Cutaneous manifestations of thyroid disease

The diagnosis of thyroid disease can often first be identified by recognizing various cutaneous manifestations associated with an imbalance of circulating thyroid hormone. This article reviews the pathophysiology of thyroid disease, characteristic cutaneous findings of the hypothyroid and hyperthyroid states, and cutaneous conditions associated with thyroid disease.     

Cutaneous manifestations of thyroid disease

Of all the endocrinopathies that may have cutaneous findings, thyroid disease is probably the one most likely to be seen by the practicing physician since the skin readily reflects the functional capacity of the thyroid gland. Cutaneous findings may be the only clue to otherwise silent thyroid disease. Skin changes may precede other clinical and laboratory evidence of thyroid malfunction by months or years. Thus, the skin not only aids in the diagnosis of thyroid dysfunction, but also helps the physician select those high-risk patients in whom thyroid abnormalities may later develop.     

Endocrine-skin interactions. Cutaneous manifestations of pituitary disease, thyroid disease, calcium disorders, and diabetes

Endocrinologic disorders occasionally manifest themselves by their associated or induced cutaneous abnormalities. In some instances the initial and most prominent complaints of the patient are related to alterations in the skin, and thus the dermatologist will at times be the first physician consulted. In this article we describe the cutaneous lesions that occur in patients with acromegaly, hypopituitarism, hypothyroidism, hyperthyroidism, diabetes mellitus, glucagonomas, hypercalcemia, hypoparathyroidism, and fibrous dysplasia. In addition, we also discuss the role of the skin in vitamin D metabolism. Whenever possible and where known, we have attempted to point out the pathophysiologic mechanisms that account for the cutaneous changes.     

Cutaneous manifestations of Crohn's disease

Crohn's disease is a chronic inflammatory bowel disease which may have distinctive mucocutaneous manifestations. Included in this group are perianal, peristomal, and perifistular ulceration, as well as granulomatous cutaneous inflammation separate from gastrointestinal tract openings (metastatic Crohn's disease). In the oral cavity, both ulcerations and granulomatous nodules may occur. Malabsorption of nutrients may lead to several changes, including an acrodermatitis enteropathica-like syndrome secondary to zinc deficiency. Patients with Crohn's disease may also have pyoderma gangrenosum, erythema nodosum, cutaneous vasculitis, and other less specific changes.     

Cutaneous manifestations of Gaucher disease

We reviewed the cutaneous manifestations of type I non-neuropathic Gaucher disease in fifty South African patients. Characteristic changes such as diffuse pigmentation, easy tanning and flitting brwon macules were found to be useful pointers to the diagnosis. Other cutaneous changes secondary to infiltration of the marrow and liver were common and important findings.     

Cutaneous manifestations of gastrointestinal disease

Numerous diseases affect the skin and gut simultaneously. The early recognition and treatment of both components is often essential to decrease morbidity and even prevent death precipitated by gastrointestinal crises. A number of the diseases affecting both the skin and gut are discussed, with particular emphasis on recent developments.     

Cutaneous manifestations of Hodgkin's disease

BACKGROUND: Cutaneous manifestations associated with Hodgkin's Disease (HD) have not been well described. Most existing studies of the cutaneous manifestations of HD are individual case reports or literature reviews. The goal of this study was to define the spectrum of cutaneous manifestations of HD, as observed by the consulting dermatologist at a cancer center. METHODS: The tumor registry database maintained by the Department of Medical Informatics and the M.D. Anderson Visits database over a 5-year period was searched to identify patients with a diagnosis of HD and an appointment with Dermatology. The medical records were reviewed to determine frequency and presentation of cutaneous findings in HD. RESULTS: The search identified a total of 1049 registered patients with HD, of which 88 were seen at the Dermatology Clinic. Of these 88 patients evaluated by dermatology, 47 patients had either paraneoplastic cutaneous manifestations associated with HD (n = 45) or cutaneous HD (n = 3). The most common paraneoplastic skin manifestations were eczema (n = 18) and pruritis (n = 17), mycosis fungoides (n = 11), and erythema nodosum (n = 3). Mycosis fungoides, observed in 1% of the patients with HD at MDACC, was more than 290 times more common in patients with HD than in the general population. CONCLUSION: Although pruritis is the most commonly recognized presenting symptom of Hodgkin's lymphoma, new onset of eczema should also be considered as a possible warning sign deserving further investigation. Patients with adult-onset pruritus or eczema should be evaluated for possible HD with full lymph-node exam, CBC with differential, and chest X-ray. Erythema nodosum and mycosis fungoides should also be considered as cutaneous manifestations of HD.     

Cutaneous manifestations of chronic kidney disease

Among the most common systemic diseases associated with cutaneous manifestations is kidney failure. Most of these occur in the setting of chronic kidney disease. In the following review, we will target 6 of these conditions in details. The entities are as follows: pruritus acquired perforating dermatoses, nail disorders, bullous disorders, calciphylaxis, and nephrogenic fibrosing dermopathy.     

