Medical Dermatology: Skin Diseases and Your Health
What Your Skin Says About Your Health
By Patricia Ceballos, MD
The skin, which is your body’s largest organ, can also be a portal to a host of common and uncommon systemic diseases. While the roster of these scenarios is much too long to list here, let’s begin by reviewing some of the more common skin clues that something may be amiss. The Western diet and sedentary lifestyles are root causes of many of these internal diseases. Here, some of the most frequent internal diseases that present as skin diseases.
Skin Diseases That Might be Signs of Internal Issues
- Hyperlipidemia, namely elevated levels of lipids such as cholesterol, can present with yellowish deposits in eyelid skin termed xanthelasma. Poor blood supply to the skin from advanced atherosclerosis will manifest as cold extremities, particularly the lower legs, in which hair growth is diminished or absent and the skin is thin and shiny. In extreme cases, ulcerations occur which may be slow to heal.
- Diabetes, for example, has its own special cutaneous repertoire. Skin yeast and recurring bacterial infections may be the presenting signs. The lower extremities may develop necrobiosis diabeticorum, waxy red-brown plaques on the shins. The skin of the upper back and neck may develop woody induration and thickening known as scleredema of Buschke. A rare disseminated form of Granuloma Annulare characterized by annular pink or red raised plaques can herald and accompany diabetes.
- In a typical clinical dermatology practice, we see common conditions which are sometimes linked to internal pathologies. Rosacea, a form of facial acne, has been associated with the presence of Helicobacter pylori in the stomach. This bacterium is implicated in gastric conditions including stomach ulcers.
- Certain forms of Alopecia (hair loss) are associated with hormonal aberrations or nutritional deficits. These include Telogen Effluvium characterized by generalized scalp thinning, or alternatively Alopecia Areata, in which smooth bald patches occur anywhere on the body, typically scalp and face.
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- Jaundice, a generalized yellow discoloration of skin, sclerae, and mucous membranes is a warning sign of liver damage, usually in the form of hepatitis or advanced cirrhosis. Another interesting tandem is lichen planus and viral hepatitis, primarily Hepatitis C.
- Excessive hair growth in unexpected anatomic sites (such as chest) in women can signify an underlying hyperandrogenic state from adrenal gland or ovarian source.
- Acanthosis nigricans, velvety darkening and thickening of the skin folds and neck, is seen quite often in clinical practice. While most often associated with overweight status, it is a harbinger of diabetes and a marker for polycystic ovaries, hormonal abnormalities, and even gastrointestinal cancer.
- Skin pigment abnormalities may be a harbinger of internal disease. Addison’s disease, a disorder of decreased cortisone, can present with dark hyperpigmentation especially in scars, but also skin creases and pressure areas. Vitiligo, a common skin disease featuring white patches, is linked to diabetes, pernicious anemia, viral hepatitis, and autoimmune thyroid disease.
- There are rare instances when a skin cancer, in this case Bowen’s disease, occurring in non-sun exposed skin is a hallmark of internal/visceral malignancy.
- Unusually dry skin marked by a “fish-scale” appearance is called ichthyosis and is linked to various diseases including internal visceral malignancies , lymphoma, and sarcoidosis.
- Certain systemic diseases are commonly associated with skin manifestations. These include systemic lupus erythematosus and its red “butterfly” facial rash, dermatomyositis and its violaceous periorbital and upper torso “stain,” certain porphyrias marked by unusual photosensitivity and blistering, systemic amyloidosis and periorbital bruising, sarcoidosis and purple nodules on the nose, systemic sclerosis and facial broken blood vessels, tight skin, and pinched nose, Cushing’s syndrome and pronounced stretch marks, easy bruisability, and a plethoric “moon” face.
- Raynaud’s phenomenon, in which the hands are unusually sensitive to cold temperature, turning blue and painful, is linked to diseases such as systemic lupus erythematosus and systemic sclerosis.
- A rare condition in which expanding ulceration develops in unexpected anatomic locations, including the face, is pyoderma gangrenosum (a complete misnomer as there is neither infection nor gangrene!) and it occurs in the setting of ulcerative colitis, Crohn’s disease, systemic lymphoma/leukemia, rheumatoid arthritis, and other rare systemic diseases.
Dr. Patricia Ceballos is a board-certified dermatologist specializing in general and cosmetic dermatology, Mohs micrographic surgery, dermatologic surgery and dermatopathology. She is currently seeing patients at Schweiger Dermatology Group’s New Rochelle and Yonkers dermatology offices in Westchester County, New York.
If you have any suspicious looking disorders on your skin, make an appointment to see a dermatologist immediately. At Schweiger Dermatology Group, we offer same day appointments with dermatologists. Call 844-DERM-DOC or book online and schedule an appointment at one of our 23 convenient office locations.