Skin manifestations of systemic diseases

Dr Siddesha G 

ABSTRACT
This article details about the skin manifestations as a mirror in internal systemic diseases, it is the sole duty of homoeopathic physician to find out the root cause of external manifestations of internal diseases, rather than the suppressing of skin symptoms by external applications.

It’s how as we throw the house hold waste from inside to outside as the same human body which is affected with internal diseases which  tries to throw the disease from inner side to out as a skin symptoms that is how skin works as a mirror of internal deviation, so when the skin symptoms starts to appear in chronic internal diseases after the administration of the similimum internally, it is a good sign that the cure is taking place from center to periphery, at this time just leave body to act itself to get complete cure instead of applying any external applications.

KEY WORDS: – Skin symptoms, internal diseases, reflection, order of cure, homoeopathic remedies. 

INTRODUCTION
Skin being the largest organ in human body, presents with many diseases on it. In fact, skin is the reflection of what is happening under the skin, or rather, inside the body. Most of the internal systems and organs in the body when get affected or diseased, they show their effects in the form of skin diseases, in various forms.

For e.g. when the immune system gets haywire, it shows on the skin in the form of diseases like psoriasis or lichen planes. When immune system gets hyper sensitive or delicate, it shows internal disease in the form of allergies such as urticaria or eczema. When internal immune system is weakened, it gets impacted by external germs and there are various skin infections such as pyoderma, boils, carbuncles, warts, molluscum contagiosum, fungus infections, etc.

Similarly, when hormonal system inside gets sick, it can lead to some of the symptoms of hormonal diseases such as hair fall, alopecia areata, alopecia totalis, hyper-pigmentation, melasma, vitiligo, dry skin, and the like. Also, some of the genetic tendencies are displayed in the form of skin diseases, such as vitiligo, skin cancer, psoriasis, pemphigus, etc.

In other words, skin is like a mirror of our body, which reflects the internal changes, internal diseases. They need to be understood accordingly. That means, the skin diseases are not skin deep; they are much deeper than the skin. They give us signal about the internal disease.

Skin as a mirror in internal systemic diseases

SKIN MANIFESTATIONS OF LIVER DISEASES:

Liver disease:

Generalized Pruritus: due to bile salts, endogenous opiates

Pigmentation:  jaundice  

Muddy grey hyperpigmentation with yellowish tinge, spotted hypo melanosis in relation to spider angiomas. Spider angiomas and caput medusae, Palmer erythema, Purpura and bruises. Thin hair, female type of hair distribution in males and loss of secondary sex characters (effect of hormonal disturbance), Terry’s nails (diffuse white colour of the nail plate with distal pink colour), white bands, clubbing & koilonychia, Lichen planus.

The pathological changes in the skin and its appendages in liver disease are:

1. Jaundice in chronic liver diseases.
2. Spider naevi, telangiectasia, palmer flush, livedo reticularis and vasculitis are common manifestations in children.
3. Purpuric rashes are due to vitamin K deficiency.
4. Hair: is fine in liver diseases.
5. Seborrhea and acneiform eruption on the upper part of the body is common manifestations.
6. Decreased testicular androgens due to hepatic dysfunction leads to fine hair in adults and gynecomastia.
7. Bier ‘s spots: white areas appear on the lower extremities when cooled.
8. Nails: changes in nails with absent lanula and nail clubbing in liver cirrhosis.

REMEDIES: Agar, Ars, Clem, Crot.T, Dolichos, Lyc, Merc, Mez, Rhus T, Rhus V, Rumex, Sepia.

