p.3
Xanthomas and Hyperlipidemia
What are the primary causes of Xanthomas?
Genetic mutations affecting enzymes/receptors/ligands, overproduction of lipoproteins, and decreased lipoprotein clearance.
p.5
Xanthomas and Hyperlipidemia
Where are eruptive xanthomas typically located?
Scattered on the buttocks and extensor surfaces.
p.10
Pretibial Myxedema and Thyroid Disease
What are the manifestations of Hyperthyroidism?
Thyroid acropachy, onycholysis, proptosis, increased sweating, warm and moist skin, alopecia.
p.3
Xanthomas and Hyperlipidemia
What are some secondary causes of Xanthomas?
Obesity, alcohol consumption, medications, diabetes, cholestasis, hypothyroidism, nephrotic syndrome, and paraproteinemia.
p.5
Xanthomas and Hyperlipidemia
What type of testing is recommended for patients with xanthomas?
Fasting lipid panel and consideration of lipoprotein subtypes.
p.12
Porphyria Cutanea Tarda
What are common skin manifestations of Porphyria Cutanea Tarda (PCT)?
Blisters, erosions, scars, milia, hyperpigmentation, and hypertrichosis on sun-exposed areas.
p.8
Acanthosis Nigricans and Metabolic Syndrome
What conditions are associated with Acanthosis Nigricans?
Diabetes, obesity, metabolic syndrome, certain medications, and malignancy (e.g., gastric adenocarcinoma).
p.13
Porphyria Cutanea Tarda
What should be considered in patients with blistering or scarring on sun-exposed areas?
The diagnosis of Porphyria Cutanea Tarda (PCT).
p.5
Xanthomas and Hyperlipidemia
Which medications can be associated with eruptive xanthomas?
Retinoids, protease inhibitors, cyclosporine, or prednisone.
p.12
Dermatitis Herpetiformis and Celiac Disease
What should all patients with dermatitis herpetiformis undergo?
A thorough review of symptoms to rule out GI disease.
p.9
Pretibial Myxedema and Thyroid Disease
What treatment options are available for pretibial myxedema?
Treat underlying condition; topical steroids or other options may be considered.
p.8
Acanthosis Nigricans and Metabolic Syndrome
What factors contribute to the pathogenesis of Acanthosis Nigricans?
It is multifactorial, with elevated insulin levels stimulating growth factor receptors on keratinocytes.
p.10
Cushing Syndrome and Skin Manifestations
What causes Cushing Syndrome?
Long-term excess glucocorticoids in the body.
What is the prevalence of diabetic dermopathy in diabetes patients?
Seen in up to 50% of patients.
What are the characteristics of erythema nodosum?
Ill-defined, erythematous, painful, warm nodules on the shins.
What is the treatment for erythema nodosum?
Symptomatic relief with NSAIDs, topical steroids, or colchicine.
p.6
Necrobiosis Lipoidica and Diabetes
What types of medications are used in the treatment of Necrobiosis Lipoidica?
Topical and intralesional steroids, anti-inflammatory medications.
p.5
Xanthomas and Hyperlipidemia
What are typical triglyceride levels in patients with eruptive xanthomas?
Often 3000-4000 mg/dl or higher.
p.12
Porphyria Cutanea Tarda
What are some acquired causes of Porphyria Cutanea Tarda?
Hepatitis C, alcohol use, HIV, liver disease, and iron overload states.
p.13
Porphyria Cutanea Tarda
What associated conditions should be looked for in patients with confirmed PCT?
Iron overload states, hepatitis, and liver disease.
p.3
Xanthomas and Hyperlipidemia
What is the pathogenesis of Xanthomas?
Circulating plasma lipoproteins permeate through dermal capillary blood vessels and are phagocytosed by macrophages, leading to the accumulation of lipid-laden macrophages (foam cells) in the dermis.
p.5
Xanthomas and Hyperlipidemia
What are the characteristics of eruptive xanthomas?
Small yellow/orange or red/brown papules that present abruptly.
p.8
Acanthosis Nigricans and Metabolic Syndrome
What are the characteristics of Acanthosis Nigricans?
Hyperpigmented velvety plaques in intertriginous sites.
p.8
Acanthosis Nigricans and Metabolic Syndrome
What skin changes occur in Acanthosis Nigricans?
Epidermal proliferation and hyperkeratosis, leading to darkening and thickening of the skin.
p.10
Cushing Syndrome and Skin Manifestations
What are some causes of Cushing Syndrome?
Iatrogenic, endogenous, Cushing disease, ectopic ACTH secretion, adrenal tumors.
p.13
Dermatologic Manifestations of Liver Cirrhosis
What are Terry's nails?
