Scribd
Upload
127 views42 pages

The Skin in Systemic Diseases

The document provides an overview of common skin manifestations seen in various systemic diseases. It discusses key skin findings in liver disease (pruritus, hyperpigmentation, spider nevi, palmar erythema, white nails), renal disease (acquired perforating dermatosis, calciphylaxis, pruritus, hyperpigmentation, half and half nails, pseudoporphyria), hyperlipidemia (xanthelasma, tuberous xanthomas, tendinous xanthomas, eruptive xanthoma, planar xanthomas), internal malignancy (acanthosis nigricans, erythema gyratum repens, acquired hypertrichosis lanuginosa, necrolytic

Uploaded by

rainmaker77771121
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
127 views42 pages

The Skin in Systemic Diseases

The document provides an overview of common skin manifestations seen in various systemic diseases. It discusses key skin findings in liver disease (pruritus, hyperpigmentation, spider nevi, palmar erythema, white nails), renal disease (acquired perforating dermatosis, calciphylaxis, pruritus, hyperpigmentation, half and half nails, pseudoporphyria), hyperlipidemia (xanthelasma, tuberous xanthomas, tendinous xanthomas, eruptive xanthoma, planar xanthomas), internal malignancy (acanthosis nigricans, erythema gyratum repens, acquired hypertrichosis lanuginosa, necrolytic

Uploaded by

rainmaker77771121
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 42

The Skin in commonly

encountered systemic
diseases
Liver disease
Renal disease
Internal malignancy
Diabetes

The skin in liver disease


Pruritus
Always suspect systemic disease when patients
complain of pruritis, follow through with basic screening
investigations, including liver profile

The skin liver disease


Diffuse hyperpigmentation of the skin

The skin in Liver disease


Spider Naevi
can be benign, seen in pregnancy , estrogen therapy,
and thyrotoxicosis

The skin in Liver disease


Palmar Erythema
It may also be a normal finding.

The skin in liver disease


White nails/Terry nails
Can be seen in other conditions Congestive heart failure
, diabetes mellitus and Malnutrition.

The skin in liver disease


Porphyria cutanea tarda
Increase in porphyrins result in photosensitivity

Sores (erosions) following relatively minor injuries


Fluid filled blisters (vesicles and bullae)
Tiny cysts (milia) arising as the blisters heal
Increased sensitivity to the sun

Avoidance of alcohol, protection against


sun,phlebotomy

The skin in Liver disease


Xanthoma
Xanthelesma- Occur in the peri orbital areas as
yellowish polygonal plaques or papules
Eruptive xanthoma- Seen on extensor surfaces as dome
shaped red papules

The skin in Renal disease


Acquired perforating dermatosis
Extensor surface and extremities of trunk
In addition to CRF seen also in DM, liver disease and
thyroid disease
Rx with- Emolient and Anti histamine to relieve pruritis
Other RX High dose Vitamin A, Isoretinoin
Rx underlying CKD

The skin in renal disease


Calciphylaxis
long-standing history of chronic renal failure
generally occur on the lower extremities
liver disease, diabetes, hypercalcemia and
hyperphosphatemia and treatment with warfarin

The skin in renal disease


Pruritis
Systemic treatments that have been used in UP include
ultraviolet light, gabapentin, opioid receptor antagonists
and agonists, antihistamines, activated charcoal, 5HT3antagonists, immunomodulators and erythropoietin.
Topical- Emolient, capsacin for localized use

The skin in renal disease


Hyperpigmentation
attributed to an increase in melanin in the basal layer
and superficial dermis due to failure of the kidneys to
excrete beta-melanocyte-stimulating hormone (b-MSH)

The skin in renal disease


Half and half nail/Lindsay nails
There is no correlation between the degree of azotemia
and the percentage of nail bed that is occupied.
There is no specific therapy

The skin in renal disease


Pseudoporphyria
Pseudoporphyria describes a bullous photosensitivity
that clinically and histologically mimics porphyria
cutanea tarda.

The skin in renal disease


Uremic frost
.

The skin hyperlipidemia

The skin in hyperlipidemia


Xanthelesma Palpebrum
Soft plaques on eyelids
Most common variant
Treatment options include laser therapy,
electrodessication followed by curettage

Skin in hyperlipidemia
Tuberous xanthoma
Firm, painless, red-yellow nodules that develop around
the pressure areas such as the knees, elbows, heels and
buttocks
Lesions can join together to form multilobated masses

The skin in hyperlipidemia


Tendinous Xanthomas
Appear as slowly enlarging subcutaneous nodules or
papules related to the tendons or ligaments
Most commonly found on the dorsum of the hands, feet,
and Achilles tendon
Consider familial Hypercholestrolemia and screen

The skin in hyperlipidemia


Eruptive xanthoma
Sudden onset crops of small, yellow or yellowish brown
papules encircled by an erythematous halo
wax and wane according to variations in plasma ( very
high) triglyceride and lipid content

The skin in hyperlipidemia


Planar Xanthomas
Yellow macular areas
approximately 50% of cases occur in the absence of
lipid or lipoprotein abnormalities
When it occurs in the eyelids..

