View
227
Download
0
Category
Preview:
Citation preview
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 1/146
SKIN MANIFESTATIONS OF
SYSTEMIC DISEASES
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 2/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 3/146
Gro!ed in "arios ways
#$ %y disease &ate'ory e$'$ &an&ers ( s)in
II$ %y or'an system in"ol"ement e$'$ s)in ( 't
III$ %y !at*o'eni& me&*anisms e$'$ &olla'en
"as&lar disease
I+$ On ,asis o- &*ara&teristi& .rea&tion !attern/ e$'$
Eryt*ema nodosm
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 4/146
%y disease &ate'ory
SKIN C0ANGE 1NDE23YING CANCE2
A&ant*osis ni'ri&ans Adeno Ca stoma&*4
ln'4o"ary4!an&reas4&olon
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 5/146
Acanthosis Nigricans
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 6/146
ACANTHOSIS NIGRICANS
characterized by
symmetric, velvety toverrucous,
hyperkeratotic adhyperpi!meted
pla"ues #ith apredilectio $or the
a%illae, ape ad other&e%ural areas'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 7/146
SKIN CHANGE UNDERLYINGCANCER
Dermatomyositis NPC, Ca breast,lung et
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 8/146
Dermatomyositis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 9/146
SKIN CHANGE UNDERLYINGCANCER
Eryt!ema Ca breast"er#i$"tongue"
gyratum !y%o%!aryn$re%ens
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 10/146
Erythema
gyratum repens
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 11/146
Nerolyti &igratory Eryt!ema 'N&E(
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 12/146
SKIN CHANGE UNDERLYING
CANCER
A)uire* i!t!yosis Lym%!omas,soli* organ tumours
Generalise* %ruritus Lym%!omas,Ca stoma!, lung
Eryt!ro*erma Lym%!omas, Soli*organ tumours
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 13/146
SKIN CHANGE UNDERLYINGCANCER
N&E 'nerolyti Gluagonomamigratory 'islet ell tumor(eryt!ema
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 14/146
Icthyosis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 15/146
Erythroderma
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 16/146
SKIN CHANGE UNDERLYINGCANCER
Pa!y*ermo%eriostitis Ca lung,uterus, bron!ietasis
lung absess
+oen-s 'une$%ose*( S)uamous
ell arinoma
Her%es .oster
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 17/146
Can&ers ( S)in
3ym!*omas53e)aemias5Myeloma
a$ S!e&i-i& in-iltrates
,$ Non6s!e&i-i& *er!es
!i'mentation
!rrits!r!ra
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 18/146
Geneti syn*romes
/0 Palmo%lantar Ca oeso%!agus1erato*erma
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 19/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 20/146
Geetic sydromePeut.23eg!ers &alignanttrans4ormation
syn*rome o4 %oly%s o4 smallguts
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 21/146
Peutz –Jegher syndrome
enet syn rome Un er y ng
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 22/146
enet syn rome Un er y ngCaner
Gar*ner-s syn*rome So4ttumours,osteomas,%oly%
Dermatitis !er%eti4ormis Lym%!oma gut
Seborr!oei arts 'multi%le 5Leser 6relat 5 signeru%ti#e(
Hy%er%igmentation '&SH, Cus!ings, Ca t!ymus,lung
AC6H2li1e %e%ti*es( %anreas &igratory t!rombo%!lebitis Ca %anreas,
laryn$, t!yroi*,breast, lung, stoma!, olon
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 23/146