Nails with a white hue, obliteration of the nail lunula, and a red band at the distal nail.
p.11
Cushing Syndrome and Skin Manifestations
What type of infections are common in patients with Cushing syndrome?
Cutaneous infections, including tinea versicolor, dermatophytosis, onychomycosis, and candidiasis.
p.6
Necrobiosis Lipoidica and Diabetes
What are the characteristics of Necrobiosis Lipoidica (NL) plaques?
Well circumscribed, atrophic, waxy yellow/brown plaques with an erythematous rim.
p.3
Xanthomas and Hyperlipidemia
What can Xanthomas indicate?
They can be a sign of hyperlipidemia.
p.2
Cushing Syndrome and Skin Manifestations
What are some causes of secondary skin pathology?
Deposition of metabolites, alterations from growth factors, and reaction patterns of inflammation.
p.9
Pretibial Myxedema and Thyroid Disease
What appearance can the skin have in pretibial myxedema?
Peau d’orange (orange peel) appearance.
p.10
Pretibial Myxedema and Thyroid Disease
What are common hair and nail issues in Hypothyroidism?
Brittle hair and nails, alopecia of the lateral eyebrows.
p.13
Dermatologic Manifestations of Liver Cirrhosis
What skin changes are associated with liver cirrhosis?
Spider angiomas and telangiectasias.
p.11
Dermatitis Herpetiformis and Celiac Disease
What is Dermatitis Herpetiformis associated with?
Gluten sensitivity and celiac disease.
What infections are associated with erythema nodosum?
Strep, TB, coccidiomycosis, and histoplasmosis.
p.4
Xanthomas and Hyperlipidemia
What does the presence of plane xanthomas on the palms suggest?
Familial dysbetalipoproteinemia.
p.2
Cushing Syndrome and Skin Manifestations
What can skin findings indicate?
Signs of systemic diseases.
p.9
Pretibial Myxedema and Thyroid Disease
What is the pathogenesis of pretibial myxedema?
Unclear, but involves cutaneous infiltration of mucin in the dermis.
p.10
Pretibial Myxedema and Thyroid Disease
What is thyroid acropachy?
Clubbing and deformity of the fingers.
p.10
Pretibial Myxedema and Thyroid Disease
What is macroglossia?
Enlargement of the tongue, associated with severe hypothyroidism.
p.10
Cushing Syndrome and Skin Manifestations
What are common symptoms of Cushing Syndrome?
Hypertension, myopathy, osteopenia/osteoporosis, psychiatric disturbances, hyperglycemia, menstrual irregularities, weight gain.
p.13
Dermatologic Manifestations of Liver Cirrhosis
What hair changes may occur in patients with liver cirrhosis?
Sparse axillary, pubic, and pectoral hair.
p.11
Cushing Syndrome and Skin Manifestations
What are common skin findings in Cushing syndrome?
Altered subcutaneous fat distribution, rounded facies, fullness of the cheeks, dorsal cervical fat deposition, pelvic girdle fat deposition, skin atrophy, multiple striae, purpura, cutaneous infections, acne, and hirsutism.
p.11
Dermatitis Herpetiformis and Celiac Disease
What diagnostic method is used for Dermatitis Herpetiformis?
Skin biopsy for histology and direct immunofluorescence (DIF).
How is erythema nodosum diagnosed?
Clinical diagnosis, but skin biopsy can confirm the diagnosis.
p.4
Xanthomas and Hyperlipidemia
What do interdigit plane xanthomas suggest?
Homozygous familial hypercholesterolemia.
p.5
Xanthomas and Hyperlipidemia
What is the primary treatment approach for eruptive xanthomas?
Treat the underlying disease.
p.12
Porphyria Cutanea Tarda
What is the pathogenesis of Porphyria Cutanea Tarda?
Abnormalities in heme biosynthesis lead to abnormal porphyrin metabolism and accumulation, activated by UV light causing local damage.
What are the characteristics of diabetic dermopathy?
Erythematous to reddish/brown macules that progress to hyperpigmented atrophic macules on the shins.
p.10
Pretibial Myxedema and Thyroid Disease
What leads to myxedema in severe hypothyroidism?
Decreased thyroid hormones lead to impaired degradation of mucin and mucin deposition in the skin.
p.13
Dermatologic Manifestations of Liver Cirrhosis
What type of edema may be present in liver cirrhosis?
Edema of the abdomen or lower extremities.
p.7
Necrobiosis Lipoidica and Diabetes
In which patients is necrobiosis lipoidica more common?
More common in patients with retinal, neuropathic, or nephrogenic complications of diabetes.
