Skin signs of internal disease.
Subject: Chronic diseases (Diagnosis)
Skin (Physiological aspects)
Skin (Medical examination)
Author: Cowper, Anne
Pub Date: 12/22/2006
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2006 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Winter, 2006 Source Volume: 18 Source Issue: 4
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 174817376
Full Text: Ghaffar SA, Clements SE, Yell J. 2005. Skin signs of internal disease. Practitioner 249:434-46.

There are many skin signs of underlying disease. A thorough history and clinical examination is crucial in obtaining a correct diagnosis.

Diabetes mellitus

About 50% of patients with diabetes mellitus (DM) have multiple erythematous papules on the shins due to microangiopathy. These slowly resolve leaving atrophic brown macules. Granuloma annulare is a harmless self limiting condition that appears as single or multiple pink purplish annular lesions, most commonly on the hands. These are often seen in diabetic patients. Necrobiosis appears as one or more shiny, atrophic plaques with visible underlying blood vessels. They are usually brown-red or yellow in colour and mostly occur on the shins. Only 0.3% of patients with DM have necrobiosis although the majority who have this condition will go on to develop diabetes. Lower limb ulceration is due to neuropathy or atherosclerosis.


About 30% of patients with systemic sarcoidosis develop skin lesions. The most common are erythema nodosum occurring as an early feature of the disease, especially in young women; asymptomatic papular, nodular and plaque forms, reddish brown or hypopigmented and associated with both acute and subacute forms of the disease; lupus peruio, dusky red infiltrated plaques on the nose and fingers; and scar sarcoidosis, granulomatous lesions occurring in long standing scars.

Thyroid disease

Hypothyroidism causes palour, pruritis, dry skin and eczema craquele, absence of sweating and diffuse hair loss. Hyperthyroidism causes pretibial myxedema (thickened waxy plaques occurring in up to 10% of patients and almost always with accompanying ophthalmopathy), palmar erythema, soft thickened skin, increased sweating of the hands and feet, and thyroid acropachy (clubbing of fingers or toes) in Grave's disease.

Gastrointestinal disease

Liver failure produces vascular changes including palmar erythema and spider naevi, and white nails with associated hypoalbuminemia. Dermatitis herpetiformis is an intensely itchy chronic blistering skin condition of the trunk and limbs that is associated with gluten sensitive enteropathy and villous atrophy. There is an increased risk of developing small bowel lymphoma.

Drug reaction

Almost any drug can cause a skin reaction that can develop a few days to several weeks after commencing treatment. A fixed drug eruption appears as erythematous plaques that flare up at the same site each time the drug is taken.

Xanthomas and xanthelasmas

Deposits of fatty material in subcutaneous tissue associated with hyperlipidemia. Xanthomas may be a symptom of underlying metabolic disorders including diabetes, primary biliary cirrhosis and hypothyroidism. They commonly appear on the elbows, joints, tendons, knees, hands, feet or buttocks.

Systemic tissue disease

In systemic sclerosis the skin becomes hardened, shiny and tethered, leading to a small mouth with surrounding radial furrowing, claw-like deformity of the hands and a beak-like nose. The best known feature of systemic lupus erythematosus is the 'butterfly' rash on the cheeks. Other features include hair loss, photosensitivity and mouth ulcers.

Anne Cowper

PO Box 45, Concord West NSW 2138

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