Skin Manifestation of Systemic Diseases

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SKIN MANIFESTATIONS OF

SYSTEMIC DISEASES





Gro!ed in "arios ways

#$ %y disease &ate'ory e$'$ &an&ers ( s)in

II$ %y or'an system in"ol"ement e$'$ s)in ( 't

III$ %y !at*o'eni& me&*anisms e$'$ &olla'en

"as&lar disease

I+$ On ,asis o- &*ara&teristi& .rea&tion !attern/ e$'$

Eryt*ema nodosm



%y disease &ate'ory

SKIN C0ANGE 1NDE23YING CANCE2

A&ant*osis ni'ri&ans Adeno Ca stoma&*4

ln'4o"ary4!an&reas4&olon



Acanthosis Nigricans



ACANTHOSIS NIGRICANS

characterized by

symmetric, velvety toverrucous,

hyperkeratotic adhyperpi!meted

pla"ues #ith apredilectio $or the

a%illae, ape ad other&e%ural areas'



SKIN CHANGE UNDERLYINGCANCER

Dermatomyositis NPC, Ca breast,lung et



Dermatomyositis




Eryt!ema Ca breast"er#i$"tongue"

gyratum !y%o%!aryn$re%ens



Erythema

gyratum repens



Nerolyti &igratory Eryt!ema 'N&E(



SKIN CHANGE UNDERLYING

CANCER

A)uire* i!t!yosis Lym%!omas,soli* organ tumours

Generalise* %ruritus Lym%!omas,Ca stoma!, lung

Eryt!ro*erma Lym%!omas, Soli*organ tumours




N&E 'nerolyti Gluagonomamigratory 'islet ell tumor(eryt!ema



Icthyosis



Erythroderma




Pa!y*ermo%eriostitis Ca lung,uterus, bron!ietasis

lung absess

+oen-s 'une$%ose*( S)uamous

ell arinoma

Her%es .oster



Can&ers ( S)in

3ym!*omas53e)aemias5Myeloma

a$ S!e&i-i& in-iltrates

,$ Non6s!e&i-i& *er!es

!i'mentation

!rrits!r!ra



Geneti syn*romes

/0 Palmo%lantar Ca oeso%!agus1erato*erma





Geetic sydromePeut.23eg!ers &alignanttrans4ormation

syn*rome o4 %oly%s o4 smallguts



Peutz –Jegher syndrome

enet syn rome Un er y ng



enet syn rome Un er y ngCaner

Gar*ner-s syn*rome So4ttumours,osteomas,%oly%

Dermatitis !er%eti4ormis Lym%!oma gut

Seborr!oei arts 'multi%le 5Leser 6relat 5 signeru%ti#e(

Hy%er%igmentation '&SH, Cus!ings, Ca t!ymus,lung

AC6H2li1e %e%ti*es( %anreas &igratory t!rombo%!lebitis Ca %anreas,

laryn$, t!yroi*,breast, lung, stoma!, olon



Eruptive seborrhoeic keratosis



n en o&r ne me a o & sease



n en o&r ne me a o & sease

Diabetes mellitus

Adrenal disease Cs*in'/s4 Addison/s disease

3i!ids 7ant*omas

T*yroid disease *y!er ( *y!ot*yroidism

8or!*yrias 8CT4 E884 CE8



DIA+E6ES &ELLI6US () is a !roup o$ metabolic disorders

characterized by chroic hyper!lycaemiadue to relative isuli de*ciecy,resistace or both'

Associated #ith disturbaces o$carbohydrate ad lipid metabolism'

It is commo ad a+ects app%' - milliopeople #orld#ide'



I .//0, the Natioal Cardiovascular Risk1actor 2revalece Study i )alaysiasho#ed that 3'34 o$ the adult populatiosu+er $rom ()'

/04 have type 56 ()

Commo amo! all ethic !roupsespecially Idias'

At least - 4 o$ diabetics have cutaeousivolvemet duri! the course o$ thedisease'



Cutaeous )ai$estatios o$ (iabetes

)ellitus

Classi7e* into 8 ategories9

Cutaneous *iseases assoiate* it!*iabetes mellitus0

Cutaneous in4etions

Cutaneous mani4estations o4 *iabetiom%liations

S1in reations to *iabeti treatment0





N7CRO8IOSIS 9I2OI(ICA (IA87TICOR:)



