Skin changes in internal conditions

Skin changes in internal conditions


Skin signs are seen with many internal disorders and are not uncommonly their presenting feature. The astute dermatologist can recognize undiagnosed systemic disease.



Skin signs of endocrine and metabolic disease


Almost all endocrine diseases (and several metabolic defects) have cutaneous signs that depend on the over- or underproduction of a hormone or metabolite (Table 1).


Table 1 Skin signs of endocrine and metabolic disorders

































Disorders Skin signs
Diabetes mellitus Necrobiosis lipoidica, granuloma annulare, xanthomas, Candida albicans infection, ‘dermopathy’, neuropathic ulcers
Thyrotoxicosis Pink soft skin, hyperhidrosis, alopecia, pigmentation, vitiligo, onycholysis, clubbing, pretibial myxoedema, palmar erythema
Myxoedema Alopecia (including eyebrows), coarse hair, dry puffy yellowish skin (e.g. hands, face), asteatotic eczema, xanthomas
Addison’s disease Pigmentation (p. 75), vitiligo, loss of axillary and pubic hair
Cushing’s disease Pigmentation, hirsutism, striae, acne, obesity, buffalo ‘hump’
Acromegaly Thickened moist greasy skin, pigmentation, skin tags
Phenylketonuria Fair hair and skin, atopic eczema (p. 36), photosensitivity
Hyperlipidaemia Xanthomas (tuberous, tendinous, eruptive, plane), xanthelasma
Cutaneous porphyrias Photosensitivity, blistering, skin fragility, atrophic scarring, thickening of skin, hypertrichosis, pigmentation (p. 46)


Diabetes mellitus


Candida albicans or bacterial infection is more common with untreated or poorly controlled diabetes. The neuropathy or arteriopathy of diabetes may result in ulcers on the feet (p. 73), and an associated secondary hyperlipidaemia can produce eruptive xanthomas (see Fig. 4). Diabetic dermopathy describes depressed pigmented scars on the shins, associated with diabetic microangiopathy. Necrobiosis lipoidica (Fig. 1), characterized by shiny atrophic yellowish–red plaques on the shins, was associated with diabetes in 65% of cases in one series, although others find a much lower figure. It affects less than 1% of all diabetics. Histologically, degenerate dermal collagen is seen with epithelioid cells and giant cells. The condition is chronic and may ulcerate. It is unresponsive to treatment. In contrast, granuloma annulare – recognized as palpable annular lesions on the hands, feet or face (Fig. 2) – is only rarely associated with diabetes and usually fades in 2 years. It must be differentiated from tinea corporis.




Apr 20, 2016 | Posted by in Dermatology | Comments Off on Skin changes in internal conditions

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