Skin manifestations in rheumatic diseases

Rheumatic diseases are usually associated with cutaneous manifestations.This ppt will present common cutaneous manifestations in rheumatology

1. Samar Tharwat Lecturer of Internal Medicine (Rheumatology & Immunology) Mansoura University Skin Manifestations in Rheumatic Diseases

2. AGENDA Presentation of Skin Manifestations Inflammatory Joint Diseases Connective Tissue Diseases Vasculitides Methodology 2

3. Presentation of Skin Manifestations Malar erythema Purpura Livedo reticularis Telangectasia Ulceration Panniculitis Puffy fingers

4. 4 Acute Cutaneous Lupus Rosacea Dermatomyositis

5. 5

6. Livedo Reticularis Mottled, reticulated vascular pattern Due to alterations in blood flow through the cutaneous microvasculature AE: physiologic, rheumatic disease Livedo racemosa 6

7. Purpura 7

8. 8 Telangiectasias Dilatation of the capillaries, arterioles, and/or venules Erythematous Blanchable Anywhere on the skin & mucous membranes Cosmetic May be primary as Hereditary hemorrhagic telangiectasia Or secondary

9. Secondary Telangiectasias 9

10. Ulceration in Rheumatic Diseases 10

11. Panniculitis Inflammation of the SC adipose tissue Associations: infections oral contraceptives antibiotics Sarcoidosis Behçet’s disease SLE Crohn’s disease primary biliary cirrhosis idiopathic 11 Erythema Nodosum

12. Puffy Fingers No clear definition Differential Diagnosis Systemic Sclerosis limited cutaneous SSc with ACA limited cutaneous SSc with Anti-Th/To Antibody Early SSc with Anti-Topoisomerase I Antibody Sclerodactyly in dcSSc with Anti-RNA Polymerase Antibody Mixed connective tissue disease SSc -Like Disorders Anti Synthetase Antibody Syndrome Rheumatoid Arthritis Overlapping Syndromes 12

13. Skin in Rheumatic Diseases Inflammatory Joint Diseases Connective Tissue Diseases Vasculitides

14. Nodules in Rheumatoid Arthritis 14 1 in 4 patients with long-standing RA will have rheumatoid nodules Seropositive disease Non-tender, firm , extensor surfaces Benign nodules: rheumatoid nodules in the absence of RA Palisaded neutrophilic & granulomatous dermatitis Rheumatoid nodules

15. Psoriasis and Psoriatic Arthritis 15

16. Inflammatory Bowel-Associated Spondyloarthropathy 16

17. Reactive Arthritis 17

18. Rheumatic Fever 18

19. Skin Manifestations of Juvenile Idiopathic Arthritis 19

20. Skin in Rheumatic Diseases Inflammatory Joint Diseases Connective Tissue Diseases Vasculitides

21. Systemic Lupus Erythematosus Acute Subacute Chronic Lupus non specific 21

22. Neonatal Lupus Erythematosus 22 Periorbital and inguinal distribution pattern of skin lesions of neonatal SCLE in a 2-month- old female baby ( left ). The sternal scar results from the implantation of a cardiac pacemaker for atrioventricular block grade III

23. Systemic Sclerosis 23

24. Localized Scleroderma Limited type Generalized type Linear type 24

25. Dermatomyositis 25

26. Sjögren’s Syndrome 26

27. Skin in Rheumatic Diseases Inflammatory Joint Diseases Connective Tissue Diseases Vasculitides

28. Giant Cell Arteritis 28

29. Kawasaki Disease 29

30. Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) 30

31. Henoch- Schönlein Purpura 31

32. Behçet’s Disease 32

33. Methodology Capillaroscopy Skin Biopsy

34. Capillaroscopy 34 Secondary Raynaud’s phenomenon The three scleroderma patters ( early , active , late )

35. Skin Biopsy Site Selection: Anatomical Region, Type of Lesion Indications: Rheumatoid Arthritis Lupus Erythematosus (LE) Scleroderma Dermatomyositis Psoriasis with Psoriatic Arthritis Vasculitis Panniculitis 35

36. 36

37. 37