Medical problems in dermamatology Inflammatory bowel disease Cutaneous Erythema nodosum, erythema Pyoderma gangrenosa, sweet’s syndrome, other neutrophilic Small vessel vasculitis, cutaneous polyarthritis Fistula & abscesses in perianal Pruritis ani, vulvi acquired acrodermatitis enteropathica, Oral Apthous granulomatous chelitis, angular gingival / mucosal Cobblestoning of buccal mucosas. Secondary systemic amyloid may be associated with longstanding inflammatory bowel disease & presents with petichiae & ecchymosis. However, primary macular amyloidosis has nothing to do with inflammatory bowel disease but only present with macular hyperpigmwentation.

Inflammatory bowel disease (continue) The main forms of inflammatory bowel disease are Crohn’s disease & ulcerative colitis, The main difference between them is the location& nature of inflammatory changes. Crohn’s disease can affect any part of G.I.T. from mouth to anus, although majority of cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon & the rectum.. Microscopically, ulcerative colitis is restricted to the mucosa ( epithelial lining of the gut), while Crohn’s disease affects the whole bowel wall. Both diseases may present with vomiting, diarrhea, rectal bleeding, weight loss, severe internal cramps, muscle spasm in region of pelvis & various complaints & diseases like arthritis, pyoderma gangrenosa, cutaneous manifestations, primary sclerosing cholangitis.

Pancreatitis Cutaneous Grey –Turner’s sign: This is a cutaeous sign of acute hemorrhagic pancreatitis & carries grave prognosis, Other causes of Grey- Turner ‘s sign include blunt abdominal trrauma, ruptured aortic aneurysm & ruptured ectopic pregnancy.It is bluish dicolaration OF THE FLANKs

Pancreatitis sign: Black blue bruising around the panniculitis: Tender fluctant nodules on the lower livedo Throbophlebitis migrans: pancreatic malignancy associated

Rheumatoid arthritis Cutaneous dermatosis: Pyoderma gangrenosa, rheumatoid neutrophilic dermatoses, sweet’s syndrome, neutrophilic Palisading granuloma: rheumatoid nodules & papules, palisaded neutrophilic & granulomatous dermatitis, interstitial granulomatous Vascular: small, medium & large vessel vasculitis, capilaritis, bywater’lesions: It is a cutaneous manifestation of rheumatoid arthritis. They are cutaneous infarcts related to small vessel rheumatoid vasculitis,. In addition,they also may present under the nails as painless red brown lesions mimking the splinter hemorrhages of subacute bacterial Thin Drug reaction to therapy

Palmer erythema Familial Chronic liver disease, alcohol connective tissue disorders e,g. lupus, rheumatoid Inflammatory dermatosis e,g. eczema, psoriasis, Chemotherapy, anti- epileptic HTLVI Paraneoplastic: especially brain malignancies. Chronic liver disease Cutaneous Palmer Clubbing of the nails, leukoplakia, spider Diffuse Loss of axillary & Xanthelasma, if obstructed elements.

Facial flushing Physiological: emotional or sexual Carcinoid Autonomic dysfunction, migraine, neurological Systemic neoplasm. Drugs related ACE Calcium channel Calcitronin Carcinod syndrome: Carcinoid syndrome occurs when a neuroendocrine carcinoid tumor metastasize to the liver & release serotenin & other mediators into the blood streem. Patients may develop a pellagra like photodistributed skin rash & the flushed areas may have violaceous hue. Bronchospasm, diarrhea & cardiac murmur can be seen. The disese is investigated by testing urine for metabolities such as 5-HIAA

Generalized pruritus Liver Hematological: leukemia, lymphoma, Drug Renal failure (late Iron, B12 or floater Hyperthyroidism, Psychogenic neuropathy Lignocaine toxiciity The maximum safe dose of plain lignocaine in an adult is 3 mg/ Kg, with adrenaline up to 7 mg/kg may be used, In children and the elderly these doses should be halved, !% lignocaine has 1O mg/ml If a 7O Kg adult may be given up to 7 mg/kg of lignocaine with adrenaline. This equates to 49O n.g.,or 49 mls of 1% solution

Macular petechial rash It consists of flattened purple macules less than 3 mm in diameter Abnormal platelet function venous Pigmented purpuric eruption e.g. Schamberg’s Macular purpura: Larger flat red purple lesions with a diameterr of 5-9 mm. Vasculitis tends to present with palpable purpura.. Vitamin K defeciency results in ecchymoses

Palpable purpuric rash Primary Immune related vasculitis: idiopathic, sepsis related, drug associated, secondary to connective tissue Non-vasculitis: Erthema multiformis, PLEVA, pigmented purpuric eruption Ecchymoses are flat round-oval purpuric lesion often over 1 cm in size, they normally result from minor traumas on a background of dermal fragility, platlet dysfunction or an anticoagulated state.