Endocrine Disorders
Diabetes Mellitus
Foot Ulcers of Diabetes
Diabetes affects over 19 million people in the U.S. and accounts for about 11 percent of health care spending. It is a state of relative or complete insulin deficiency, leading to problems in glucose, fat, and protein metabolism. Diabetes is associated with many different skin conditions. Metabolic defects leads to conditions such as eruptive xanthomas. Leg and foot ulcers, as well as cutaneous infections, are found more often in diabetics due to immune dysfunction, neuropathy, and vasculopathy. Other conditions can affect patients with diabetes, including:
-Rubeosis (reddening of the skin)
-Diabetic dermopathy
-Diabetic bullae
-Acanthrosis nigricans
-Necrobiosis lipoidica
-Rubeosis (reddening of the skin)
-Diabetic dermopathy
-Diabetic bullae
-Acanthrosis nigricans
-Necrobiosis lipoidica
Hyperthyroidism
Thyroid Dermopathy - Fitzpatrick's Dermatology
Skin changes are very common in hyperthyroidism. Fine, velvety, smooth skin ( warm and moist due to swelling) is classically associated with this condition, and can be compared to the skin of an infant. Hair is typically fine and soft.
Patients with Graves disease are commonly affected by thyroid dermopathy. Thyroid dermopathy classically occurs as painless, bilateral nodule and plaques of varying color and a waxy texture. The most common distribution is on the extensor surfaces of the legs.
Patients with Graves disease are commonly affected by thyroid dermopathy. Thyroid dermopathy classically occurs as painless, bilateral nodule and plaques of varying color and a waxy texture. The most common distribution is on the extensor surfaces of the legs.
Hypothyroidism
Hypothyroidism - FItzpatrick's Dermatology
In hypothyroidism, the skin is cool and pale due to decreased core temperature and increased peripheral vasoconstriction. Distinct facial changes can be realized, including broadened nose, thick lips, puffy eyelids, and a clumsy tongue. The following findings are common in hypothyroidism:
-Dry, rough, coarse, pale skin
-Yellow discoloration (carotenemia)
-Ichthyosis (scaling, thick skin, like a fish)
-Eruptive xanthomas
-Dull, coarse, brittle hair
Picture: "This patient has many of the characteristic features of hypothyroidism, including dry, pale skin; the absence of hair on the lateral third of the eyebrow; and puffiness of the face and lips due to accumulation of mucopolysaccharides in the dermis. The nose is broadened; the tongue is large, smooth, red, and clumsy; and there is drooping of the eyelids. Also, note the lack of facial expression that is the most pathognomonic of any of the features." - Fitzpatrick's Dermatology in General Medicine
-Dry, rough, coarse, pale skin
-Yellow discoloration (carotenemia)
-Ichthyosis (scaling, thick skin, like a fish)
-Eruptive xanthomas
-Dull, coarse, brittle hair
Picture: "This patient has many of the characteristic features of hypothyroidism, including dry, pale skin; the absence of hair on the lateral third of the eyebrow; and puffiness of the face and lips due to accumulation of mucopolysaccharides in the dermis. The nose is broadened; the tongue is large, smooth, red, and clumsy; and there is drooping of the eyelids. Also, note the lack of facial expression that is the most pathognomonic of any of the features." - Fitzpatrick's Dermatology in General Medicine
Cushing's Disease
Abdominal Striae of Cushing's - FItzpatrick
Excessive production of cortisol in the body leads to Cushing syndrome. Long-term use of glucocorticoid drugs can also lead to the same findings of Cushing syndrome. It is diagnosed by measuring serum and urine cortisol, and failure of the suppression of cortisol with a dexamethasone challenge. Cutaneous findings include the following:
-Increased central adiposity
-Moon facies and buffalo hump
-Global skin atrophy, epidermal and dermal components
-Striae on abdominal flanks, arms, thighs
-Purpura with minor trauma - reduced connective tissue support
-Increased central adiposity
-Moon facies and buffalo hump
-Global skin atrophy, epidermal and dermal components
-Striae on abdominal flanks, arms, thighs
-Purpura with minor trauma - reduced connective tissue support
Addison's Disease
Hyperpigmentation of Sun-Exposed Face
A deficiency of glucocorticoids, mineralcorticoids, and adrenal androgens from the destruction of the adrenal glands, Addison's disease is not typically realized clinically or cutaneously until adrenals have lost 90% of their function. With chronic adrenal insufficiency, the classical finding is skin hyperpigmentation, most pronounced in sun-exposed areas, creases, and folds. This results from low negative feedback on the hypothalamus, prompting unregulated productions of ACTH, and MSH (melanocyte stimulation hormone). Skin findings of Addison's disease may include:
-Hyperpigmentation (Melanocyte Stimulating Hormone like effect due to secretion of ACTH)
-Sun-exposed areas accentuated
-Loss of ambisexual hair in women
-Chronic mucocutaneous candidiasis
-Hyperpigmentation (Melanocyte Stimulating Hormone like effect due to secretion of ACTH)
-Sun-exposed areas accentuated
-Loss of ambisexual hair in women
-Chronic mucocutaneous candidiasis