N9(;a%y,ta pla"ue o shi'

Tela!iectatic atrophic

cetre'

Solitary or multiple'

<045/-4 o lo#er

e%tremities, especiallypretibial areas'

;he N9( occurs i areas

other tha the le!s, it isless commoly associated#ith ()'



DIA+E6IC:RU&

'NLD(

:nly ;0<= o4 all %atients it! D& ill!a#e NLD0Muller SA. Mayo Clin proc 1966

>;= !a#e D& an* anot!er ?;=s!oe* gluose intolerane or a%ositi#e 4amily !istory0

Muller Sa. Arch Derm 1966

&9@ ratio /9<



NECR:+I:SIS LIP:IDICA DIA+E6IC:RU&

'NLD(

<r* an* 8t! *ea*e o4 li4e0

Assoiate* it! bot! IDD& an*

NIDD&

It is in*e%en*ent o4 %atients

glyaemi ontrol0





TR7AT)7NT

Hi!h5 potecy topical steroids to the activemar!is may arrest the pro!ressio'

Others = aspiri, dipyrimadole



(iabetic(ermopathy

2atho!eesis =

uko# Treatmet =oe



(IA87TIC

(7R)O2ATH>

hyperpi!metedor atrophic

macules o theshis



(IA87TIC(7R)O2ATH>

?shi spots@'

1oud i -5

-4'

Atrophic,hyper

pi!meted,ovalBroud areas

distributedbilaterally but

otsymmetrically'



(iabetic(ermopathy'

Histolo!y=

7arly lesios = oedemao$ papillary

dermis,e%travasatedR8Cs ad mild

lymphocytic i*ltrate'Older lesios = Thick#alled capillaries i

papillary dermis ade%travasated R8Cs



G2AN13OMA

ANN13A2E





(iabetic Thick Ski

1orms = Scleroderma5 like sydrome Geeralized thick ski

Sclerederma adultorum o$ 8uschke

Scleredema adultorum o$ (iabetes )ellitus



Scleredema adultorum o$ (iabetes )ellitus

C!arateri.e* by mar1e* inrease in *ermal t!i1nesso#er u%%er ba1 an* u%%er ne1 in mi**le2age*,o#ereig!t, %oorly ontrolle* ty%e2// *iabeti0

?0= in %atients it! ty%e2// *iabetis0

Lierbeman et al re%orte* *erease s1in t!i1ness it!tig!t bloo* sugar ontrol an* insulin a*ministration0

No 1non treatment 4or *iabeti slere*erma0



Knuckle pebblesThickening of the skin

on the dorsum of thehand can be due tomany causes, includingDM. with pebbling ofthe skin on the knucklearea.30% of diabetics hae

hand skin thickening.!igni"cance#$iterature suggeststhat digital sclerosis is

a marker for retinal



Adult oset diabeticsmay have

spotaeous oset o$multiple bullae olo#er e%tremities'

These lesios may otsecodary to trauma

or i$ectio'

Spotaeous heali!occurs #ithi 650

#eeks'



(iabetic 8ullae types=

S%ontaneous an* non2sarring ty%e9 5 commoest, heals spotaeously #ithi 650 #eeks 5 itraepidermal cleava!e #ithout acatholysis'

Haemorr!agi an* !eals it! atro%!i sarring9 5 cleava!e belo# (7 ad destructio o$ achori! *brils

&ulti%le ten*er nonsarring blisters in sun2e$%ose* an* *ee%ly tanne* s1in 9

5 cleava!e plae at lamia lucida



(iabetic 8ullae'

Clear Bui*27lle* bullae

on t!e

*istal /"<r*me*ialsur4ae o4

le4t LL0



Sydrome o$ Isuli

Resistace Acathosis

i!ricas

> ll N il



>ello# Nails(iabetics ted to have yello# ails'Lithner et al.Acta Med Scand

200.1976

Ca occur i all ails but esp' o the distal ed o$ the ail o$

the hallu%'



