THE SKIN MANIFESTATION

OF SYSTEMIC DISEASES

Mirror of the human body. Window through which we can

look inside the body. Virtually no disease of the body

that does not give itself away on the skin.

Greatest ‘system’ it can reveal the secrets of all body systems

SKIN

COMMON SYSTEMIC DISEASES GIT diseases

Liver cirrhosis, Inflammatory bowel disease, Carcinoid syndrome

Endocrine disorders DM, Thyroid disorders

Cardiovascular diseases Renal disease

CRF Haematologic diseases

HIV/AIDS Respiratory diseases-

sarcoidosis Neurological diseases

ENDOCRINE DISEASES

DIABETES MELLITUS Infective manifestations Non infective manifestations Features of vascular insufficiency

INFECTIOUS SKIN MANIFESTATIONS Pyodermas Malignant external otitis Necrotizing fascitis Erythrasma Dermatophytosis Candidiasis

FEATURES OF VASCULAR INSUFFICIENCY Ischaemic ulcer Digital gangrene Erysipelas-like erythema Periungual telangiectasia (microvascular

engorgement and tortuosity involving the proximal nail fold.)

Red Skin and Rubeosis Facei(a function of the degree of engorgement of superficial veins)

Pigmented Purpura(salt and pepper appearance)

Gangrene

Periungual Telangiectasia

Pigmented Purpura. Salt and Pepper type of yellow-tan hyperpigmentation of the shin

ERYSIPELAS-LIKE ERYTHEMA Microcirculatory compromise Well demarcated erythema on the lower leg or

dorsum of the foot Radiological evidence of underlying bone

destruction Incipient gangrene Mistaken for erysipelas

No associated pyrexia No elevated ESR No leukocytosis.

NON-INFECTIOUS SKIN MANIFESTATIONS Acanthosis nigricans Diabetic dermopathy Granuloma annulare Lipodystrophy Necrobiosis lipoidica Pruritus (due to dry skin, yeast infection or poor

blood flow) Scleroderma diabeticorum Xanthoma Vitiligo(associated with type 1 than type 2) Stiff hand syndrome Lichen planus Yellow nails

ACANTHOSIS NIGRICANS SymmetricVelvety to verrucousHyperkeratoticHyperpigmented Plaques predilection for

AxillaeNape Flexural areas.

ACANTHOSIS NIGRACANS

DIABETIC DERMOPATHYPost traumatic atrophy post-

inflammatory hyperpigmentation in poorly vascularized skin.

Atrophic hyperpigmented macules on the shins,

Most common cutaneous finding

DIABETIC DERMOPATHY

GRANULOMA ANNULARE Can occur on any site of the body

occasionally widespread. Skin coloured bumps

occur in rings often over joints, particularly knuckles. centre depressed.

GRANOLOMA ANNULARE

NECROBIOSIS LIPOIDICA

Well-defined, small, firm, dusky-red papule topped with a fine scale.

Slow enlargement or coalescence, form indurated plaques centre is yellow, indicating lipid accumulation.

NECROBIOSIS LIPOIDICA

SCLEREDEMA ADULTORUM Marked increase in dermal

thickness on the posterior back and upper neck in middle agedOverweightpoorly controlled type II diabetic

SCLEREDEMA DIABETICORUM

DIABETIC BULLAE

Spontaneous onset of multiple bullae on his lower extremities Not secondary to

trauma Infection

Healed without special intervention.

THYROID Hypothyroidism

Diffuse hair lossVitiligodry skin itching

Hyperthyroidism Diffuse hair loss itching

Grave’s diseas -pretibial myxoedema

PRETIBIAL MYXOEDEMA

CUSHING’S SYNDROME

Acne Striae skin atrophy

STRIAE

ACROMEGALY Excessive soft tissue hypertrophy

Skin tags Seborrhoea

SKIN TAGS

ADDISON’S DISEASE

Hyperpigmentation

GIT DISEASES Liver cirrhosis Gardner’syndrome Peutz-jeghers syndrome

CUTANEOUS MANIFESTATIONS OF LIVER CIRRHOSIS Fluffiness of the hair Spider angiomata (spider nevi) Caput medusae Dupuytren’s contracture Palmar erythema Generalized pruritus Nail changes

Finger clubbing Terry’s nails-prox 2/3 of nails are white due to

hypoalbuminaemia(leuconychia) Muehrcke’s nail- paired horizontal bands

seperated by area of normal colour.

