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Endocrine Abnormalities

  1. Diabetes Mellitus
    1. Diabetic skin spot:
      Diabetic skin spot begins as an erythematous area and evolves into an area of circular hyperpigmentation. These lesions result from minor mechanical trauma in the pretibial region and are more common in elderly men with DM.
    2. Necrobiosis lipoidica diabetorium (NLD)
      It usually presents as symmetrical, well defined plaques on both shins and feet.
      Sometimes, it may appear on the face, arms and trunk.

      The plaques are irregular and are brown-red on violaceous in colour. The epidermis is atrophic and delicate vessels occur over the surface. In chronic stage, the lesion may develop into painful ulcer.
      Treatment of NLD is very unsatisfactory.

      The course of the lesions do not correlate with normalization of hyperglycaemia. Intralesional steroids are sometimes useful
    3. Diabetic dermopathy
      Multiple asymptomatic discrete atrophic brown macules are common on the shins. These are known as diabetic shin spots (or diabetic dermopathy).
    4. Granuloma annulare
      Well defined, annular lesions with the margin made up of multiple discrete flat topped papules.
      These lesions are commonly found over the backs of the hands, feet, ankle and limbs.
      Though it responds well to intralesional steroids, it easily recurs.
      The generalize form has a stronger association with glucose intolerance than the localize variant.
    5. Lipoatrophy/Lipohypertrophy
      Lipoatrophy refers to depression of the skin due to repeated injections of impurified insulin preparations. It usually occurs in children and young women.
      Lipohypertrophy is due to subcutaneous deposition of fat in situ of skin having repeated injections.
    6. Bullous diabeticorum
      Subepidermal blisters may occur on the lower legs of diabetics but the cause is unknown.
    7. Diabetic cheiroarthropathy (sclerodactyly)
      In 40% of juvenile IDDM patients, tight thickened and waxy skin develop over the dorsum of the hands. Subsequently, it results in contracture of the proximal interphalangeal joints.
    8. Scleredema: Areas of skin thickening on the back or neck at site of previous superficial infection:
    9. Acanthosis nigricans (hyperpigmented velvety plaques seen on the neck, axilla, or extensor surfaces) is sometimes a feature of severe insulin resistance and accompanying diabetes.
    10. Infections
    11. Kryle's disease
    12. Eruptive xanthoma
    13. Drug eruptions
    14. Acanthosis nigricans
    15. Xerosis
    16. Pruritus
  2. Thyroid Diseases
    1. Hyperthyroidism
      1. The skin is warmth and moist due to hyperdynamic circulation.
      2. The hair is fine and friable.
      3. On the face, there may be telangiectasia and facial flushing.
      4. On the hands, there may be palmer erythema and onycholysis of nails. In Grave's disease, clubbing of fingers (thyroid acropachy) may occur.
      5. Others possible associated skin manifestations include pruritis, dermographism and urticaria.
      6. In Grave's disease, pretibial myxoedema occurs in 5 per cent of this group of patient. It presents as well-defined plaques or nodules with prominent follicles and peau d' orange appearance. It commonly appears over the anterior aspect of the shins and is usually bilateral.
    2. Hypothyroidism
      1. On the face, there may be non-pitting oedema around the eyes. The lateral third of the eyebrow may be thinned.
      2. The scalp and body hair is dry and brittle. Diffuse or partial alopecia may occur.
      3. In general, the skin is cool, dry and with a yellow tint.
      4. The nails are brittle and there are longitudinal ridges.
      5. Purpura and ecchymoses are not uncommon.
  3. Adrenal Diseases
    1. Adrenal Insufficiency
      1. Diffuse hyperpigmentation is noticed but is more marked on pressure points such as the knees, knuckles, ischial tuberosities and in intertriginous areas.
      2. The palmar creases are darkened.
      3. Mucous membranes including the vagina, anus and mouth are commonly pigmented.
      4. New scars are easily pigmented, too.
      5. There are longitudinal pigmented lines in the nails.
    2. Cushing's Syndrome
      1. Typical features include: moon face, buffalo hump, central obesity but with thinning of extremities.
      2. Skin atrophy is very common and is frequently associated with ecchymoses and purpura.
      3. There are striae, mainly on the flanks of the abdomen, arms and thighs. These striae are usually broader and are purplish then the striae of pregnancy, obesity and adolescence.
      4. Decreased vascular tone may appear as purplish mottling on the lower limbs (cutis marmorata).
      5. Hypertrichosis occurring on the face, upper lip, chin and lateral cheeks is common. Hirsutism due to over-production of adrenal androgens may occur in females.
      6. Acne of monomorphic type is common on the face and back.
      7. In general, patient with cushing¡¦s syndrome is more susceptible to cutaneous infections such as pityriasis versicolour, trichophyton rubum and candidosis.

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