Modern science and the ever-evolving tools of examination have brought about a revolutionary change in how we understand, diagnose and tackle disease. However, in earlier times, expert physicians could diagnose disorders by merely examining the pulse and its characteristics — pulse rate, rhythm, volume and force. Likewise, a qualified dermatologist, too, can detect or predict undiagnosed and hidden internal organ disorders by careful examination of skin, hair and nails.
While a detailed skin examination is necessary to diagnose skin disorders, dermatologists can also detect obscure internal diseases through a thorough skin examination. Skin is the body’s largest and outermost organ system and even small changes on the skin can serve as markers of thyroid, liver and kidney disorders, diabetes, tuberculosis, sarcoidosis (an inflammatory disease in which the immune system overreacts), blood disorders, polycystic ovarian disorders, AIDS and even certain cancers.
For example, if a patient is suffering from symptoms like cough, loss of appetite, weight loss or gain, abdominal pain, passing of blood in urine or stools, etc, and is undergoing many blood, radiological/pathological investigations, taking various medications and still not responding and/or there is no conclusive diagnosis, in many such cases, even minor skin changes can serve as diagnostic markers.
Recently, I had a 50-year-old female patient from Himachal Pradesh who, apart from having chronic cough and loss of weight, had a skin rash on her hands and feet. A peculiar rim of lichenoid purple hue around the rash was indicative of an internal malignancy. She was then diagnosed with a lung disorder. Another male patient (40) had nodules at the back that were indicative of blood cancer — acute myeloid leukaemia.
Skin findings precede the onset of symptoms referable to the underlying neoplasm (an abnormal mass of tissue) by several months in certain cases, thus providing an essential clinical and diagnostic clue for the search of hidden neoplasm.
Sudden appearance of numerous wart-like lesions over neck, chest and trunk with or without pruritus could sometimes indicate hidden cancer of other internal organs. Non-healing skin ulcerations or sores, especially over leg and pelvic area, bullous skin lesions (large blisters filled with clear fluid) in the elderly, tightening and binding down of skin, loss of elasticity and thickening of palms and soles with velvety or honeycombed appearance warrant immediate diagnosis.
Changes in the skin condition thus demand a comprehensive search for suspected internal disorders as an early diagnosis is of paramount importance.
SKIN MARKERS that can indicate various disorders
Diabetes
- Multiple pigmented areas symmetrically distributed over legs, forearms and thighs, starting as dull red-coloured and oval-shaped skin lesions, gradually followed by superficial scaling and ending in thinned brownish scars.
- White-yellow patches on skin over eyelids.
- Darkening and thickening of skin, assuming a velvety texture on sides of neck, underarms, thighs with obesity.
- Darkness and thickening of skin on hands and feet.
- Thick curdy white vaginal discharge.
- Whitish deposits over glans penis of males, followed by appearance of skin lesions.
- Pebbled or rough skin on the fingers and knuckles with thickening of skin.
Thyroid disorders
- Hair loss on scalp, dry and coarse hair.
- Non-pitting swelling (excess fluid build-up causing swelling that does not indent when pressure is applied) of legs and feet.
- Puffy skin on face, thick lips, large and clumsy tongue.
- Brittle nails | Redness on palms.
- Ovarian disorders
- Increased hair growth in unwanted areas in females.
- Hair loss on scalp.
- Severe acne on face.
- Weight gain.
Liver diseases
- Generalised yellow colouration of skin and mucosae, first visible over outer white portion of the eye and soft palate in mouth.
- Prolonged itching over trunk and limbs.
- Sudden appearance of multiple red-colour skin lesions on neck, chest, trunk.
- Thinning and partial loss of body hair.
- Clubbing and white colouration of nails.
Kidney disorders
- Severe disabling itching.
- Dry skin with thickening of skin around hair follicles/pores.
- Bleeding spots on skin. Darkening of exposed areas.
- Hard cornflake-like lesions over the trunk and legs.
- Dark-colour linear bands on nails.
- Swelling on face/legs.
Cancers
- In 10 per cent of cases with blood cancer, skin lesions in the form of violet-coloured nodules over abdomen and back known as leukaemia cutis tend to appear before diagnoses of systemic leukaemia is made.
- Skin lesions in the form of red-coloured patches with white scales, but having a violet-coloured rim around them symmetrically distributed over the dorsal aspect of hands and feet with thickening of skin over palms and soles, is another skin marker of various internal cancers.
- It has been reported most commonly with neoplasia of lower lip, tongue, oesophagus, upper 1/3rd of the lung and carcinoma stomach spreading to the cervical region.
— The writer is head, dermatology, National Skin Hospital, Panchkula
