A Potpourri of Complex Medical Dermatology


Gabriela Cobos, MD, Director of the Connective Tissue Disease clinic at Brigham and Women’s Hospital, highlighted complex medical dermatologic conditions through case presentations in an interesting lecture. As psoriasis is a chronic immune-mediated inflammatory systemic disease, Dr. Cobos reports she will risk stratify these patients in a lengthy first appointment. One in three patients who present with psoriasis will have psoriatic arthritis; therefore, it is imperative to ask detailed questions related to patients’ arthritis symptoms. The lag time from onset of arthritis to initial skin presentation can be up to 12 years. A pearl Dr. Cobos imparted from her experience is patients with inflammatory arthritis tend to report activity will improve their symptoms, rather than worsen them as with OA.  Of note, psoriasis is an independent risk factor for myocardial infarction (MI). The risk for MI is greatest in younger adults, and psoriatic patients have a worse prognosis after a first MI than patients without psoriasis. Routine monitoring of HgbA1c, lipids, and blood pressure were encouraged in the approach of psoriatic patients.

COVERAGE: SDPA Annual Summer Dermatology Conference, June 16-19, 2022, Austin, Texas

Systemic sclerosis presents with the triad of excessive fibrosis, endothelial cell dysfunction, and autoimmunity. Differentiating primary vs secondary Raynaud’s syndrome is an important step in the proper management of these patients. When evaluating primary Raynaud’s syndrome patients, Dr. Cobos evaluates the frequency and severity of symptoms, smoking history, and medication review. Certain medications, such as dextroamphetamine, can worsen the symptoms of Raynaud’s symptoms for patients. Key characteristics of patients with secondary Raynaud’s include presentation at an older age, male sex, a history of ulcerations, and a positive review of symptoms which may point to comorbid conditions such as SLE, RA, and vasculitis. A helpful pearl Dr. Cobos communicated is patients with a positive ANA and puffy fingers are more likely to have systemic sclerosis. Early diagnosis of systemic sclerosis is essential for screening internal organ abnormalities.

Finally, the heterogenous complex condition of cutaneous lupus erythematous presentations was highlighted by Dr. Cobos. The 2012 SLICC clinical and immunologic criteria was reviewed as well as the sub-classifications within each category. Properly recognizing the presentation of CLE allows for the ability to meet the goal of treatment to prevent permanent scarring. Dr. Cobos conveyed 100% of patients who present with the true butterfly malar rash will have systemic lupus. Key features of the malar rash include a well-demarcated presentation with sparing of the nasolabial folds. These patients will also have systemic symptoms of fever and joint pain. Finally, Dr. Cobos finished her lecture with a discussion of dermatomyositis.

Byline: Sarah B.W. Patton, PA-C