بسم الله الرحمن الرحيم

Skin in systemic diseases Dr.RZAN Skin in systemic diseases

Demonstrate skin manifestations of common systemic diseases. Objectives Demonstrate skin manifestations of common systemic diseases.

THE SKIN& THEPSYCH Psychatric problems that have dermatological presentations: Stress & anxiety may lead to trichotillomanea(hair pulling habbit resultig in allopecia with normal underleing skin), nurodermatitis, lip liking dermatitis, nose picking, nail biting, ... Obsessive compulsive nuroses may lead to irritant contact dermatitis. Phobias: like syphliphobia, parasitopho; scabephobia, Hysteria: may leads to dermatitis artifacta.

lip liking dermatitis

Dermatitis artifacta. Self induced lesions. Accessible part. Bizarre shapes. No primary lesions. Secondary gain Abnormal personlity. Commonly female. May have some medical knowledge

Dermatological diseases that lead to psychiatric problems. Most of dermatological diseases affect the psych because they directly affect the appearance, so there effect may range from Discomfort. Dysmorphophobia (delusion of ugly body part) Anxiety Depression Social isolation. Suicidal ideation & attempts. It is found that suisides occure in higher rates among dermatological patients (like those with psoriasis & acne...).

SKIN & ENDOCRINE SYSTEM Hyperthyroidism: Fine hair, hair loss. Onycholysis, clubbing. Pruritus. Warm smooth skin, hyperhidrosis. Pretibial myxedema. ± Hypothyroidism: Coarse hair, diffuse hair, broken hair, brittle nails. Pruritus. Loss of outer third of eyebrow. Cold,dry skin (xeroderma). Thickened yellow skin. myxoedema brittle nails

Acromegaly: Addison’s disease: Cushing’s syndrome: Soft tissue hypertrophy. Seborrheic dermatitis, Acanthosis nigricans, Addison’s disease: Increased skin pigmentation. Cushing’s syndrome: fat maldistribution: Moon face& Buffalo hump. Acne. Hirsutism. telangiectasia, Striae thin & atrophic skin Acanthosis nigricans.

Acanthosis nigricans,

Diabetes: Dry skin . Hair loss. Pale skin & nails (diabetic angiopathy). Poor sensation (diabetic nuropathy). Diabetic dermopathy. Diabetic dermopathy is a skin condition characterised by light brown, oval or round, slightly indented patches most often appearing on the shins. Pruritus. Foot ulcers (diabetic foot). Fungal & bacterial skin infections. Poor wound healing. Sclerotic skin. Bullous diabeticorum. Acanthosis nigricans & skin tags. Necrobiosis lipoidica (diabeticorum). Granuloma annulare .

DIABETIC BULLAE

Necrobiosis lipoidica diabeticorum Atrophic, yellow with erythematous or violet margin. The underlying blood vessels are easily seen through the atrophic skin.

prayer sign Stiff thick skin (diabetic sclerodactyly or cheiroarthropathy) palms cannot be opposed properly

SKIN & RESPIRATORY DISEASES Asthma associated with atopic dermatitis. TB. may be associated with TB. of skin. CObD. : cyanosis ,clubbing of fingers.

SKIN & CARDIAC DISEASES Cyanotic congenital heart diseases: Cyanosis. Clubbing of fingers. Endocarditis: Splinter hemorrhages.

Skin & Gastrointestinal Diseases Ulcerative colitis: Erythema nodosum & pyoderma gangrinosum. Crohn’s disease: : Erythema nodosum, pyoderma gangrinosum, Perineal ulceration, skin tags & sinus tracts. Abnormality in zinc absorption: Acrodermatitis enteropathica. Coeleac disease:Dermatitis herpetiformis: Peutz-Jeghers syndrome: Small intestine polyps+ perioral pigmentitions.

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Skin & Liver diseases Jaundice. Spider navae. Pruritus. Gynecomastia. Dilated abdominal wall veins. Palmar erythema, doputrin contracture & clubbing of fingers.

Spider nevus

The skin in renal disease 1 Pruritus and dry skin. 2 Pigmentation. A yellowish sallow colour and pallorfrom anaemia 3 Half-and-half nail. The proximal half is white and the distal half is pink or brownish. 4 ‘Perforating disorders’. Small papules in which collagen or elastic fibres are being extruded through the epidermis. 5 ‘Pseudoporphyria’

PSUDOPORPHYRIA skin fragility and photosensitivity, blisters form at the sites of trauma on sun exposed skin, bursting early to leave scabs and erosions. The blisters are most often seen on the hands and feet. They sometimes heal with some scarring and tiny white cysts under the skin (milia).

Skin & haematology Haemolytic anaemia’s: Pallor, jaundice. Iron deficiency anaemia: pallor, atrophic glositis, choilonechya. Polycythemia rubra vera: erythema, itching.

Skin Manifestations of Metabolic Diseases Hyperlipidemia: Xanthelasma Xanthomas : —tendinous, tuberous, eruptive, Plane. Porphyria: photosensitivity, skin fragility, Blister formation, hypertrichosis, milia,pigmentation

Erruptive xanthoma.

Plane xanthoma.

Pellagra: (nicotinic acid deficiency): 3Ds—dementia, dermatitis,diarrhea; erythema following sun exposure Scurvy: Bleeding gums, coiled hairs, perifollicular purpura, poor wound healing. Vitamin B2 (riboflavine) deficiency Angular stomatitis Smooth purple tongue Seborrhoeic dermatitis-like eruption Vitamin B6 (pyridoxine) deficiency Ill-defined dermatitis

PELLAGRA

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