Warning Signs From Your Skin About Your General Health
Your skin is giving you warning signs about your health. This is how to know what its saying.
I have read a lot of applications for dermatology residency positions. The most commonly stated reason aspiring dermatologists give for being passionate about the skin is: “Just as the eyes are the window to the soul, the skin is the window to the body”. I even used a version of this statement in my own application. Like many clichés, this statement is rooted in the truth. More than ten years after I wrote this statement, I am still amazed at just how much the skin can tell me about a person’s overall health. A good dermatologist can definitely give House or Quincy a run for his money in the “medical detective” department.
I love most aspects of dermatology, but if I’m being honest, I love rashes the most. Nothing in medicine excites me as much as a good rash on a sick patient that has the other specialties flummoxed. Aside from being a love letter to dermatology, this blog discusses what we call in the business “cutaneous signs of systemic disease”, or in layman’s terms, what your skin can tell you and your doctor about your health. Entire books are written on this subject, so the skin findings I’ll discuss will be common ones, but this list is by no means exhaustive.
Skin Tags
Diabetes and its precursor, insulin resistance, can result in multiple skin findings, including the much hated SKIN TAGS. Also called acrochordons (correct term), flesh moles, or my personal favorite, the quintessentially Kentucky term “tit moles”, skin tags are small projections of skin that grow on little stalks in skin folds, like the underarms, groin, neck, and bra-line.
It’s not unusual to have these gross little friends hanging around, but having 5 or more is positively correlated with having insulin resistance, diabetes, obesity, and elevated cholesterol (1). Tags are often found together with acanthosis nigricans, which means thickened, dark skin in either Greek or Latin (I can’t remember).
Like most dermatology jargon, this term describes perfectly what the condition looks like, assuming you speak Greek and Latin. Acanthosis nigricans is dark, velvety, thick-looking skin that is also seen in skin folds in people with insulin resistance. I have diagnosed many a diabetic by finding AN and tags on skin checks, which I then followed up with bloodwork like a hemoglobin A1C.
Elevated insulin levels are present when someone has insulin resistance, which stimulates production of other hormones that cause the epidermis to grow and thicken (2), resulting in tags and AN. So if you have a lot of skin tags, before you come see me to get those babies snipped off, first make an appointment with your primary care doctor to get checked for diabetes.
The same goes with AN; although it’s unsightly, it is more important to diagnose, and then address the underlying problem with diet and exercise and diabetes medications if needed. Acanthosis nigricans is also seen in the context of stomach cancer, although this is extremely rare. If you think you have AN, see a doctor.
Thyroid and Skin
Both under and over-functioning thyroid can cause a variety of skin findings. Dry skin, leg swelling, excessive sweating, brittle nails and hair, hair loss, and thinning eyebrows are all possible skin symptoms of thyroid disease. Of course, people can get all of those symptoms without thyroid disease, but awareness of the skin findings of thyroid disease can be important in people with other symptoms (fatigue, weight changes, bowel changes), as well as in the management of thyroid disease.
For instance, in a patient with a known history of underactive thyroid, the development of very dry skin or hair loss could indicate inadequate treatment. If you have any of those skin symptoms, see your dermatologist who can help you determine if there is any cause for concern for thyroid disease.
Hair Loss
Speaking of hair loss, this is another common complaint that can be a sign of internal illness. Hair loss can be seen as a symptom, not only of thyroid disease, but also anemia, iron deficiency, and auto-immune diseases such as lupus.
Telogen effluvium is a common form of hair loss that is very dramatic and worrisome to patients. Normally about 2-5% of the hair is in telogen, the falling out phase of the hair cycle. However, sometimes more of the hair shifts into telogen than normal, resulting in the loss of as much 40-50% of the hair over the course of a few months. As you might imagine, watching half of your hair fall out can cause some panic.
Some common triggers for telogen effluvium (effluvium means “to flow out” or “run off”) include giving birth, miscarriage, general anesthesia/ surgery, serious illness or infection, certain medications, and stressful life events. Usually the stressful event precedes the hair loss by 2-4 months.
Fortunately, it’s temporary and the hair does grow back. I have had really impressive telogen effluvium after I had each of my children. Even though I knew what was happening, seeing all that hair in the drain made me anxious, and it made my husband an expert in cleaning drains.
Another common form of hair loss with possible systemic implications is alopecia areata. Alopecia areata usually presents as one or more perfectly round, totally bald patches on the scalp. This type of hair loss almost always resolves, even if it isn’t treated, but it is positively correlated with several other diseases, including thyroid disease, vitiligo, Addison’s disease (adrenal insufficiency), lupus, and certain anemias (3).
These diseases don’t cause alopecia areata, but the genetic predispositions for these diseases travel together. There are many different types of hair loss, and it is not uncommon to see more than one kind at the same time, for instance, telogen effluvium superimposed on female pattern hair loss.
A dermatologist can take a history which will help narrow down the causes, and then order laboratory tests if they are appropriate or perform a biopsy of the scalp. If your hair loss is from an underlying systemic illness, it may improve when that condition is treated.
