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Skin Manifestations of Internal Disease

Skin Manifestations of Internal Disease

Jean L. Bolognia

Irwin M. Braverman

It is now a generally accepted concept in medicine that the skin can show signs of internal disease. Therefore, in textbooks of medicine one finds a chapter describing in detail the major systemic disorders that can be identified by cutaneous signs. The underlying assumption of such a chapter is that the clinician has been able to identify the disorder in the patient and needs only to read about it in the textbook. In reality, concise differential diagnoses and the identification of these disorders are actually difficult for the nondermatologist because he or she is not well versed in the recognition of cutaneous lesions or their spectrum of presentations.

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Skin and soft tissue infectionsViral infections

Skin and soft tissue infectionsViral infections

Eczema herpeticum

This is defined as dermatitis with secondary herpes simplex virus infection and should be considered as a possible cause of any acute flare of dermatitis. The signs are grouped vesicles and erosions on a weeping dermatitis, with associated fever and malaise. Skin tenderness is more common than itching. A viral swab is needed for diagnosis. Hospital admission may sometimes be required. Staphylococcus aureus commonly colonises but diffuse redness and crusting suggest bacterial infection (see Impetigo). This condition is more often seen in children than adults. Treatment is with antiviral drugs

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Skin biopsies

Skin biopsies

Up to 10% of general practice consultations are for skin disease. While in many cases the diagnosis is clear, often it is not. In some circumstances a skin biopsy may help establish the diagnosis and then enable specific treatment.

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Skin and soft tissue infections

Skin and soft tissue infections

Bacterial skin and soft tissue infections

Bites and clenched fist injuries

Bites and clenched fist injuries often become infected. The organisms involved in human bites and clenched fist injuries are Staphylococcus aureus, Eikenella corrodens, Streptococcus species and beta-lactamase-producing anaerobic bacteria. The organisms involved in animal bites are Pasteurella species, Staphylococcus aureus, Capnocytophaga canimorsus, Streptococcus species and anaerobes. Cat bites have a higher incidence of infection than dog bites. In all cases a patient's tetanus immunisation status must be assessed. Postexposure rabies or Lyssavirus prophylaxis may need to be considered, eg bat bite.

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