Before every doctor who encounters a patient with a skin disease, the question arises whether to consider it exclusively dermatological or is it a manifestation of an internal disease. The skin is called a window to the body for a reason. In some cases, it serves as a
marker of internal disease and demonstrates the type of lesion characteristic of it: rash, dryness, redness, and many other symptoms. Therefore, it is important to be able to determine the nature of the manifestation of dermatological diseases and, ultimately, their cause.
Margarita Gekht, a dermatologist at the Butterfly Children charity foundation, a leading speaker at the Skill for Skin online academy of skin problems
The difficulty is that not all skin problems are associated with a malfunction of some system or organ. So, infectious dermatoses, for example, pyoderma, can proceed on their own, and can serve as a marker of an internal disease. Acne and acne-like diseases, such as rosacea, can also exist on their own or worsen against the background of disruption of the gastrointestinal tract - the stomach or duodenum. In turn, vitiligo - a pigmentation disorder in which melanin disappears in areas of the skin - can occur due to a hereditary predisposition or appear against the background of thyroid dysfunction.
There are many such examples, so it is important to get the advice of a dermatologist in a timely manner in order to understand what exactly is behind the skin problem.
When the body gives a sign
Skin changes, especially extensive ones, are a serious call that may indicate internal diseases, associated complications or side effects of treatment. Early detection
the reasons for such signs allows you to take action in time and prevent serious consequences. To this end, accurate diagnosis and assessment of lesions are essential. The most important thing here is a thorough and complete examination of the skin, considering the adjacent mucous membranes and appendages, for example, the mucous membranes of the eyes and mouth. At the first stage of the examination, the doctor must determine the features and location of the skin lesion, and then assess its distribution. As a result of such an examination, various symptoms are often revealed, which make it possible to identify an internal disease at an early stage. Then the dermatologist announces the preliminary diagnosis. This will allow you to start treatment as early as possible.
What internal problems does the skin react to?
The most common internal causes of skin manifestations can be divided into three main groups:
- Diseases of the gastrointestinal tract;
- Deficiency of nutrients associated with a lack of vitamins;
- Diseases of the endocrine glands.
Diseases of the digestive tract
The skin and the gastrointestinal tract are interconnected organs, so pathological processes in one affect the work of the other. Skin manifestations are often the first signs of gastrointestinal illness.
How does the connection between skin manifestations and disorders in the work of the digestive tract appear?
- Pyoderma gangrenosum may indicate inflammatory bowel disease. Classical ulcerative pyoderma gangrenous has two stages - ulcerative and epithelialization stage. The ulcerative stage is a rapidly progressive wound with a red border with raised, reddish-purple edges. The lesions are often accompanied by severe pain, especially with rapid progression. Late cutaneous porphyria can signal hepatomegaly, that is, a pathological increase in the size of the liver, and fatty degeneration of the liver. With tardive cutaneous porphyria, itchy blisters up to 10 mm in diameter, filled with transparent contents, appear on open areas of the skin - hands, face, neck, ears. Bubbles quickly break open with the formation of erosions, which are covered with crusts. The skin is injured at the slightest injury. Atrophic superficial scars remain in place of the blisters.
- Erythema nodosum can be a sign of inflammatory bowel disease such as Crohn's disease or colitis. With erythema, inflammation of the subcutaneous fat occurs, which is accompanied by the appearance of painful, palpable subcutaneous nodules of red or purple color. Most often they appear on the shins, sometimes in other areas.
- Eruptive xanthomas may indicate elevated serum triglyceride levels. Visually, xanthomas are rashes of red-yellow papules on reddened skin.
- Hemochromatosis can be a sign of liver cirrhosis. With hemochromatosis, bronze hyperpigmentation occurs throughout the body, including blue crescents on the nails.
- Dry and pigmented skin of the elbow joints can be a sign of biliary dyskinesia, that is, a violation of the outflow of bile.
Gastritis and peptic ulcer of the stomach and duodenum, which are provoked by the well-known bacterium Helicobacter pylori, can cause the following skin diseases:
- scleroderma, in which the skin is characterized by progressive tightness and induration;
- idiopathic urticaria, causing the spontaneous
appearance of blisters, as well as bright red and
In addition, scientists have found that Helicobacter pylori infection is also
associated with atopic dermatitis and prurigo, or prurigo. With prurigo, papules with serous-hemorrhagic
crusts form on the skin.
