Skin Deeper (Part 2)
Like the depths that selfishly guard their secrets, our bodies hold inner truths that may or may not become evident at some mysteriously designated point in time. When, how, and why concern us very little. What is a weightier element, as we feel the visible can actually hurt us. We continue on our journey to investigate the skin as a window to hidden disease and our physiologic workings.
Do we dare breathe a sigh of relief through a purple nose? Perhaps for a Sioux warrior on the Little Bighorn that might have been possible. The war paint of today, however, in the form of red to purple plaques on the nose, raises smoke of an impending doom, reversing the historical tides of victory. Sarcoidosis, a multisystem, inflammatory disease with large cellular nodules in the lungs, bones, eyes, and skin, is a worthy and indomitable adversary who might have made even Custer proud.
It doesn’t end there, however. Patients with psoriatic arthritis, lupus erythematosus, and scleroderma are already behind the eight ball. They suffer from a battery of symptoms and signs resembling rheumatoid arthritis, as well as graver, more systemic manifestations. When it rains, they find themselves without umbrellas, and the facial rash, photosensitivity, skin calcification, oral ulcers, blisters, baldness, finger pallor, cyanosis, and redness, and further cutaneous incursions can be extremely annoying and demoralizing for their already ceaselessly trodden psyches.
The abdomen is a funny creature. We are alerted to its grumblings when nausea and vomiting point to our lack of self-control at the dinner table, a bug that has crept into our lives, or Montezuma’s revenge. But if that were not enough, just the sound of terms like Peutz-Jeghers syndrome and hereditary hemorrhagic telangiectasias (Osler-Weber-Rendu syndrome) are enough to scare the living daylights out of us. What we don’t know can hurt us, however, so the skin, lip, and oral freckles of Peutz-Jeghers and the dilated blood vessels in the lungs, liver brain, eye, and gastrointestinal tract of Osler-Weber-Rendu warrant a careful search for polyps of the small intestine and brain tumors, respectively. Throw the cutaneous manifestations of dermatitis herpetiformis, hepatitis C infection, and pyoderma gangrenosum into the mix, and we become painfully aware of the intricate nature of the tryst involving skin and gastrointestinal tract. In the case of pyoderma gangrenosum, the painful ulcers of the legs, often following trauma, may affect patients having inflammatory bowel disease or rheumatoid arthritis.
Which brings us to the stuff of nightmares. Who’s afraid of the big bad wolf, vampires, werewolves, gargoyles, goblins, ghosts, and mummies? Not us, you say. Well, that’s well and good, but the blistering skin lesions of porphyria and pseudoporphyria were once connected with folk tales, the living dead, and Count Dracula’s aversion to sunlight. Today we know the former disease processes to be connected to the ingestion of alcohol and medications (estrogen, diuretics, nonsteroidal anti-inflammatory drugs, tretracycline), to kidney dialysis, to hepatitis B or C infection, and to tanning bed use.
Finally, the best (or worst) for last. It has been noted that 30%-50% of diabetic patients have or will have skin disease. Truth in numbers gives added weight to the already widely held notion that strict blood glucose control can do much to ward off the evil complications of this ubiquitous malady.
While a thick skin can do much to buttress a fragile ego, in much the same way that a wetsuit protects from the blue depths, thinner is better when it sounds the medical alarm to dive skin deep.
© 2006, Albert M. Balesh, M.D. All rights reserved.
Do we dare breathe a sigh of relief through a purple nose? Perhaps for a Sioux warrior on the Little Bighorn that might have been possible. The war paint of today, however, in the form of red to purple plaques on the nose, raises smoke of an impending doom, reversing the historical tides of victory. Sarcoidosis, a multisystem, inflammatory disease with large cellular nodules in the lungs, bones, eyes, and skin, is a worthy and indomitable adversary who might have made even Custer proud.
It doesn’t end there, however. Patients with psoriatic arthritis, lupus erythematosus, and scleroderma are already behind the eight ball. They suffer from a battery of symptoms and signs resembling rheumatoid arthritis, as well as graver, more systemic manifestations. When it rains, they find themselves without umbrellas, and the facial rash, photosensitivity, skin calcification, oral ulcers, blisters, baldness, finger pallor, cyanosis, and redness, and further cutaneous incursions can be extremely annoying and demoralizing for their already ceaselessly trodden psyches.
The abdomen is a funny creature. We are alerted to its grumblings when nausea and vomiting point to our lack of self-control at the dinner table, a bug that has crept into our lives, or Montezuma’s revenge. But if that were not enough, just the sound of terms like Peutz-Jeghers syndrome and hereditary hemorrhagic telangiectasias (Osler-Weber-Rendu syndrome) are enough to scare the living daylights out of us. What we don’t know can hurt us, however, so the skin, lip, and oral freckles of Peutz-Jeghers and the dilated blood vessels in the lungs, liver brain, eye, and gastrointestinal tract of Osler-Weber-Rendu warrant a careful search for polyps of the small intestine and brain tumors, respectively. Throw the cutaneous manifestations of dermatitis herpetiformis, hepatitis C infection, and pyoderma gangrenosum into the mix, and we become painfully aware of the intricate nature of the tryst involving skin and gastrointestinal tract. In the case of pyoderma gangrenosum, the painful ulcers of the legs, often following trauma, may affect patients having inflammatory bowel disease or rheumatoid arthritis.
Which brings us to the stuff of nightmares. Who’s afraid of the big bad wolf, vampires, werewolves, gargoyles, goblins, ghosts, and mummies? Not us, you say. Well, that’s well and good, but the blistering skin lesions of porphyria and pseudoporphyria were once connected with folk tales, the living dead, and Count Dracula’s aversion to sunlight. Today we know the former disease processes to be connected to the ingestion of alcohol and medications (estrogen, diuretics, nonsteroidal anti-inflammatory drugs, tretracycline), to kidney dialysis, to hepatitis B or C infection, and to tanning bed use.
Finally, the best (or worst) for last. It has been noted that 30%-50% of diabetic patients have or will have skin disease. Truth in numbers gives added weight to the already widely held notion that strict blood glucose control can do much to ward off the evil complications of this ubiquitous malady.
While a thick skin can do much to buttress a fragile ego, in much the same way that a wetsuit protects from the blue depths, thinner is better when it sounds the medical alarm to dive skin deep.
© 2006, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
8/14/2006 01:03:00 PM
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