Eruptive seborrhoeic keratosis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 24/146
n en o&r ne me a o & sease
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 25/146
n en o&r ne me a o & sease
Diabetes mellitus
Adrenal disease Cs*in'/s4 Addison/s disease
3i!ids 7ant*omas
T*yroid disease *y!er ( *y!ot*yroidism
8or!*yrias 8CT4 E884 CE8
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 26/146
DIA+E6ES &ELLI6US () is a !roup o$ metabolic disorders
characterized by chroic hyper!lycaemiadue to relative isuli de*ciecy,resistace or both'
Associated #ith disturbaces o$carbohydrate ad lipid metabolism'
It is commo ad a+ects app%' - milliopeople #orld#ide'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 27/146
I .//0, the Natioal Cardiovascular Risk1actor 2revalece Study i )alaysiasho#ed that 3'34 o$ the adult populatiosu+er $rom ()'
/04 have type 56 ()
Commo amo! all ethic !roupsespecially Idias'
At least - 4 o$ diabetics have cutaeousivolvemet duri! the course o$ thedisease'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 28/146
Cutaeous )ai$estatios o$ (iabetes
)ellitus
Classi7e* into 8 ategories9
Cutaneous *iseases assoiate* it!*iabetes mellitus0
Cutaneous in4etions
Cutaneous mani4estations o4 *iabetiom%liations
S1in reations to *iabeti treatment0
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 29/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 30/146
N7CRO8IOSIS 9I2OI(ICA (IA87TICOR:)
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 31/146
N9(;a%y,ta pla"ue o shi'
Tela!iectatic atrophic
cetre'
Solitary or multiple'
<045/-4 o lo#er
e%tremities, especiallypretibial areas'
;he N9( occurs i areas
other tha the le!s, it isless commoly associated#ith ()'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 32/146
DIA+E6IC:RU&
'NLD(
:nly ;0<= o4 all %atients it! D& ill!a#e NLD0Muller SA. Mayo Clin proc 1966
>;= !a#e D& an* anot!er ?;=s!oe* gluose intolerane or a%ositi#e 4amily !istory0
Muller Sa. Arch Derm 1966
&9@ ratio /9<
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 33/146
NECR:+I:SIS LIP:IDICA DIA+E6IC:RU&
'NLD(
<r* an* 8t! *ea*e o4 li4e0
Assoiate* it! bot! IDD& an*
NIDD&
It is in*e%en*ent o4 %atients
glyaemi ontrol0
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 34/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 35/146
TR7AT)7NT
Hi!h5 potecy topical steroids to the activemar!is may arrest the pro!ressio'
Others = aspiri, dipyrimadole
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 36/146
(iabetic(ermopathy
2atho!eesis =
uko# Treatmet =oe
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 37/146
(IA87TIC
(7R)O2ATH>
hyperpi!metedor atrophic
macules o theshis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 38/146
(IA87TIC(7R)O2ATH>
?shi spots@'
1oud i -5
-4'
Atrophic,hyper
pi!meted,ovalBroud areas
distributedbilaterally but
otsymmetrically'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 39/146
(iabetic(ermopathy'
Histolo!y=
7arly lesios = oedemao$ papillary
dermis,e%travasatedR8Cs ad mild
lymphocytic i*ltrate'Older lesios = Thick#alled capillaries i
papillary dermis ade%travasated R8Cs
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 40/146
G2AN13OMA
ANN13A2E
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 41/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 42/146
(iabetic Thick Ski
1orms = Scleroderma5 like sydrome Geeralized thick ski
