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CUTANEOUS MEDICINE LECTURE 2
Tom Paige
Department of Dermatology
CCRMC
Music Series
• Name the composer
• Name the piece
Best Answer Is ???
• A. Patient has scabies• B. Classic case of atopic dermatitis• C. Need to have patient seen by Dr. Reif in
GI• D. Biopsy for direct immunofluorescense
would not be helpful in making the diagnosis • E. None of the above
Dermatitis herpetiformis
Dermatitis Herpetiformis• Dermatitis herpetiformis (DH), or Duhring’s
disease, is characterized by – Grouped, pruritic, erythematous, papulovesicles– Located on the extensor surfaces of body
• Skin biopsy reveals– Neutrophils in the dermal papilla
• DIF of perilesional skin shows– Granular deposition of IGA in the dermal papillary tips
Microscopic findings
Facts about DH
• Virtually all patients with DH have gluten-sensitive enteropathy of small bowel biopsy.
• Only 25% of patients with DH have GI symptoms
• The skin disease and GI symptoms when present improve with a gluten restrictive diet
Other associated diseases
• Thyroid disorders have been reported in DH patients– Hypo and hyperthyroidism, thyroid nodules,
and asymptomatic goiters
• 4% of DH patients develop lymphomas– A gluten free diet may prevent the development
of lymphomas
Best Answer Is ????
• A. Child has a candida albicans infection• B. Needs to be placed on fluconazole for the
yeast infection after failing nystatin lotion • C. Laboratory testing would show a low
alkaline phosphatase level in the blood.• D. Answers (A.) and (B.)• E. None of the above
Malabsorption
Zinc deficiency• Genetic: ADE• Dietary deficiency• Excessive alcohol consumption• Malabsorption• IBD• Anorexia nervosa• Acquired immunodeficiency syndrome• Prolonged diarrhea• Total parenteral nutrition• Chelating agents (penicillamine)• Chronic renal disease• Pediatric “short bowel syndrome”
Choose the best answer
• A. The leg ulcer is caused by a brown recluse spider bite (loxsocles reclusans)
• B. The patient needs to see a rheumatologist
• C. A GI workup is indicated • D. The three slides are not caused by
one disease.
Inflammatory bowel disease
QuickTime™ and a decompressor
are needed to see this picture.
Peutz Jeghers syndrome
• Rare inherited disease characterized by– Gastrointestinal polyps– Associated pigmentation of skin and mucous
membranes
• The risk of developing some form of internal cancer is 15 times greater for PJS than the general population
Gardner’s syndrome
• Synonym = Familial polyposis of the colon• Key features• Autosomal dominant disorder w/
premalignant polyposis and adenocarcinoma of the GI tract
• Tumors and cysts of the skin, mesentary, and retroperitoneum
• CHRPE• Mutations of the APC gene
Birt-Hogg-Dube Syndrome
• Classic triad– Fibrofolliculomas– Trichodiscomas– Acrochordon-like lesions
• Predisposition to develop renal tumors
• Tendency for spontaneous pneumothoraces
Gastrointestinal Disease
• Gluten sensitive enteropathy• Malabsorption• Inflammatory bowel disease• Peutz Jeghers syndrome• Gardner’s syndrome• Birt-Hogg-Dube syndrome
Renal disease
• Pruritis
• Nodular prurigo
• Calcinosis and calciphylaxsis
• Perforating collagenosis
• Porphyria cutanea tarda and pseudoporphyria
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