Salt an* %e%%er!y%er%ig2mentation

on s!ins it! noatro%!y

Common in el*erly

*iabetis0

Due to R+Ce$tra#asation in

su%er7ial %le$us0'Cayenne %e%%er

s%ots(



Er!ti"e 7ant*omas

3i!id a,normality6Ty!e #

• in&rease in TG5+3D34 'ly&osria

and *y!er'ly&aemia$

• sdden onset o- &ro!s o-

non!rriti&4 nontender4 -irm

yellow !a!les4ea&* wit* an

eryt*ematos rim$

• e9tensor sr-a&es6)nees4

el,ows4 ,a&)4,tto&)s and

trn)$



Eru%ti#e ant!omas

9esios resolve#he CHO ad lipidmetabolismcotrolled'

H27 = lipid lade

histiocytes admi%ed lympho5eutrophilici&ammatory

i*ltrate i dermis



DyrleEs

(isease=

a ucommo

*di! i patiet oreal dialysis'



Kyrle-s *isease

•

Reactive per$orati!colla!eosis

• characterised byhyperkeratotic $ollicular

ad peri$ollicular papules

• Trasepidermal

elimiatio o$ dermalmaterial that may

represets altered colla!e

DIA+E6IC NEUR:PA6HY



DIA+E6IC NEUR:PA6HY

(istal symmetrical europathy #ith mi%ed motor ad sesory erve ivolvemet'

dorsallysublueddigits,distally

displacedplantar fatpads,depressedmetatarsal

heads,hammertoesand pes caus.

& painless and



Ga!ree i

(iabetes'Hyper!lycaemia

ca allo# usuallyopatho!eic

or!aisms to

establish ai$ectio i

traumatized ski'Occasioally

resulti! i!a!ree adloss o$ limbs'





Chroic cadidiasis o$ the *!erails'

Althou!h dystrophic ails are o$tethou!ht to be the result o$ dermatophyte

i$ectio, ail plate cultures sho#Cadida species i 04 o$ the time'



1at hypertrophysecodary to repeated

isuli iFectio'



T*yroid disease

0y!ot*yroidism 0y!ert*yroidism

S)in 6 &old4 dry4 t*i&)ened4 s&aly sweaty4 miliaria

0air 6 di--se alo!e&ia4 t*i&)4 &oarse di--se alo!e&ia5-ine5so-t

Generalised !rrits 'eneralised !rrits

Carotenemia !i'mentation4

melasma4 "itili'oOny&*olysis1rti&aria8reti,ial my9oedemaa&ro!a&*y







%y or'an system in"ol"ement

#$ S)in ( 't

:$ S)in ( )idney

;$ S)in ( li"er



#$ S)in ( t*e 't

GI ,leedin' 0eno&* s&*onlein !r!ra40ereditary *aemorr*a'i&

telan'ie&tasia

8oly!osis 8et<6=e'*er/s4 Gardner/s4Cron)*ite6Canada syndromes

3i"er &irr*osis Wilson/s disease4 8rimary ,iliary&irr*osis4 0aema&*romatosis

2etro!eritoneal 8an&reatitis > !erim,ili&al ,risin'0aemorr*a'e ?Cllen/s si'n@

6 -lan) ,risin' ? Grey Trner/s si'n@



Hereditary Haemorrhagic Telangiectasia



:$ S)in ( t*e )idney

2enal Failre

7erosis4 rea -rost

8i'mentation -a&e4 *ands

Generalised !rrits

8r!ra

Gynae&omastia

S1i



S1in

/0 S1in mani4estations o4 li#er *iseases

?0 Li#er abnormalities ause* by s1in*iseases

<0 +ot! s1in li#er in#ol#e* in samesystemi *isease

80 He%atoto$iity o4 *ermatologial *rugs ora*#erse utaneous reations to *rugsuse* 4or li#er *iseases



S1in &ani4estations o4 Li#erDiseases

audice 2ruritus 2i!metary cha!es ascular cha!es 2urpura Nail cha!es athomas (upuytreEs cotracture

