All are seen in dermatomyositis except :
Correct Answer: Calcinosis cutis
Description: Ans: A (Calcinosis cutis) Ref: Connective tissue disorders. In: Thappa DM. editor. Essentials in Dermatology, 2nd ed., Jaypee 2009; 134-47.Explanation:Calcinosis cutis is characteristically seen in CREST syndromeDermatomyositisConnective tissue disorder characterized by inflammatory myositis presenting with proximal muscle weakness and cutaneous manifestations in the form of:Pathognomonic features:Gottron's papules - violaceous flat-topped papules on IP joints and knuckles; also knee, elbow, medial malleoli.Gottron's sign- violaceous erythematous macules with or without edema at the above-mentioned sites.Characteristic features:Heliotrope rash- periorbital violaceous erythema with edema.Shawl sign - erythema and scaling with or without poikiloderma over shoulder region.Periungual telangiectasia and dystrophic cuticles.Mechanic's hands-hyperkeratosis, scaling, fissuring, and hyperpigmentation over fingertips, sides of thumbs and fingers.Compatible features:Calcinosis cutisPoikiloderma trophicans vasculareCREST SYNDROMEA limited form of systemic scleroderma.Anti-centromere antibody (remember as centromere is the central small part so anticentromere antibody in limited type in comparison to progressive systemic sclerosis where anti-scl 70 refers to diffuse sclerosis).C-Calcinosis cutisR-Raynaud's phenomenonE-Esophageal dysmotilityS-SclerodactylyT-TelangiectasiaProgressive systemic sclerosis- cutaneous + internal organ fibrosisAmerican Rheumatism Association criteria (ARA criteria 1980) for systemic sclerosis97% sensitivity; 98% specificityOne major+twro or more minorMajor:Scleroderma proximal to digits affecting limbs, face, neck, trunkMinor:SclerodactylyDigital pitted scarringBilateral basal pulmonary fibrosisTable 20: Other Nail AbnormalitiesNail abnormalityDescriptionCausesKoilonychiaReverse curvature in the longitudinal and transverse axisIron deficiency anemiaMacronychia / MicronychiaToo small or large nails--OnycholysisDistal or lateral separation of the nail from nail bedPsoriasisOnychomycosisPterygiumCentral fibrotic tongue like a band from proximal nail fold joins the nail bed dividing the nail proximally into two.Lichen PlanusSubungual hyperkeratosisExcessive collection of squamous debris under the free edge of nailPsoriasisOnychomycosisOnychogryphosisNail get thickened and grows upwards in a spiral mannerChronic traumaPachyonychia congenitalHypertrophy of nails associated with nail bed and hyponychial hyperkeratosis--Beau's linesTransverse grooves on nailsTemporary cessation of nailformationChemotherapyHypocalcemiaNail infectionCoronary occlusionMalnutritionTerry's nailNail is white proximally but normal distallyCongestive cardiac failureCirrhosisDiabetes mellitusPittingPunctate erosions on nail surfacePsoriasisAlopecia areataRed LunulaeNails shows erythema of lunulaPsoriasis (Dotted red lunula) Congestive cardiac failure Cirrhosis SLESplinter hemorrhagesLongitudinal hemorrhages in nail bedPsoriasis DermatitisFungalInfectionsInfective endocarditisSLEMycosis fungoidesRheumatoid arthritisMees linesWhitening or discoloration of the nail in bands or "stria" that run parallel the lunula (nail base)CirrhosisChemotherapyHeavy metal poisoning(Arsenic, Thallium)TraumaMuehrcke's nailsWhite lines (leukonychia) that extend all the way across the nail and lie parallel to the lunula (half moon)NonspecificAssc with decreased protein synthesis Hypoalbuminemia Nephrotic syndrome
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