1 / 82

SKIN MANIFESTATIONS IN RHEUMATIC DISEASES AROMA 2011

SKIN MANIFESTATIONS IN RHEUMATIC DISEASES AROMA 2011 . Tarek Mahmoud El Ghandour , MD Professor of Dermatology, Andrology & STD’s. Faculty of Medicine Ain shams University. Systemic Lupus Erythematosus. Raynaud’s phenomenon is commonly found in lupus. It lack specificity.

branxton
Download Presentation

SKIN MANIFESTATIONS IN RHEUMATIC DISEASES AROMA 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. SKIN MANIFESTATIONS INRHEUMATIC DISEASESAROMA 2011 • TarekMahmoud El Ghandour, MD • Professor of Dermatology, Andrology & STD’s. • Faculty of Medicine • Ain shams University

  2. Systemic Lupus Erythematosus

  3. Raynaud’s phenomenonis commonly found in lupus. It lack specificity. (a triphasic reaction of distal digits to cold or emotion, in which the skin colour changes from white to blue to red)

  4. Dermatological involvement • Up to 85% of SLE • Butterfly rash • Maculopapular eruption • Discoid lupus • Relapsing nodular non-suppurativepanniculitis • Vasculitic skin lesin • Livedoreticularis • Purpuric lesions • Alopecia • Oral ulcer

  5. Malar rash: This is a "butterfly-shaped" red rash over the cheeks below the eyes and across the bridge of the nose. It may be a flat or a raised rash.The rashes are made worse by sun exposure.

  6. Systemic Lupus Erythematosus

  7. Discoid lupus These are red, raised patches with scaling of the overlying skin.

  8. Oral ulcer: Painless sores in the nose or mouth need to be observed and documented by a doctor.

  9. Systemic Lupus Erythematosus • Discoid Lupus: Cutaneous manifestations • Scar upon healing

  10. Maculopapular eruption

  11. Vasculitic skin lesin

  12. Alopecia

  13. Systemic Lupus Erythematosus • Criteria for the Classification of SLE • Malar rash • Fixed erythema • Malar eminences • Sparing of the nasolabial fold • Discoid Rash • Erythematous plaques • Scaling, follicular plugging • Atrophic scarring

  14. Systemic Lupus Erythematosus • Serositis • Pleuritis • Pericarditis • Oral ulcers • Arthritis • Nonerosive • Photosensitivity

  15. Systemic Lupus Erythematosus • Blood/Hematologic • Hemolytic anemia • Leukopenia • Lymphopenia • Thrombocytopenia • Renal disorder • Persistent proteinuria >0.5 gm/day • Cellular casts • (+) ANA

  16. Systemic Lupus Erythematosus • Immunologic • Anti-native DNA OR • Anti-Smith OR • Antiphospholipid antibody (ACA, B2GPI) • Lupus anticoagulant (DRVVT) • False (+) serologic test for syphilis • Neurologic • Seizures • Psychosis • Focal deficits

  17. Systemic Lupus ErythematosusUnconventional Criteria • Multi-organ systemic inflammatory disease • AND • +ANA

  18. Systemic Lupus Erythematosus • Other organ system involvement not part of the criteria: • GI • Peritonitis • Elevation of LFTs • Pancreatitis • Pulmonary • Acute lupus pneumonitis • Pulmonary hemorrhage • Pulmonary HTN • Shrinking lung syndrome

  19. Systemic Lupus Erythematosus • ANA • + in >90% of patients • + in 25-33% of healthy normal population • Anti-dsDNA • Nephritis • Associated with flares • Anti-SSA/Ro and Anti-SSB/La • SLE, Sjogren’s syndrome • Neonatal lupus • SubacuteCutaneous Lupus

  20. Systemic Lupus Erythematosus • Anti-Smith • More specific for a diagnosis of SLE • Anti-RNP • SLE • Mixed Connective Tissue Disease

  21. Systemic Lupus Erythematosus • Treatment • Corticosteroids • Anti-malarials (i.ePlaquenil) • Azathioprine • Cellcept • Methotrexate, Cyclosporine • Cyclophosphamide • Plasmapheresis • IVIG • Rituxan

  22. Drug-Induced Lupus • Drugs • Chlorpromazine • Hydralazine • Isoniazid • Methyldopa • Minocycline • Procainamide • Quinidine

  23. Drug-Induced Lupus • Weeks to months after starting drug • Presentations • Constitutional symptoms • Joints • Pleuropulmonary • RARE – cutaneous, renal, neurologic • Rapid resolution of clinical features with d/c of drug, ANA may persist longer • Anti-histone antibodies

  24. Systemic Sclerosis (SS) • Subsets • Diffuse SS • Limited SS • CREST syndrome – calcinosis, raynaud’s, esophageal dysmotility, sclerodactyly, telangiectasias • Overlap syndromes • Mixed Connective Tissue Disease • Localized scleroderma

  25. Diffuse SclerodermaClinical Features

  26. Diffuse SclerodermaClinical Features • Other features of diffuse SS: • Cardiac: diastolic dysfunction, arrhythmia • Renal crisis

  27. Systemic Sclerosis (SS) • CREST syndrome

  28. Systemic Sclerosis (SS)

  29. Localised scleroderma(Morphea) • Localised injury • Tick bites – it has been associated withLyme diseasedue toBorreliaburgdorferiinfection • Pregnancy • Measlesand other viral infections • Autoimmune diseases includinglichen sclerosusandlichen planus

  30. Localised SclerodermaClinical Features Plaques

  31. Localised SclerodermaClinical Features • Plaques: most common pattern of morphoea. • Superficial Morphoea: • Middle-aged women • In the skin folds, particularly the groin, armpits and under the breasts. • Linear scleroderma: • On the limb of a child. • A long and narrow plaque may be associated with underlying contractures. • En coup de sabre.

  32. Localised SclerodermaClinical Features En coup de sabre

  33. Localised SclerodermaClinical Features • Generalisedmorphoea. • Pansclerotic disabling morphoea: • children • extensive hardening of skin and underlying muscle • bone growth may be affected. • Atrophoderma of Pierini and Pasini severe loss of subcutaneous tissue with depression.

  34. Localised SclerodermaClinical Features Subcutaneous atrophy

  35. SCLERODERMA TREATMENT • Skin – symptomatic • Topical calcipotriol • Methotrexate • Systemic steroids • Intralesionalsteroid injections • Photochemotherapy or phototherapy with UVA1 • Long courses of oral penicillin or tetracyclines

  36. SCLERODERMA TREATMENT • GI – acid reduction • Raynaud's – vasodilators • Pulmonary alveolitis – Cytoxan, steroids(?) • Pulmonary hypertension – ca+channel blockers, sildenafil, bosentan, epoprostenol, lung transplantation

  37. Idiopathic Inflammatory Myopathies • Dermatomyositis • Juvenile • Adult • Polymyositis • Inclusion Body Myositis • Overlap syndromes • Myositis associated with neoplasia

  38. Idiopathic Inflammatory Myopathies • Clinical features • Symmetrical proximal weakness • Elevation of skeletal muscle enzymes • Myopathic changes on EMG • Presence of inflammation of skeletal muscles on biopsy

  39. Idiopathic Inflammatory Myopathies

  40. Idiopathic Inflammatory Myopathies

  41. Idiopathic Inflammatory Myopathies

  42. Myositis Antibodies

  43. Dermatomyositis

  44. Dermatomyositis

  45. Dermatomyositis

  46. Dermatomyositis Gottron’sPapules

  47. Dermatomyositis

  48. Dermatomyositis

More Related