Hormoal e+ects

iral Hepatitis ?A,8,C@ 2orphyrias ?2CT@ Alcoholic liver disease )ali!at carcioid

sydrome ?&ushi!@ Necrolytic mi!ratory

erythema ?N)7@ Alpha5. atitrypsi

de*ciecy ?paiculitis@ Autoimmue

hepatitis?AIH@



8almer Eryt*ema S!ider Telan'ie&tasia

Terry/s ?w*ite@ NailsKayser6 Fleis&*er rin'

iral He%atitis t!e S1in



iral He%atitis t!e S1in

He%atitis A He%atitis +He%atitis C

3aun*ie F Polyarteritis no*osa F &i$e*CroyoglobulinemiaUrtiaria F Pa%ular aro*ermatitis F Por%!yria'PC6 (

E$ant! ras! o4 !il*!oo* 'PAC( FLeuoyto#asulitis #asulitis Cut #asulitis Serum si1ness2li1e F Li!en

%lanusCryoglobulinemia syn*rome Polyarteritis

no*osa

Eryt!ema no*osum Sogren-ssyn*romeUrtiaria +e!!t-s

syn*rome&i$e* ryglobulinemia Nerolyti

migratory

eryt!ema2

Polyarteritis No*osa ' PAN ( H+



Polyarteritis No*osa ' PAN ( H+

:p to 0-4 o$ people #ith 2AN are H8sA! ve

.- J 6-4 have cutaeous ivolvemet

9esios iclude = palpable purpuravasculitic ulcersteder odules

livedo reticularisurticaria B a!ioedemadistal !a!ree

No correlatio #ith severity o$ liver ivolvemet

Treatmet iclude = corticosteroids, immuosuppressives

?cyclophosphamide@, cyclospori, plasma e%cha!e



S1in in Polyarteritis No*osa 'PAN(

3i"ido reti&laris

+as&litis &asin' s)in in-ar&tion

3e&o&yto&lasti& "as&litis



S1in in Polyarteritis No*osa 'PAN(

To!i&al Cy&los!orin Treatment

8yoderma Gan'renosm6



Pa%ular Aro*ermatitis o4 C!il*!oo* '!ianotti Cro"ti Syn#rome( H+

Childre 65 years

Cliical $eatures = o relapsi! papular dermatitis

$ace ad limbs , spares truklymphadeopathyacute hepatitis ?mostly aicteric@H8sA! ati!eaemia

hepatitis ca pro!ress chroic liverdisease dermatitis resolves i K #eeks

Pa%ular Aro*ermatitis o4 C!il*!oo* PAC



Gianotti Crosti Syn*rome H+

8a!lar lesions on Fa&e4 lim,s



&i$e* Cryoglobulinemias HC

- J 0- 4 o$ patiets #ith HC have circulati!cryo!lobulis

- 5.-- 4 o$ patiets have ski *di!s J

palpable purpuralivedo reticularis

acrocyaosisurticarial pla"uesulceratios

Dermatol Clin 20 (2002) 449-458)

Cryo!lobuliemia i HC



y !

3i"ido 2eti&laris

8al!a,le 8r!ra

+as&litis

Cryo'lo,lins

2eti&late 8laes

3e&o&yto&lasti& +as&litis



3e&o&yto&lasti& +as&litis



Li!en Planus HC

Erosi"e oral 3i&*en !lans

8a!lar 38



Por%!yria Cutanea 6ar*a 'PC6( HC

2CT see i 64 o$ patiets #ith HC 2resets as = tese bullae

vesicles erosios heals #ith scarri! L milia 9esios o su e%posed ski Complai o$ $ra!ility o$ ski )echaism = decrease uroporphyrio!e decarbo%ylase

activity

Dermatol Clin 20 (2002) 449-458



8or!*yria Ctanea Tarda ( 0C+

Al!*a6#6antitry!sin asso&iated8anni&litis ? ln'4 li"er4renal4 GIT

@



6!e S1in in



&alignant Carinoi* Syn*rome

.- 4 o$ patiets #ith carcioid tumour Symptoms #he liver ivolved #ith metastasis mediators escape ito circulatio Cutaeous $eatures =

&ushi! ?early all cases@ pella!ra ?iaci de*ciecy@

scleroderma ?a variat, lo#erlimbs, heart@

pruritusrosaceaski metastasis

British Journal of Dermatology 2005 152, !1-!5

Cutaneous &ani4estations o4



Alo!ol Abuse

Spidertela!iactasias

2almer erythema Caput madusae 1lushi! audice 2ruritus :rticaria 2lethoric $acies

Doiloychia TerryEs ail Clubbi! Hyperpi!metatio 8lack hairy to!ue Glossitis 9eucoplakia



