Dermatology | Dr. rzan
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Skin in systemic diseases
Objectives
Demonstrate skin manifestations of common systemic diseases.
THE SKIN & THE PSYCHOLOGY
Psychiatric problems that have dermatological presentations:
Stress & anxiety may lead to trichotillomanea (hair pulling habit
resulting in alopecia with normal underling skin), nurodermatitis, lip
liking dermatitis, nose picking, nail biting, ...
Obsessive compulsive neuroses may lead to irritant contact
dermatitis.
Phobias: like syphliphobia, parasitopho; scabephobia,
Hysteria: may leads to dermatitis artifacta.
Dermatitis artifacta
Self-induced lesions.
Accessible part.
Bizarre shapes.
No primary lesions.
Secondary gain
Abnormal personlity.
Commonly female.
May have some medical knowledge
Dermatological diseases that lead to psychiatric problems
Most of dermatological diseases affect the psych because they directly
affect the appearance, so there effect may range from:
Discomfort.
Dermatology | Dr. rzan
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Anxiety
Dysmorphophobia (delusion of ugly body part)
Depression
Social isolation.
Suicidal ideation & attempts.
It is found that suicides occur in higher rates among dermatological
patients (like those with psoriasis & acne...).
SKIN & ENDOCRINE SYSTEM
Hyperthyroidism:
Fine hair, hair loss
Pruritus
brittle nails
Onycholysis
Clubbing
Warm smooth skin, hyperhidrosis
Pretibial myxedema. ±
Hypothyroidism:
Coarse hair, diffuse hair, broken hair. Outer third of eyebrow lost.
Pruritus
Brittle nails.
Cold, thickened yellow dry skin (xeroderma).
Myxedema
Acromegaly
Soft tissue hypertrophy
Seborrheic dermatitis
Acanthosis nigricans
Dermatology | Dr. rzan
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Addison’s disease
Increased skin pigmentation.
Cushing’s syndrome:
Fat maldistribution: Moon face& Buffalo hump. Acne.
Hirsutism.
telangiectasia,
thin & atrophic skin
Striae.
Poor wound healing.
Easy bruising.
Acanthosis nigricans.
Diabetes:
1. Dry skin.
2. Pale skin & nails (diabetic angiopathy).
3. Hair loss.
4. Poor sensation (diabetic nuropathy).
5. Diabetic dermopathy. is light brown, oval or round, slightly indented
patches most often appearing on the shins (shin spots).
6. Pruritus
7. Foot ulcers (diabetic foot).
8. Fungal & bacterial skin infections.
9. Poor wound healing.
10. Sclerotic skin.
11. Bullous diabeticorum.
12. Acanthosis nigricans & skin tags.
13. Necrobiosis lipoidica (diabeticorum).
14. Granuloma annulare .
Dermatology | Dr. rzan
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Necrobiosis lipoidica diabeticorum
Atrophic, yellow with erythematous or violet margin. The underlying blood
vessels are easily seen through the atrophic
Prayer sign
Stiff thick skin (diabetic sclerodactyly or cheiroarthropathy) palms
cannot be opposed properly.
SKIN & RESPIRATORY DISEASES
Asthma associated with atopic dermatitis.
TB. May be associated with TB. Of skin.
COPD. : Cyanosis, clubbing of fingers.
SKIN & CARDIAC DISEASES
Cyanotic congenital heart diseases
Cyanosis
Clubbing of fingers.
Endocarditis:
Splinter hemorrhages.
Skin & Gastrointestinal Diseases
Ulcerative colitis: Erythema nodosum & pyoderma gangrinosum.
Crohn’s disease: Erythema nodosum, pyoderma gangrinosum,
Perineal ulceration, skin tags & sinus tracts,fistula.
Abnormality in zinc absorption: Acrodermatitis enteropathica.
Coeliac disease: Dermatitis herpetiformis
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Peutz-Jeghers syndrome: Small intestine polyps+ perioral
pigmentitions.
Skin & Liver diseases
Jaundice.
Pruritus.
Spider navae.
Palmar erythema.
doputrin contracture.
Clubbing of fingers.
Gynecomastia.
Dilated abdominal wall veins.
The skin in renal disease
Pruritus and dry skin
Pigmentation. Earthy color,A yellowish sallow colour and pallor from
anaemia
Half-and-half nail. The proximal half is white and the distal half is pink
or brownish.
‘Perforating disorders’. Small papules in which collagen or elastic
fibres are being extruded through the epidermis.
‘Pseudoporphyria’
PSUDOPORPHYRIA
Skin fragility and photosensitivity, blisters form at the sites of trauma on
sun exposed skin, bursting to leave erosions. Sometimes heal with some
scarring and (milia).
Dermatology | Dr. rzan
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Skin & haematology
Haemolytic anaemia’s: Pallor, jaundice.
Iron deficiency anaemia: pallor,atrophic glositis, Choilonechya
Polycythaemia rubra vera: erythema, itching.
Skin Manifestations of Metabolic Diseases
Hyperlipidaemia:
Xanthelasma
Xanthomas: —tendinous, tuberous, eruptive, Plane.
Porphyria: photosensitivity, skin fragility, Blister formation,
hypertrichosis, milia,pigmentation.
Vitamin B2 (riboflavine) deficiency
Angular stomatitis
Smooth purple tongue
Seborrhoeic dermatitis-like eruption
Pellagra: (nicotinic acid-Viv.B3- deficiency):
3Ds—dementia, dermatitis,diarrhea;
Erythema following sun exposure.
Scurvy:
erythema following sun exposure.
coiled hairs, perifollicular purpura,
poor wound healing