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,
⢠Raynaudâs phenomenon found in 14% of
cases
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.
7. 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
8.
9. 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)
13. ⢠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 âlupus hairâ
⢠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
14.
15.
16. 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
17.
18.
19. 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
(Gottronâs papules) occur over the knuckles, on
the dorsa of the finger and around the nail folds .
20.
21. 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
26. 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
27. SCROFULODERMA
At first bluish-red nodule
overlying the infected
gland forms which breaks
down to form undermined
ulceration with granulating
tissue at the base
39. 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
(plummerâs nail)
⢠HAIR- fine thin hair ,diffuse alopecia
40.
41. 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)
42.
43. ADRENAL DISORDERS
Cutaneous manifestation of cushingâs syndrome
⢠Truncal obesity (classically deposits of fat over the clavicles and back of
the neck, the âbuffalo humpâ)
⢠Facial fullness and plethora (âmoon faciesâ)
⢠Slender limbs
⢠Skin atrophy
⢠Fragility, bruising and poor healing leading to Striae (typically white and
red)
⢠Hirsuties,Acneiform lesions
⢠Male-pattern baldness in women
44.
45. Cutaneous manifestation of Addisonâs 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 frictionâelbows, knees, waistline
3. Accentuation of normally high pigmentation areasâgenital,
perineum, axillae, areolae, umbilicus
4. Palmar creases
5. Tongue and mucous membranes
46.
47. 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
48. 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
51. LIVER CIRRHOSIS
Skin lesions associated with chronic liver disease
â˘Spiderangiomas , telangiectasis
â˘Palmar erythema
â˘Dilated abdominal/chest veins (including periumbilical
caput medusae)
â˘Jaundice
â˘Increased melanin pigmentation
â˘Thin âpaper-moneyâ skin
â˘Loss of secondary sexual hair in males
52.
53. ACUTE PANCREATITIS
Grey Turner sign (Turner
sign)âtracks 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)
54. Bryantâs signâtracks to
the scrotum to produce
the âblue scrotumâ sign.
Cullenâs signâtracks
into the falciparum
ligament then through the
connective tissues of the
round ligament to the
periumbilical area
57. 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
58.
59. 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
60.
61. B12 Deficiency -
⢠Skin hyperpigmentation with accentuation
in flexural areas ,palms ,soles and oral
cavity
⢠Angular stomatitis , glossitis(hunters
glossitis), xerostomia
⢠Vitiligo
62.
63. 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
66. 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
67.
68. 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
69. Dialysis associated amyloidosis
⢠cutaneous involvement is rare
⢠manifests as hyper pigmentation
,lichenoid eruptions,or nodules that
demonstrate amyloid deposition on HPE
examination
70. 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
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