logo Cutaneous medicine

Systemic dermatology

Cutaneous medicine

Objectives

  • Recognise skin conditions that may be signs of endocrine, gastrointestinal, haematological and nutritional diseases.

Diabetes mellitus

Necrobiosis lipoidica

Close-up of necrobiosis lipoidica
© R Suhonen

Granuloma annulare


Thyroid disease

Pretibial myxoedema

Pretibial myxoedema in an unusual location
© R Suhonen

Eczema due to dry skin in patient with hypothyroidism


Cushing’s syndrome

Cushing’s syndrome

Striae due to systemic steroids


Acromegaly

Skin tags

Addison’s disease

Gastrointestinal disease

Dermatitis herpetiformis

Ulcerated PG

Gardner’s syndrome (multiple epidermal cysts)


Renal disease

Chronic renal failure is associated with:

Calciphylaxis

Renal pruritus

Warts, solar keratoses and squamous cell carcinomas in renal transplant patient aged 33


Haematological diseases

Porphyria

Porphyrias are due to abnormalities of the haem pathway and result in cutaneous photosensitivity. Diagnosis is confirmed by detection of excessive porphyrins in blood, urine or faeces. The most common to present to dermatologists are:

EPP

Urine of patient with PCT

Hands in VP


Hyperlipidaemias

Xanthelasma

Eruptive xanthomata

Tuberous xanthoma


Behçet’s disease

Oral ulceration

Vulval ulceration

Pathergy


Nutritional disorders

Scurvy

Pellagra

Pellagra

Kwashiorkor

Fatty acid deficiency

Obesity

Amyloidosis

Amyloidosis is an extracellular deposition in various tissues of amyloid fibril proteins.

Macroglossia due to systemic amyloidosis

Macular cutaneous amyloidosis


Sarcoidosis

Sarcoidosis is diagnosed histologically by the presence of noncaseating granulomas in the skin, lymph nodes, lungs, liver, spleen, eyes, parotid glands or joints. The mainstay of treatment is systemic corticosteroids.

Cutaneous features are highly variable:

Scar sarcoidosis

Facial granulomas due to sarcoidosis

Extensive sarcoidal plaques

Lupus pernio

Bihilar lymphadenopathy

Erythema nodosum


Acquired immunodeficiency syndrome