=andi&e

D!ytren/s

Contra&tre

Gynae&omastia

As&ites

Cl,,in'

3e&ony&*ia



%y !at*o'eneti& me&*anism

Colla'en "as&lar disease

3!s Eryt*ematoss

Systemi& s&lerosis

Dermatomyositis

3!s eryt*ematoss



3!s eryt*ematoss

CC3E Dis&oid lesionsSC3E 8soriasi-orm4 annlar 5 !oly&yli&

AC3E Malar 5 ,tter-ly eryt*ema4 !*otosensiti"e

dermatoses4 mot* l&ers4 D3E lesions4alo!e&ia4 !r!ra4 "as&litis4 rti&arial "as&litis4li"ido reti&laris4 ,llae4 eryt*ema mlti-orme4'an'rene -in'ers 5 toes ?2aynad/s@4 !erin'al nail-old telan'ie&tasia4 s,&taneos nodles5 !laes4

!anni&litis@4 s&leroderma6li)e &*an'es4eryt*romelal'ia4 !oi)iloderma

Neonatal C0%4 annlar 5 !oly&y&li& lesions









Systemi& s&lerosis



y

T*i&)enin' s&lerosis 6 *ands4 -orearms4 arms4 -a&e4 &*est ?,ea)6li)e mot*4 !in&*ed nose@

2aynad/s !*enomenon

8i'mentation > di--se4 or *y!o!i'mentation

Nail -old eryt*ema 5 telan'ie&tasia

Fin'erti!s4 )n&)les 6 "as&litis5l&ers5'an'rene5atro!*y

Fa&e > matt6li)e 5 !a!lar telan'ie&tasia

8arony&*ia

3e' l&ers

8alma eryt*ema

Cal&inosis &tis > *ands4 el,ow4 ilia& &rest4 s!ine

8oi)iloderma





Dermatomyositis

Fa&e !eri6or,ital *eliotro!e ras* 5 oedema

Nail -old !erin'al eryt*ema 5 telan'ie&tasia4

&ti&lar *y!er)eratosis

Kn&)les Gottron/s !a!les

8*otosensiti"ity

8oi)iloderma

2aynad/s !*en1rti&aria4 EN4 EM

+iola&eos -olli&lar !a!les$



Dermatomyositis

On ,asis o- &*ara&teristi& .rea&tion !attern/8rrits



8rrits

Eryt*ema ( annlar eryt*ema

8ete&*iae4 !r!ra4 "as&litis

1rti&ariaEryt*ema mlti-orme4 TEN

S,&taneos nodles o- le' > EN

Asym!tomati& nodles5!laes

DermatitisEryt*roderma

I&*t*yosis

8soriasi-orm lesions

8a!lar4 a&nei-orm ( nodlar lesions

Yellow nodles ( !laes

%llos lesions

3e' l&ers

8i'mentary disorders

Nails4 *air



Thak >ou



8rrits

3o&alised Genital it&* ? &andidiasis @ 6 DM

Generalised 8rimary s)in disease

Se&ondary systemi& diseaseMali'nan&y > lym!*omas

3e)aemia 5 CA

3i"er > o,str&ti"e Bandi&e

2enal > raemia

Fe6de-i&ien&y anaemia82+

Disorders o- 8i'mentation



'