How long does erythema nodosum typically last?
3-6 weeks, and it spontaneously regresses without scarring.
What should be evaluated in patients with erythema nodosum?
Associated conditions through further testing based on ROS.
p.4
Xanthomas and Hyperlipidemia
What is a significant health risk associated with plane xanthomas?
Independent risk factor for atherosclerosis.
p.6
Necrobiosis Lipoidica and Diabetes
What should all patients with Necrobiosis Lipoidica be evaluated for?
Diabetes and its complications.
p.4
Xanthomas and Hyperlipidemia
What is the most common condition associated with tuberous xanthomas?
Familial dysbetalipoproteinemia.
p.3
Xanthomas and Hyperlipidemia
What are Xanthomas?
Smooth yellow or orange papules and plaques on the skin.
p.9
Pretibial Myxedema and Thyroid Disease
What is the primary characteristic of pretibial myxedema?
Nonpitting edema of the shins with overlying pink/red or yellow/brown papules or plaques.
p.9
Pretibial Myxedema and Thyroid Disease
What should all patients with suspected pretibial myxedema be evaluated for?
Underlying thyroid disease.
p.12
Porphyria Cutanea Tarda
How is Porphyria Cutanea Tarda diagnosed?
By testing for plasma or urine total porphyrins.
At what age is diabetic dermopathy typically seen?
Typically seen in patients in their 50s.
p.7
Necrobiosis Lipoidica and Diabetes
What is necrobiosis lipoidica associated with?
Can have associated pain, pruritus, or dysesthesia.
What symptoms can accompany erythema nodosum?
Patients can have associated arthralgias.
p.4
Xanthomas and Hyperlipidemia
What are the characteristics of plane xanthomas?
Yellow or orange thin plaques that tend to occur in the 4th or 5th decade of life.
p.6
Necrobiosis Lipoidica and Diabetes
Does treating diabetes affect Necrobiosis Lipoidica?
No, treating diabetes does not treat NL.
p.4
Xanthomas and Hyperlipidemia
What are tendinous xanthomas?
Smooth firm nodules over the extensor tendons.
p.12
Porphyria Cutanea Tarda
What are some treatment options for Porphyria Cutanea Tarda?
Sun protection, phlebotomy, hydroxychloroquine, and treatment of underlying disease.
p.8
Acanthosis Nigricans and Metabolic Syndrome
What action should be taken if Acanthosis Nigricans is sudden onset or extensive?
Perform a thorough review of systems and consider evaluating for malignancy.
What is the suspected pathogenesis of diabetic dermopathy?
Thought to be from microangiopathy or trauma.
p.7
Necrobiosis Lipoidica and Diabetes
What are the characteristics of necrobiosis lipoidica?
Red/brown with yellow hue, prominent telangiectasias, and erosions/ulcerations.
p.11
Dermatitis Herpetiformis and Celiac Disease
What are the skin manifestations of Dermatitis Herpetiformis?
Pruritic vesicles and papules arranged on extensor surfaces with symmetric distribution.
What is the underlying condition associated with erythema nodosum?
Panniculitis (inflammation of the subcutaneous fat).
p.6
Necrobiosis Lipoidica and Diabetes
What complications from diabetes are patients with Necrobiosis Lipoidica at higher risk for?
Peripheral neuropathy, retinopathy, and nephropathy.
p.4
Xanthomas and Hyperlipidemia
What is the most common cause of tendinous xanthomas?
Familial hypercholesterolemia.
What should all patients with diabetic dermopathy be evaluated for?
Diabetes and complications of diabetes.
p.7
Necrobiosis Lipoidica and Diabetes
What is the prevalence of necrobiosis lipoidica in diabetes patients?
Approximately 0.3% of DM patients.
p.11
Dermatitis Herpetiformis and Celiac Disease
What is the pathogenesis of Dermatitis Herpetiformis?
Deposition of IgA immune complexes in the papillary dermis.
What are some non-infectious conditions associated with erythema nodosum?
Pregnancy, medications (particularly OCPs), sarcoidosis, IBD, connective tissue disease, and malignancy (lymphoma or leukemia).
p.11
Dermatitis Herpetiformis and Celiac Disease
What serologic tests are used for diagnosing Dermatitis Herpetiformis?
Anti-Transglutaminase-3, total IgA, anti-TG2 IgA, and anti-endomysial IgA.
What tests should be conducted for patients with erythema nodosum?
CBC, throat culture, ASO titer, pregnancy testing, and CXR.
p.4
Xanthomas and Hyperlipidemia
What is the treatment focus for xanthomas?
Focus on the underlying disorder.
