SKIN MANIFESTATIONS SKIN MANIFESTATIONS OF OF

SYSTEMIC DISEASESSYSTEMIC DISEASES

SKIN MANIFESTATIONS SKIN MANIFESTATIONS OF OF

SYSTEMIC DISEASESSYSTEMIC DISEASES

Dr.MOHAMED NASRDr.MOHAMED NASR Lecturer Of Lecturer Of

Dermatology & VenereologyDermatology & Venereology

The relation between skin and the body is The relation between skin and the body is three dimensional:three dimensional:

A-Effect of skin on the body: A-Effect of skin on the body:

B-Diseases affecting both the skin and body:B-Diseases affecting both the skin and body:

C-Skin as a mirror of the systemic diseases:C-Skin as a mirror of the systemic diseases:

A-Effect of skin on the bodyA-Effect of skin on the body::

Extensive burnsExtensive burns ErythrodermaErythroderma

Bullous diseasesBullous diseases

ElectrolyteElectrolyte imbalanceimbalance

HypoproteinaemiaHypoproteinaemia HypothermiaHypothermia MassiveMassive sepsissepsis

B-Diseases affecting both the skin B-Diseases affecting both the skin and bodyand body::

- Connective tissue diseases: - Connective tissue diseases:

1- Systemic lupus erythematosis 1- Systemic lupus erythematosis

2- Systemic sclerosis2- Systemic sclerosis

3- Dermatomyositis 3- Dermatomyositis

- - Hereditary diseasesHereditary diseases::

e.g neurofibromatosis (Von Reckling e.g neurofibromatosis (Von Reckling Housen's disease).Housen's disease).

C-Skin as a mirror of the systemic diseases:C-Skin as a mirror of the systemic diseases:

1-Thyroid disease1-Thyroid disease

Both hyper and hypothyroidism are associated Both hyper and hypothyroidism are associated with characteristic skin manifestations.with characteristic skin manifestations.

HyperthyroidismHyperthyroidism

Warm skin, flushing, palmar erythema and Warm skin, flushing, palmar erythema and increased sweating (palms and soles).increased sweating (palms and soles).

Fine thin hair and sometimes diffuse alopecia.Fine thin hair and sometimes diffuse alopecia.

Plummers nails and thyroid acropachy.Plummers nails and thyroid acropachy.

Hyperpigmentation.Hyperpigmentation.

Pretibial myxedema.Pretibial myxedema.

Pruritus , urticaria.Pruritus , urticaria.

Flushing

Fine thin hair

Plummers nails Plummers nails

Thyroid acropachyThyroid acropachy

Black Black haloshalos

Pretibial Pretibial myxedemamyxedema

HypothyroidismHypothyroidism

Pale cold ivory yellow scaly wrinkled skin.Pale cold ivory yellow scaly wrinkled skin.Absent sweating, dry skin (xerosis). Absent sweating, dry skin (xerosis). Eczema and pruritus.Eczema and pruritus.Palmoplantar keratoderma.Palmoplantar keratoderma.Xanthomatosis.Xanthomatosis.Puffy oedema of hands, face and eyelids.Puffy oedema of hands, face and eyelids.Purpura and ecchymoses.Purpura and ecchymoses.Punctuate telangiectasia on arms and fingertips.Punctuate telangiectasia on arms and fingertips.Delayed wound healing.Delayed wound healing.Brittle striated nails and slow nail growth.Brittle striated nails and slow nail growth.Coarse sparse scalp hair. Coarse sparse scalp hair. Loss of axillary and facial hair.Loss of axillary and facial hair.

xerosisxerosis

Palmoplantar Palmoplantar keratodermakeratoderma

Xanthomatosis Xanthomatosis

22--Diabetes mellitusDiabetes mellitus::

Diabetic dermopathy is the most common manifestation Diabetic dermopathy is the most common manifestation (brownish depressed spots on the shins, forearms, thigh and (brownish depressed spots on the shins, forearms, thigh and over bony prominences ). over bony prominences ). Erysipelas like erythema on the legs or feet in elderly diabetics.Erysipelas like erythema on the legs or feet in elderly diabetics.Diabetic rubeosis of face , hands and feet.Diabetic rubeosis of face , hands and feet.Recurrent cutaneous infections (bacterial ex; Staph and fungal Recurrent cutaneous infections (bacterial ex; Staph and fungal ex; candidiasis).ex; candidiasis).Diabetic bullae and wet gangrene.Diabetic bullae and wet gangrene.Diabetic microangiopathy.Diabetic microangiopathy.Diabetic neuropathy.Diabetic neuropathy.Trophic ulcers and diabetic foot.Trophic ulcers and diabetic foot.Pruritus especially perianal and genital regions.Pruritus especially perianal and genital regions.

