This is the html version of the file http://effiwe.net/Resources/Medcine/NEUROLOGY/skin%20&%20systems.ppt.

Google automatically generates html versions of documents as we crawl the web. ALADEJEBI OLAIDE. Clinical II. OUTLINE

-INTRODUCTION -SKIN CHANGES IN PARTICULAR DISEASES; Skin & Internal malignancy Skin & Diabetics Mellitus The skin in Liver disease The Skin in Renal Disease The Skin in Malabsorbtion & Malnutrition HIV & the Skin -SKIN CHANGES ASSOCIATED WITH VARIOUS CONDITIONS. CONCLUSION.

INTRODUCTION.

The Skin is often described as a mirror of the internal organs. The skin is in intimate contact with underlying tissues and in intimate functional contact with other organs in the body. It acts as a window not only on the underlying structures, but also on near or distant internal organs.

SKIN & INTERNAL MALIGNANCY.

In case of an internal malignancy, the tumour can invade the skin directly or send metastasis to it. The tumous, can act physiologically e. g acne in adrenal tumours, flushing in carcinoid tumours, jaundice in bile duct carcinoma. The following are examples of skin conditions that could be a manifestation of internal malignancy: ACANTHOSIS NIGRICANS: A velvety thickening and pigmentation of the major flexures. It could manifest as a result of tumor in the abdominal cavity. But conditions like obesity, Diabetics mellitus characterised by insulin resistance, drugs e.g. nicotinic acid in treating hyperlipidermia, should be excluded.

NECROTIC MIGRATORY ERYTHEMA It is a figurate erythema with a moving crusted edge. When it is present, with anaemia, stomatitis, weight loss and diabetics mellitus, it signals the presence of Glucagon secreting tumour of the pancreas. GENERALISED PRURITUS: Generalised pruritus has many causes though but one of them is an internal malignancy, usually a lymphoma.

SKIN AND DIABETICS MELLITUS.

Diabetics can have a number of cutaneous manifestations. Complications of Diabetics itself include : Fungal infection e.g candidiasis Bacteria infections e.g recurrent boils Xanthomas Arterial diseases ( ulcers, gangrene) Neuropathic ulcers specific dermatoses of diabetics mellitus include:

NECROBIOSIS LIPOIDICA

It is a patch of spreading erythema over the shin which becomes yellowish and atrophic in the centre. It may ulcerate.

DIABETICS DERMOPATHY

Red brown flat- topped papules, found on the limbs particularly on the shin.

DIFFUSE GRANULOMA ANNULARE

It is characterised by clusters of small dermal papules, with no surface change. They are flesh coloured or slightly erythematous & usually asymptomatic.

DIABETICS STIFF SKIN (cheiroarthropathy)

There is tight waxy skin over the fingers with limitations of joint movement, owing to thickened collagen.

THE SKIN IN LIVER DISEASE.

Some examples of skin manifestation in liver disease include:

PRURITUS. It is related to obstructive jaundice e.g extrahepatic or intra hepatic . Pruritus may precede it.

SPIDER NAEVI

It is often multiple in chronic liver disease. These are telangiectasis that consist of a central arteriole with radiating small vessels. PALMAL ERYTHEMA XANTHOMAS: cholesterol deposits are seen in the palmar cr eases or above the eyes in primary biliary cirrhosis.

JAUNDICE: this is yellowish discoloration of sclera and skin due to excess bilirubin in plasma and tissue fluids.

THE SKIN IN RENAL DISEASE

PRURITUS: one of the symptoms of chronic renal disease.

HALF & HALF NAIL: the proximal half is white & the distal half is pink or brownish,

PERFORATING DISORDERS: Small papules in which collagen or elastic fibres are been extruded through the epidermis.

MALABSORPTION & MALNUTRITION HIV AND THE SKIN

HIV infection commonly causes significant dermatological problem.

A rash may even be the presenting feature of underlying HIV infection. CUTANEOUS INFECTION & OPPORTUNISTIC INFECTIONS.

Molluscum contagiosum are common on the face. Viral infectionsextensive ulcerative herpes or widespread viral wart. Bacteria infections- staphlococcal boils. Fungal infections- tinea & candidiasis. Opportunistic infections- cytomegalovirus(pustules or necrotic ulcers). Sporotrichosis-linear nodules. Cryptococcus red papules.

INFLAMMATORY DERMATOSES

This is probably due to an immune imbalance or dysfunction. Severe, extensive seborric eczema, other types of eczema, psoriasis, ichthyosis(dry skin), pruritus are all common in HIV and can be severe.

SPECIFIC HIV DERMATOSIS

ITCHY FOLLICULITIS OF HIV(pruritic papular eruption) : it presents with intensely itchy papules centered on hair follicles and occur most commonly over the trunk & upper arms. The face is more commonly involved in blacks

ORAL HAIRY LEUKOPLAKIA : it is characterised by white plaques with vertical ridging on the sides of the tongue. Unlike oral candidiasis, the lesions cannot be peeled off to leave raw areas underneath.

SKIN CONDITIONS ASSOCIATED WITH VARIOUS CONDITIONS.

PRURITUS

It is the commonest symptom of skin disease & commonest cutaneous symptom associated with internal disease. Examples Diabetes Mellitus- skin is dry because of decrease in surface lipid and decrease in water holding capacity of the horny layer of epidermis.

Liver disease-in biliary obstruction. Itching due to increase bile salts in the system. Also in cancer of pancreas, colon, stomach obstructing the biliary ducts

Renal disease-increase blood urea in ureamia, chronic renal disease.

Anaemia there is mild or moderate itching in sicle cell anaemia, iron deficiency anaemia, megaloblastic anaemia. Polycythemia causes marked itching. Leukamia- itching is a marked feature of both myelocytic & lymphocytic leukamia. Infestations- filiaria & helminthic infestation Neuropsychiatry disease- in anxiety, obsessive neurosis Pigmentary changes

Cyanosis- seen in emphysema, pulmonary edema, pneumonia, cyanotic congenital heart disease. Pallor- occur in anaemia. Also seen in fainting, & severe nausea & vomiting. Jaundice- sickle cell disease , malaria, hepatocellular liver disease, biliary obstruction.

conclusion

If we bear in mind that approach to managing dermatological patients must always be whollistic as there is no walking skin. This would help in the early detection and adequate treatment of patients with various skin diseases and also the underlying systemic disease.

THANK YOU FOR LISTENING