CUTANEOUS MEDICINE LECTURE 2

Tom Paige

Department of Dermatology

CCRMC

Music Series

• Name the composer

• Name the piece

Best Answer Is ???

• A. Patient has scabies• B. Classic case of atopic dermatitis• C. Need to have patient seen by Dr. Reif in

GI• D. Biopsy for direct immunofluorescense

would not be helpful in making the diagnosis • E. None of the above

Dermatitis herpetiformis

Dermatitis Herpetiformis• Dermatitis herpetiformis (DH), or Duhring’s

disease, is characterized by – Grouped, pruritic, erythematous, papulovesicles– Located on the extensor surfaces of body

• Skin biopsy reveals– Neutrophils in the dermal papilla

• DIF of perilesional skin shows– Granular deposition of IGA in the dermal papillary tips

Microscopic findings

Facts about DH

• Virtually all patients with DH have gluten-sensitive enteropathy of small bowel biopsy.

• Only 25% of patients with DH have GI symptoms

• The skin disease and GI symptoms when present improve with a gluten restrictive diet

Other associated diseases

• Thyroid disorders have been reported in DH patients– Hypo and hyperthyroidism, thyroid nodules,

and asymptomatic goiters

• 4% of DH patients develop lymphomas– A gluten free diet may prevent the development

of lymphomas

Best Answer Is ????

• A. Child has a candida albicans infection• B. Needs to be placed on fluconazole for the

yeast infection after failing nystatin lotion • C. Laboratory testing would show a low

alkaline phosphatase level in the blood.• D. Answers (A.) and (B.)• E. None of the above

Malabsorption

Zinc deficiency• Genetic: ADE• Dietary deficiency• Excessive alcohol consumption• Malabsorption• IBD• Anorexia nervosa• Acquired immunodeficiency syndrome• Prolonged diarrhea• Total parenteral nutrition• Chelating agents (penicillamine)• Chronic renal disease• Pediatric “short bowel syndrome”

Choose the best answer

• A. The leg ulcer is caused by a brown recluse spider bite (loxsocles reclusans)

• B. The patient needs to see a rheumatologist

• C. A GI workup is indicated • D. The three slides are not caused by

one disease.

Inflammatory bowel disease

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Peutz Jeghers syndrome

• Rare inherited disease characterized by– Gastrointestinal polyps– Associated pigmentation of skin and mucous

membranes

• The risk of developing some form of internal cancer is 15 times greater for PJS than the general population

Gardner’s syndrome

• Synonym = Familial polyposis of the colon• Key features• Autosomal dominant disorder w/

premalignant polyposis and adenocarcinoma of the GI tract

• Tumors and cysts of the skin, mesentary, and retroperitoneum

• CHRPE• Mutations of the APC gene

Birt-Hogg-Dube Syndrome

• Classic triad– Fibrofolliculomas– Trichodiscomas– Acrochordon-like lesions

• Predisposition to develop renal tumors

• Tendency for spontaneous pneumothoraces

Gastrointestinal Disease

• Gluten sensitive enteropathy• Malabsorption• Inflammatory bowel disease• Peutz Jeghers syndrome• Gardner’s syndrome• Birt-Hogg-Dube syndrome

Renal disease

• Pruritis

• Nodular prurigo

• Calcinosis and calciphylaxsis

• Perforating collagenosis

• Porphyria cutanea tarda and pseudoporphyria

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