Misnomers
Diffuse planar xanthoma
A form of histicytosis
Associate with myeloma and leukemia

Xanthoma disseminatum
Again a rare form of histiocytosis

Both have normal lipid values

The Skin in Internal Malignancy


Acanthosis nigricans

cutaneous sign of an underlying condition or disease.


Associated with GIT based tumours

esp Stomach

However its prudent to exclude more common causes


DM, HL, Obesity, syndromic- PCOS, cushings, Benign and
even hereditary

The Skin in Internal Malignancy


Erythema gyratum repens
Pathogenesis is unknown but is thought to be mediated
by tumour Ag and its interaction with skin
Most common underlying causes are bronchial ,
oesophageal , breast

The Skin in Internal Malignancy


Acquired hypertrichosis lanuginosa
Seen in the latter part so usually poor prognosis
Seen in lung , breast, uterine carcinoma

The Skin in Internal Malignancy


Necrolytic Migratory erythema
Seen in glucagnoma (Alpha cell pancreas tumour)
The results of excessive glucagon also include:
Diabetes mellitus
Weight loss
Diarrhoea etc.so look and ask for these

The Skin in Internal Malignancy


Bazex syndrome
Associated with squamous cell carcinoma of the upper
respiratory or gastrointestinal tract, thymus or vulva.
Topical steroidsandemollient creams containingurea ,
lactic acid orSalycylic acid, may reduce the thickness
and irritation of the scaly skin lesions.
Search underlying malignancy

The Skin in Internal Malignancy


Dermatomyositis
In the young it can be the autoimmune spectrum of the
disease
But in the elderly > 60 years suspect Malignancy
Associated with carcinoma cervix, lung , pancreas ,
breast

The Skin in Internal Malignancy


Acquired ichthyosis
Acquired in

Underactivethyroid
Sarcoidosis
Hodgkin lymphoma
HIV

The Skin in Internal Malignancy


Generalized Pruritis
Localized pruritis

The Skin in Internal Malignancy


Sweet syndrome
Associated with AML , haematological malignancy

The Skin in DM
Necrobiosis Lipoidica
Treatment includes Steroid topical or intralesional ,
ciclosporin, PUVA

The Skin in DM
Granuloma Annulare
But there are variants- Generalised, Deep
subcutaneous, Perforating etc
The localized variant usually needs no treatment and
tends to clear byitself

The Skin in DM
Diabetic Dermopathy
Seen in diabetics of at least 10 years plus
Indicator of poor control in diabetics
Harmless, improves with glycemic control

The Skin in DM
Diabetic bullosis
blister-like lesions that occur spontaneously on the feet and
hands of diabetic patients
Intraepidermal bullae these are blisters filled with a clear,
sterile viscous fluid and normally heal spontaneously within 2-5
weeks without scarring and atrophy.
Subepidermal bullae these are less common and may be filled
with blood. Healed blisters may show scarring and atrophy.
Most cases diabetic bullae heal spontaneously without treatment

The Skin in DM
Diabetic stiff skin
Thickening and induration.
Especially dorsum of the fingers.
Leads to clawing.
Correlation with angiopathy.
restricted mobility of the joints of their hands and stiff, waxy,
thickened and yellowed skin.
Finger pebbles = multiple, tiny, flesh-coloured papules on the
dorsum of the fingers, knuckle pads and periungual areas.

The Skin in DM
Vitiligo
idiopathic disorder of melanogenesis characterized by
depigmented macules in an otherwise normal skin.
Autoimmune spectrum and association

The Skin in DM
Neuropathic ulcer
mechanical changes in conformation of the bony architecture of
the foot, peripheral neuropathy, and atherosclerotic peripheral
arterial disease
diabetic foot ulcers may be rated between 0 and 3
0: at risk foot with no ulceration
1: superficial ulceration with no infection
2: deep ulceration exposing tendons and joints
3: extensive ulceration or abscesses
Management is needs off loading, surgery-debridement/vascular,
dressing, antibiotics , grafting and glycemic control

The Skin in Sarcoidosis


Erythema nodosum
A form of panniculitis
Early stages, Red lumps appear on the shins or about
the knees and ankle, hot and painful
Color change occurs over weeks--- Red to purple
Remember there are other causes!!

The Skin in Sarcoidosis


Scar sarcoidosis
Granulomatous lesions arising from scars
rare but highly specific for cutaneous sarcoidosis
Can involve IM sites, tattoos,
Cutaneous sarcoidosis is often not suspected, and
clinical diagnosis is made on subsequent biopsy
Steroids topical or Oral

The Skin in Sarcoidosis


Lupus pernio
large bluish-red and dusky purple infiltrated nodules and
plaque-like lesions on nose, cheeks, ears, fingers and
toes
Sarcoid specific and implies pulmonary and upper
respiratory tract involvement due to disease

The Skin in Sarcoidosis


Annular lesions
Brownish red and violaceous
Vary in size and number

There are other variantsmacularpapular, verrucous,


psoriaform etc

You might also like