2. The following is a summary of
systemic diseases most
commonly encountered in
practice which manifest
themselves by changes in the
skin:
3. hyperlipidaemia
Skin manifestations of hyperlipidaemia
include: flat yellow deposits around the eye
xanthelasma). Elsewhere on the body they
present as yellowish papules or nodules
called xanthoma. Sudden eruptions can
appear in large numbers over the
buttocks, trunk and limbs, or a few larger
lesions can develop on the
elbows, knees, hands and over the Achilles
tendon.
4.
5. Gastrointestinal disease
Inflammatory bowel disease
This can include pyoderma gangrenosum
and erythema nodosum. Oral
manifestations include aphthous
stomatitis, mucosal nodularity
(cobblestoning) and pyostomatitis
vegetans
erythematous thickened mucosa(.
6.
7.
8. Carcinoid syndrome
Cutaneous metastases can present as
deep nodules, hyperkeratosis and
pigmentation changes similar to those
seen in pellagra ( Niacin/ Vitamine B 3
deficiency).
9.
10. Diabetes mellitus
Recurrent skin infections are common, either
due to fungi (e.g. genital candidiasis) or bacteria
(e.g. folliculitis). Blisters on the feet may be
found as granuloma annulare. when these
blisters develop the condition is called bullosis
diabeticorum
Brown macules sometimes develop on the shin
Necrobiosis lipoidica diabeticorum can also occur
on the shins. The lesions have the appearance
of plaques with dark red or purple
we on the surface. edges, atrophic centres and
11.
12. Liver disease
The cutaneous manifestations
characteristically include
Jaundice
Erythema of the palms
Purpura
Spider naevi
Generalised itching
Lichen planus is known to be linked to
hepatitis C infection.
15. Dermatitis•
The appearance can resemble psoriasis Reiter's
Disease or seborrheic dermatitis and has been
termed 'psoriasiform dermatitis of AIDS
Infections
Bacillary angiomatosis is a treatable
infection caused by a rickettsia-like
organism
Viral infections such as chronic herpes
zoster can also occur
16. Malignancy•
Kaposi's sarcoma is an AIDS-defining
illness characterized by initial bruise-
like macules developing into brown-
red or purple firm-to-hard nodules. In
AIDS these are widespread, especially
on the face and trunk.
17.
18. Sarcoidosis
Sarcoidosis can present with erythema
nodosum, or with plaques, papules or
nodules. The latter are commonly seen as
smooth, dark brown/violaceous lesions
arranged in an annular pattern. Infiltration of
an old scar is characteristic so that it
becomes brightly purple coloured. Lupus
pernio is a slowly developing form that
spreads into large areas of plaque on the
chin and nose that
results usually in clear
deformity.
19. Mastocytosis
This is a condition in which there is
proliferation of mast cells. In the skin it can
cause single or multiple, dark red nodules
or plaques that develop into a blister or
wheal when rubbed. This is commonest in
babies. It can also cause urticaria
pigmentosa either as skin wheals in infancy
often following a bath, or extensive areas of
dark brown macules that swell and go red
when stroked in adults.
20. Amyloidosis
Amyloidosis appears in middle age with
bruising petechiae and purpura related to
deposition of amyloid in the dermal blood
supply. This is most frequently seen in the
anogenital, periorbital and peri-umbilical
regions, at the side of the neck and in the
axillae. Atrophic waxy lesions with areas of
purpura inside them may sometimes be
seen, or as shiny smooth firm flat topped
papules of waxy colour.
21. The tips of the fingers may exhibit
softening and loosening of the skin. A
case of advanced primary amyloidosis
presenting as a non-healing leg ulcer
has also been reported.
22. Cutaneous amyloidosis is
associated with various
autoimmune/immune disorders
and associations with sarcoidosis
and IgA nephropathy have been
reported.
23. Acromegaly
Cutaneous changes in acromegaly
can include skin puffiness, oily skin
with large
pores, hypertrichosis pigmented skin
tags, acanthosis nigricans and
psoriasis. Skin creases in the head
area are deeper than normal (cutis
head verticis gyrata or ‘ Klingon
24. Hypopituitarism
The skin is dry, scaly and puffy and the
nails become brittle. The hair is coarse
and sparse, especially in the axillae.
Fine wrinkles around the eyes and
typical. mouth are
25. Hypothyroidism
The skin in myxoedema is cool to the
touch, doughy, dry and puffy and there
may be hair loss. Peri-orbital oedema
may be accompanied by a yellowish
colour to the skin.
26. Hyperthyroidism
The skin in thyrotoxicosis is the
obverse of that seen in myxoedema. It
is warm and moist and flushing of the
face and palms is sometimes seen.
Pre-tibial myxoedema is characteristic.
27. Cushing's syndrome
Abdominal striae may be a prominent
feature, caused by skin atrophy. The
skin may bruise easily and skin
infections and acne may be frequent
problems. Skin darkening may occur
in the palmar creases, on areas
subject to pressure and the axillae.
28. Porphyria
There are a number of different forms of
porphyria, e.g. porphyria cutanea
tarda, erythropoietic porphyria. All are
characterized by photosensitivity, with
fragility and blistering of the skin when
exposed to sunlight or ultraviolet
rays.
29. Rheumatoid arthritis
Rheumatoid nodules - subcutaneous
lumps seen near an affected joint –
in about 25% of the patients. occur
The phenomena include thinning of
the skin, translucency of the skin on
the back of the hands, brittle nails
which split lengthwise and reddened
palms erythema).
30. Dermatitis in which neutrophils are
prominent on biopsy neutrophilic
dermatosis may present as
erythematous areas, and interstitial
granulomatous dermatitis is a rare
condition in which rheumatoid papules
may appear on the trunk. Cutaneous
vasculitis may present as purpuric
areas on the skin.
31. Reiter's disease
Keratoderma blennorrhagicum is
sometimes seen in this condition. It is
characterised by hyperkeratotic lesions on
the palms of the hands or the soles of the
feet. Clear vesicles on an erythematous
base develop which then progress to
macules, papules and nodules. The lesions
may be impossible to distinguish from
pustular psoriasis.
32. Myelodysplastic syndrome
Various cutaneous manifestations can
occur including leukaemia
cutis, photosensitivity, prurigo nodularis and
purpura. Cutaneous conditions are thought
to indicate that the patient belongs to a
high-risk group, associated with bone
marrow transformation and
hypergammaglobulinaemia.
