Our Skin Often Mirrors Many Silent Diseases

Southern DermatologySouthern Dermatology News & Articles

As seen in Health & Healing in the Triangle, Volume 16, Number 3

“Lupus is the Latin word for wolf. It’s not uncommon for an early-stage lupus rash to be misdiagnosed as rosacea by a practitioner who is simply unaccustomed to seeing the variety of rashes and skin conditions that make up the professional life of a dermatologist.”

“Not only is the skin our largest organ but, for the careful observer, it often reveals vital information
about an array of disease states that, in early stages, are free of symptoms,” notes Dr. Laura Briley of Southern Dermatology, PA, in Raleigh.

“For example, rashes appearing as pimples, lumps, bumps, and blisters can in fact be visible clues to such underlying conditions as kidney, liver, thyroid, or even Hodgkin’s disease, as well as diabetes, inflammatory bowel disease, or connective tissue disorders such as lupus. Even a condition as common as xanthoma may signal an underlying problem.”

Health&Healing: What is xanthoma?

DR. BRILEY: It’s a condition that can forewarn elevated cholesterol, which is often a precursor of heart disease. Basically, xanthoma, usually in older patients, is a concentration of fat beneath the surface of the skin. As a result of that concentration, the skin takes on a yellowish hue. Xanthoma appears in patches on the skin and has a slightly bumpy texture. It usually appears on the eyelids, knees and elbows. And it is a good example of a silent disease: It does not itch, nor is it painful. The important point is that xanthoma may be a symptom of underlying metabolic disorders that are associated with an increase in blood lipids—such as diabetes and some types of cancer. We can surgically remove these bumps, but the key is to identify and control the underlying disorders.

There are connective tissue diseases, such as lupus, that can also at times be detected by way of our skin. Lupus is a chronic autoimmune disease, ranging from mild to severe, in which the immune system becomes hyperactive and attacks normal tissue. Sometimes lupus may first show up as a rash on the face, often in a design similar to a wolf’s face—across the cheeks and nose. Lupus is the Latin word for wolf. It’s not uncommon for an early-stage lupus rash to be misdiagnosed as rosacea by a practitioner who is simply unaccustomed to seeing the variety of rashes and skin conditions that make up the professional life of a dermatologist. Again, the lupus rash is most often a silent indicator of an underlying problem.

By the time they develop this type of rash, most lupus patients are tired and may have signs of mild arthritis. Lupus, which sometimes runs in families, can strike as early as the teenage years. Eventually, other telltale signs of lupus appear as more advanced rashes, sores, lesions, and enlarged blood vessels around fingernails.

Symptoms of lupus—which remains incurable but can be effectively managed— vary greatly from one patient to another. Patients with severe problems are best treated by a team approach where effective care can be rendered by dermatologists, rheumatologists, nephrologists, immunologists, and family practice physicians.

H&H: Does scleroderma qualify as a silent disease?

DR. BRILEY: Scleroderma offers signals, and they are silent. The word scleroderma means “hard skin,” which describes thickening of the skin from increased deposits of collagen. So paying attention to the texture of your skin is important.

A symptom of scleroderma is the smooth tightening of the skin on the fingers, the back of the hand and around the mouth. Hallmarks of this slowly progressive and potentially serious disease are deposits of fibrous connective tissue in the skin and internal organs. Middle-aged women are most susceptible.

With scleroderma, the skin takes on a scarred or hardened appearance. The back of the hand may look thicker, and patients may become aware of extra blood vessels. If the disease is not detected early it travels internally, hardening tissues and causing damage to organs such as the kidneys.

Dermatologists are often the first to see the symptoms of scleroderma, and the first to help the patient because scleroderma initially manifests in the skin. There is no known cause or cure for scleroderma, although there are a number of effective organ-specific treatments for the disease. While dermatologists are often on the front line in diagnosing scleroderma, a team of physicians from various specialties are involved in caring for people with these kinds of autoimmune disorders.

H&H: Other examples of where the skin is often a mirror reflecting underlying health problems?

DR. BRILEY: There are many examples. Severe acne in a teenager sometimes signals the existence of polycystic ovary disease, often as the result of an imbalance in androgen hormones. The skin also signals infectious diseases that, in some cases, could be fatal, such as Rocky Mountain spotted fever and meningococcal meningitis, among others. Pink, purple, dark red, or brown lesions varying in size from a pinhead to a large coin that appear anywhere on the skin and neither hurt nor itch are sometimes a symptom of Kaposi’s sarcoma, a rare form of cancer related to HIV/AIDS.

H&H: And of course skin cancer is a silent disease that occupies your attention every working day.

DR. BRILEY: Melanoma is one of the most well-known serious diseases affecting the skin. And because it is a cancer, it is a true silent killer. It doesn’t itch. It doesn’t hurt. There’s not a bump. It’s asymptomatic. Just a brown patch of skin. By the time people find out they have melanoma, it is sometimes too late.

I advise my patients to keep an eye on freckles and spots on their body. Get a friend or spouse to check your back or take a close look in the mirror. Look for multiple tones of brown or perhaps what seems to be a flat mole. These spots are not the same color. Sometimes they’re pinkish brown or blue-brown. They are asymmetrical and the border of the spot is irregular or scalloped. These small harbingers are rarely larger than six millimeters, about the size of a pencil eraser. Men find more spots on their back, while more appear on the thighs in women. A changing mole also may represent melanoma.

If you have a brown spot that looks different and gets your attention, see a dermatologist. Change in spots can occur within months. Melanoma peaks in the 60s age group, but has been diagnosed in 22-year-olds.