Cutaneous manifestations of metastatic Crohn's disease

Metastatic Crohn's disease is a rare cutaneous complication of primary Crohn's disease. It is a granulomatous inflammatory process, similar to the pathogenic mechanism of Crohn's disease, that occurs in sites discontiguous from the gastrointestinal tract. Metastatic Crohn's disease can precede the development of Crohn's disease by months to years, and children are more likely to present with metastatic Crohn's disease in the absence of gastrointestinal symptoms. Given that approximately 30% of individuals with Crohn's disease present in childhood, early recognition of extraintestinal manifestations of Crohn's disease such as metastatic Crohn's disease can aid in timely diagnosis and management of bowel disease. We present data from two pediatric cases of metastatic Crohn's disease recently seen at our institution in addition to the 61 reported cases of pediatric metastatic Crohn's disease in the literature. This review article will focus on the epidemiology, pathogenesis, clinical features, and histology of and treatment options for pediatric metastatic Crohn's disease.     

Cutaneous manifestations of end-stage renal disease

Examination of the skin and nails can reveal many abnormalities in patients with end-stage renal disease that precede or follow initiation of dialysis treatment or kidney transplantation. This article focuses on specific and nonspecific cutaneous signs of end-stage renal disease, reviewing both banal and life-threatening conditions, including pruritus, perforating disorders, calcifying disorders, and bullous dermatoses. The pathogenesis, clinical findings, histologic findings, differential diagnosis, and treatment of these diseases are discussed. Cutaneous manifestations unique to kidney transplantation will not be covered. (J Am Acad Dermatol 2000;43:975-86.)     

Cutaneous manifestations of chronic graft-versus-host disease

Graft-versus-host disease (GVHD) occurs in a number of clinical settings. It is well recognized after bone marrow transplantation, an increasingly used therapeutic option for haematologicl disorders. Chronic GVHD, occurring at an interval greater than 100 days post-transplant, has many systemic manifestations, but it is the cutaneous manifestations which are most frequent and often most troubling to the patient In this review article, the wide spectrum of cutaneous chronic GVHD (including involvement of hair, nails and mucosae), and its complications and associations are discussed. The clinical and histological features and management guidelines are presented to assist the dermatologist with diagnosis and treatment of this condition.     

Cutaneous manifestations in end-stage renal disease

The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.     

Cutaneous manifestations of neutrophilic disease. A study of seven cases.

Seven patients with a complex form of neutrophilic dermatosis are reported. Clinically, they had variable associations of four types of lesions: blisters/pustules, plaques, nodules and ulcerations. Histologically, a neutrophilic infiltrate was observed at variable levels in the epidermis, dermis and subcutis. Systemic manifestations were present in all cases (general symptoms, joint, renal, ocular and lung involvements). Three patients had an associated disease (myelodysplasia, metastatic carcinoma, IgG gammopathy). Steroids were the most efficient treatment. These observations, as well as a review of the literature, support the opinion that the neutrophilic dermatosis represents a continuous spectrum encompassing four well-defined entities: subcorneal pustular dermatosis, Sweet's syndrome, erythema elevatum diutinum and pyoderma gangrenosum. We propose that the different patterns of the neutrophilic dermatosis are the most obvious manifestations of a potentially multisystemic neutrophilic disease and allow its recognition.     

Cutaneous manifestations of acrodynia (pink disease)

A 14-month-old girl who presented with multiple systemic complaints was found to have gingivitis, peeling of her palms and soles, and a peculiar acral eruption. A diagnosis of acrodynia, or pink disease, was confirmed by elevated levels of mercury in the urine. The many cutaneous manifestations of this once common disease are discussed.     

Cutaneous manifestations

Characteristic and pathognomonic skin lesions in flexural sites are the hallmark of hereditary PXE. Because existence of these lesions was taken as the single essential diagnostic criterion for hereditary PXE, all of the patients in the present group had such lesions to one degree or another. Without typical lesions in flexural sites, the diagnosis remains in question, although very early or subclinical histologic expressions in normal-appearing flexural skin may rarely occur and present confounding diagnostic dilemmas.PXE skin lesions usually appear during childhood or adolescence and progress slowly with age and duration of disease, normally beginning on the lateral neck and later involving the flexural sites of the trunk and lower extremities. The disorder progresses at vastly different rates for unknown reasons. Rare, late-onset skin lesions, as late as the fifth decade of life, are of immense theoretical interest and may represent a unique new subset of PXE.In patients with the most extensive skin involvement of long duration, the skin gradually loses its original pebbly, leathery look and becomes thickened with heavy, redundant, sagging folds. The neck, axillae, and groins are particularly susceptible. Similar involvement of the face may occur; however, the admixture with solar elastosis often makes it difficult to tell which of the two processes accounts for most of the clinical change.Mucosal lesions are common, most often occurring in the buccal mucosa and occasionally involving the anogenital mucosa in those with the most extensive skin lesions.Various, unusual, and uncommon skin lesions may occur, including examples of transepiderma1 elimination, called perforating PXE, that resemble EPS but differ from it in that the material extruded in perforating PXE is calcified, which is not the case in ordinary EPS. Acneiform lesions and depressed, scarred, “burned out” flexural areas have been described.     

Cutaneous manifestations of pancreatic diseases.

An awareness of the cutaneous signs of diseases of the pancreas is extremely valuable. They alert the astute examiner to several life-threatening problems that result from both benign and malignant islet cell tumors, adenocarcinomas of the pancreas, and pancreatic endocrine and inflammatory diseases. Many of the cutaneous manifestations of pancreatic disease are discussed in detail, with emphasis on both the clinical presentation and pathogenesis.