SKIN MANIFESTATIONS OF RENAL DISEASES:

Chronic renal failure (uremia)

Muddy brown or grey skin coloration (earthy look).Pallor due to reduced erythropoesis and increased haemolysis. Dry skin with urea frost and generalized intense Pruritus. Half and half nails (the distal part of nail plate is reddish brown while the proximal part is white).  Purpura, calcification and perforating dermatoses.Pruritus: is a common manifestation of renal failure. The exact mechanism is not clear and may be related to secondary hyperparathyroidism that leads to mast cells proliferation. Dryness of the skin: dryness of skin in renal disease may be related to different factors mainly:

• Excretion of nitrogen containing compounds on to the skin surface. Decreased sebaceous gland activity leads to more dryness and also increases the viscous cycle of itching.
• Impaired androgen metabolism: increases dryness of the skin. This also causes fine scalp hair, with falling of axillary and pubic hair after puberty.

Skin color changes: This is due to increase of melanocyte stimulating hormone occurring in chronic renal failure since the kidney is the major site of metabolism of this hormone. The skin color in renal failure varies from pallor due to anemia and hyper pigmentation due to increased melanocyte activity.

REMEDIES: – Apis, Ars Alb, Aur.Mur, Chin.S, Colch, Dig, Glon, Iod, Kali Iod, Merc.C, Merc.D, Nat.Iod, Nit Acid, Plumb.Iod.

SKIN MANIFESTATIONS OF ENDOCRINE DYSFUNCTIONS:

PITUITARY DISEASES

Acromegaly: The skin is thick due to increased collagen related to increase in circulating growth hormone leading to coarse features and tendency of keloids formation, skin tags and folds on the scalp (cutis verticis gyrate).The skin in acromegalic patient is greasy and pigmented and covered by thick coarse dark hair.

Hypopituitarism: The skin is dry, thin, atrophic leading to wrinkles, which are apparent mainly on the face with hypo pigmented, faint yellowish brown patches.

CUSHING‘S DISEASE:

The different skin manifestations are:

Hyperpigmentation:  This is due to increase in the melanocyte-stimulating hormone (MSH)

Acne: due to excessive androgen secretion forming keratotic plugs occluding the pilo sebaceous gland orifices is a common manifestation of Cushing‘s syndrome. The lesions are in the form of superficial papules and pustules with minimal black heads. This type covers different areas of the skin surface and unlike acne vulgaris, which affects seborrheic areas of the face, back, and upper chest.

Hirsutism: This is due to increased circulating androgen that is related to increased androgen production.

1. Striae: this is due to the increased circulating glucocorticosteroids. Skin lesions are pinkish in colour arranged usually in linear shapes. Old striae due to Cushing ‘s disease retains its blue- pink colour in contrast to the other types of striae which become faint whitish streaks later on.

2. Purpura: is a common manifestation. Atrophy of dermal collagen leads to less support of the dermal vessels, which become liable to rupture. The presence of purpura in children and young ages should raise the possibility of Cushing ‘s syndrome.

3. Moon face: this may be due to hydration of subcutaneous fat.

4. Superficial fungal infections: Tinea versicolor is also one of the   

manifestations seen in Cushing ‘s syndrome.

REMEDIES: – Arg.Nit, , Ars Alb, Ars Iod, Iodum, Pituitarinum, Sil, Tub.

SKIN MANIFESTATIONS OF THYROID DYSFUNCTION:

Thyroid disease  –  Both hyper and hypothyroidism are associated with characteristic skin manifestations.

Hyperthyroidism
Warm skin, flushing, palmar erythema and increased sweating (palms and soles), Fine thin hair and sometimes diffuse alopecia, Plummer’s nails and thyroid acropachy, Hyperpigmentation. . Pruritus, urticaria.

Hypothyroidism

• Pale cold ivory yellow scaly wrinkled skin.
• Absent sweating, dry skin (xerosis).  
• Eczema and Pruritus.
• Palm plantar keratoderma.
• Xanthomatosis.
• Puffy oedema of hands, face and eyelids.
• Purpura and ecchymoses.
• Punctuate telangiectasia on arms and fingertips.
• Delayed wound healing.
• Brittle striated nails and slow nail growth.
• Coarse sparse scalp hair. 
• Loss of axillary and facial hair.