Skin manifestations associated with diabetes:Skin manifestations associated with diabetes:

--Necrobiosis lipoidica (pretibial yellowish --Necrobiosis lipoidica (pretibial yellowish smooth firm atrophic plaque with erythematous smooth firm atrophic plaque with erythematous border and telangiectasia on the surface)border and telangiectasia on the surface)

--Dessiminated granuloma annulare--Dessiminated granuloma annulare

--Eruptive xanthomas--Eruptive xanthomas

Diabetic dermopathy Diabetic dermopathy

Necrobiosis lipoidica Necrobiosis lipoidica

Dessiminated granuloma annulare Dessiminated granuloma annulare

33 - -Gastrointestinal diseasesGastrointestinal diseases::

a-Acrodermatitis enteropathica:a-Acrodermatitis enteropathica:Probably caused by an inherited defect in the Probably caused by an inherited defect in the absorption of zinc leading to acute zinc deficiency, absorption of zinc leading to acute zinc deficiency, usually at the time of weaning.usually at the time of weaning.The child becomes photophobic, irritable or The child becomes photophobic, irritable or withdrawn and may suffer from diarrhea.withdrawn and may suffer from diarrhea.Vesiculobullous dermatitis, periorificial and on hands Vesiculobullous dermatitis, periorificial and on hands and feet.and feet.Loss of scalp hair, stunted growth and higher Loss of scalp hair, stunted growth and higher incidence of infection.incidence of infection.Poor wound healing.Poor wound healing.

b-Ulcerative colitis:b-Ulcerative colitis: Skin lesions occur in 10% - 30% of patients with Skin lesions occur in 10% - 30% of patients with

ulcerative colitis; ulcerative colitis; pyoderma gangrenosum pyoderma gangrenosum erythema nodosum erythema nodosum erythema multiformeerythema multiformeaphthus stomatitisaphthus stomatitisurticaria & angioedema urticaria & angioedema vascultitis, purpura and gangrene.vascultitis, purpura and gangrene.

44 - -Liver diseaseLiver disease::

Generalized pruritus:Generalized pruritus: due to bile salts, endogenous opiates due to bile salts, endogenous opiatesPigmentation:Pigmentation:

– jaundice jaundice – muddy grey hyperpigmentation with yellowish tinge muddy grey hyperpigmentation with yellowish tinge – spotted hypomelanosis in relation to spider angiomasspotted hypomelanosis in relation to spider angiomas

Spider angiomas and caput medusaeSpider angiomas and caput medusaePalmar erythemaPalmar erythemaPurpura and bruisesPurpura and bruisesThin hair, female type of hair distribution in males and loss of Thin hair, female type of hair distribution in males and loss of secondary sex characters (effect of hormonal disturbance)secondary sex characters (effect of hormonal disturbance)Terry's nailsTerry's nails ( diffuse white colour of the nail plate with distal ( diffuse white colour of the nail plate with distal pink colour), white bands, clubbing & koilonychiapink colour), white bands, clubbing & koilonychiaLichen planus Lichen planus

Spider angiomaSpider angioma

Caput medusaeCaput medusae

Palmar erythemaPalmar erythema

Terry’s nailTerry’s nail

55 - -Chronic renal failure (uraemia)Chronic renal failure (uraemia)

Muddy brown or grey skin colouration (Muddy brown or grey skin colouration (earthy earthy looklook).).

PallorPallor due to reduced erythropoesis and increased due to reduced erythropoesis and increased haemolysis.haemolysis.

Dry skin with Dry skin with urea frosturea frost and generalised intense and generalised intense prurituspruritus..

Half and half nailsHalf and half nails (the distal part of nail plate is (the distal part of nail plate is reddish brown while the proximal part is white). reddish brown while the proximal part is white).

Purpura, calcification and perforating dermatoses.Purpura, calcification and perforating dermatoses.

Urea frostUrea frost

Half and half nailHalf and half nail

66 - -Paraneoplastic lesionsParaneoplastic lesions

They are skin diseases or manifestations which They are skin diseases or manifestations which have higher incidence with malignancies. have higher incidence with malignancies.

Lesser Trélat sign;Lesser Trélat sign; sudden development of sudden development of numerous seborrheic keratoses with numerous seborrheic keratoses with adenocarcinoma of GIT and breast. adenocarcinoma of GIT and breast.

Pyoderma gangrenosum;Pyoderma gangrenosum; with lymphomas, with lymphomas, leukemias, multiple myeloma.leukemias, multiple myeloma.

DermatomyositisDermatomyositis;; with gynecological with gynecological tumors in women & lung cancer in men.tumors in women & lung cancer in men.

Acanthosis nigricansAcanthosis nigricans with GIT tumors. with GIT tumors.

Acanthosis palmaris;Acanthosis palmaris; with bronchogenic with bronchogenic carcinoma. carcinoma.

Palmoplantar keratodermaPalmoplantar keratoderma with carcinoma of with carcinoma of the eosophagus. the eosophagus.

Acquired icthyosis;Acquired icthyosis; with lymphomas. with lymphomas.

PruritisPruritis with Hodgkin lymphoma.with Hodgkin lymphoma.

FlushingFlushing with carcinoid syndrome. with carcinoid syndrome.

ErythrodermaErythroderma;; with Sézary syndrome, with Sézary syndrome, lymphomas and leukemias.lymphomas and leukemias.

Erythema annulare centrifugumErythema annulare centrifugum with with myeloproliferative disorders.myeloproliferative disorders.