AFTER MID
TOTAL LEC: 14
Dermatology
Cutaneous Manifestation of
systemic diseases
DR. BASMAN LEC: 4
Dr. Basman
Cutaneous manifestations in systemic diseases
Endocrine diseases
Diabetes mellitus
Diabetes is a systemic disease associated with wide range of dermatological
manifestations .. mainly
1 generalized pruritus , is propably related to dry skin rather than high blood sugar.
2 increased liability to infections especially in uncontrolled diabetes. And include
bacterial infections especially staph , like boils ,carbuncles and cellulitis.
candidal infection in foots , genetilia and toe webs.
3 bullous diabeticorum as bullous lesions on hands and feet that reslove spotaneously
after few weeks without scarring.
4 ischemic gangrene due to atherosclerosis especially on feet and toes.
5 leg ulcers . due to angiopathy, neuropathy, tauma and infection
6 diabeteic dermopathy , shin spots. As brownish macules and atrophic scars mainly
on the shins in symetrical distribution.
7 necrobiosis lipoidica in 1% 0f patients as brownish plaques and patches on the
shins with atrophic center. Rarely on other parts if the body...histopathology showing
palisading granuloma.
8 Acanthosis nigricans which is thikening and hyperpigmentation around the neck
and other magor flexures,
Thyroid gland diseases
Hypothyroidism main skin manifestations
Puffy face and eyelids
Thinning of hair and eyebrows
Brittle nails
Generalized pruritus
Poor wound healing
Dry skin
Hyperthyroidism
Skin is red and moist
Generalized pruritus
Difuse thininhg of hair
Onycholysis
Clubbing
Palmer erythema
Preitibial myxedema , as nonnpitting edema with red plaques on the shins.
Histopathologically dermal edema and mucin deposition
Acromegally
Wet and oily skin
Thickened lower lip and eyelids and toungue
Hirsutism
Acanthosis nigricans
Hyperprolactemia
Main skin manifestation is hirsutism and acne
Cushing syndrom
which result from high corticosteroid level from adrenal or ovarian or pituitary
disease or exogenous source.
skin manifestations ,
plethoric puffy face
buffalo hump from fat distribution
striae distensae
easy bruising
acne form erupton on face and trunck , monomorphus and no comedons
hirsutism
hyperpigmentation if high ACTH
striae distensae
main causes
idiopathic
pregnancy
obesity
cushing syndrom
main sites abdomen inner thighs and inner arms
early lesions as red linear lesions and after many months become white like a scar
histology dermal colagen rupture and thinning of skin and blood vessels there is no
convenient treatment with good results
skin and liver diseases
1 generalized itching occur mainly in obstructive biliary disease due to the circulating
bile salts and acids..
2 palmer erythama and spider naevi occur whith liver cirrhosis
3 thinning or loss of axillary and pubic hair.
4 white nail in hypoalbuminimia
5 gynecomastia
6 yellow disloration of skin , jaundice
7 xanthomas coolection of lipid in the dermis.. occur in obstructive liver diseae
8 thinning of scalp hair
9 echymosis and purpura
10 urticaia in viral and autoimunehepatitis
skin and renal failure
skin manefestations uaually appear in advenced renal failure
1 generalized itching in half of patients
2 urea frost on the skin
3 dry skin
4 purpura due to platlet dysfuncion
5 brown disloration of skin
6 pallor due to anemia
7 half half nail , proximal part white distal part red
8 calcinosis cutis due to secondary hyperparathyroidism appear as firm papules and
nodules on the extesor surfaces of joint.
Skin and malabsorption
Non specific features in general malabsorption and general nutritional deffeciency
1 pruritus mainly due iron deffeciency anemia and dry skin
2 dry skin due to vitamines deffeciency
3 pallor due to anemia
4 edema and white nails and palmer erythama due to hypoalbuminimia
5 thinning ohf hair and nails .
some skin conditions due to specific nutrients deffiecency
1 follicular hyperkeratosis and dryness due to vit A diffeciency , phrynoderma
2 angular chielitis and glositis , smooth red tounge , in B 12 def.
3 echymosis , purpura and gum bleeding in vit C def.
