45
Skin Signs of Systemic Disease
Introduction
• With the exception of endocrinologic disorders and paraneoplastic dermatoses, most of these skin signs have been discussed in other chapters – for example, pyoderma gangrenosum in Chapter 21, telangiectasias of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) in Chapter 87, and sebaceous neoplasms of Muir–Torre syndrome in Chapters 52 and 91.
Pulmonary Disease and the Skin
• Table 45.1 and Fig. 45.1.
Table 45.1
Examples of skin signs of pulmonary disease.
* Primary pulmonary infection also occurs in other systemic mycoses due to dimorphic pathogens, including coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis.
AVM, arteriovenous malformation; DcSSc, diffuse cutaneous systemic sclerosis; LcSSc, limited cutaneous systemic sclerosis; ILD, interstitial lung disease; PAH, pulmonary arterial hypertension.
Fig. 45.1 Skin signs of pulmonary disease. A Periorificial and facial papules of sarcoidosis. The presence of lesions on the nasal rim is often associated with granulomatous inflammation of the upper respiratory tract. B Hereditary hemorrhagic telangiectasia. Multiple small bright red macules and papules on the tongue and lips. C Yellow nail syndrome. A, B, Courtesy, Jeffrey P. Callen, MD; C, Courtesy, Karynne O. Duncan, MD.
Cardiac Disease and the Skin
• Table 45.2 and Fig. 45.2.
Table 45.2
Examples of skin signs of cardiac disease.
The cutaneous features of these disorders are discussed in the chapters cited. Cardiofaciocutaneous syndrome is characterized by generalized ichthyosis-like scaling, keratosis pilaris, café-au-lait macules, sparse curly hair, and developmental delay.
Gastrointestinal Disease and the Skin
• Tables 45.3–45.5 and Figs. 45.3 and 45.4.
Table 45.5
Peristomal skin disorders.
Peristomal skin disorders are common and may limit use and efficacy of the stoma appliance. When the etiology is uncertain, evaluation can include KOH examination, microbial cultures, patch testing, and histologic examination.
| Skin Disorder | Comments |
| Irritant contact dermatitis | Most common cause of peristomal dermatitis, especially in patients with an ileostomy. Primarily attributed to exposure to feces or urine |
| Pre-existing skin disease (e.g. psoriasis, seborrheic dermatitis, atopic dermatitis) | Exclude primary contact dermatitis or infection or superimposed contact dermatitis |
| Cutaneous infection (Candida spp. dermatophyte, herpes-virus [primarily simplex], bacteria [especially Staphylococcus aureus]) |
