I.

SLE
>4 American College of DDx
Rheumatology Seb Der
- (+) nasolabial folds
1. Discoid rash
- raised! DR
- (+) follicular plugging
- (+) atrophic scarring= HM
- CHRONIC cutaneous LE

2. Ulcers (Oral)
- painless

3. Malar rash
- butterfly facial erythema
- flat or raised
- ACUTE cutaneous LE
- (-) nasolabial folds

4. Photosen

OU

PS

5. Bullous lupus PM
erythematosus
6. Papulonodular
mucinosis
- Reddish purple to skin-
colored lesions
7. Palisaded Neutrophilic
Granulomatous Dermatitis
 Surface: bilateral, smooth PGI PNGD
(atrophic), ulcerated, or
umbilicated

SCLERODERMA
(hardening of the
skin)
- circumscribed or
diffuse, hard,
smooth, ivory-
colored areas
2 TYPES 1. Localized Morphea LM
A. CUT - Rose or violaceous
macules may appear
smooth, hard, some- what
depressed, yellowish-
white or ivory lesions
- MC: trunk

2. Generalized
Morphea
- widespread indurated
plaques with pigmentary
change GM
- muscle atrophy may be
present, but NO visceral
involvement

3. Morphea Profunda
- involves deep
subcutaneous tissue,
including fascia APP
4. Atrophoderma of
Pasini and Pierini
- brownish-gray, oval,
round or irregular,
smooth atrophic
lesions, depressed

5. Pansclerotic
Morphea
- sclerosis of the dermis,
panniculus, fascia, muscle,
and at times, bone. There
LS
is disabling limitation of
motion of joints

6. Linear Scleroderma
- may follow lines of
Blaschkohe
- begins during the 1st
decade of life
- lesions: occur parasagittal on
the frontal scalp and extend
 part way down the forehead
(En coup de sabre) EdS

B. SYSTEMIC 1. Progressive Systemic PSS

Sclerosis
FORM
- thickening of dermal
collagen bundles and
fibrosis
- vascular abnormalities
in internal organs
- Raynaud phenomenon is
the first manifestation of
PSS
- "woody edema" of the
hands
Pterygium lnversum
unguis

1. Thibierge-
Weissenback
Syndrome (aka
CREST syndrome)
- most favorable prognosis
- Calcinosis cutis,
Raynaud phenomenon
Esophageal dysmotility,
Sclerodactyly, and
Telangiectasia
- Telangiectasia = smooth
outline,
- vs Osler-Weber-Rendu
syndrome = irregular
outline with more
radiating vessels

DERMATOMYOSITIS
(DM)
- Characterized by
inflammatory
myositis and skin
disease
- Although
amyopathic DM
(DM with
subclinical or
absent myopathy)
also occurs
- Muscle
involvement
without skin
 changes is called
polymyositis (PM)
- weakness of
proximal muscle
groups is
characteristic

begins with
erythema and
edema of the upper
face and eyelids

Eyelid involvement
may be characterized
by pruritic and
scaly pink patches,
edema, and
pinkish-violet
(heliotrope)
discoloration (fig.8-
10) or bullae

Extensor surfaces of
the extremities are
often pink, red or
violaceous with an
atrophic appearance
(Fig. 8-11) or
overlying scale.

Enlarged capillaries of
the nail fold

A pink to reddish
purple atrophic (Fig.
8-13) or scaling
eruption often occurs
over the knuckles,
knees, and elbows
(Gottron's sign).
Flat topped,
polygonal, violaceous
papules over the
knuckles (Gottron's
papules) (Fig,8-14)
are less common, but
are highly
characteristic of DM.

Hyperkeratosis,
scaling, fissuring, and
hyperpigmentation
over the fingertips,
sides of the thumb,
and fingers with
occasional
involvement of the
palms is referred to as
mechanic's hands
and has been reported
in 70% 0f patients
with antisynthetase
antibodies.

Mottled hyper- and

hypo-pigmentation,
atrophy, and
 telangiectasia
(poikiloderma)

PREGNANCY 1.
- Levels of MSH
are elevated
Estrogen and
progesterone also
have melanocyte
stimulating effects
Pigmentary 2. Melasma HP
- aka mask of preg
- aggrav by sunlight and
OCPs

3. Hyperpigmentation
-
Axillary, areola, inner
thigh, genital, and in
abdomen near linea
alba called linea nigra)

Hair 1. Hirsutism
2. Thickening of scalp
hair
3. P/p telogen
effluvium
- Dim w/in 3-6mo

4. P/p androgenic
alopecia
- Terminal vellus hair
Nail 1. Subungual
hyperkeratosis
- an excessive
reproduction of
skin cells that
accumulate between
the nail

