medications (minoxidil and
cyclosporine). Slide 70 Hirsutism Slide 71 Skin Disease and
Internal Cancer Sweets syndrome (acute neutrophilic dermatosis)
Strong association with acute myelocytic or myelomonocytic
leukemia. Clinical appearance: abrupt onset of tender or painful
reddened plaques or nodules occasionally with vesicles, bullae or
pustules on the face, extremities, and trunk usually in middle-aged
women. Slide 72 Sweets Syndrome (acute febrile neutrophilic
dermatosis) Slide 73 Sweets Syndrome Slide 74 Skin Disease and
Internal Cancer Sweets syndrome (acute neutrophilic dermatosis)
Associated systemic symptoms: fever, peripheral leukocytosis,
arthralgias, myalgias and conjunctivitis. Differential diagnosis:
erythema multiforme, SLE, deep fungal infection, pyoderma
gangrenosum, cutaneous metastases. Treatment: systemic
corticosteroids, NSAIDs and dapsone. Slide 75 Skin Disease and
Internal Cancer Amyloidosis May be a sign of multiple myeloma.
Clinical: waxy, smooth, shiny, flat-topped or spherical papules,
nodules or plaques. Pinch Purpura Location: midface, tongue, scalp,
body folds, axillae, umbilicus, anogenital area. Treatment: no
effective therapy, chemotherapy and stem cell transplantation.
Slide 76 Primary systemic amyloidosis Slide 77 Macroglossia
(Amyloidosis) Slide 78 Purpura (Amyloidosis) Slide 79 Skin Disease
and Internal Cancer Dermatomyositis An inflammatory systemic
disease; Characterized: proximal muscle weakness, photosensitivity,
violaceous (heliotrope) inflammatory changes of eyelids and
periorbital area, papules and plaques of hands, elbows, and knees
(Gottrons papules). Elevated creatine kinase or aldolase level,
positive Jo-1 antibody, and EKG changes. Slide 80 Heliotrope
erythema Slide 81 Gottrons papules Slide 82 Dermatomyositis Slide
83 Skin Disease and Internal Cancer Dermatomyositis Other features:
scaly, telangiectatic plaques with atrophy and hypopigmentation
(poikiloderma) on face, neck, trunk, extremities, malar erythema
and nail abnormalities (periungal telangiectases and cuticular
hypertrophy). Slide 84 Dermatomyositis Slide 85 Skin Disease and
Internal Cancer Dermatomyositis Diagnosis: requires muscle bx,
electromyogram, measurement of muscle enzymes (aldolase, creatine
kinase, transaminases). Internal association: Adenocarcinoma of
breast, GI tract or lung in adults. Differential diagnosis: SLE,
photosensitive drug eruption. Treatment: systemic corticosteroids,
MTX, immunosuppressants and TNF alpha inhibitors. Slide 86 Skin
Disease and Internal Cancer Paraneoplastic pemphigus Autoimmune
disease with clinical and histological features of EM and PV.
Clinical appearance: intractable stomatitis and blisters,
conjunctival reactions, polymorphous skin lesions. Location: oral
mucosa, trunk, extremities. Slide 87 Paraneoplastic pemphigus Slide
88 Skin Disease and Internal Cancer Paraneoplastic pemphigus
Internal association: non-Hodgkins lymphoma, chronic lymphocytic
leukemia, thymoma. Diagnosis: histopathology and immunopathology.