+itili'o Atoimmne disorders 6

t*yroid dis4 Addison/s dis$

%rown !i'mentation ?CA3M@ Nero-i,romatosis

8erioral lenti'o4 int$ !oly! 8et<6=e'*er/s

Fle9ral4 t*i&)ened4 s)in ta'sDM4 Ca ?stoma&*@

Di--se4 ,rown >wit* 'rey6,rown *e 0aemo&*romatosis

Wit* ,lla4 *y!ertri&*osis 8CTs&ars4 e9!osed !arts

0y!o wit* *y!er!i'mentation S&leroderma



Eryt*ema



Wides!read 5 !rodromal sym!toms "iral ras*

3o&alised > -a&e .,tter-ly/ 3E

"iola&eos 5 *eliotro!e Dermatomyositis8i'mentary &*an'es5dermal s&lerosis

5nail -old telan'ie&tasis S&leroderma

Nasola,ial4 eye in"ol"ement4 !eriodi&

-ls*in' 2osa&ea4 meno!ase8eriodi& -ls*in'4 ast*ma4 a,d$ !ain Car&inoid syndrome

diarr*oea

8almar eryt*ema 8re'nan&y4 li"er dis$4

S3E4 2A4

*y!ert*yroidism

Eryt*ema



Annlar

eyt*ema annlare &entri-'m In-e&tion4 in-estation4 Mali'nan&y4 S3E

Eryt*ema 'yratm re!ens Mali'nan&y

8ete&*iae !r!ra



8ete&*iae4 !r!ra?8latelet5+as&lar5Coa'lation@

In-e&tion

Se!ti&aemia > menin'o&o&&al4 'ono&o&&al

D0F

S&r"y

Cs*in'/s syndrome

Dr's

+as&litis



+as&litis

8rimary

Se&ondary

Dr's

In-e&tions 6 Stre!4 0%+4 E%+Colla'en 6 S3E4 2A4 Dermatomyositis

Cryo'lo,linaemia

3ym!*oma 5 le)aenia



1rti&aria



Ordinary

A&te ? w)s@ Food4 dr's4 in-e&tion > !arasite4 stre!

C*roni& ? w)s@ Food4 dr's4 in-e&tion4 S3E4 mali'nan&yt*yroto9i&osis4 !sy&*olo'i&

8*ysi&al

1+3 E884 CE8Cold Cryo'lo,linaemia4 ?myeloma4 &olla'en4

CA4 sy!*ilis@

1rti&arial

"as&litis S3E4 3ym!*oma4 0%+? :; *ors4 !ain

8i'mentation@

Conta&t



Eryt*ema Mlti-orme



Eryt*ema Mlti-orme

In-e&tion 0S+ ?re&rrent EM@

Stre!4 s!er-i&ial ( dee! my&oses

Tri&*omoniasis4 My&o!lasma

Dr's

Colla'en "as&lar disease2adiot*era!y

Mali'nan&y



To9i& E!idermal Ne&rolysis



To9i& E!idermal Ne&rolysis

In-e&tion 6 Sta!* ?SSSS6&*ildren@4 "irs

2adiot*era!y

3ym!*oma4 Ca

Dr's



S,&taneos ?!ain-l nodles @ o- le's



Eryt*ema nodosm In-e&tion Stre!4T%4 3e!rosy

C*lamydia4 Yersenia4dee! my&oses4 "irs

Dr's OC84 Sl!*onamide

Sar&oidosis

In-lammatory ,owel dis$ > Cro*n/s

%e*&et/s disease4 CA

Eryt*ema indratm T%

Nodlar "as&litis Stre!4 T%4 dr's4 Colla'en dis$

8olyarteritis nodosa 8ossi,le systemi& in"ol"ement8anni&litis 8an&reati& dis4 Colla'en dis4