4 iron defeciency lead to general itching , hair thinning and fall and spoon nails,
koilonychia
5 pellagra is due to niacin def. ,B 3 this condition common ia alcoholics and in
malabsorption syndrom. Main features ,
dermatitis maily arounrd the neck ,necklace like,and the nose as erythama and scales
with photosensitivity and easy sun burning
diarrhea
dementia
treatment with niacin , nicotinamide tab in high dose and nutritional support
6 zinc deffiiciency ....2 types ,
primary deffeciency
is autosomal reccisive condition in which there is enzymetic defieceny in zinc
absorption , the condition known as acrodermatitis enteropathica.
Manifestation start to appear in infancy or earlly childhood as ,
Failure to thrive
Diarrhia
Vesicoboulus lesions with erotions and crustation around orficec mainly around
mouth anus and napkin area
Difinite diagnosos is to check level of zinc in serum
Treatment , zinc supplementation in high dose continuously
Secondar difecieny in
Premature infants
Malabsorption
Alcoholism
Long parentral nutrition
Same diagnisis and treatment
Skin and inflamatory bowl diseases
Crohns disease
Main skin manifestations
1 perianal abcess and fistula in 20% .
2 multiple sinuses in abdominal wall and inguinal folds
3 oral aphthosis
4 erythema nodusum
5 cutaneuos vasculitis
6 cutaneuos granuloma
7 features of malabsorption in sever cases
8 pyoderma gangrenosum
occurs in crohn disease and ulcerative colitits
condition starts as inflamatory pustule that rapidly progress to necrotic large ulcer
with undermined borders that is slow to heal , very paiful and mainly on legs and
truck. It needs high dose of systemic steroids and immunosupressives like imuran for
treatment and control.
Ulcerative colitis
Same as crohn disease but more pyoderman gangrenosum and oral ulcerations and
erythama nodusum
cutaneuos markers of internal malignancy
malignant tumours can affect the skin in the following ways
1 by direct spread and metastasis and presest as firm nodules or papules near the
tumour site. Other example is carcinoma erysipiloidis and carcinoma telangiectoides
which occuer in breat cancer.
2 distant metatasis ..can produce firm papules and nudules far from the primary
tumour site by lymphatic or hematobenous fpread. Other examples is sister Josef
nodules on the umbilicus and alopecia neoplastica on the scalp .
3 genetically determined sydroms that have skin manifestation and associated whith
internal malignany. For example Peutz Jeghers syndrom which is multilple intestinal
polyposis and pigmrnted macules on the lips and oral mucosa.
4 cutaneuos sings of exposure to carcinogenes . eg. Nicotine stain on the fingers.
5 reactive conditions to the neoplsm , called paraneoplastic manifestations eg.
1 acanthosis nigricans , eg. gastric cancer
2 dermatomyosistis eg. lung cancer
3 aquired ecthyosis , eg. Hodgins diseaes
4 pruritus , Hodgins diseaes
5 paraneoplastic pemphigus eg.lymphoma
6 pyoderma gangrenosum ,eg. leukemaia
7 flushing , carcinoid sydrom
8 clubbing.
6 features result from organ invasion, eg.
Bone marrow , purpura and pallor anf infections
Liver , jaundice and pruritus
Xanthomatosis
This is deposition of lipids in the skin..its important because sometimes may be
assosiated with hyperlipidemia.
Hyperlipedimia is of 2 types ,
Primary , which is genetically determined abnormality in lipid metabolism.
Secondary, which occur mainly in liver disease , nephrotis syndrom , diabetes and
hypothyroidism.
Clinical types of skin xanthomas
1 xanthelesma ,its the most common type. Present as yellow plaques or papules
around the eyes. Only 20% have incease in serum lipids. Other cases are idiopathic
and occur mainly in middle age persons.
Treament is removal by light cautery and curetage .
2 tuberous xanthoma , as plaques and papules or nodules mainly on knees and elbows
and usyally seen in primary hypercholestrolemia.
3 Tendinous xanthoma , as papules and nodules on extensor tendons of hands and
feet and tendon achelis , usually with primary hyperlipidemia.
4 eruptive xanthoma as generalized yelow papules , usually with high triglecerides
5 palmer xanthoma on palmer crease.
In all types of xanthoma the most important is tho check and treat hyprtlipedimia if
present .