SKIN MANIFESTATIONS OF SYSTEMIC DISEASES Dr MOHAMED NASR

SKIN MANIFESTATIONS OF SYSTEMIC DISEASES Dr. MOHAMED NASR Lecturer Of Dermatology & Venereology

The relation between skin and the body is three dimensional: A-Effect of skin on the body: B-Diseases affecting both the skin and body: C-Skin as a mirror of the systemic diseases:

A-Effect of skin on the body: Extensive burns Erythroderma Bullous diseases Electrolyte imbalance Hypoproteinaemia Hypothermia Massive sepsis

B-Diseases affecting both the skin and body: - Connective tissue diseases: 1 - Systemic lupus erythematosis 2 - Systemic sclerosis 3 - Dermatomyositis - Hereditary diseases: e. g neurofibromatosis (Von Reckling Housen's disease).

C-Skin as a mirror of the systemic diseases: 1 -Thyroid disease Both hyper and hypothyroidism are associated with characteristic skin manifestations.

Hyperthyroidism Warm skin, flushing, palmar erythema and increased sweating (palms and soles). Fine thin hair and sometimes diffuse alopecia. Plummers nails and thyroid acropachy. Hyperpigmentation. Pretibial myxedema. Pruritus , urticaria.

Fine thin hair Flushing

Plummers nails

Thyroid acropachy

Black halos

Pretibial myxedema

Hypothyroidism Pale cold ivory yellow scaly wrinkled skin. Absent sweating, dry skin (xerosis). Eczema and pruritus. Palmoplantar keratoderma. Xanthomatosis. Puffy oedema of hands, face and eyelids. Purpura and ecchymoses. Punctuate telangiectasia on arms and fingertips. Delayed wound healing. Brittle striated nails and slow nail growth. Coarse sparse scalp hair. Loss of axillary and facial hair.

xerosis

Palmoplantar keratoderma

Xanthomatosis

2 -Diabetes mellitus: Diabetic dermopathy is the most common manifestation (brownish depressed spots on the shins, forearms, thigh and over bony prominences ). Erysipelas like erythema on the legs or feet in elderly diabetics. Diabetic rubeosis of face , hands and feet. Recurrent cutaneous infections (bacterial ex; Staph and fungal ex; candidiasis). Diabetic bullae and wet gangrene. Diabetic microangiopathy. Diabetic neuropathy. Trophic ulcers and diabetic foot. Pruritus especially perianal and genital regions.

Skin manifestations associated with diabetes: --Necrobiosis lipoidica (pretibial yellowish smooth firm atrophic plaque with erythematous border and telangiectasia on the surface) --Dessiminated granuloma annulare --Eruptive xanthomas

Diabetic dermopathy

Necrobiosis lipoidica

Dessiminated granuloma annulare

3 - Gastrointestinal diseases: a-Acrodermatitis enteropathica: Probably caused by an inherited defect in the absorption of zinc leading to acute zinc deficiency, usually at the time of weaning. The child becomes photophobic, irritable or withdrawn and may suffer from diarrhea. Vesiculobullous dermatitis, periorificial and on hands and feet. Loss of scalp hair, stunted growth and higher incidence of infection. Poor wound healing.

b-Ulcerative colitis: Skin lesions occur in 10% - 30% of patients with ulcerative colitis; pyoderma gangrenosum erythema nodosum erythema multiforme aphthus stomatitis urticaria & angioedema vascultitis, purpura and gangrene.

4 - Liver disease: Generalized pruritus: due to bile salts, endogenous opiates Pigmentation: – jaundice – muddy grey hyperpigmentation with yellowish tinge – spotted hypomelanosis in relation to spider angiomas Spider angiomas and caput medusae Palmar erythema Purpura and bruises Thin hair, female type of hair distribution in males and loss of secondary sex characters (effect of hormonal disturbance) Terry's nails ( diffuse white colour of the nail plate with distal pink colour), white bands, clubbing & koilonychia Lichen planus

Spider angioma

Caput medusae

Palmar erythema

Terry’s nail

5 - Chronic renal failure (uraemia) Muddy brown or grey skin colouration (earthy look). Pallor due to reduced erythropoesis and increased haemolysis. Dry skin with urea frost and generalised intense pruritus. Half and half nails (the distal part of nail plate is reddish brown while the proximal part is white). Purpura, calcification and perforating dermatoses.

Urea frost

Half and half nail

6 - Paraneoplastic lesions They are skin diseases or manifestations which have higher incidence with malignancies.

Lesser Trélat sign; sudden development of numerous seborrheic keratoses with adenocarcinoma of GIT and breast.

Pyoderma gangrenosum; with lymphomas, leukemias, multiple myeloma.

Dermatomyositis; with gynecological tumors in women & lung cancer in men.

Acanthosis nigricans with GIT tumors.

Acanthosis palmaris; with bronchogenic carcinoma.

Palmoplantar keratoderma with carcinoma of the eosophagus.

Acquired icthyosis; with lymphomas.

Pruritis with Hodgkin lymphoma.

Flushing with carcinoid syndrome.

Erythroderma; with Sézary syndrome, lymphomas and leukemias.

Erythema annulare centrifugum with myeloproliferative disorders.