GARDENER’S SYNDROME variant of FAP

GI polyps, multiple osteomas skin and soft tissue tumours

Most noticeable cutaneous feature is appearance of epidermoid cysts

PEUTZ-JEGHERS SYNDROME polyps in association with pigmentation

affecting skin and mucous membranes melanocytic macules usually appears before 5 years of age

and may fade after puberty.

SKIN MANIFESTATIONS 0F RENAL DISORDERS

Pruritus Pallor Pigmentary changes Nodular prurigo Ureamic frosts Purpura Metastatis calcification Ecchymoses Reccurent viral warts Half-on-half nail Koilonychia Onychomycosis Splinter haemorrhages Beau’s lines Subungal hyperkeratosis

INTERNAL MALIGNANCIES Often be the first sign 2 major types:

Genetically determined syndromesParaneoplastic syndromes

GENODERMATOSES Cowden's disease Gardner syndrome Gorlin's syndrome Multiple endocrine neoplasm type 2B Neurofibromatosis Peutz-Jeghers syndrome Torre-Muir syndrome

COWDEN’S DISEASE

Hamartomas of skin and mucosa At least one of the four types of skin lesions

Facial papules – flesh-coloured flat-topped dry or warty 1-5mm papules around the mouth, nostrils and eyes.

Oral lesions – numerous 1-3 mm smooth whitish spots on the gums and palate that join together to create a cobblestone appearance known as papillomatosis.

Acral keratoses – flesh-coloured or slightly pigmented smooth or warty papules on the upper surface of hands and feet.

Palmoplantar keratoses – scaly spots on the palms and soles

Lipomas,Neuromas,Haemangiomas.

Acral keratoses Facial papule Close-up

CD IS SEEN IN Breast cancer Genitourinary tumours Thyroid cancer,especially follicular

thyroid carcinoma Skeletal abnormalities such as bone

cysts. Gastrointestinal polyps

NEUROFIBROMATOSIS Café au let patches

oval-shaped light brown patches greater than 0.5cm in diameter

Multiple neurofibromas Freckling Lisch nodules

Café-au-lait mark Freckling in the armpit

Neurofibromas

PARANOEPLASTIC SYNDROMESPapulosquamous Acanthosis nigricans Acquired ichthyosisAcrokeratosis paraneoplasticaExtramammary Paget diseaseFlorid cutaneous papillomatosisPalmoplantar keratodermaPityriasis rotundaSign of Leser-TrelatTripe palms

SIGN OF LESER-TRÉLAT

The sign of Leser-Telat characterised by the abrupt appearance of multiple

seborrhoeic keratoses Associated with

adenocarcinoma of the stomach or colonsquamous cell carcinoma lymphoma leukaemia.

Multiple eruptive seborrhoeic keratoses

TRIPE PALMS

‘acanthosis palmaris’ thickened velvety palms 90% associated with internal malignancy. Tripe palms are frequently seen in conjunction

with acanthosis nigricans.

Tripe palms associated with acanthosis nigricans

CONTDErythematous Dermatomyositis Erythema gyratum repens Hypertrophic osteoarthropathy and

digital clubbing Multicentric reticulohistiocytosis Necrolytic migratory erythema Sweet disease

SWEET DISEASE sudden appearance of red tender lumps

(plaques) on the skin usually of the limbs or neck, sometimes elsewhere

It may follow internal cancer usually of bowel, genitourinary organ or breast

Sweet disease

Neutrophilic dermatosis of the dorsal hands

CONTDBullous Paraneoplastic pemphigusMiscellaneuos Generalised granuloma annulare (rarely) Carcinoid syndrome Hypertrichosis lanuginosa acquisita Trousseau syndrome

HYPERTRICHOSIS LANUGINOSA ACQUISITA

very rare rapid growth of long, fine, lanugo-type

hair particularly around the eyebrows, forehead, ears and nose.

Most commonly affected area is mouth, some patients have extensive involvement that includes the trunk, axillae and extremities.

Palms, soles, scalp and pubic regions tend to be spared

CONTDThe most frequently associated cancers

include: lung cancer breast cancer uterine cancers colorectal cancer lymphoma bladder cancer.

TROUSSEAU SYNDROME

migratory superficial thrombophlebitis. Lesions appear as inflamed, reddened

lines or lumps in the fat under the skin.

CONTD 50% of patients with Trousseau

syndrome have an associated cancer. Pancreatic cancer Adenocarcinomas Lung cancers

THANK YOU