Treatment: based on underlying dz. Slide 89 Skin Disease and
Internal Cancer Erythema gyratum repens Rare by most distinctive
skin eruption Clinical appearance: reddened concentric bands in a
wood grain or whorled pattern. Internal association: lung, breast,
cervical and GI cancers. Treatment: removal of cancer clears the
eruption. Slide 90 Erythema gyratum repens Slide 91 Skin Disease
and Cardiovascular Disease Multiple Lentigines LEOPARD Syndrome
(Moynahans) Lentigines Electrocardiographic changes Ocular telorism
Pulmonary stenosis Abnormal genitalia Retarded growth Deafness
Slide 92 LEOPARD Slide 93 Skin Disease and Cardiovascular Disease
Multiple Lentigines NAME Nevi Atrial myxoma Myxoid neurofibromas
Ephelides Slide 94 Skin Disease and Cardiovascular Disease Multiple
Lentigines LAMB Syndrome Lentigines Atrial myxoma Mucocutaneous
myxomas Blue nevi Slide 95 Skin Disease and Cardiovascular Disease
Pseudoxanthoma elasticum (PXE) An inherited or acquired defect of
elastic tissue. Mutations in the gene ABCC6 on chromosome 16 have
been linked to PXE. Clinical appearance: yellow cobblestone lesions
over redundant skin folds in flexural location arranged in linear
distribution plucked chicken. Location: Neck and axillae most
common sites. Slide 96 Pseudoxanthoma Elasticum (PXE) Slide 97
Angioid Streaks Slide 98 Skin Disease and Cardiovascular Disease
Pseudoxanthoma elasticum (PXE) Internal association: HTN,
peripheral vascular and coronary dz, retinal and GI hemorrhage,
strokes and angioid streaks. Differential diagnosis: cutis laxa,
Ehlers- Danlos syndrome. Treatment: no definitive therapy. Slide 99
Skin Disease and Cardiovascular Disease Ehlers-Danlos syndrome An
inherited defect of collagen tissue at least eleven types. Clinical
appearance: hyperextensibility, hypermobility, skin fragility,
fish-mouth scars. Internal association: MVP, blue sclerae,
aneurysm, aortic dissection, hernias, angina, GI bleeding and
peripheral vascular dz. Treatment: protection of skin and treatment
of systemic findings. Slide 100 Ehlers-Danlos Syndrome Slide 101
Slide 102 Skin Disease and Pulmonary Disease Sarcoidosis Chronic
multisystem granulomatous inflammation. Clinical appearance: red to
violaceous plaques of the nose (lupus pernio), midfacial papules,
annular plaques, nodules or plaques on trunk and extremities.
Erythema nodosum-mt common cutaneous manifestation. Higher
prevalence in women and African Americans. Differential diagnosis:
trichoepitheliomas, rosacea, granuloma annulare. Treatment:
systemic corticosteroids, antimalarials, MTX, thalidomide and TNF
alpha inhibitors. Slide 103 Sarcoidosis Slide 104 Slide 105 Skin
Disease and Rheumatic Disease Psoriatic arthritis A distinct form
of arthritis with negative rheumaotoid factor. HLA-B27 genotype in
50% of affected patients. Clinical appearance: five types:
Asymmetric arthritis-most common type with sausage fingers and toes
Symmetric arthritis Distal interphalangeal joint disease Arthritis
mutilans Ankylosing spondylitis Slide 106 Psoriatic Arthritis Slide
107 Slide 108 Skin Disease and Rheumatic Disease Psoriatic
arthritis Differential diagnosis: rheumatoid arthritis. Treatment:
Biologic agents, NSAIDs, antimalarials, MTX, retinoids,
cyclosporine. Slide 109 Skin Disease and Rheumatic Disease Lupus
erythematosus A multisystem autoimmune photosensitive dermatosis.
Clinical forms: 1. DLE- localized to head or neck with scarring
plaques usually negative ANA. 2. SCLE-annular plaques on trunk and
arms with positive ANA, Ro(SS-A), La(SS-B). 3. SLE-malar erythema,
photosensitivity, oral ulcers, discoid plaques, alopecia, positive-
ANA, dsDNA, Ro(SS-A), La(SS- B), sm. Slide 110 Discoid Lupus
Erythematosus Slide 111 Systemic Lupus Erythematosus (SLE) Slide
112 Skin Disease and Rheumatic Disease Lupus erythematosus.
Clinical forms: 4. Neonatal LE- noticed in first month,
photosensitive, papulosquamous and annular patterns, congenital
heart block 50% of cases. Maternal passage of antibodies- Ro, La, U
1- RNP, Antiphospholipids. 5. Drug-Induced LE- rash uncommon, ANA,
ssDNA, antihistone positive. Procainamide, Hydralazine, Isoniazid.
