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DermNet NZ


Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Cutaneous medicine

Learning objectives
Introduction
Endocrine disorders
Gastrointestinal disease
Renal disease
Haematological disease
Porphyria
Hyperlipidaemia
Behçet’s disease
Nutritional disorders
Amyloidosis
Sarcoidosis
Acquired immunodeficiency syndrome
Activity

Learning objectives

Introduction

Cutaneous signs can be a clue to the diagnosis of systemic diseases or may be a complication of them requiring specific attention. More details on specific skin conditions can be found in other parts of the course or On DermNet NZ.

Endocrine disorders

Diabetes mellitus

Necrobiosis lipoidica
Necrobiosis lipoidica
Necrobiosis lipoidica
Close-up of necrobiosis lipoidica
© R Suhonen
Granuloma annulare
Granuloma annulare
Cutaneous signs of diabetes

Thyroid disease

Pretibial myxoedema
Pretibial myxoedema
Myxoedema
‘Pretibial’ myxoedema on toe
© R Suhonen
Eczema due to dry skin and hypothyroidism
Eczema due to dry skin and hypothyroidism
Cutaneous signs of thyroid disease

Cushing’s syndrome
Hypercorticism can result in acne, striae and cutaneous atrophy.

Moon face from systemic steroids
Moon face
Striae due to systemic steroids
Striae due to systemic steroids
The effects of systemic steroids

Acromegaly
Growth hormone excess results in soft tissue hypertrophy, skin tags and seborrhoea.

Skin tags
Skin tags

Addison’s disease
Lack of cortisol increases ACTH with resultant generalised hyperpigmentation.

Gastrointestinal disease

Dermatitis herpetiformis
Dermatitis herpetiformis
Pyoderma gangrenosum
Pyoderma gangrenosum
Gardner syndrome
Gardner syndrome
Cutaneous signs of gastrointestinal disease

Renal disease

Chronic renal failure is associated with:

Calciphylaxis
Calciphylaxis
Renal pruritus
Renal pruritus
Warts, actinic keratoses and squamous cell carcinomas in renal transplant patient
Warts, actinic keratoses and squamous cell carcinomas
in renal transplant patient aged 33
Cutaneous signs of renal disease

Renal transplantation and the use of immunosuppressive medication gives rise to a high risk of viral infections (mainly warts) and skin cancers (especially squamous cell carcinomas). These may be very aggressive.

Haematological diseases

Porphyria

Porphyrias are due to abnormalities of the haem pathway and result in cutaneous photosensitivity. Diagnosis is confirmed by detection of excessive porphyrins in blood, urine or faeces. The most common to present to dermatologists are:

Erythropoeitic protoporphyria
Erythropoeitic protoporphyria
Urine of patient with porphyria cutanea tarda
Urine of patient with porphyria cutanea tarda
Hands in variegate porphyria
Hands in variegate porphyria
Porphyria

Hyperlipidaemias

Xanthelasma
Xanthelasma
Eruptive xanthomata
Eruptive xanthomata
Tuberous xanthoma
Tuberous xanthoma
Cutaneous signs of hyperlipidaemia

Behçet’s disease

Oral ulceration in Behcet disease
Oral ulceration
Vulval ulceration in Behcet disease
Vulval ulceration
Pathergy in Behcet disease
Pathergy
Behçet’ disease

Nutritional disorders

Scurvy
Vitamin C deficiency presents with corkscrew hairs and bleeding gums or easy bruising and may occur in the elderly. Low levels of leucocyte ascorbic acid confirm the diagnosis.

Pellagra
Nicotinic acid deficiency presents with photosensitive eruption on neck and feet, diarrhoea and dementia.

Kwashiorkor
Protein deficiency may cause dry red skin and hair and is associated with oedema and ascites.

Fatty acid deficiency
Fatty acid deficiency in infants or with total parenteral nutrition may result in dry red skin and delayed healing.

Obesity

Pellagra Pellagra Pellagra
Pellagra

Amyloidosis

Macroglossia in systemic amyloidosis
Macroglossia
systemic amyloidosis
Macular cutaneous amyloidosis
Macular cutaneous amyloidosis

Sarcoidosis

Sarcoidosis is diagnosed histologically by the presence of noncaseating granulomas in the skin, lymph nodes, lungs, liver, spleen, eyes, parotid glands or joints. The mainstay of treatment is systemic corticosteroids.

Cutaneous features are highly variable:

Scar sarcoidosis
Scar sarcoidosis
Facial sarcoidosis
Facial granulomas
Extensive cutaneous sarcoidosis
Extensive plaques
Lupus pernio
Lupus pernio
Bihilar lymphadenopathy in sarcoidosis
Bihilar lymphadenopathy
Erythema nodosum
Erythema nodosum
Sarcoidosis

Acquired immunodeficiency syndrome

Acquired immunodeficiency syndrome (AIDS) is due to infection of T cells with human immunodeficiency virus (HIV) resulting in progressive immunodeficiency and a decrease in T-cell helper / suppressor ratio.

A variety of cutaneous inflammatory conditions, infections and malignancies arise and tend to be more vigorously expressed than in normal individuals.

Activity

How may xanthelasma be removed?

 

Page 3 of 7. Next topic: Cutaneous vasculitis. Back to: Cutaneous signs of systemic disease contents.

Related information

References:

On DermNet NZ:

Information for patients

Other websites:

Books about skin diseases:

See the DermNet NZ bookstore

Author: Clin Assoc Prof Amanda Oakley

DermNet NZ does not provide an online consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.