The skin and systemic diseaseGenetics and

skin disease (JA Savin)

When a man has on the skin of his body a swelling or an eruption or a spot... and the disease appears to be deeper than the skin it is a leprous disease.

Leviticus 13: 2-3

In ancient times changes in the skin were taken to indicate that the whole body was diseased and although arguments continue about what the Old Testament writers understood by "leprous", there was clearly an appreciation of the connection between the skin and systemic illness. Clinical signs in the skin may give valuable diagnostic clues to underlying disease. The cutaneous signs of systemic disease is a very large subject; and what follows is only an outline of the more common skin changes that may be associated with systemic illness.

A disease affecting internal organs may produce the same changes in both the skin and other organs—as in the connective tissue diseases. However, underlying conditions may be associated with skin changes brought about by quite different processes, as in acanthosis nigricans or dermatomyositis in which there is an underlying neoplasm with characteristic skin signs. Sometimes severe skin disease itself may be the cause of generalised illness.

The skin is also a common site for allergic reactions to drugs, with a rash being the first clinical sign. The florid skin lesions of AIDS illustrate the results of infections when the immune response is impaired.

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