Date post: | 06-Aug-2015 |
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THE SKIN MANIFESTATION
OF SYSTEMIC DISEASES
Mirror of the human body. Window through which we can
look inside the body. Virtually no disease of the body
that does not give itself away on the skin.
Greatest ‘system’ it can reveal the secrets of all body systems
SKIN
COMMON SYSTEMIC DISEASES GIT diseases
Liver cirrhosis, Inflammatory bowel disease, Carcinoid syndrome
Endocrine disorders DM, Thyroid disorders
Cardiovascular diseases Renal disease
CRF Haematologic diseases
HIV/AIDS Respiratory diseases-
sarcoidosis Neurological diseases
ENDOCRINE DISEASES
DIABETES MELLITUS Infective manifestations Non infective manifestations Features of vascular insufficiency
INFECTIOUS SKIN MANIFESTATIONS Pyodermas Malignant external otitis Necrotizing fascitis Erythrasma Dermatophytosis Candidiasis
FEATURES OF VASCULAR INSUFFICIENCY Ischaemic ulcer Digital gangrene Erysipelas-like erythema Periungual telangiectasia (microvascular
engorgement and tortuosity involving the proximal nail fold.)
Red Skin and Rubeosis Facei(a function of the degree of engorgement of superficial veins)
Pigmented Purpura(salt and pepper appearance)
Gangrene
Periungual Telangiectasia
Pigmented Purpura. Salt and Pepper type of yellow-tan hyperpigmentation of the shin
ERYSIPELAS-LIKE ERYTHEMA Microcirculatory compromise Well demarcated erythema on the lower leg or
dorsum of the foot Radiological evidence of underlying bone
destruction Incipient gangrene Mistaken for erysipelas
No associated pyrexia No elevated ESR No leukocytosis.
NON-INFECTIOUS SKIN MANIFESTATIONS Acanthosis nigricans Diabetic dermopathy Granuloma annulare Lipodystrophy Necrobiosis lipoidica Pruritus (due to dry skin, yeast infection or poor
blood flow) Scleroderma diabeticorum Xanthoma Vitiligo(associated with type 1 than type 2) Stiff hand syndrome Lichen planus Yellow nails
ACANTHOSIS NIGRICANS SymmetricVelvety to verrucousHyperkeratoticHyperpigmented Plaques predilection for
AxillaeNape Flexural areas.
ACANTHOSIS NIGRACANS
DIABETIC DERMOPATHYPost traumatic atrophy post-
inflammatory hyperpigmentation in poorly vascularized skin.
Atrophic hyperpigmented macules on the shins,
Most common cutaneous finding
DIABETIC DERMOPATHY
GRANULOMA ANNULARE Can occur on any site of the body
occasionally widespread. Skin coloured bumps
occur in rings often over joints, particularly knuckles. centre depressed.
GRANOLOMA ANNULARE
NECROBIOSIS LIPOIDICA
Well-defined, small, firm, dusky-red papule topped with a fine scale.
Slow enlargement or coalescence, form indurated plaques centre is yellow, indicating lipid accumulation.
NECROBIOSIS LIPOIDICA
SCLEREDEMA ADULTORUM Marked increase in dermal
thickness on the posterior back and upper neck in middle agedOverweightpoorly controlled type II diabetic
SCLEREDEMA DIABETICORUM
DIABETIC BULLAE
Spontaneous onset of multiple bullae on his lower extremities Not secondary to
trauma Infection
Healed without special intervention.
THYROID Hypothyroidism
Diffuse hair lossVitiligodry skin itching
Hyperthyroidism Diffuse hair loss itching
Grave’s diseas -pretibial myxoedema
PRETIBIAL MYXOEDEMA
CUSHING’S SYNDROME
Acne Striae skin atrophy
STRIAE
ACROMEGALY Excessive soft tissue hypertrophy
Skin tags Seborrhoea
SKIN TAGS
ADDISON’S DISEASE
Hyperpigmentation
GIT DISEASES Liver cirrhosis Gardner’syndrome Peutz-jeghers syndrome
CUTANEOUS MANIFESTATIONS OF LIVER CIRRHOSIS Fluffiness of the hair Spider angiomata (spider nevi) Caput medusae Dupuytren’s contracture Palmar erythema Generalized pruritus Nail changes
Finger clubbing Terry’s nails-prox 2/3 of nails are white due to
hypoalbuminaemia(leuconychia) Muehrcke’s nail- paired horizontal bands
seperated by area of normal colour.