Madarosis
Madarosis is a term that refers to loss of eyebrows or eyelashes. It is a not uncommon finding as people age. It can also be seen in the context of thyroid disease, particularly when the lateral, or outer, third of the eyebrows are lost, known as Hertoghe’s sign.
However, madarosis has a very broad differential diagnosis that includes many skin conditions, as well as many internal problems (4). Syphilis, leprosy, and cutaneous lymphoma are three scary conditions that can cause eyebrow or eyelash loss (4). Madarosis can be a side effect of certain medications, including blood pressure medications and anticoagulant therapy (blood thinners). Treatment with synthetic retinoids (like Accutane) or high dose vitamin A can also result in madarosis, as well as vitamin deficiency (zinc,biotin, and iron4). Minoxydil (Rogaine) may help regrow eyebrows.
Depending on the cause of thinning lashes, people can get excellent results with Latisse. Before you treat the problem, see your dermatologist to determine the cause, since you don’t want to have beautiful eyelashes, but fail to get your syphilis treated.
Psoriasis
Psoriasis is a relatively common disease that causes plaques of red, flaking skin. Until relatively recently, psoriasis was considered mainly a skin disease that was sometimes accompanied by arthritis. Now we know that psoriasis is a disease with many significant implications for overall health.
Metabolic syndrome (having three or more of the following conditions: obesity, high cholesterol and triglycerides, high blood pressure, and elevated blood glucose) is seen more commonly in patients with psoriasis (5), and psoriasis is an independent risk factor for diabetes and heart disease5. Interestingly, not only are psoriatic patients more likely to be obese, but being obese makes a person more likely to develop psoriasis (5).
Obesity can exacerbate psoriasis, and weight loss can improve it. Managing risk factors for heart disease has become very important in the treatment of psoriasis; a person with psoriasis who has identical risk factors (smoking, obesity, diabetes) as a patient without psoriasis is more likely to have a heart attack.
The complex interplay between psoriasis and metabolic syndrome is the result of both shared genes as well as the chronic inflammation present in psoriasis. Severe psoriasis increases the risk of chronic kidney disease, including end-stage renal disease requiring dialysis (6), and it is now recommended that patients with severe psoriasis have their renal function monitored regularly. Patients with psoriasis are also at increased risk of depression (7), and the arthritis that can be associated with psoriasis can cause permanent joint damage and disability.
Psoriasis should no longer be thought of or treated as a “skin only” disease. So if you think you might have psoriasis, you should definitely see a dermatologist. Not only are there treatments that improve the appearance and the itching of your skin, but a dermatologist can evaluate you for other conditions that could shorten your life.
A dermatologist can tell you a lot about your insides by looking at your outside. Sometimes a rash is just a rash, but sometimes a rash is an important clue to your overall health. These clues can be missed by other healthcare professionals who don’t recognize the significance of certain skin findings. So if you are having a problem with your skin, hair, nails, or mucous membranes, see a board-certified dermatologist. We can help you decipher the message your body is sending you, and we can help keep you and your skin healthy.
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Sources
- Tamega, Andréia de Almeida, Aranha, Adriana Milanezi Pinheiro, Guiotoku, Marcelo Massaki, Miot, Luciane Donida Bartoli, & Miot, Hélio Amante. (2010). Association between skin tags and insulin resistance. Anais Brasileiros de Dermatologia, 85(1), 25-31. Accessible online at https://dx.doi.org/10.1590/S0365-05962010000100003.
- Hermanns-Lê T, Scheen A, Piérard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol. 2004;5:199-203. Accessible online at http://www.ncbi.nlm.nih.gov/pubmed/15186199.
- Thomas EA, Kaydan RS. Alopecia areata and autoimmunity; a clinical study. Indian J Dermatol. 2008;53(2):70-74. doi:10.4103/0019-5154.41650. Accessible online at http://www.ncbi.nlm.nih.gov/pubmed/19881991.
- Kumar A, Karthikeyan K. Madarosis: a marker of many maladies. Int J Trichology. 2012;41):3-18. doi:10.4103/0974-7753.96079. Accessible online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358936/.
- Gelfand JM, Yeung H. Metabolic syndrome in patients with psoriatic disease. J Rheumatol Suppl. 2012;89:24-28. doi:10.3899/jrheum.120237. Accessible online at http://www.ncbi.nlm.nih.gov/pubmed/22751586.
- Wan J, Wang S, Haynes K, Denburg MR, Shin DB, Gelfand JM. Risk of moderate to advanced kidney disease in patients with psoriasis; population based cohort study. BMJ. 2013;347:f5961. Accessible online at http://www.bmj.com/content/347/bmj.f5961.
- Olivier C, Robert P, Daihung D, et al. The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol. 2010;146(8):891-895. doi:10.1001/archdermatol.2010.186. http://www.ncbi.nlm.nih.gov/pubmed/20713823.
Sarah G. Smith, MD
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