Transcript THE CUTANEOUS MANIFESTATIONS OF SYSTEMIC DISEASES

THE CUTANEOUS
MANIFESTATIONS OF
SYSTEMIC DISEASES
‫هدف عبداألمير‬.‫د‬
DIABETES MELLITUS & SKIN
1- Infections:bacterial as staph.,E-coli &
pseudomonas,fungal as candida albicans
2-diabetic dermopathy: most common, 50% 0f
diabetics mostly men, atrophic,
hyperpigmented spots on shins.
3- diabetic bullae: painless, spontaneously
occuring & resolving, mostly acral parts.
4- ulceration: especially of feet (neuropathic,
microvascularly compromised & infection prone
foot) endangers life & limb.
DIABETES MELLITUS & SKIN
5- Carotenosis: mainly palm & sole.
6- Necrobiosis lipoidica: well-circumscribed
depressed, firm, waxy lesion, yellowish
centre, red border+ telangectasia±
ulceration,85% on shins, females more,
0.3-0.7% of diabetics, & 60% of them
have diabetes, 20% abnormal GT or +ve
FH of diabetes.
DIABETES MELLITUS & SKIN
7- Granuloma annulare: dermal nodules
singly or annular configuration, asympt.,
on hands & feet, ? Association.
8- Eruptive xanthoma & PCT.
9- Acanthosis nigricans.
10- many other minor complications.
THE SKIN IN LIVER DISEASES
1- Pruritis: usually related to obstructive jaundice,
but may precede it.
2- jaundice.
3- spider nevi.
4-palmar erythema.
5-white nails.
6-xanthoma in primary biliary cirrhosis.
7-porphyria cutanea tarda: bullae, scarring &
dyspigmentation sun exposed skin.
CUTANEOUS MANIFESTATIOS
OF RENAL FAILURE
1- Pruritis & a generally dry skin.
2- Pigmentation: earthy color- with a
yellowish tinge & pallor from anemia.
3- Half & half nail: proximal white & distal
pink or brown.
4- Infections: as onychomycoses & tinea
pedis.
5-xanthoma.
TYHROID DISEASES
HYPOTHYROIDISM
1- Dry & pale skin.
2- edema of eyelids & hands.
3- Decreased sweating.
4- Hair changes: coarse, thin, brittle hair
with loss of pubic,axillary, outer eyebrows
5- Brittle, poorly growing nails.
6- Purpura & bruising
HYPERTHYROIDISM
1- Pretibial myxedema: plaques & nodules
on the shins, non-pitting.
2-Increased sweating especially palm+sole
3-Thinning of scalp hair.
4-Diffuse pigmentation.
5-rapidly growing nails ± clubbing.
6- palmar erythema +facial flushing.
CUSHING SYNDROME
1- Truncal obesity +moon face.
2- Striae distensiae.
3- Hypertension &↓ CHO tolerance.
4- Protein catabolism.
5- Psychiatric disturbances.
6- Amenorrhea & hirsutism in females.
XANTHOMAS
Deposition of fatty material in the skin,
subcutaneous tissue & tendons.
May be the first clue to primary or
secondary hyperlipidemia.
Primary genetic with many types.
Secondary to diabetes, obesity, biliary
cirrhosis, CRF, nephrotic syndrome,
pancreatitis, hypothyroidism, drugs as
estrogen, retinoid, steroids.
Types of xanthoma
1-Xanthelasma: inner canthi, flat,
commonest, 50% no lipid abn., removal.
2- Tuberous: firm nodules, elbow & knee.
3- Tendinous: s.c nodules, back of fingers
& Achilles tendon.
4- Eruptive: small papules in crops,
anywhere, esp. shoulders & buttocks,
more↑ TG.
5- Plane: flat, palmar creases, axillae
CUTANEOUS MANIFESTATIONS
OF INTERNAL MALIGNANCY
Can be either specific or non-specific.
1- Acanthosis nigricans: velvety thickening &
hyperpigmentation of flexures, 3 types, the
malignant is widespread, itchy,60% associated
with adenocarcinoma usually gastric.
2-Necrolytic migratory erythema: ass. With
glucagon secreting tumor of pancreas, figurate
erythema with crusted edge + anemia, w.t loss,
stomatitis, & diabetes.
INTERNAL MALIGNANCY
3-Bazex syndrome: erth. Plaques on
fingers, toes, ears, nose+ nail dystrophy+
palmoplantar keratoderma+ URT tumor.
4-Erythema gyratum repens: gyrate erth.+
wood grain pattern of scaling.
5-Dermatomyositis: patients over 40
usually ass. With tumors esp. of GIT,
lung, ovary.
INTERNAL MALIGNANCY
6- Generalized pruritis.
7- Acquired ichthyosis.
8- Leser-Trelat sign: sudden appearance of
multiple, pruritic seborrheic warts.
9- Paraneoplastic pemphigus.
10- Exfoliative erythroderma.
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