Sclerederma adultorum o$ 8uschke
Scleredema adultorum o$ (iabetes )ellitus
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 43/146
Scleredema adultorum o$ (iabetes )ellitus
C!arateri.e* by mar1e* inrease in *ermal t!i1nesso#er u%%er ba1 an* u%%er ne1 in mi**le2age*,o#ereig!t, %oorly ontrolle* ty%e2// *iabeti0
?0= in %atients it! ty%e2// *iabetis0
Lierbeman et al re%orte* *erease s1in t!i1ness it!tig!t bloo* sugar ontrol an* insulin a*ministration0
No 1non treatment 4or *iabeti slere*erma0
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 44/146
Knuckle pebblesThickening of the skin
on the dorsum of thehand can be due tomany causes, includingDM. with pebbling ofthe skin on the knucklearea.30% of diabetics hae
hand skin thickening.!igni"cance#$iterature suggeststhat digital sclerosis is
a marker for retinal
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 45/146
Adult oset diabeticsmay have
spotaeous oset o$multiple bullae olo#er e%tremities'
These lesios may otsecodary to trauma
or i$ectio'
Spotaeous heali!occurs #ithi 650
#eeks'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 46/146
(iabetic 8ullae types=
S%ontaneous an* non2sarring ty%e9 5 commoest, heals spotaeously #ithi 650 #eeks 5 itraepidermal cleava!e #ithout acatholysis'
Haemorr!agi an* !eals it! atro%!i sarring9 5 cleava!e belo# (7 ad destructio o$ achori! *brils
&ulti%le ten*er nonsarring blisters in sun2e$%ose* an* *ee%ly tanne* s1in 9
5 cleava!e plae at lamia lucida
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 47/146
(iabetic 8ullae'
Clear Bui*27lle* bullae
on t!e
*istal /"<r*me*ialsur4ae o4
le4t LL0
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 48/146
Sydrome o$ Isuli
Resistace Acathosis
i!ricas
> ll N il
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 49/146
>ello# Nails(iabetics ted to have yello# ails'Lithner et al.Acta Med Scand
200.1976
Ca occur i all ails but esp' o the distal ed o$ the ail o$
the hallu%'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 50/146
Salt an* %e%%er!y%er%ig2mentation
on s!ins it! noatro%!y
Common in el*erly
*iabetis0
Due to R+Ce$tra#asation in
su%er7ial %le$us0'Cayenne %e%%er
s%ots(
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 51/146
Er!ti"e 7ant*omas
3i!id a,normality6Ty!e #
• in&rease in TG5+3D34 'ly&osria
and *y!er'ly&aemia$
• sdden onset o- &ro!s o-
non!rriti&4 nontender4 -irm
yellow !a!les4ea&* wit* an
eryt*ematos rim$
• e9tensor sr-a&es6)nees4
el,ows4 ,a&)4,tto&)s and
trn)$
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 52/146
Eru%ti#e ant!omas
9esios resolve#he CHO ad lipidmetabolismcotrolled'
H27 = lipid lade
histiocytes admi%ed lympho5eutrophilici&ammatory
i*ltrate i dermis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 53/146
DyrleEs
(isease=
a ucommo
*di! i patiet oreal dialysis'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 54/146
Kyrle-s *isease
•
Reactive per$orati!colla!eosis
• characterised byhyperkeratotic $ollicular
ad peri$ollicular papules
• Trasepidermal
elimiatio o$ dermalmaterial that may
represets altered colla!e
DIA+E6IC NEUR:PA6HY
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 55/146
DIA+E6IC NEUR:PA6HY
(istal symmetrical europathy #ith mi%ed motor ad sesory erve ivolvemet'
dorsallysublueddigits,distally
displacedplantar fatpads,depressedmetatarsal
heads,hammertoesand pes caus.
