Dermatological Manifestations of Systemic Diseases Skin

1
Dermatological Manifestations of Systemic Diseases

2
Skin manifestations of Diabetes mellitus

• 1.- skin manifestations due to vascular
  abnormalities
• A- wet gangrene of the foot
• B- Diabetic rubeosis
• C- Diabetic dermopathy shin spots
• D- Erysiepilas- like erythema

3

• 2. Diabetic neuropathy (peripheral)
• -Autonomic neuropathy
• 3. Cutaneous infections
• A- Staphylococcus aureus
• B- Non- clostridial gangrene
• C- Candidiasis

4
4. Various skin disorders associated with
diabetes mellitus

• A- Diabetic bullae
• B- Pruritus
• C- Granuloma annulare

5
Skin problems associated with diabetes mellitus

• Necrobiosis lipoidica
• Rare, insulin dependent DM
• One or more tender yellowish brown patches
  develop slowly on the lower legs over several
  months
• Round, oval or an irregular shape
• The centre of the patch becomes shiny, pale,
  thinned
• Prominent blood vessels (telangiectasia)
• Often painless

6

7

• D- Necrobiosis lipoidica
• Treatment control of diabetes doesnt help in
  disappearance of the lesions.
• Intralesional steroids.
• Systemic aspirin 300mg/day and dipyridamole 75
  mg/day.
• Nicotineamide
• Ticlopidine as antiplatelet
• pentoxyfylline.
• Preilesional heparin injection
• - Oral cyclosporin
• - Photochemotherapy (PUVA)
• E- (Carotenoid skin)
• F- Vitiligo
• G- Xanthoma

8
Hyperlipidemia

• Xanthomata
• 4 forms tendinous subcutaneous nodule found in
  fascia, ligament and extensor tendon of hand,
  knee and elbow
• Planar yellow, soft, macule or plaque found on
  the upper eyelids
• Tuberous yellow to reddish nodule at extensor
  surface of elbows, knees and knuckles
• Eruptive sudden, multiple reddish yellow papule
  extensor of extremities, buttock

9
(No Transcript)
10
PLANAR XANTHOMA
11
ERUPTIVE XANTHOMA
12
Pituitary disorders

• 1. Acromegaly
• Skin is oily and wet due to hyperhidrosis with
  wet hands on hand shaking.
• The lower lip is thickened, protruded with wide
  spaced teeth.
• Large and furrowed tongue.
• Increased skin pigmentation.
• Hirsutism.
• 2. Hypopitutirism Sheehan syndrome

13

• Suprarenal syndrome
• Cushing syndrome endogenous or exogenous
• Deposition of fat over the clavicles and back of
  the neck Buffalo hump
• Puffy, rounded erythematosus face with
  telangiectasia Moon face
• Trunkal obesity with slender wasting limbs.
• Striae distensae .
• Hirsutism, acneform rash, androgenetic alopecia.
• Addisonian-like pigmentation
• Easy bruising of the skin on simple trauma.

14
Striae distensae

• Aetiology
• Idiopathic
• pregnancy Striae gravidarum
• Endocrine cushing
• Iatrogenic systemic or potent topical steroids,
  anabolic drugs or androgens.

15

• Hypocorticism Addison,s disease Generalized
  hyperpigmentation that is more prominent in light
  exposed areas, scars, genitalia, palmar and
  finger creases, and under the nails. The
  pigmentation characteristically affects the
  mucous membranes.
• Loss of pubic and axillary hair in females.
• Improvement of acne.

16

• IV- Thyroid diseases
• Hyperthyroidism
• red,soft, moist and hot skin.
• addisonian hyperpigmentation i.e. not affect the
  mucous membranes.
• Diffuse thinning of scalp hair
• Rapid nail growth and onycholysis.
• Generalised pruritus and urticaria.
• Palmar erythema and facial flushing.
• Hyperhidrosis or increased sweating.

17

• Pretibial myxoedema appears as small red or skin
  colored coalescing
• Nodules
• Thyroid acropatchy

18
Endocrinologic Diseases

• Hypothyroidism
• Macroglossia

19

• Hypothyroidism
• Buffy face with coarse features.
• The skin is pale, thickened, cold, finely
  scaling and wrinkled.
• Coarse sparse hair of the scalp with loss of
  the lateral third of the eyebrows.
• Brittle and striated hair.
• Poor wound healing.
• Decreased or absent sweating.

