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welcome. Patient itch/ Itchy Rash-2. Prof. DOULAT RAI BAJAJ Professor & Chairman Dept. of Dermatology. Goals of Presentation. At the end of presentation you would be able to: Identify the skin manifestations in a patient who may have known or unknown underlying systemic disease.

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  1. welcome

  2. Patient itch/Itchy Rash-2 Prof. DOULAT RAI BAJAJ Professor & Chairman Dept. of Dermatology

  3. Goals of Presentation At the end of presentation you would be able to: • Identify the skin manifestations in a patient who may have known or unknown underlying systemic disease. • Manage it in concern with systemic disease

  4. Diabetes Mellitus

  5. Diabetes Mellitus • It is a clinical syndrome, characterized by: • Chronic hyperglycemia, glycosuria • Disturbance in CHO, protein, & lipid metabolism • Result from lack of insulin(partial or absolute), receptor insensitivity to insulin

  6. Cutaneous Manifestations • Skin disorders due to Micro- or macroangiopathy • Specific cutaneous disorders • Cutaneous Infections: bacterial, viral, parasitic, fungal etc • Skin disorders due to medication, Insulin therapy

  7. Macroangiopathy related Skin Ds • skin atrophy • hair loss • Cold Extremities • nail dystrophy • Pallor upon elevation, and mottlingon dependence

  8. Micro-angiopathy Related Skin Ds Microangiopathy results into: retinopathy, nephropathy, neuropathy & dermopathy. Skin Ds include: • Diabetic Dermopathy (Diabetic Shin spots) • Erysipelas-like erythemy • Diabetic Rubeosis • PeriungualTelangiectasia

  9. Dermopathy This is most common dermatosis associated • Lesions oval, dull red papules 0.5-1 cm. • Shins, forearms, thighs & over bony prominences • Lesions evolves producing superficial scale & healing with atrophic brownish scar. • R/: Topical steroids Anti histamines

  10. ERYSIPELAS LIKE ERYTHEMA • Dull erythematous plaques on legs feet, well demarcated.

  11. DIABETIC RUBEOSIS • - Occurs in long standing disease • Rosy reddening of face, sometimes of hands, feet.

  12. PERIUNGUAL TELANGIECTASIA The nail fold is an excellent site for viewing functional and structural changes in the microvascular of the skin.

  13. DIABETIC FOOT • An umbrella term for various foot problems seen in diabetics. • Multiple factors involved in pathogenesis: e.g. micro-angiopathy, macro-angiopathy neuropathy as well as a tendency to delayed wound healing, infection or gangrene of the foot is relatively common.

  14. CUTANEOUS INFECTION IN DIABETES • - Furuncle and carbuncle • Non Clostridial gas gangrene: Mixed anaerobic and aerobic organisms (E. Coli, Pseudom. Klebsella, bacteriodes)produce gas with foul odor. • Candida Infections • Phycomycetes Infections • - Dermatophytosis

  15. CANDIDA INFECTIONS - Yeast infections are common in diabetic patients. Yeast infections may even be the presenting manifestation of diabetes - Involvement of the glans & vulva are common. - Vaginal candidiasis:almost universal among women with long term diabetes. - Angular stomatitisdue to Candida is a classic complication in diabetic children. Result from Increased concentrations of salivary glucose

  16. Candidal Vulvovaginitis

  17. ANGULAR STOMATITIS

  18. SPECIFIC SKIN DISORDERS Necrobiosis lipoidica granuloma annulare Scleredema acanthosis nigricans skin tags vitiligo diabetic bullae eruptive xanthoma finger pebbles perforating dermatosis

  19. NECROBIOSIS LIPOIDICA • Sharply demarcated plaques of atrophic yellow skin, which may ulcerate. • Female ˃ males • Common site shins, but may occur on face, limbs, trunk

  20. NLD

  21. GRANULOMA ANNULARE • characterized by skin coloured papules occurring in a ring configuration. • Do not itch. • Common sites: dorsa of hands and feet. May occur on wrists, arms trunk. • Association with diabetes inconclusive

  22. Diabetic bullae

  23. SCLEREDEMA - Seen mainly in over weight Type-1 diabetes. - Characterized by a non-pitting woody induration of the skin with occasional erythema. - Occurs mostly commonly over the back. - No specific treatment, may try methotrexate and cyclosporin.

  24. ERUPTIVE XANTHOMAS • - Lesions typically erupt as crops of small, red-yellow papules • Most commonly over buttocks, shoulders, arms & legs but may occur anywhere. • Hypertriglyceridemia

  25. Acanthosis Nigricans

  26. Skin Tags

  27. Skin disorders due to medication Insulin therapy - Bruising - lumps (lipodystrophy) - Subcutaneous fat deposition (lipohypertrophy) - Subcutaneous Fat loss (lipoatrophy) - Erythema, Infections.

  28. Liver Disease

  29. 1.Pruritus 10.Gynaecomastia 2.Jaundice 11.Clubbing 3.Erythema nodosum 4.Erythema multiforme 5.Lichen planus 6.Cryoglobulinemia 7.Porphyria cutanea tarda 8.Spider naevi 9.Palmer erythema

  30. PRURITUS IN LIVER DISEASE • CAUSES : Primary biliary cirrhosis, Cirrhosis Autoimmune hepatitis, Viral: B & C • Mechanism • Exact mechanism is not clear • Most probably due to presence of bile salts in the skin and release of mast cell mediators • Treatment: treat underlying cause. May use URSODEOXYCHOLIC ACID 10-15mg/kg • CHOLESTRYMINE 4-16g/day, Rifampicin, Ultraviolet rays, Opoid antagonists(naloxone)

  31. JAUNDICE • Yellow pigmentation of skin,sclerae and mucosa due to raised bilirubin level • Clinically jaundice appears when bilirubin level Rises above 3mg/dl

  32. ERYTHEMA NODOSUM • Painful,red,raised lesions on shin (may also on thighs or arms) • May be single or multiple • MALAISE, FEVER, arthralgias • Treatment : treat underlying cause • Nsaids • Saturated potassium iodide solution , 5-15 drops three times daily • Bed rest

  33. ERYTHEMA MULTIFORME • Erythematous circular lesions with target appearance. • lesions may be urticaria-like or sometimes bullous

  34. CRYOGLOBULINAEMIA • Cryoglobulins are circulating immunoglobulins that precipitate out in cold. Three types( i , ii and iii ) • It is traid of skin, renal and joint disease • Pathogenesis unknown. May be Ag-Ab mediated. • Manifested by: palpable purpura over the lower extremities, arthralgia, Raynaud’s phenomenon & neuropathy. • For hcv-positive patients,interferon –alpha and ribavirin is treatment of choice.

  35. PORPHYRIA CUTANAE TARDA • Due to over production of porphyrin • Characterized by vesicles, blisters and milia on the dorsal surfaces of hands • Confirmed by elevated elevated porphyrins and their precursors in urine and faeces.

  36. SPIDER ANGIOMA(NAEVI) • Small angiomata appear on the surface of the skin. • Common sites are face ,neck,upper part of trunk and arms. • Size vary from a pinhead to 0.5 cm in diameter

  37. PALMER ERYTHEMA • Reddening of the skin of palms especially over thenar & hypothenar eminences. • Can involves soles of feet , where it is termed planter erythema

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