& painless and
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 56/146
Ga!ree i
(iabetes'Hyper!lycaemia
ca allo# usuallyopatho!eic
or!aisms to
establish ai$ectio i
traumatized ski'Occasioally
resulti! i!a!ree adloss o$ limbs'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 57/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 58/146
Chroic cadidiasis o$ the *!erails'
Althou!h dystrophic ails are o$tethou!ht to be the result o$ dermatophyte
i$ectio, ail plate cultures sho#Cadida species i 04 o$ the time'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 59/146
1at hypertrophysecodary to repeated
isuli iFectio'
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 60/146
T*yroid disease
0y!ot*yroidism 0y!ert*yroidism
S)in 6 &old4 dry4 t*i&)ened4 s&aly sweaty4 miliaria
0air 6 di--se alo!e&ia4 t*i&)4 &oarse di--se alo!e&ia5-ine5so-t
Generalised !rrits 'eneralised !rrits
Carotenemia !i'mentation4
melasma4 "itili'oOny&*olysis1rti&aria8reti,ial my9oedemaa&ro!a&*y
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 61/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 62/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 63/146
%y or'an system in"ol"ement
#$ S)in ( 't
:$ S)in ( )idney
;$ S)in ( li"er
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 64/146
#$ S)in ( t*e 't
GI ,leedin' 0eno&* s&*onlein !r!ra40ereditary *aemorr*a'i&
telan'ie&tasia
8oly!osis 8et<6=e'*er/s4 Gardner/s4Cron)*ite6Canada syndromes
3i"er &irr*osis Wilson/s disease4 8rimary ,iliary&irr*osis4 0aema&*romatosis
2etro!eritoneal 8an&reatitis > !erim,ili&al ,risin'0aemorr*a'e ?Cllen/s si'n@
6 -lan) ,risin' ? Grey Trner/s si'n@
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 65/146
Hereditary Haemorrhagic Telangiectasia
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 66/146
:$ S)in ( t*e )idney
2enal Failre
7erosis4 rea -rost
8i'mentation -a&e4 *ands
Generalised !rrits
8r!ra
Gynae&omastia
S1i
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 67/146
S1in
/0 S1in mani4estations o4 li#er *iseases
?0 Li#er abnormalities ause* by s1in*iseases
<0 +ot! s1in li#er in#ol#e* in samesystemi *isease
80 He%atoto$iity o4 *ermatologial *rugs ora*#erse utaneous reations to *rugsuse* 4or li#er *iseases
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 68/146
S1in &ani4estations o4 Li#erDiseases
audice 2ruritus 2i!metary cha!es ascular cha!es 2urpura Nail cha!es athomas (upuytreEs cotracture
Hormoal e+ects
iral Hepatitis ?A,8,C@ 2orphyrias ?2CT@ Alcoholic liver disease )ali!at carcioid
sydrome ?&ushi!@ Necrolytic mi!ratory
erythema ?N)7@ Alpha5. atitrypsi
de*ciecy ?paiculitis@ Autoimmue
hepatitis?AIH@
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 69/146
8almer Eryt*ema S!ider Telan'ie&tasia
Terry/s ?w*ite@ NailsKayser6 Fleis&*er rin'
iral He%atitis t!e S1in
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 70/146
iral He%atitis t!e S1in
He%atitis A He%atitis +He%atitis C
3aun*ie F Polyarteritis no*osa F &i$e*CroyoglobulinemiaUrtiaria F Pa%ular aro*ermatitis F Por%!yria'PC6 (
E$ant! ras! o4 !il*!oo* 'PAC( FLeuoyto#asulitis #asulitis Cut #asulitis Serum si1ness2li1e F Li!en
%lanusCryoglobulinemia syn*rome Polyarteritis
no*osa
Eryt!ema no*osum Sogren-ssyn*romeUrtiaria +e!!t-s
syn*rome&i$e* ryglobulinemia Nerolyti
migratory
eryt!ema2
Polyarteritis No*osa ' PAN ( H+
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 71/146
Polyarteritis No*osa ' PAN ( H+
:p to 0-4 o$ people #ith 2AN are H8sA! ve
.- J 6-4 have cutaeous ivolvemet
9esios iclude = palpable purpuravasculitic ulcersteder odules
livedo reticularisurticaria B a!ioedemadistal !a!ree
No correlatio #ith severity o$ liver ivolvemet
Treatmet iclude = corticosteroids, immuosuppressives
?cyclophosphamide@, cyclospori, plasma e%cha!e
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 72/146
S1in in Polyarteritis No*osa 'PAN(
3i"ido reti&laris
+as&litis &asin' s)in in-ar&tion
3e&o&yto&lasti& "as&litis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 73/146
S1in in Polyarteritis No*osa 'PAN(
To!i&al Cy&los!orin Treatment
8yoderma Gan'renosm6
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 74/146
Pa%ular Aro*ermatitis o4 C!il*!oo* '!ianotti Cro"ti Syn#rome( H+
Childre 65 years
Cliical $eatures = o relapsi! papular dermatitis
$ace ad limbs , spares truklymphadeopathyacute hepatitis ?mostly aicteric@H8sA! ati!eaemia
hepatitis ca pro!ress chroic liverdisease dermatitis resolves i K #eeks
Pa%ular Aro*ermatitis o4 C!il*!oo* PAC
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 75/146
Gianotti Crosti Syn*rome H+
8a!lar lesions on Fa&e4 lim,s
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 76/146
&i$e* Cryoglobulinemias HC
- J 0- 4 o$ patiets #ith HC have circulati!cryo!lobulis
- 5.-- 4 o$ patiets have ski *di!s J
palpable purpuralivedo reticularis
acrocyaosisurticarial pla"uesulceratios
Dermatol Clin 20 (2002) 449-458)
Cryo!lobuliemia i HC
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 77/146
y !