Symptoms clear with stopping the med. Treatment: Sun protection,
steroids, dapsone and immunosuppressants. Slide 113 Neonatal LE
Slide 114 Skin Disease and Rheumatic Disease Reiters syndrome
Triad: urethritis, conjunctivitis, and oligoarthritis. Circinate
balanitis-vesicles and crusted plaques. Keratoderma
blennorrhagicum-erythematous pusutles and papules on palms and
soles. Sacroiliitis-present 50% of pt (HLA-B27). Treatment: topical
corticosteroids for skin dz. Slide 115 Skin Disease and
Gastrointestinal Disease Hepatitis C infection association:
Leukocytoclastic vasculitis Cutaneous B-cell lymphoma
Cryoglobulinemia Pruritus Porphyria cutanea tarda Urticaria Prurigo
nodularis Lichen planus Slide 116 Leukocytoclastic Vasculitis Slide
117 Skin Disease and Gastrointestinal Disease Peutz-Jeghers
Syndrome Characterized: lentigines on skin and mucosa-lips, buccal
mucosa, periorbital region, dorsal of fingers and soles.
Associated: benign polyps (hamartomas) of small intestine with low
malignant potential. DDx: LEOPARD syndrome, Carney complex and
Cronkhite-Canada syndrome Tx: regular and routine endoscopy and
symptomatic treatment. Slide 118 Peutz-Jeghers Syndrome Slide 119
Skin Disease and Gastrointestinal Disease Pyoderma gangrenosum
Neutrophilic dermatosis with painful ulcers with boggy, undermined
edges and a border of gray or purple pigmentation. Associated:
inflammatory bowel dz, rheumatoid arthritis or paraproteinemia
usually IgA gammopathy. Differential diagnosis: infection,
vasculitis, factitious disorder. Treatment: systemic, intralesional
and topical corticosteroids; cyclosporine, infliximab and
immunosuppressants. Slide 120 Pyoderma Gangrenosum Slide 121 Skin
Disease and Metabolic Disease Porphyrias A group of inherited or
acquired blistering disorders of heme biosynthetic pathway.
Porphyria cutanea tarda (PCT) Most common porphyria. Hepatic
porphyria (acquired/sporadic). Deficiency uroporphyrinogen
decarboxylase. Accumulation of by products in urine/serum. Slide
122 Porphyria Cutanae Tarda (PCT) Slide 123 Slide 124 Skin Disease
and Metabolic Disease Porphyrias Porphyria cutanae tarda (PCT)
Precipitating factors: alcohol ingestion, estrogen administration,
dinitrochlorobenzene, carbon, tetrachloride, dialysis, hepatitis B
or C infection. Clinical appearance: photosensitivity, skin
fragility, bullae, erosions of sun-exposed skin, milia and
hypertrichosis. Differential diagnosis: bullous SLE, EBA,
pseudoporphyria. Treatment: phlebotomy, antimalarials. Slide 125
Test 1.Exfoliative dermatitis 2.Dermatitis herpetiformis
3.Acanthosis nigricans 4.Gardnerss syndrome 5.Muir-Torre Syndrome
6.Cowdens Syndrome 7.Erythema nodosum 8.Erythema Multiforme
9.Amyloidosis 10.Sweets Syndrome A. HSV/Mycoplasma B. Strep.
Pharyngitis C. Psoriasis, Eczema, drug D. Gluten sensitive
enteropathy E. Obesity-Insulin resist. DM F. Colonic Polyposis G.
Colorectal/GU CA (Sebaceous tumors) H. Breast & Thyroid CA
(Tricholemmomas) I. Multiple Myeloma J. AML Slide 126 References 1.
Longshore S, Tomecki K. The Cleveland clinic disease management
project. Skin signs of systemic disease. 2002;1-8. www.
Clevelandclinicmeded.com/diseasemanagement/dermatology/skinsigns 2.
Von den Driesch P. Sweets syndrome (acute febrile neutrophilic
dermatosis). J Am Acad Dermatol. 1994;31:535. 3. Poole S. Fenske
NA. Cutaneous markers of internal malignancy. I, II J Am Acad
Dermatol. 1993;28:1,147. 4. Fitzpatrick T, Johnson R et al. Color
atlas and synposis of Clinical Dermatology 2 nd edition. 1994.
Habif T. Clinical Dermatology: A color guide to diagnosis and
treatment. 3 rd edition. 1996. Arndt K, Leboit P et al. Cutaneous
medicine and surgery: an integrated program in dermatology. 1996.
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