dermatology

1. CUTANEOUS MANIFESTATIONS
OF GASTROINTESTINAL
DISEASES

2. LIVER
DISEASES

3. 1.PIGMENTARY CHANGES
2. VASCULAR CHANGES
3.COAGULATION DEFECTS
4.NAILCHANGES
5.PRURITIS
6.DUE TO HEPATITIS B
7.DUE TO HEPATITIS C
8.DUE TO PRIMARY BILIARY CIRRHOSIS

4. PIGMENTARY CHANGES
• Jaundice/Icterus:
•Diffuse muddy discoloration
• Accentuation of freckling, areolar, perioral,
and periorbital and palmar crease pigmentation

5. VASCULAR CHANGES
Spider angioma (nevus araneus, spider nevus)
➢ A central arteriole from which numerous small
twisted arterioles radiate.
➢ Blanchable lesions, pin head to 2 cms.

6. •Palmar erythema/ Liver Palms: Exaggerated mottling
or a well defined hypothenar erythema that later spreads to
fingers and rest of the palm.
• Unilateral nevoid telengiectasia: Fine thread like
telengiectasia present mostly over C3, C4 dermatome

7. •Paper money Skin: Presence of numerous
threadlike small blood vessels scattered randomly
throughout the skin
• Caput medusae – dialated & radiating
veins seen around the umblicus due to
portal hypertension

8. • Cork screw- vessels present at the margins of sclera.
• Facial flushing.

9. COAGULATION DEFECTS
• Bruising, petechiae, purpura, and ecchymosis.
• Mucosal bleeding (epistaxis or gingival
bleeding).

10. •PRURITUS
• Mostly seen in cholestasis & less commonly with viral
hepatitis
• Due to- Retained cutaneous bile acids
Endogenous opiods

11. Treatment:
• Bile acid sequestrants like cholestyramine,
drugs relieving cholestasis like ursodeoxycholic acid
• Opiod antagonists – Naltrexone
Naloxone
Nalmefene
• Sedating antihistaminics
• Phototherapy
• Plasmapheresis
• Rifampicin.

12. NAIL CHANGES
- Clubbing
- Watch glass deformity.
- Longitudinal ridging
- Thickening
- Brittleness
- Total leuconychia
• Terry’s nails
(whitening of the entire nail plate
except for a narrow pink band distally)
• Muehrcke’s nails
(multiple parallel
transverse white bands)

13. Hepatitis B infection
1.Serum sickness like syndrome: 20-30%
2.PAN: 7-8%
ANCA negative
3.Cryoglobulinemia: 15%
4. Gianotti-crosti syndrome
5. Dermatomyositis
6.Lichen planus
7.Pyoderma gangrenosum

14. Hepatitis C
1. Porphyria Cutanea Tarda
•Anti HCV antibodies - upto 2/3rd
of cases.
•HCV serology should be a part of routine
investigative work up in PCT.
2. Lichen Planus
3. NECROLYTIC ACRAL ERYTHEMA

15. NECROLYTIC ACRAL ERYTHEMA
•Starts as erythematous papules that coalesce into
well-circumscribed dusky areas with scaling and erosions.
•Older lesions- hyperkeratotic surface.
• Mc site- dorsal surface of feet-great toes.
• Spares periorificial areas-
(unlike necrolytic migratory
erythemas and
zinc deficiency )

16. PRIMARY BILIARY CIRRHOSIS
1.Jaundice & pruritis
2.Reynold’s syndrome – PBC & CREST syndrome
3.Higher incidence of Sjogren syndrome, calcinosis cutis
& telengiectasia

17. INFLAMMATORY BOWEL
DISEASES

18. INFLAMMATORY BOWEL DISEASES
❖ Direct extension from the bowel (CD>UC)
Perianal abscess
Fissures, fistula
Anal tags
❖ Disorders secondary to malnutrition/malabsorption:
Anemia, cheilitis, glossitis (vitamin B, Fe)
Acrodermatitis enteropathica (zinc)
Pellagra (niacin)
❖Disorders secondary to treatment:
Acne, cushingoid features
Infections
Drug eruptions

19. Associated disorders:
Erythema nodosum – 5% UC, 2% CD
- MC cutaneous manifestation
- A sudden eruption of painful, tender, erythematous, s/c, firm nodules
-Extensor surfaces of the lower legs
- Appearance of EN usually parallels intestinal ds activity.

20. PYODERMA GANGRENOSUM
2-5% of UC pts, UC>CD.
✕ rapidly expanding ulcer
with purple
undermined border
start as pustules
✕ Ulcerative and
pustular variant.

21. Aphthous ulceration: 5-8%of UC, UC>CD.
Sweets syndrome
Erythema multiforme
Urticaria, angioedema
Vasculitis and coagulation disorders.