Systemic Problem

Endocrine

Dermatologic Manifestations

Hyperthyroidism
Hypothyroidism

Increased sweating, warm skin with persistent flush, thin nails, alopecia; fine, soft hair
Cold, dry, pale to yellow skin; generalized nonpitting edema; dry, coarse, brittle hair; brittle,
slow-growing nails
Atrophy; striae; epidermal thinning; telangiectasia; acne; decreased subcutaneous fat over
extremities; thin, loose dermis; impaired wound healing; increased vascular fragility; mild
hirsutism; excessive collection of fat over clavicles, back of neck, abdomen, and face
Loss of body hair (especially axillary), generalized hyperpigmentation (accentuated in folds)
Enlarged facial pores, male sex characteristics, acne, acceleration of coarse hair growth
Development of sparse hair; marked reduction in sebum production
Opaque, brittle nails with transverse ridges; coarse, sparse hair with patchy alopecia
Coarsened skin, deepened lines; increased oiliness and sweating; acne; increased number
of nevi, hyperpigmentation; hypertrichosis (excess hair growth)
Erythematous plaques of shins, delayed wound healing, neuropathy

Glucocorticoid excess (Cushing syndrome)

Addisons disease
Androgen excess
Androgen deficiency
Hypoparathyroidism
Hyperpituitarism (acromegaly)
Diabetes mellitus

Gastrointestinal
Inflammatory bowel disease
Liver disease and biliary tract obstruction
Deficiency of essential fatty acids
Malabsorption syndrome
Cystic fibrosis

Mouth ulcers, erythema nodosum

Jaundice, itching, pigmentary abnormalities, alterations in nails and hair, spider angiomas,
telangiectasia
Scaly skin
Acquired ichthyosis (dry, scaly skin)
Abnormal sweat gland function

Musculoskeletal and Connective Tissue

Systemic lupus erythematosus
Scleroderma
Dermatomyositis

Discoid lesions, maculopapular semiconfluent rash (butterfly rash), alopecia, mouth ulcers
Leathery hardening and stiffness of skin
Edema; purplish-red upper eyelids; scaly, macular erythema over knuckles

Metabolic
Vitamin B1 (thiamine) deficiency
Vitamin B2 (riboflavin) deficiency
Nicotinic acid (niacin) deficiency
Vitamin C deficiency

Edema, redness of soles of feet

Red fissures at corner of mouth, glossitis
Redness of exposed areas of skin of handor foot, face, or neck; infected dermatitis
Petechiae, purpura, bleeding gums

Immune
Hodgkins lymphoma
Non-Hodgkins lymphoma
HIV infection

Pruritus and nonspecific erythemas

Papules, nodules, plaques, pruritus
Kaposi sarcoma, eosinophilic folliculitis

Cardiovascular
Rheumatic heart disease
Thromboangiitis obliterans (Buergers disease)
Peripheral vascular disease
Venous ulcers

Petechiae, urticaria, nodules, erythema

Pallor or cyanosis, gangrene, ulceration
Loss of hair on hands and feet; delayed capillary filling; dependent rubor (redness), pain
Leathery, brownish skin on lower leg; pruritus, concave lesion with edema; scar tissue
with healing

Respiratory
Inadequate oxygenation due to respiratory disease

Cyanosis

Hematologic
Anemia
Clotting disorders

Pallor, hyperpigmentation, pale mucous membranes, hair loss, nail dystrophy

Purpura, petechiae, ecchymosis

Renal
Chronic kidney disease

Dry skin, pruritus, uremic frost, pallor, bruises

Reproductive Organs
Primary syphilis
Secondary syphilis
Tertiary syphilis
Pagets disease

Chancre
Generalized skin lesions, alopecia
Gummas
Eczematous patch of nipple and areola

Neurologic
Chronic sensory polyneuropathies
Spinal cord trauma

Trophic changes in skin resulting from sensory denervation, pressure ulcers, anesthesia,
paresthesias

*Refer to the systemic disease for specific information.

Copyright 2014, 2011, 2007, 2004, 2000, 1996, 1992, 1987, 1983 by Mosby, an imprint of Elsevier Inc.

Integumentary System

eTABLE 24-1 DISEASES WITH DERMATOLOGIC MANIFESTATIONS*