Dermatitis herpetiformis is an itchy, chronic rash of hair-infused papules that can leave pigmentation and scarring. Such lesions are characterized by symmetrical rashes on the extensor surfaces of the body and may be a sign of celiac disease, that is, gluten intolerance
With a deficiency of fat-soluble vitamins, the following conditions occur:
- Deficiency of vitamin A causes follicular hyperkeratosis - the appearance of papules penetrated with hair on the extensor surface of the skin of the thighs and shoulders.
- Vitamin D deficiency in infants and children leads to delayed teething with poor enamel. In adults, it predisposes to caries.
- Vitamin K deficiency affects blood clotting, leads to bleeding, delayed stopping of bleeding, spontaneous bruising.
Also, the connection between a low level of vitamin D and exacerbation of atopic dermatitis and psoriasis, as well as a long course of infectious skin disease in children - molluscum contagiosum - has been proven. With it, foci of infection appear on the skin, which at first are small (2-4 mm) bodily papules of a hemispherical shape, slightly rising above the surface of the skin. They may shine slightly or appear more pink in color compared to the surrounding skin. Sometimes papules grow a thin leg. As the lesions grow, they reach sizes up to 1 cm in diameter and acquire a distinctive feature - a slight depression in the center. Through this hole, when pressed, the whitish cheesy masses are released.
With a deficiency of water-soluble vitamins, the following skin conditions are often diagnosed:
Acute deficiency of vitamin B2 leads to:
- dark red erythema (redness of the skin);
- prolonged peeling of the skin;
- angular cheilitis, or "jams";
- seborrheic dermatitis.
Deficiency of vitamin B3 causes:
- pellagra, characterized by photosensitivity of the skin, that is, the appearance of foci of pigmentation in the sun;
- cheilitis, or inflammation of the red border of the lips;
- glossitis, or inflammation of the tongue.
Deficiency of vitamin B6 provokes:
- seborrheic dermatitis-like rash, which are characterized by reddish spots with yellow scales;
- angular cheilitis ("jams").
Deficiency of vitamin B9 / B12 can be associated with:
- angular cheilitis;
- depigmentation of hair;
- hyperpigmentation (diffuse and symmetrical) of hands, nails, face, palmar folds, skin in places of folds.
- Vitamin C deficiency causes scurvy. It is characterized by swelling of the gums, purple lesions. The affected area is prone to subcutaneous hemorrhage;
Biotin deficiency leads to:
- perioral dermatitis - a chronic recurrent disease, in which a rash of small acne occurs mainly around the mouth;
- non-genetic alopecia, which is characterized by areas with no hair growth;
- intertrigo, that is, bacterial or mycotic (fungal) lesions of skin folds. This disease is characterized by itching, pain, odor, redness, detachment, and white stripes of rolled epidermis.
Diseases of the endocrine glands
Pancreas. Patients with diabetes mellitus may experience:
- Acanthosis nigricans - severe hyperpigmentation up to black, when skin staining occurs mainly in the armpit.
- Lipoid necrobiosis. Skin lesions in classical lipoid necrobiosis begin as well-defined papules ranging in size from 1 to 3 mm, which expand to form plaques with active, more dense borders and waxy stanza centers.
- Scleroderma - progressive tightness and tightening of the skin.
- Thyroid disease - both hypothyroidism and hyperthyroidism - can affect hair, nails, and skin;
With polycystic ovary syndrome, the following dermatological manifestations are possible:
- hyperandrogenism, mainly hirsutism, that is, excessive growth of terminal - dark, hard and long hair - in women and children according to the male pattern;
- acne vulgaris;
- androgenetic alopecia, that is, pathological hair loss, leading to hair thinning or complete disappearance.
- acanthosis nigricans, that is, hyperpigmentation, which usually manifests itself on the neck, in the armpit, in the groin.
Sometimes, during self-examination, a person considers his skin problem obvious, for example, decides that the appearance of acne is associated with overeating sweets. Therefore, checking with the Internet, he begins self-medication, which can lead to an aggravation of the skin condition and the further development of the internal disease that provoked him. Therefore, be sure to seek the advice of your doctor.
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