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Chapter 054. Skin Manifestations of Internal Disease (Part 1)

Harrison's Internal Medicine Chapter 54. Skin Manifestations of Internal Disease Skin Manifestations of Internal Disease: Introduction 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. | Chapter 054. Skin Manifestations of Internal Disease Part 1 Harrison s Internal Medicine Chapter 54. Skin Manifestations of Internal Disease Skin Manifestations of Internal Disease Introduction 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. Therefore the authors of this chapter have decided to cover this particular topic of cutaneous medicine not by discussing individual disorders but by describing and discussing the various presenting clinical signs and symptoms that indicate the presence of these disorders. Concise differential diagnoses will be generated in which the significant diseases will be briefly discussed and distinguished from the more common disorders that have no significance for internal diseases. The latter disorders are reviewed in table form and always need to be excluded when considering the former. For a detailed description of individual diseases the reader should consult a dermatologic text. Papulosquamous Skin Lesions Table 54-1 When an eruption is characterized by elevated lesions papules 1 cm or plaques 1 cm in association with scale it is referred to as a papulosquamous lesion. The most common papulosquamous diseases psoriasis tinea pityriasis rosea and lichen planus are primary cutaneous disorders Chap. 53 . When psoriatic lesions are accompanied by arthritis the possibility of psoriatic arthritis or Reiter s disease should be .