Cutaneous Manifestations of Systemic Diseases — WACS Viva & Clinical Scenarios (Dermatology and Venereology)

Exam-style cutaneous manifestations of systemic diseases viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 38-year-old woman presents with symmetrical proximal muscle weakness, violaceous periorbital oedema, and hyperkeratotic violaceous papules overlying the interphalangeal and metacarpophalangeal joints. Describe the diagnostic pathway, serological evaluations including myositis-specific autoantibodies, multi-organ systemic screening, and age-appropriate occult malignancy evaluation protocol for this patient.
• SCENARIO 2: A 46-year-old man with known inflammatory bowel disease develops an acutely painful, rapidly enlarging, necrotic cutaneous ulcer with violaceous, undermined, ragged borders on the lower extremity following minor superficial trauma. Discuss the primary differential diagnosis, explain the phenomenon of pathergy and its diagnostic implications, outline the histopathological findings, and define the definitive medical management strategy.
• SCENARIO 3: A 29-year-old man presents with non-blanching, symmetrical, palpable purpura on the lower extremities, accompanied by arthralgias, crampy abdominal pain, and microscopic haematuria. Formulate a structured clinical approach to small-vessel cutaneous vasculitis, detail the indications and timing of cutaneous biopsy with direct immunofluorescence, and state the principles of systemic risk stratification and therapy.
• SCENARIO 4: A 54-year-old woman presents with the sudden explosive eruption of numerous pruritic seborrhoeic keratoses on the trunk, associated with velvety hyperpigmentation in the intertriginous areas and diffuse rugose thickening of the palmar creases. Analyze the diagnostic significance of these dermatological signs, identify the specific underlying systemic and paraneoplastic associations, and construct a comprehensive diagnostic workup.
• SCENARIO 5: A 42-year-old woman with type 1 diabetes mellitus presents with slowly enlarging, shiny, yellowish-atrophic plaques on the pretibial surfaces exhibiting prominent telangiectasias and violaceous borders. Review the diagnostic characteristics of this condition, contrast it with other endocrine and metabolic dermatoses, and detail the therapeutic options and systemic monitoring requirements.