Info
🌱 來自: Huppert’s Notes
Inflammatory and Autoimmune Conditions🚧 施工中
Inflammatory and Autoimmune Conditions
Pyoderma gangrenosum (PG)
• Pathophysiology: Neutrophilic dermatosis; often associated with underlying systemic disease (IBD, RA, malignancy)
• Clinical features: Classically presents as a rapidly expanding ulcer with a purulent base and violaceous overhanging borders; often occurs at sites of prior trauma (+pathergy)
• Treatment: Search for underlying disease, treat with topical/intralesional steroids, oral steroids, oral antineutrophilic agents (dapsone), and wound care
Sweet syndrome
• Pathophysiology: Acute febrile neutrophilic dermatosis; often occurs after an upper respiratory or gastrointestinal infection but can be associated with malignancy (MDS, AML, solid tumor) or GM-CSF
• Clinical features: Presents with high fevers, peripheral neutrophilia, and painful, edematous “juicy” red-violaceous papules on the face, neck, and extremities
• Treatment: Systemic glucocorticoids (should see rapid improvement)
Erythema nodosum (EN)
• Pathophysiology: Panniculitis; can occur due to an underlying condition (Strep spp. infection, oral contraceptive pills, IBD, malignancy, sarcoidosis, pregnancy) but etiology is unknown in ~50% cases
• Clinical features: Presents as an ill-defined, red subcutaneous nodule, often on the lower extremity
• Treatment: Search for underlying condition, treat symptoms with leg elevation and NSAIDs
Dermatomyositis
• Pathophysiology: Autoimmune disease with characteristic skin findings, +/− muscle involvement, and systemic symptoms; skin-limited disease (amyopathic dermatomyositis) in up to 30% of patients
• Clinical features: Presents with violaceous lesions around the eyes (heliotrope sign), on the anterior chest and back (shawl sign), over the finger and hand joints (Gottron’s papules), and lateral hips (holster sign)
• Treatment: Age-appropriate cancer screening, chest imaging to evaluate for ILD, sun protection, topical glucocorticoids, systemic steroids if extensive disease
Cutaneous lupus
• Subtypes:
- Acute cutaneous lupus: Classic sun-exacerbated malar erythema (butterfly rash); spares the nasolabial folds; associated with active systemic disease
- Sub-acute cutaneous lupus: Photo-distributed erythematous plaques on the trunk, back, and extremities; can be annular or look like psoriasis; may be drug-induced (hydrochlorothiazide, PPIs, terbinafine)
- Chronic cutaneous lupus: Most common; well-demarcated erythematous macules and papules on the face, scalp, and extremities that can develop into indurated discoid plaques
• Treatment: Rheumatology involvement if systemic disease, treat skin symptoms with sun protection, topical/intralesional glucocorticoids, hydroxychloroquine, methotrexate