3i"ido 2eti&laris
8al!a,le 8r!ra
+as&litis
Cryo'lo,lins
2eti&late 8laes
3e&o&yto&lasti& +as&litis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 78/146
3e&o&yto&lasti& +as&litis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 79/146
Li!en Planus HC
Erosi"e oral 3i&*en !lans
8a!lar 38
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 80/146
Por%!yria Cutanea 6ar*a 'PC6( HC
2CT see i 64 o$ patiets #ith HC 2resets as = tese bullae
vesicles erosios heals #ith scarri! L milia 9esios o su e%posed ski Complai o$ $ra!ility o$ ski )echaism = decrease uroporphyrio!e decarbo%ylase
activity
Dermatol Clin 20 (2002) 449-458
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 81/146
8or!*yria Ctanea Tarda ( 0C+
Al!*a6#6antitry!sin asso&iated8anni&litis ? ln'4 li"er4renal4 GIT
@
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 82/146
6!e S1in in
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 83/146
&alignant Carinoi* Syn*rome
.- 4 o$ patiets #ith carcioid tumour Symptoms #he liver ivolved #ith metastasis mediators escape ito circulatio Cutaeous $eatures =
&ushi! ?early all cases@ pella!ra ?iaci de*ciecy@
scleroderma ?a variat, lo#erlimbs, heart@
pruritusrosaceaski metastasis
British Journal of Dermatology 2005 152, !1-!5
Cutaneous &ani4estations o4
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 84/146
Alo!ol Abuse
Spidertela!iactasias
2almer erythema Caput madusae 1lushi! audice 2ruritus :rticaria 2lethoric $acies
Doiloychia TerryEs ail Clubbi! Hyperpi!metatio 8lack hairy to!ue Glossitis 9eucoplakia
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 85/146
=andi&e
D!ytren/s
Contra&tre
Gynae&omastia
As&ites
Cl,,in'
3e&ony&*ia
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 86/146
%y !at*o'eneti& me&*anism
Colla'en "as&lar disease
3!s Eryt*ematoss
Systemi& s&lerosis
Dermatomyositis
3!s eryt*ematoss
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 87/146
3!s eryt*ematoss
CC3E Dis&oid lesionsSC3E 8soriasi-orm4 annlar 5 !oly&yli&
AC3E Malar 5 ,tter-ly eryt*ema4 !*otosensiti"e
dermatoses4 mot* l&ers4 D3E lesions4alo!e&ia4 !r!ra4 "as&litis4 rti&arial "as&litis4li"ido reti&laris4 ,llae4 eryt*ema mlti-orme4'an'rene -in'ers 5 toes ?2aynad/s@4 !erin'al nail-old telan'ie&tasia4 s,&taneos nodles5 !laes4
!anni&litis@4 s&leroderma6li)e &*an'es4eryt*romelal'ia4 !oi)iloderma
Neonatal C0%4 annlar 5 !oly&y&li& lesions
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 88/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 89/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 90/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 91/146
Systemi& s&lerosis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 92/146
y
T*i&)enin' s&lerosis 6 *ands4 -orearms4 arms4 -a&e4 &*est ?,ea)6li)e mot*4 !in&*ed nose@
2aynad/s !*enomenon
8i'mentation > di--se4 or *y!o!i'mentation
Nail -old eryt*ema 5 telan'ie&tasia
Fin'erti!s4 )n&)les 6 "as&litis5l&ers5'an'rene5atro!*y
Fa&e > matt6li)e 5 !a!lar telan'ie&tasia
8arony&*ia
3e' l&ers
8alma eryt*ema
