is it only skin deep? dermatologic evidence of systemic disease maj amanda cuda , md 7 sept 2011

Is it Only Skin Deep?Dermatologic Evidence of Systemic

Disease

MAJ Amanda Cuda, MD

7 Sept 2011

Objectives

• To review the dermatologic exam, including hair and nails

• To learn dermatologic conditions and their systemic associations

• To identify these same conditions and associations from photographs

Dermatologic Exam

• Break up into pairs:–Examine your partner’s hands and

fingers only, include fingernails–Document exam using medical terms–Present exam to your partner

Dermatologic Exam:Patient seated• Inspect the hair

–Pattern of distribution and texture• Inspect nail beds• Inspect nails for clubbing, pitting• Inspect skin of face and neck• Inspect skin over back

Dermatologic Exam: Patient lying • Inspect skin of chest• Inspect skin of abdomen• Inspect skin of lower extremities

Systemic Conditions

• Skin wellness = overall wellness• Many manifestations, many conditions

Systemic Conditions

• View photo of a skin manifestation• Write 3 descriptive exam findings• Identify systemic condition(s)

Beau’s Lines

Onycholysis

Acanthosis Nigricans

Café au Lait Spots

Erythema Multiforme

Telangiectasia

Butterfly Rash

Heliotrope rash

Viral Exanthems

Viral Exanthems con’t

Purpura

Which of these skin findings can be normal?

A. Acanthosis nigricansB. Palpable purpuraC. Heliotrope rashD. Café au Lait macule

[Default][MC Any][MC All]

Which of the following is not a cause of this nail finding?

A. Diabetes MellitusB. PsoriasisC. ThyrotoxicosisD. Trauma

[Default][MC Any][MC All]

All of the following are manifestations of an underlying vasculitis except:

A. Acanthosis nigricansB. Erythema multiformeC. PurpuraD. Telangiectasia

[Default][MC Any][MC All]

Possible cause of this nail finding?A. Kawasaki DiseaseB. Telogen EffluviumC. Scarlet FeverD. All of the above

[Default][MC Any][MC All]

Which of the following, pictured here, was known as Sixth Disease?

A. RubellaB. MeaslesC. RoseolaD. Scarlet Fever

[Default][MC Any][MC All]

Clinic Challenge

• Derm exam, hair and nails included, • 1 patient/day for 1 week

Conclusion

• Reviewed dermatologic exam• Learned dermatologic conditions

and their systemic associations• Identified these conditions on photo

quiz

Questions?

References• DeGowin RL, Brown DD. DeGowin’s Diagnostic

Examination, Seventh Edition.• Fitzpatrick TB, Johnson RA, Wolff K, Suurmond D. Color

Atlas and Synopsis of Clinical Dermatology, Fourth Edition.• Habif TP etal. Skin Diseases Diagnosis and Treatment,

Second edition.• www.dermnet.com• http://en.wikipedia.org/wiki• http://www.myfootshop.com/• www.mdconsult.com• http://health.allrefer.com• http://www.clevelandclinicmeded.com• http://dermatlas.med.jhmi.edu• http://emedicine.medscape.com