20
Gastrointestinal tract and the skin

• Crohn,s disease regional ileitis
• Perianal abscess and fisulae.
• Erythema nodosum
• Erythema multiforme
• Aphthous-like stomatitis and glossitis.
• Cutaneous vasculitis.
• Epidermolysis bullousa acquisita.
• Metastatic Crohn,s disease as numerous eroded
  cutaneous granulomas at sites distant from the
  affected intestine.
• Pyoderma gangrenosum.

21
Pyoderma gangrenosum

• Aetiology
• Idiopathic in 50 of the cases.
• Inflammatory bowel disease- Crohn,s disease and
  ulcerative colitis.
• Connective tissue diseases- Rheumatoid arthritis,
  SLE or Behc,et disease.
• Blood disease Leukemia, multiple myeloma,
  polycythemia or monoclonal gammopathy.
• Treatment
• Dealing with underlying cause.
• Systemic steroids in high dose like 60-80 mg oral
  prednisolone daily and then reduce gradually.
• Azathioprime, Dapsone, or cyclosporine

22

• Ulcerative colitis identical to Crohn,s disease
  but pyoderma gangrenosum and erythema nodosum are
  more common in ulcerative colitis.
• Malabsorption specific or non-specific features.
• Non- specific features Pallor, dry skin, oedema,
  acquired icthyosis, Pigmentary disorders,
  glossitis, mouth ulcers.
• Specific features due to certain factor
  deficiency
• e.g. Follicular hyperkeratosis ---------------
  Vit. A deficiency.
• Echymosis and scurvy ------------------ Vit. C
  deficiency.
• Acrodermatitis enteropathica ---------- Zinc
  deficiency.

23

• Liver diseases
• Pruritus generalized itching especially in the
  presence of biliary obstruction or jaundice.
• Urticaria especially in infectious hepatitis.
• Jaundice.
• Spider naevi small telangeictatic blood vessels
  especially on the face and upper chest.
• Palmar erythema.
• Diffuse hyperpigmentation.

24

• Thinning of the hair and sometime loss of sexual
  hair in the axillae and pubic areas.
• Gynaecomastia.
• Acneform-lesions.
• Porhyria cutanea tarda.
• Xanthoma collection of lipid in the dermal
  tissue especially in primary biliary cirrhosis.

25
Behc, et disease

• Recurrent aphthous oral ulcerations more than
  three times per a year is a must plus two of the
  following
• Genital ulceration or other skin manifestations
  Erythema-nodosum like lesions, pseudofolliculitis,
  papulopustular lesions or acneform rash.
• Eye lesions anterior or posterior uveitis
• Positive pathergy test

26
Cutaneous markers of internal malignancy

• I.Genetically determined syndromes
• Gardners syndrome, Howel-Evans syndrome,
  Torre-Muir syndrome.
• II. II. Skin signs of exposure to carcinogen
• e.g. Nicotine staining, X-ray damage

27
Paraneoplastic dermatoses

• 1. Acanthosis nigricans
• 2. Dermatomyositis
• 3. Erythema gyratum repens
• 4. Erythema nodosum and erythema multiforme

28

• 5. Acquired icthyosis
• 6. Pruritus
• 7. Bullous eruptions
• 8. Pyoderma gangrenosum
• 9. Erythroderma
• 10. Flushing of the face
• 11. Urticaria

29
12. Acquired hypertrichosis lanuginosa
30

• 13. Disseminated herpes zoster
• 14. Migratoratory superficial
  thrombophlebitis
• 15. Hypertrophic osteoarthropathy and Finger
  clubbing
• 16. Tripe palms
• 17. The sign of Leser-Telat
• 18. Necrolytic migratory erythema
• IV. Direct metastases to the skin e.g. Carcinoma
  of the breast or lymphoma.

31
Sign of Leser-Trelat

• Sudden appearance of multiple seborrheic
  keratoses
• Association with internal malignancy is unproven

32
(No Transcript)
33

• 18. Necrolytic migratory erythema

34
Thank you