Cal&inosis &tis > *ands4 el,ow4 ilia& &rest4 s!ine
8oi)iloderma
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 93/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 94/146
Dermatomyositis
Fa&e !eri6or,ital *eliotro!e ras* 5 oedema
Nail -old !erin'al eryt*ema 5 telan'ie&tasia4
&ti&lar *y!er)eratosis
Kn&)les Gottron/s !a!les
8*otosensiti"ity
8oi)iloderma
2aynad/s !*en1rti&aria4 EN4 EM
+iola&eos -olli&lar !a!les$
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 95/146
Dermatomyositis
On ,asis o- &*ara&teristi& .rea&tion !attern/8rrits
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 96/146
8rrits
Eryt*ema ( annlar eryt*ema
8ete&*iae4 !r!ra4 "as&litis
1rti&ariaEryt*ema mlti-orme4 TEN
S,&taneos nodles o- le' > EN
Asym!tomati& nodles5!laes
DermatitisEryt*roderma
I&*t*yosis
8soriasi-orm lesions
8a!lar4 a&nei-orm ( nodlar lesions
Yellow nodles ( !laes
%llos lesions
3e' l&ers
8i'mentary disorders
Nails4 *air
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 97/146
Thak >ou
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 98/146
8rrits
3o&alised Genital it&* ? &andidiasis @ 6 DM
Generalised 8rimary s)in disease
Se&ondary systemi& diseaseMali'nan&y > lym!*omas
3e)aemia 5 CA
3i"er > o,str&ti"e Bandi&e
2enal > raemia
Fe6de-i&ien&y anaemia82+
Disorders o- 8i'mentation
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 99/146
'
+itili'o Atoimmne disorders 6
t*yroid dis4 Addison/s dis$
%rown !i'mentation ?CA3M@ Nero-i,romatosis
8erioral lenti'o4 int$ !oly! 8et<6=e'*er/s
Fle9ral4 t*i&)ened4 s)in ta'sDM4 Ca ?stoma&*@
Di--se4 ,rown >wit* 'rey6,rown *e 0aemo&*romatosis
Wit* ,lla4 *y!ertri&*osis 8CTs&ars4 e9!osed !arts
0y!o wit* *y!er!i'mentation S&leroderma
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 100/146
Eryt*ema
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 101/146
Wides!read 5 !rodromal sym!toms "iral ras*
3o&alised > -a&e .,tter-ly/ 3E
"iola&eos 5 *eliotro!e Dermatomyositis8i'mentary &*an'es5dermal s&lerosis
5nail -old telan'ie&tasis S&leroderma
Nasola,ial4 eye in"ol"ement4 !eriodi&
-ls*in' 2osa&ea4 meno!ase8eriodi& -ls*in'4 ast*ma4 a,d$ !ain Car&inoid syndrome
diarr*oea
8almar eryt*ema 8re'nan&y4 li"er dis$4
S3E4 2A4
*y!ert*yroidism
Eryt*ema
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 102/146
Annlar
eyt*ema annlare &entri-'m In-e&tion4 in-estation4 Mali'nan&y4 S3E
Eryt*ema 'yratm re!ens Mali'nan&y
8ete&*iae !r!ra
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 103/146
8ete&*iae4 !r!ra?8latelet5+as&lar5Coa'lation@
In-e&tion
Se!ti&aemia > menin'o&o&&al4 'ono&o&&al
D0F
S&r"y
Cs*in'/s syndrome
Dr's
+as&litis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 104/146
+as&litis
8rimary
Se&ondary
Dr's
In-e&tions 6 Stre!4 0%+4 E%+Colla'en 6 S3E4 2A4 Dermatomyositis
Cryo'lo,linaemia
3ym!*oma 5 le)aenia
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 105/146
1rti&aria
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 106/146
Ordinary
A&te ? w)s@ Food4 dr's4 in-e&tion > !arasite4 stre!
