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Beware of Skin Signs of Illness and Disease
While moisturizers and make-up, facial peels and Botox can make our skin look beautiful and young, sometimes the external skin discolorations, blemishes, blotches or other unsightly marks we seek to remove are actually signs of an underlying internal disease. And your dermatologist may be the critical first line of defense against serious illness such as cancer, lupus, high cholesterol, pulmonary and cardiac disease, among others.
“While many patients come to our offices searching for ways to look and feel more beautiful by removing or reducing unsightly skin lesions or discolorations, some of those marks may actually be a sign of an internal disease or illness,” says Joshua Fox, MD, a leading dermatologist, founder of Advanced Dermatology and a spokesperson for the American Academy of Dermatology. It turns out that in scheduling regular visits with their dermatologist patients’ are actually taking an important first step in managing their overall health. Dermatologists will recognize which skin marks can be resolved with cosmetics, pharmaceuticals or cosmetic surgeries and which require a visit to a primary physician or specialist who can treat the underlying causes.
Dr. Fox cited 12 examples of dermatological problems that may be the first signs of internal disease.
1. Xanthelasma, or flat, yellowish plaque on the outside of the eyelid, usually close to the nose. These non-cancerous blemishes are composed of fatty material and typically appear after age 40. One-third of patients with xanthelasma, which occurs twice as often in women as in men, have an elevated serum cholesterol level. When they appear in teenagers and young adults, xanthelasmas are almost always a warning sign of high cholesterol levels.
2. Thrombotic Thrombocytopenic Purpura (TTP), or purplish rash on the stomach. This rash may signal blood cancer or lymphoma. It is not known what triggers TTP, but some factors that may play a role include pregnancy, cancer, HIV, infection and lupus.
3. Scaling skin, or loss of the outer layer of epidermis in large, scale-like flakes. This condition may be caused by illnesses including hypoparathyroidism (decreased function of the parathyroid glands); ringworm (a fungal skin infection); psoriasis (a chronic skin condition caused by an overactive immune system); Kawasaki disease (an uncommon childhood illness that causes inflammation of the blood vessels), and toxic shock syndrome (a rare, often life-threatening illness, that develops suddenly after an infection and can rapidly affect several organ systems, including the lungs, kidneys and liver).
4. Severe psoriasis. A five-year study at the Karolinska Institute in Sweden found genetic links between psoriasis, the systemic skin disease, and heart disease. The study showed that people, especially those under 40, with severe psoriasis are at greater risk for cardiovascular disease and death because they have higher than average blood cholesterol levels.
5. Follicular plugging, or inactive hair follicles. Particularly when found in the ears, this symptom can be a sign of lupus, an autoimmune disease that occurs when the immune system attacks its own tissues, causing inflammation, swelling, pain and damage.
6. Raynaud’s phenomenon, or cold hands and extremities. In this condition, the blood vessels in the fingers or toes tighten, severely limiting the flow of blood to the skin and resulting in the feeling of cold hands or feet. While most cases of Raynaud’s phenomenon have no known cause, some people may develop Raynaud’s as a result of a disease such as lupus, scleroderma, atherosclerosis or rheumatoid arthritis.
7. Cancer. According to the American Cancer Society, some cancers (besides skin cancer, or melanoma) can cause skin symptoms or signs that can be seen. These include: darker looking skin (hyperpigmentation), yellowish skin and eyes (jaundice), reddened skin (erythema), itching and excessive hair growth. In fact, skin changes may be the first sign of an internal malignancy. These signs of skin disease may appear before, with or after the detection of an associated cancer. In a patient whose cancer is in remission, these skin changes may be the first sign of the cancer recurring.
8. Jaundice, or yellowing of the skin. Jaundice is a key sign of chronic liver disease.
9. Pruritis, or intense itching, along with dry skin and changes in skin color. These symptoms may be a sign of kidney or liver disease.
10. Pale or flesh-colored lesions on the backs of the fingers or hands; vitiligo, or depigmentation of the skin; or dull, red oval papules with small blisters. These skin marks may signal diabetes.
11. Painful erythematous (red skin) on the face, extremities and body. These symptoms, often combined with fever, malaise, arthralgias, myalgias and conjunctivitis in middle-aged women, may be a sign of Sweet’s Syndrome, or acute febrile neutrophilic dermatosis, Sweet’s syndrome can occur with inflammatory bowel disease, bowel bypass syndrome and pregnancy.
12. Unusual freckling, especially in children. Children who develop unusual freckling, or light brown “café au lait” spots on the skin, measuring more than 5 millimeters in diameter, may be at risk for neurofibromatoses, a group of three disorders of the nervous system that cause tumors to grow around the nerves. The freckling can appear in adolescents and adults, as well, but are larger, measuring more than 15 millimeters across. Tumors begin in the cells of the thin membrane that envelops and protects nerve fibers, and often spread into nearby areas. The type of tumor that develops depends on its location in the body and the kind of cells involved. The most common tumors are neurofibromas, which develop in the tissue surrounding peripheral nerves. Most tumors are not malignant, but they may become cancerous over time.
“These are just a few of the internal diseases that may present initially via the skin,” Dr. Fox says. “The skin is our largest and most visible organ. By examining your skin regularly, keeping track of changes to the skin and including a dermatologist in your regular schedule of physician check ups, you will be taking an important first step toward ensuring your overall health.”