Chapter 054. Skin Manifestations of Internal Disease (Part 5)

To date, FDA-approved for men.bMay also be scarring.Exposure to various drugs can also cause diffuse hair loss, usually by inducing a telogen effluvium. An exception is the anagen effluvium observed with antimitotic agents such as daunorubicin. Alopecia is a side effect of the following drugs: warfarin, heparin, propylthiouracil, carbimazole, vitamin A, isotretinoin, acitretin, lithium, beta blockers, colchicine, and amphetamines. Fortunately, spontaneous regrowth usually follows discontinuation of the offending agent.Lesscommonly,nonscarringalopeciaisassociatedwithlupuserythematosus and secondary syphilis. In systemic lupus there are two forms ofalopecia—one is scarring secondary to discoid lesions (see below) and the other is nonscarring. ...
Nội dung trích xuất từ tài liệu:
Chapter 054. Skin Manifestations of Internal Disease (Part 5) Chapter 054. Skin Manifestations of Internal Disease (Part 5) a To date, FDA-approved for men. b May also be scarring. Exposure to various drugs can also cause diffuse hair loss, usually byinducing a telogen effluvium. An exception is the anagen effluvium observed withantimitotic agents such as daunorubicin. Alopecia is a side effect of the followingdrugs: warfarin, heparin, propylthiouracil, carbimazole, vitamin A, isotretinoin,acitretin, lithium, beta blockers, colchicine, and amphetamines. Fortunately,spontaneous regrowth usually follows discontinuation of the offending agent. Less commonly, nonscarring alopecia is associated with lupuserythematosus and secondary syphilis. In systemic lupus there are two forms ofalopecia—one is scarring secondary to discoid lesions (see below) and the other isnonscarring. The latter form may be diffuse and involve the entire scalp, or it maybe localized to the frontal scalp, eventually resulting in multiple short hairs (lupushairs). Scattered, poorly circumscribed patches of alopecia with a moth-eatenappearance are a manifestation of the secondary stage of syphilis. Diffuse thinningof the hair is also associated with hypothyroidism and hyperthyroidism (Table 54-4). Scarring alopecia is more frequently the result of a primary cutaneousdisorder such as lichen planus, folliculitis decalvans, chroniccutaneous (discoid)lupus, or linear scleroderma (morphea) than it is a sign of systemic disease.Although the scarring lesions of discoid lupus can be seen in patients withsystemic lupus, in the majority of cases the disease process is limited to the skin.Less common causes of scarring alopecia include sarcoidosis (see PapulonodularSkin Lesions, below) and cutaneous metastases. In the early phases of discoid lupus, lichen planus, and folliculitisdecalvans, there are circumscribed areas of alopecia. Fibrosis and subsequent lossof follicles are observed primarily in the center of the individual lesions, while theinflammatory process is most prominent at the periphery. The areas of activeinflammation in discoid lupus are erythematous with scale, whereas the areas ofprevious inflammation are often hypopigmented with a rim of hyperpigmentation.In lichen planus the peripheral perifollicular macules are usually violet-colored.Complete examination of the skin and oral mucosa combined with a biopsy anddirect immunofluorescence microscopy will aid in distinguishing these twoentities. The peripheral active lesions in folliculitis decalvans are follicularpustules; these patients can develop a reactive arthritis. Figurate Skin Lesions (Table 54-6) In figurate eruptions, the lesions form rings and arcs that areusually erythematous but can be skin-colored to brown. Most commonly, they aredue to primary cutaneous diseases such as tinea, urticaria, erythema annularecentrifugum, and granuloma annulare (Chaps. 53 and 55). An underlying systemicillness is found in a second, less common group of migratory annular erythemas. Itincludes erythema gyratum repens, erythema migrans, erythema marginatum, andnecrolytic migratory erythema. Table 54-6 Causes of Figurate Skin Lesions I. Primary cutaneous disorders A. Tinea B. Urticaria (≥90% of cases) C. Erythema annulare centrifugum D. Granuloma annulare E. PsoriasisII. Systemic diseases A. Migratory 1. Erythema migrans 2. Urticaria (≤10% of cases) 3. Erythema gyratum repens 4. Erythema marginatum 5. Pustular psoriasis 6. Necrolytic migratory erythema (glucagonoma syndrome)aB. Nonmigratory 1. Sarcoidosis 2. Subacute lupus erythematosus 3. Secondary syphilis 4. Cutaneous T cell lymphoma (e.g., mycosis fungoides)