C*roni& ? w)s@ Food4 dr's4 in-e&tion4 S3E4 mali'nan&yt*yroto9i&osis4 !sy&*olo'i&
8*ysi&al
1+3 E884 CE8Cold Cryo'lo,linaemia4 ?myeloma4 &olla'en4
CA4 sy!*ilis@
1rti&arial
"as&litis S3E4 3ym!*oma4 0%+? :; *ors4 !ain
8i'mentation@
Conta&t
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 107/146
Eryt*ema Mlti-orme
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 108/146
Eryt*ema Mlti-orme
In-e&tion 0S+ ?re&rrent EM@
Stre!4 s!er-i&ial ( dee! my&oses
Tri&*omoniasis4 My&o!lasma
Dr's
Colla'en "as&lar disease2adiot*era!y
Mali'nan&y
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 109/146
To9i& E!idermal Ne&rolysis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 110/146
To9i& E!idermal Ne&rolysis
In-e&tion 6 Sta!* ?SSSS6&*ildren@4 "irs
2adiot*era!y
3ym!*oma4 Ca
Dr's
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 111/146
S,&taneos ?!ain-l nodles @ o- le's
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 112/146
Eryt*ema nodosm In-e&tion Stre!4T%4 3e!rosy
C*lamydia4 Yersenia4dee! my&oses4 "irs
Dr's OC84 Sl!*onamide
Sar&oidosis
In-lammatory ,owel dis$ > Cro*n/s
%e*&et/s disease4 CA
Eryt*ema indratm T%
Nodlar "as&litis Stre!4 T%4 dr's4 Colla'en dis$
8olyarteritis nodosa 8ossi,le systemi& in"ol"ement8anni&litis 8an&reati& dis4 Colla'en dis4
Trama4 Forei'n ,ody4 Mali'nan&y
S,a&te nodlar
mi'ratory !anni&litis Trama4 OC84 idio!at*i&
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 113/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 114/146
Non tender nodles
3e!rosy
Mali'nan&y lym!*omas4 le)aemias
mlti!le myeloma4 MF4se&ondaries
Sar&oidosis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 115/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 116/146
E&<ema 5 Dermatitis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 117/146
Se,orr*oei&4 !ete&*iae4 !r!ra 3etterer > Siwe!a!les ?0istio&ytosis 7@
Se,orr*oei&4 diarr*oea4 in-e&tion 3einer/s dis ? C de-y@
Se,orr*oei&4 ato!i&4 in-e&tions Wis)ott Aldri&* syn
!r!ra
Ato!i&4 *y!omelanosis4 M2 8*enyl)etonria
8*otodermatitis 3E4 Dermatomyositis48CT
E - li i d i i ?E * d @
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 118/146
E9-oliati"e dermatitis ?Eryt*roderma@
S)in disease e&<ema4 !soriasis
Dr's sl!*onamides4 !*enytoin4 allo!rinol
Mali'nan&ies 3ym!*oma4 le)aemia4 MF4 Ca
Idio!at*i&
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 119/146
I *t* i
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 120/146
I&*t*yosis
Con'enital +l'aris4 Se96lin)ed4 CIE
A&ired 3ym!*omas4 le!rosy4 dr's4 0I+4
raemia4 mala,sor!ton4*y!ot*yroidism
8soriasi-orm
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 121/146
8soriasi-orm
8soriasis
2eiter/s disease
Se&ondary Sy!*ilis
3!s eryt*ematoss 6 SC3E
Mali'nan&y
Dr's
8a!lar4 a&nei-orm4 nodlar ? -a&e @
A&nei-orm4 *irstism4 menstral Endo&rine dis4 CA
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 122/146
4 4 4
irre'larity
Adenoma se,ae&em4 e!ile!sy4 T,eros s&lerosis
M24 s*a'reen !at&*4 !erin'al
-i,roma4 as*6lea- *y!o!i'$ ma&le
Co,,lestone4 li&*enoid !a!les T*yroid adenoma4
CA 5 -i,ro&ysti& ,reast
E!idermal &yst4 -i,roma4 ,one Gardner/s syndrome
osteoma4 ( &oloni& !oly!osis