Trama4 Forei'n ,ody4 Mali'nan&y

S,a&te nodlar

mi'ratory !anni&litis Trama4 OC84 idio!at*i&





Non tender nodles

3e!rosy

Mali'nan&y lym!*omas4 le)aemias

mlti!le myeloma4 MF4se&ondaries

Sar&oidosis





E&<ema 5 Dermatitis



Se,orr*oei&4 !ete&*iae4 !r!ra 3etterer > Siwe!a!les ?0istio&ytosis 7@

Se,orr*oei&4 diarr*oea4 in-e&tion 3einer/s dis ? C de-y@

Se,orr*oei&4 ato!i&4 in-e&tions Wis)ott Aldri&* syn

!r!ra

Ato!i&4 *y!omelanosis4 M2 8*enyl)etonria

8*otodermatitis 3E4 Dermatomyositis48CT

E - li i d i i ?E * d @



E9-oliati"e dermatitis ?Eryt*roderma@

S)in disease e&<ema4 !soriasis

Dr's sl!*onamides4 !*enytoin4 allo!rinol

Mali'nan&ies 3ym!*oma4 le)aemia4 MF4 Ca

Idio!at*i&



I *t* i



I&*t*yosis

Con'enital +l'aris4 Se96lin)ed4 CIE

A&ired 3ym!*omas4 le!rosy4 dr's4 0I+4

raemia4 mala,sor!ton4*y!ot*yroidism

8soriasi-orm



8soriasi-orm

8soriasis

2eiter/s disease

Se&ondary Sy!*ilis

3!s eryt*ematoss 6 SC3E

Mali'nan&y

Dr's

8a!lar4 a&nei-orm4 nodlar ? -a&e @

A&nei-orm4 *irstism4 menstral Endo&rine dis4 CA



4 4 4

irre'larity

Adenoma se,ae&em4 e!ile!sy4 T,eros s&lerosis

M24 s*a'reen !at&*4 !erin'al

-i,roma4 as*6lea- *y!o!i'$ ma&le

Co,,lestone4 li&*enoid !a!les T*yroid adenoma4

CA 5 -i,ro&ysti& ,reast

E!idermal &yst4 -i,roma4 ,one Gardner/s syndrome

osteoma4 ( &oloni& !oly!osis

Nero-i,romas4 CA3Ms4 3is&* Nero-i,romatosis







Yellow nodles ( !laes



Wit* *y!erli!idaemia4 DM 7ant*oma4 9ant*elasma

Ne!*roti& syndrome4 ,iliary ?-amilial *y!er&*olesterolemia&irr*osis4 *y!ot*yroidism 5*y!ertri'lyseridemia4 ,road

,eta dis4 li!o!rotein li!ase

de-i&ien&y@

Normoli!idemia 8lane 9ant*oma4 myelomalym!*oma4 Ca

Wit* an'ioid strea)s4 loss o- 8sedo9ant*oma elasti&m

&entral "ision4 int$ &ladi&ation4an'ina !e&toris4 GI ,leed





%llos diseases



Con'enital

A&ired

Dr's Ste"ens6=o*nson syndrome

FDE

Atoimmne Dermatitis *er!eti-ormis

?a5w 'lten sensiti"e entero!at*y@

8em!*i's > &an ,e a5w t*ymoma4 Ca

S3E4 8A







Non in-e&ti"e 'ranlomas



Non in-e&ti"e 'ranlomas

2ed !a!le4 !lae4 annlar Sar&oidosis

wit* systemi& in"ol"ement

2ed !a!les arran'ed in rin's Granloma annlare

? a5w DM @

2ed yellow atro!*i& !lae Ne&ro,iosis li!oidi&awit* telan'ie&tasia4 o"er s*ins ? a5w DM @



3e' l&ers

Stasis +enos disease



+as&litis Colla'en "as&lar disease4 8AN4 0S8

In-e&ti"e

Mali'nant

Nero!at*i& 3e!rosy4 DM4 ta,es dosalis4

syrin'omyelia4 !olynero!at*y

Ot*ers 8yoderma 'an'renosm



Nails



Color6 ,rown &*roni& renal -ailre yellow4 oedema4 !l in-e&tion4 yellow nail syndrome e--sion6 *al- moon Wilson/s disease

Ony&*olysis 0y!ert*yroidism!soriasis4 !ella'ra

Koilony&*ia Fe de-$ anaemia4trama

8erin'al telan'ie&tasia 3E4 Dermatomyositis











0air

S&arrin'3E4 S&leroderma4 3i&*en !lano6!ilaris4 In-e&tion48sedo6!elade

Non s&arrin'Di--se 3E4 Fe de-y4 0y!o!ititarism4

t*yroid disease

Fo&al Alo!e&ia areata





Dr' er!tions

J 8rrits Anti6de!ressants CNS



J$ 8rrits Anti6de!ressants4 CNS

stimlants

$ 8soriasi-orm %6,lo&)ers4 3i4 'old4anti6malarials

#L$A&nei-orm Steroids4 anti6e!ile!ti&

##$ 8*otosensiti"ity 0ydralla<ine4 isonia<id4

*ydantoins4 OC8s4t*ia<ides

#:$Alo!e&ia 0e!arin4 &ytoto9i&4

neomer&a<ole

#H$3i&*enoid Anti6malarials4 8AS4

'old#;$EN OC8s4 sl!*a



T0ANK YO1

Skin Manifestation of Systemic Diseases

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