2. Distal Onycholysis
- separation of a
fingernail or toenail
from its nail bed

3. Brittleness
4. Transverse
grooving/ Beaus
lines
- nail matrix is injured
and the growth of the
nail is slowed.

Structural A. Molluscum Fibrosum

Gravidarum
- fleshy papules similar to
acrochordons
- 2nd half of pregnancy
B. Striae Gravidarum
- Reddish, slightly
depressed streaks
commonly develop in the
abdominal skin and
breasts and thighs.
- Glistening, silvery lines
that represent the cicatrices
of previous striae; usually
during 3rd trimester

Vascular 1. Spider angioma CM

2. Palmar erythema
3. Varicosities
4. Cutis memorata PG
- Esp dg cold
weather
5. Pyogenic
granuloma
- Pregnancy epulis
- Skin growths bloody-red
in color w/ large number
of blood vessels

6. Dermatographism
- Writing
on the
skin
- 2nd half
DERMATOSIS AND
MALIGNANCY
CURTHS
POSTULATES

1. Bazexs S papulosquamous 1. primary malignant

plaques, neoplasms of the
- Acrokeratosis
resembling upper aero digestive
Paraneoplastica tract
psoriasiform
2. metastatic cancer
dermatitis
to lymph nodes, often
begins with scaling in the cervical region.
dermatosis of the fingers and
toes spread to the nails

scaling of the
palms and soles
(keratoderma),
with a peculiar
honeycomb
appearance; some
patient presents
paraneoplastic
pruritus

Severely
abnormal nails with
painful paronychia
(swollen red nail
folds) with no
evidence of
bacterial or
fungal infection

2. Carcinoi (+) Embryological

dS neuroendocrine foregut
mediators -stomach, lung,
Classically involves pancreas, biliary
the GI tract, tract bright
respiratory system, salmon pink to
cardiovascular red
system, and the
skin. Midgut tumors
(classical
Cutaneous carcinoid flush)
manifestations : - appendix, ileum
4 main cyanotic flush
categories:

a. Flushing
- Character
of flush is
site
dependent
(tumor
origin
color)
 - After years
of flushing,
features
of
rosacea
may
develop.
- Classical
features of
rosacea
with facial
erythema,
telangiect
asia, and
pustules
b. Pellagra
- Onset of
skin
fragility,
erythema,
hyperpigm
entation
and
hypopigme
ntation
predomina
ntly over
the
knuckles
and shin
(hyperker
atosis,
xerosis,
scaling,
cheilitis)
- VitB3 def
~ Trp
c. Scleroderma
- Indicator
of poor
prognosis
- Lesion
descriptio
n:
progressiv
e skin
tightness
and
induration,
preceded
by
swelling
and
puffiness,
both
hyperpig
mentation
and
hypopigm
entation,
and
diffuse
pruritus
d. Cutaneous
Metastasis
- only after
hepatic
metastases
 have
occurred,
or when
the
primary
tumor is a
bronchial
carcinoid,
or if the
carcinoid
arises in
an
ovarian
teratoma,
where the
venous
drainage
bypasses
the hepatic
circulation
.

3. Erythem annular erythema that is

a usually associated with
gyratum underlying malignancy
Intense
repens
pruritus
A course of rash that closely
mirrors the course of the
underlying illness, with
clearance of rash and relief of
pruritus within 6 weeks

4. Acquired not localized to MC: lung and colon

Hypertri androgen-dependent
chosis areas of the skin (vs AHL cases
hirsutism) may be
lanugino associated
sa with
ominous sign of internal various
malignancy syndromes:
Down
Syndrome,
Lipoatrophi
c diabetes,
stiff skin
syndrome
Maybe
secondary
to drug
intake:
Minoxidil,
Cyclosporin
e,
Diphenylhy
dantoin
 5. POEMS S Polyradiculoneuropathy
Organomegaly
- Osteosclerotic
Endocrinopathy
myeloma Monoclonal plasma cell
- Takatsuki S disorder
- Crow-Fusake S Skin changes
Skin changes
includes
diffuse
hyperpigment
ation,
dependent
edema, skin
thickening,
hyperhidrosis
and
hypertrichosi
s
Lesions are
characterized
as small,
firm, red to
violaceous
papules appear
on the trunk
and proximal
extremities in
approximately
one third of
patients (called
as
GLOMERULO
ID
HEMANGIOM
A)
6. Tripe a honeycombed and Palms- Lung Ca
Palms/ corrugated thickening Palms + AN
Acantho appearing as a Gastric
sis RUGOSE surface
palmaris similar to the rugose
surface of the bovine
stomach,

Melanocortin and EGFS

are upregulated in
malignancy-associated
tripe palms

7.