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The skin frequently serves as a marker for underlying internal disease. The type of lesion typically relates to a specific disease or type of disease.
Internal
malignancy:
Dermatomyositis is associated with breast, lung, ovarian, and GI cancers in up to 50% of affected adults. Acute onset of multiple seborrheic keratoses (Leser-Trélat sign) may indicate underlying internal malignancy, particularly adenocarcinoma. However, because of the high prevalence of seborrheic keratoses in healthy adults, this sign may be overdiagnosed. Acute febrile neutrophilic dermatosis is associated with hematologic malignancies. Acanthosis nigricans that is associated with cancer can be of rapid onset and particularly widespread. Pruritus without a clearly associated dermatitis may indicate occult malignancy, often lymphoma. Paraneoplastic pemphigus is a relatively rare autoimmune blistering disease that has been associated with various malignancies, including leukemias. The carcinoid syndrome (flushing and erythema of the neck) is associated with carcinoid tumor. Erythema gyratum repens is a rare eruption consisting of concentric erythematous lesions, resembling wood grain, which has been associated with various malignancies.
Endocrinopathies:
Many skin findings associated with endocrinopathies are not specific. Patients with diabetes mellitus may have acanthosis nigricans, necrobiosis lipoidica, perforating disorders, and scleredema adultorum. Thyroid disease, both hypo- and hyperthyroidism, can affect hair, nails, and skin. Cushing's disease causes striae distensae, moon facies, and skin fragility. Addison's disease is characterized by hyperpigmentation that is accentuated in areas of trauma.
GI disease:
Skin conditions commonly associated with GI diseases include pyoderma gangrenosum, which occurs in patients with inflammatory bowel disease; lichen planus and porphyria cutanea tarda, which are associated with hepatitis C infection; and diffuse hyperpigmentation, or “bronze diabetes,” which occurs in hemochromatosis. Erythema nodosum may accompany inflammatory bowel disease, sarcoidosis, and various infections. Eruptive xanthomas may result from elevated serum triglycerides.
Last full review/revision November 2005
Content last modified November 2005
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