Dr. Yashwant Tawade*
It is the skin that is an instrument on which actions and reactions are played and displayed. If one can understand the music of this instrument properly, theh he/she can diagnose what is happening inside the body. It is especially important in pediatric age group. In this article there is an effort to discuss about few of the cutaneous signs of internal disease.
  1. PUO and Skin Rash:
  2. PUO is a very common symptom and most of the time it is infective in origin. Micro organisms can directly affect the cutaneous cells and micro vessels or through immunological stimulations resulting in various types of skin rashes. Most of the time, these rashes are non-specific. However, sometimes they are very specific to a particular organ or the disease process and such rashes help in clinical diagnosis of PUO.

    1. Infectious Conditions
    1. Bacterial infections:

    2. Streptococcal infections: Can cause various manifestations.

      • Erythema nodosum
      • Erythema marginatum
      • Scarlet fever

    • Staphylococcal infections- Staphylococcal scalded Skin Syndrome
    • Hansen's disease in reaction
    • Urticaria

    1. Viral Infections:
      • Kawasaki's disease
      • Measles
    1. Rickettsial disease
    1. Henoch Schonlein purpura
    1. Non Infectious Conditions-
      • Drug rash
      • Lupus erythematous
  3. Examination of the Nails:
    1. Beau's lines-sign of catabolism
    2. Mee's lines - Arsenic poisoning
    3. Splinter Haemorrhage - LE, SBE
    4. Half and half nail -CRF
  4. Examination of Mouth:
    1. Gum hypertrophy - Leukemia and dilantin.
    2. Hemangioma -Internal hemangioma.
    3. Pigmented spots- Peutz Jegher's Syndrome

  5. Pigmentation on Skin:
  6. Neurocutaneous syndromes have got one common link i.e. melanocyte which is neuroectodermal in origin. Therefore most of the neurocutaneous syndromes have some pigmentary abnormalities.
    1. Hyperpigmentation -
    2. Café au lait spots-Neurofibromatosis
    3. Melanocytic nerves - Melanoma
    4. Hypopigmentation -
    5. Linear marks - Hypomelanoses of Ito

  7. Vascular lesions:
    1. Strawberry hemangioma
    2. Nevus flemmeus -
      • Sturge Weber's Syndrome
      • KTW Syndrome
  8. Hair abnormalities:
    1. Sacral hair growth -Spina bifida
    2. Alopecia areata - DM, Hypothyroidism
    3. Poliosis
  9. Ichthyosis:
    1. Congenital- Various syndromes
    2. Acquired- Hypothyroidism
  10. Adenoma sebaceum: Tuberous sclerosis
  11. Xeroderma pigmentosus
  12. Linear vesicular lesions
  13. Congenital anomalies
  14. Ehler Danlos Syndrome
  15. Nutritional and Metabolic Diseases:
    1. Phrynoderma
    2. B12 deficiency pigmentation
    3. Xanthomatosis
    4. Calcinosis cutis
    5. Lipoidproteinosis
    6. Porphyria
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