Nero-i,romas4 CA3Ms4 3is&* Nero-i,romatosis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 123/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 124/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 125/146
Yellow nodles ( !laes
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 126/146
Wit* *y!erli!idaemia4 DM 7ant*oma4 9ant*elasma
Ne!*roti& syndrome4 ,iliary ?-amilial *y!er&*olesterolemia&irr*osis4 *y!ot*yroidism 5*y!ertri'lyseridemia4 ,road
,eta dis4 li!o!rotein li!ase
de-i&ien&y@
Normoli!idemia 8lane 9ant*oma4 myelomalym!*oma4 Ca
Wit* an'ioid strea)s4 loss o- 8sedo9ant*oma elasti&m
&entral "ision4 int$ &ladi&ation4an'ina !e&toris4 GI ,leed
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 127/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 128/146
%llos diseases
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 129/146
Con'enital
A&ired
Dr's Ste"ens6=o*nson syndrome
FDE
Atoimmne Dermatitis *er!eti-ormis
?a5w 'lten sensiti"e entero!at*y@
8em!*i's > &an ,e a5w t*ymoma4 Ca
S3E4 8A
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 130/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 131/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 132/146
Non in-e&ti"e 'ranlomas
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 133/146
Non in-e&ti"e 'ranlomas
2ed !a!le4 !lae4 annlar Sar&oidosis
wit* systemi& in"ol"ement
2ed !a!les arran'ed in rin's Granloma annlare
? a5w DM @
2ed yellow atro!*i& !lae Ne&ro,iosis li!oidi&awit* telan'ie&tasia4 o"er s*ins ? a5w DM @
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 134/146
3e' l&ers
Stasis +enos disease
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 135/146
+as&litis Colla'en "as&lar disease4 8AN4 0S8
In-e&ti"e
Mali'nant
Nero!at*i& 3e!rosy4 DM4 ta,es dosalis4
syrin'omyelia4 !olynero!at*y
Ot*ers 8yoderma 'an'renosm
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 136/146
Nails
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 137/146
Color6 ,rown &*roni& renal -ailre yellow4 oedema4 !l in-e&tion4 yellow nail syndrome e--sion6 *al- moon Wilson/s disease
Ony&*olysis 0y!ert*yroidism!soriasis4 !ella'ra
Koilony&*ia Fe de-$ anaemia4trama
8erin'al telan'ie&tasia 3E4 Dermatomyositis
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 138/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 139/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 140/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 141/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 142/146
0air
S&arrin'3E4 S&leroderma4 3i&*en !lano6!ilaris4 In-e&tion48sedo6!elade
Non s&arrin'Di--se 3E4 Fe de-y4 0y!o!ititarism4
t*yroid disease
Fo&al Alo!e&ia areata
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 143/146
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 144/146
Dr' er!tions
J 8rrits Anti6de!ressants CNS
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 145/146
J$ 8rrits Anti6de!ressants4 CNS
stimlants
$ 8soriasi-orm %6,lo&)ers4 3i4 'old4anti6malarials
#L$A&nei-orm Steroids4 anti6e!ile!ti&
##$ 8*otosensiti"ity 0ydralla<ine4 isonia<id4
*ydantoins4 OC8s4t*ia<ides
#:$Alo!e&ia 0e!arin4 &ytoto9i&4
neomer&a<ole
#H$3i&*enoid Anti6malarials4 8AS4
'old#;$EN OC8s4 sl!*a
7/24/2019 Skin Manifestation of Systemic Diseases
http://slidepdf.com/reader/full/skin-manifestation-of-systemic-diseases 146/146
T0ANK YO1
Recommended