Assorted Skin Conditions

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Introduction

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Lichen planus

Prurutic, purple, polygonal papules

General self-limiting and resolves spontaneously 1-2 years after onset, often leaving zones of postinflammatory hyperpigmentation.

Oral lesions may last for years.

 

Signs and Symptoms

 

Pathology

Pathogenesis is not well known, though may be related to cell-mediated immune reactions following antigenic release at levels of basal cell layer and dermoepidermal junction.

 

Treatments

Malginancy emerging from lichen planus areas has been observed, but direct pathogenic relationship is not clear.

 

 

 

Dermatomyositis

Dermomyositis is an autoimmune connective tissue disease of unkown cause characterized by inflammation of muscle and skin. adult and juvenile forms.

may be paraneoplastic, especially later in life: 20-30% chance of malignancy

• lung
• ovarian
• GI
• breast
• nasopharyngeal

Signs and Symptoms

characteristic skin findings

• Gottron's papules: purplish papules over knuckles
• heliotrope eruption
• periungula erythemia
• poikiloderma (Shawl sign): looks like a sunburn with a characteristic pattern on the chest

proximal muscle weakeness

elevated serum levels of muscle enzymes

abnormal muscle biopsy

abnormal electromyogram

Pathology

 

Treatments

 

 

 

 

Bullous Pemphigoid

Elderly people

tense blisters, can be hemorrhagic

autoimmune: IgG, C3l subepidermal blisters

Negative Nikolsy's sign

 

usually very itchy at first

 

Signs and Symptoms

 

 

Pathology

 

 

treatments

oral steroids; can use lower doses, ie 0.25-0.5 mg/kg

can also use other immunosuppressants

can also use topical steroids

 

treat with vitamin D and bisphosphonate

 

 

 

Dermatitis Herpatiformis

Often diagnosis is profoundly delayed

 

Signs and Symptoms

INTENSE pruitus

almost everyone has mild celiac disease

Elbows, knees, lumbar spine

 

Pathology

Tissue transglutaminase is almost always positive

autoimmune IgA mediated

neutrophils

 

Treatments

Refractory to steroids.

 

Dapsone 100mg po OD, works within 24 hours. Can cause leukopenia, hypersensivity, and peripheral neuropathy (long term use).

 

Gluten-free diet takes 6 monhts.

 

 

Erythema Multiforme

Drug-induced. Stephens-Johnsons Sundrome

Sulfa, NASIDs

 

Signs and Symptoms

less than 10% blistering

 

 

Pathology

 

 

Treatments

 

 

Erythema Nodosum

EN is the most common form of panniculitis, inflammation affecting subcutaneous fat lobules or the connective etissue separating them.

 

Signs and Symptoms

Subcutaneous non-ulcerative nodules are present on extensor surfaces - usually the shins but sometimes the arms.

They are:

• poorly defined
• very painful
• often felt better than seen

fever, malaise, and joint pain may accompany.

Over weeks, lesions usually flatten and become bruise-like, leaving no residual scar.

 

 

Pathology

Many times the causes cannot be identified.

Erythema nodosum may be caused by various agents:

• infection: Strep throat, tuberculosis, systemic fungal infections, Yersinia
• inflammation: sarcoidosis, inflammatory bowel disease
• drugs: sulfonamides, oral contraceptives
• malignancy: lymphoma

 

Treatments

treat symptoms with NSAIDs

 

 

Miliaria Rubra

Also known as [prickly heat'.

 

Signs and Symptoms

Obstruction of sweat, as in miliaria crystalina, but located in the mid-epidermis.

It worsens with creams/ointments, with heat (overdressing etc).

 

Pathology

 

 

Treatments

 

 

Neurodermatitis/Prurigo Nodularis/Lichen Simplex Chronicus

Due to excessive scratching/picking

Morgellons

Signs and Symptoms

 

 

Pathology

 

 

Treatments

 

 

Pemphigus

group of autoimmune disorders characterized by intraepidermal blister formation

• uncommon but important
• tends to be body-wide and very painful
  • also mucosal involvment in the marority of patients
• Nikolsy's sign is positive, with large blisters that easily shear
• can be paraneoplastic
• IgG directed against keratinocyte cell surface protein
• occurs just above basal layer
• affects men and women equally
• age of onset 50-60
• more common in Jewish/Mediterranean
• can be found using indirect immunofluorescence or skin biopsy staining

Beofre glucocorticoids, disease was uniformly fatal. Still signigicant morbidity and mortality.

 

Signs and Symptoms

 

 

Pathology

take edge of blister for histology, and para-blister region for immunofluorescence

 

Treatments

Glucocorticoid treatment is tarted early, with good control

 

 

Sweet's Syndrome

Signs and Symptoms

Characteristic eruption of pseudovesicular papules and plaques on face, upper
extremities and trunk with

• Fever
• Neutrophilic infiltrates in skin
• Arthralgias
• Conjunctivitis

 

Pathology

• malignancy most common (20-25%); AML especially
• connective tissue disease
• inflammatory bowel disease
• drugs: estrogens, tetracyclines, lithium

Treatments

 

Toxic Epidermal Necrolysis

Drug-induced.

More than 30% of skin blixyered.

Mortality in TEN

• age over 40

Signs and Symptoms

very painful

sheetlike loss of skin

 

Pathology

genetic predisposition

allopurinol

anticonvulsants: phenytoin, lamotrgine, carbamazepine, phenobarbital

sulfa

NSAIDs

 

Treatments

stop offending drug

IV IgG

 

admit to burn unit

 

 

Resources and References

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