GARDENER’S SYNDROME variant of FAP
GI polyps, multiple osteomas skin and soft tissue tumours
Most noticeable cutaneous feature is appearance of epidermoid cysts
PEUTZ-JEGHERS SYNDROME polyps in association with pigmentation
affecting skin and mucous membranes melanocytic macules usually appears before 5 years of age
and may fade after puberty.
SKIN MANIFESTATIONS 0F RENAL DISORDERS
Pruritus Pallor Pigmentary changes Nodular prurigo Ureamic frosts Purpura Metastatis calcification Ecchymoses Reccurent viral warts Half-on-half nail Koilonychia Onychomycosis Splinter haemorrhages Beau’s lines Subungal hyperkeratosis
INTERNAL MALIGNANCIES Often be the first sign 2 major types:
Genetically determined syndromesParaneoplastic syndromes
GENODERMATOSES Cowden's disease Gardner syndrome Gorlin's syndrome Multiple endocrine neoplasm type 2B Neurofibromatosis Peutz-Jeghers syndrome Torre-Muir syndrome
COWDEN’S DISEASE
Hamartomas of skin and mucosa At least one of the four types of skin lesions
Facial papules – flesh-coloured flat-topped dry or warty 1-5mm papules around the mouth, nostrils and eyes.
Oral lesions – numerous 1-3 mm smooth whitish spots on the gums and palate that join together to create a cobblestone appearance known as papillomatosis.
Acral keratoses – flesh-coloured or slightly pigmented smooth or warty papules on the upper surface of hands and feet.
Palmoplantar keratoses – scaly spots on the palms and soles
Lipomas,Neuromas,Haemangiomas.
Acral keratoses Facial papule Close-up
CD IS SEEN IN Breast cancer Genitourinary tumours Thyroid cancer,especially follicular
thyroid carcinoma Skeletal abnormalities such as bone
cysts. Gastrointestinal polyps
NEUROFIBROMATOSIS Café au let patches
oval-shaped light brown patches greater than 0.5cm in diameter
Multiple neurofibromas Freckling Lisch nodules
Café-au-lait mark Freckling in the armpit
Neurofibromas
PARANOEPLASTIC SYNDROMESPapulosquamous Acanthosis nigricans Acquired ichthyosisAcrokeratosis paraneoplasticaExtramammary Paget diseaseFlorid cutaneous papillomatosisPalmoplantar keratodermaPityriasis rotundaSign of Leser-TrelatTripe palms
SIGN OF LESER-TRÉLAT
The sign of Leser-Telat characterised by the abrupt appearance of multiple
seborrhoeic keratoses Associated with
adenocarcinoma of the stomach or colonsquamous cell carcinoma lymphoma leukaemia.
Multiple eruptive seborrhoeic keratoses
TRIPE PALMS
‘acanthosis palmaris’ thickened velvety palms 90% associated with internal malignancy. Tripe palms are frequently seen in conjunction
with acanthosis nigricans.
Tripe palms associated with acanthosis nigricans
CONTDErythematous Dermatomyositis Erythema gyratum repens Hypertrophic osteoarthropathy and
digital clubbing Multicentric reticulohistiocytosis Necrolytic migratory erythema Sweet disease
SWEET DISEASE sudden appearance of red tender lumps
(plaques) on the skin usually of the limbs or neck, sometimes elsewhere
It may follow internal cancer usually of bowel, genitourinary organ or breast
Sweet disease
Neutrophilic dermatosis of the dorsal hands
CONTDBullous Paraneoplastic pemphigusMiscellaneuos Generalised granuloma annulare (rarely) Carcinoid syndrome Hypertrichosis lanuginosa acquisita Trousseau syndrome
HYPERTRICHOSIS LANUGINOSA ACQUISITA
very rare rapid growth of long, fine, lanugo-type
hair particularly around the eyebrows, forehead, ears and nose.
Most commonly affected area is mouth, some patients have extensive involvement that includes the trunk, axillae and extremities.
Palms, soles, scalp and pubic regions tend to be spared
CONTDThe most frequently associated cancers
include: lung cancer breast cancer uterine cancers colorectal cancer lymphoma bladder cancer.
TROUSSEAU SYNDROME
migratory superficial thrombophlebitis. Lesions appear as inflamed, reddened
lines or lumps in the fat under the skin.
CONTD 50% of patients with Trousseau
syndrome have an associated cancer. Pancreatic cancer Adenocarcinomas Lung cancers
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