Skin a mirror to internal diseases

(Staff reporter)

14 August 2010,
DUBAI — Dermatology refers to the branch of medicine that deals with the skin, hair and nail, and their diseases.
Skin diseases and lesions can also be a marker of internal disease. As the famous saying goes, ‘face is the
mirror of the mind’ so is our skin, which quite often mirrors the diseases of the internal organs.
Internal diseases like liver diseases, iron deficiency anemia, hyper and hypo-thyroidism are
sometimes associated with intractable itchy skin without any other skin pathology. More than 80 per
cent of chronic kidney failure patients experience generalised itching.

Any generalised itching without skin rash should be investigated to rule out underlying malignancy
(cancer). Characteristic itching, mainly on the legs, is the presenting symptom in about 25 per cent of
cases of Hodgkin’s lymphoma. HIV infection (AIDS) can result in generalised itching with or without
skin rashes. Persistent itching is at times a manifestation of post-menopausal syndrome.

Psychological disturbances can lead to localised or generalised itchy skin. Unless the patient has very
evident psychiatric symptoms, the diagnosis of psychogenic itching is made through a process of
exclusion of systemic (internal) and skin diseases. Itching of anal and genital areas is typically
psychogenic in origin most of the times. Rapidly expanding ulcers on the leg can be the presenting
symptom of some major blood disorders or ulcer of the colon.

Deficiency of protein, vitamins, iron etc can show on the skin as red scaly and bronzed patches, or dry
scaly skin with small papules, or small bleeding points under the skin, or hypo or hyper pigmentation.
Flat yellowish elevated lesions on the skin of the eyelid or yellowish nodules located over the joints,
can be an early marker of high blood cholesterol.

Red scaling plaques on light-exposed areas especially of the face and scalp, and sensitivity to
sunlight can be an early sign of autoimmune diseases like systemic lupus erythematosus.

The skin often presents a clue to an internal malignancy. Wavy, red, urticarial bands with scales,
which slowly migrate in a wood grain-pattern, can be a marker of cancer of the breast, stomach,
prostate, cervix or bladder. Migratory red patches, and ulceration of the abdomen, thighs and buttocks
can be a marker of pancreatic cancer.

Skin of the axillae, groin and neck may be remarkably blackish in colour, thick, velvety and sometimes
thrown into folds, in cancer of the abdomen. Recent alteration in skin texture (thickening and
hardening) of the palms and soles may be noticed in patients with cancer of the bronchus or
oesophagus.

Sudden eruption of small multiple itchy, nodular lesions around the neck and/ or the trunk can indicate
cancers especially that of the stomach.

A characteristic crease in the skin of the earlobes, large skin tags on the neck, vitiligo, cherry
angiomas, blackish discoloration and velvety thickening of the skin folds are more common in diabetic
patients and warrant blood sugar estimation.

Shin spots (pigmented patches on the leg) and brownish yellow areas with waxy surface on the leg
have been implicated in late diabetes and are often associated with complications of the eye and
kidney.

Hair fall is common a few months after a major precipitating event like surgery, severe illness or
delivery. It can be a common presentation of iron deficiency and thyroid disease. Male pattern hair
growth in female pigmentation and acne can be an indicator of polycystic ovarian syndrome. Nails can
become bulbous and club shaped in diseases affecting the lungs, liver, heart etc.

Dr Lilly Jose Specialist Dermatologist and Venereologist Zulekha Hospital, Sharjah