Dermatologic Signs of Systemic Diseases

Introduction:

The skin is the human body's main organ, providing protective covering to all over the body, including internal organs. The cutaneous signs associated with systemic disease refer to the medical conditions indicative of underlying health problems. These conditions may affect other body parts. Several systemic diseases can be diagnosed by identifying skin signs. The dermatologic signs can be skin discoloration, rashes, blisters, and growth. Early diagnosis and identification of these signs are essential for effective treatment. The treatment modalities include topical medications, systemic therapies, and lifestyle modifications.

In some cases, surgical interventions are required. In addition, education about the cutaneous manifestations of systemic diseases can lead to early identification and better treatment of skin diseases. The article discusses various systemic diseases and their dermatological manifestation.

What Are Systemic Diseases?

Systemic diseases affect more than one organ or even the entire body. They do not originate from a single organ but affect other organs or parts of the body and cause infection, inflammation, and metabolic dysfunction. Several systemic diseases include endocrine, renal, cardiovascular, inflammatory, and rheumatic diseases.

What Are the Dermatological Signs of Systemic Diseases?

The skin manifestations of systemic diseases are as follows:

Endocrine and Metabolic Disease:

• Diabetes Mellitus: Skin infections caused by fungi and bacteria are commonly associated with diabetes mellitus. Around 30 to 50 percent of diabetic people develop cutaneous disease.

• Acanthosis Nigricans: It is a metabolic syndrome commonly associated with diabetes, insulin resistance, and obesity. Its dermatological features include hyperpigmented velvety plaques on the axilla, neck, and groin.

• Bullous Diabeticorum: The appearance of noninflammatory vesicles or bullae on the lower extremities, such as toes. However, hands and forearms are also affected. The vesicles or bullae can be resolved with supportive measures. In addition, the doctor may prescribe antibiotics to prevent secondary infections.

• Diabetic Foot Ulcer: The symptoms include ulcers surrounded by a thick callus on the weight-bearing areas of the foot, such as heels. It may also occur on the tips of prominent toes.

• Necrobiosis Lipoidica Diabeticorum: During the initial stage, yellow-orange papules or nodules appear on the lower extremities. As the disease progresses, the color changes into yellow-brown-red atrophic plaques with elevated borders. These plaques are atrophic and shiny. It can be unilateral or bilateral.

• Calciphylaxis: In the early stages, the patient may experience painful, violaceous retiform patches or plaques. In the late stages, there will be necrosis and ulceration, and possibly lead to gangrene. The commonly affected areas are the thighs, buttocks, and abdomen.

• Thyroid Disease: In hypothyroidism, the skin is rough, dry, puffy, and cool to the touch with hair loss. There can be periorbital edema. In hyperthyroidism, the skin is warm and moist, and the face is flushed.

• Cushing Syndrome: The features include abdominal striae and skin darkening in the creases. The skin may bruise easily. The frequent problems include skin infections and acne.

• Porphyria: Several forms of porphyria (the condition in which there is a problem in making heme), including erythropoietic porphyria and porphyria cutaneous tarda, may cause photosensitivity, skin fragility, and blistering on exposed areas of skin to sunlight or ultraviolet light.

Internal Malignancies:

• Paget’s Disease: It commonly affects the nipple and areola of the breasts. The affected area is red and inflamed, with a scaly and flaky texture. The patient may experience a burning sensation and itching. There may be pigmentation changes, and as the disease progresses, ulceration and oozing may occur.

• Cowden’s Syndrome: There will be wart-like growth or multiple non-cancerous growths in various tissues, which increases the risk of thyroid or breast cancer.

• Amyloidosis: The condition of unusual infiltration of proteins leading to organ failure. Purpuric (blood collection under the skin in a large flat area) and ecchymotic (blood collection under the tissue in a large bruised area) bumps on the eyelids due to increased blood vessel fragility. These may occur due to rubbing. There can be an enlarged tongue.

Gastrointestinal Disease:

• Gardner Syndrome: These are slow-growing tumors that develop under the skin. Adenocarcinoma of the colon and large bowel polyps can also occur.

• Carcinoid Syndrome: The skin metastasis is present with deep nodules with pigmented changes.

• Inflammatory Bowel Disease: The condition can cause oral manifestations such as aphthous ulcers, cobblestoning, and thickened erythematous (red and inflamed) mucosa.

Inflammatory Disease:

• Erythema Nodosum: It is an inflammatory disease affecting the pretibial region. The patient may experience symmetrical and bilateral inflammation in the pretibial (in front of the tibia) area. The nodules are smooth and deep-seated in appearance and do not ulcerate. Arthralgia (joint stiffness or pain) is common.

• Erythema Migrans (Lyme Disease): The symptoms include facial nerve palsy. In untreated cases, the patient may experience chronic arthritis.

• Sarcoidosis: It is an inflammatory disorder causing red-brown dermal papules or plaques. The commonly affected areas include the face, neck, upper extremities, and trunk. When the sarcoid lesion is compressed, a yellow-brown apple jelly is seen. Subcutaneous nodules, hypopigmentation, ulceration, and scar formation can also occur.

Lupus:

• Systemic Lupus Erythematosus: The rashes are raised, scarred, or atrophic, affecting the scalp and sun-exposed areas on the face, arms, and ears. There can be depigmentation in the center and hyperpigmentation at the periphery. The erythema covers the nose and cheeks, giving a butterfly appearance. The person may experience oral ulceration.

• Discoid Lupus Erythematosus: There are raised and atrophic erythematous plaques. There can be permanent hair loss or alopecia associated with scarring.

• Bullous Systemic Lupus Erythematosus: The small blood vessels leak under the skin (purpura) and may be secondary to vasculitis.

Rheumatic Disease:

• Rheumatoid Arthritis: Subcutaneous lumps can be found near the affected joint. Other symptoms include skin thinning, skin transparency at the back of the hands, reddened palms, and brittle nails. Skin inflammation and rheumatoid bumps may appear on the trunk.

• Reactive Arthritis: Hyperkeratotic lesions can develop on the palms of the hands and soles of the feet. Clear vesicles may progress into macules, nodules, and papules. The affected person may also experience oral ulcers, patches on the tongue's surface, nail inflammation, and nail infection.

• Psoriatic Arthritis: The person may experience swelling in the interphalangeal joints, phalanges (fingers) erosion, and nail damage.

• Scleroderma: The erythematous patches may change into hypopigmented plaques on the trunk, skin thickening (fibrosis), joint pain, large patches on the face and hands, and skin inflammation.

Conclusion:

Several systemic diseases are diagnosed through dermatological signs and symptoms. These signs and symptoms help in the early diagnosis of the systemic condition and prevent further complications by providing appropriate treatment. They also help in understanding the prognosis and managing the condition. If an individual is experiencing any skin signs associated with systemic diseases, consult a dermatologist for early diagnosis and prompt treatment.