REMEDIES: – Ars.Iod, Aur, Bell, Calc.Carb, Ferr Met, Fluoric Acid, Iod, Lycop, Thyroidinum.

SKIN MANIFESTATIONS DUE TO ADRENAL DYSFUNCTION:

Addison ‘s disease:

Skin manifestations of Addison ‘s disease is due to increased melanin and androgen. These may cause different skin manifestations mainly:

1. Diffuse hyper pigmentation: of the buccal mucosa and skin usually on the sun exposed areas of the face, neck and extremities, due to increased production of melanin. Skin creases of the palms, sites of friction, old scars and previous pigmented areas become darker.

2. Virilism: due to increased circulating androgens leading to Hirsutism, male pattern baldness.

3.Increased thickening of the skin: this is due to increased dermal collagen. Acneiform eruption and increased seborrhea of the skin and scalp due to increased androgens.

REMEDIES: – Arg.Nit, Adren, Ars Alb, Ars Iod, Iodum, Sil, suprarenal ext., Tub.

SKIN MANIFESTATIONS DUE TO PANCREATIC DISEASES:

SKIN MANIFESTATIONS OF DIABETES:

Diabetes mellitus:

• Erysipelas like erythema on the legs or feet in elderly diabetics.
• Diabetic rubeosis of face, hands and feet.
• Recurrent cutaneous infections (bacterial ex; Staph and fungal ex; candidiasis).
• Diabetic bullae and wet gangrene.
• Diabetic microangiopathy.
• Diabetic neuropathy.
• Trophic ulcers and diabetic foot.
• Pruritus especially perianal and genital regions. Anhidrosis: is patchy due to diabetic neuropathy leading to heat intolerance. Manifestations due to diabetes therapy
• Lipodystrophy: at the sites of insulin injections.
• Urticarial reactions due to insulin.
• Drug reactions: this is due to the oral medications as sulphonylureas leading to erythema multiform and phototoxic reactions.
• Xanthomatosis: The lesions appear in later stages of diabetics due to increased serum lipids.
• Tropic ulcers and bullous lesions: due to diabetic neuropathy mainly on the feet.
• Diabetic dermopathy is the most common manifestation (brownish depressed spots on the shins, forearms, thigh and over bony prominences).  The skin lesion is in the form of dull red, oval papules and may show small blisters, which ulcerate leaving small erosions healing with atrophic, pigmented patches   

REMEDIES: – Ars, Atrop, Ars, Iod, Iris, Merc ,Phos, Piloc, Puls.

SKIN MANIFESTATIONS OF GASTRO INTESTINAL TRACT:

Gastrointestinal diseases:

a-Acrodermatitis enteropathica:

This is a genetic disorder that may be due to zinc deficiency as in malabsorption syndrome. The condition may be fatal in infants and young children.

Clinical Features:

• Skin lesions.
• Candidiasis like lesions appears on peri-oral, around the genitalia, scalp, elbows and fingers. The skin eruption is small blisters, pustules, erosions, crusting and scaling lesions.
• Hair and nail loss
• Vesiculobullous dermatitis, periorificial and on hands and feet.
• Loss of scalp hair, stunted growth and higher incidence of infection.  

REMEDIES: – Apis, Bor, Calc.C, Cham, Cic, Led, Rhus V, Spiranth, Sumb.

HOMOEOPATHIC MANAGEMENT OF SKIN DISEASES:
According to Dr. Hahnemann, “local maladies signifies those changes and ailments that appear on the external parts of the body,” as mentioned in §185 of the Organon of medicine. However, strictly speaking there cannot be any local disease, as any disturbance in the nature of a dynamic change is never confined to a specific part of the organism. Therefore, skin symptoms cannot be regarded as merely a local affection and to treat it exclusively by local applications is absolutely erroneous and most detrimental to the health of the patient. So, the treatment of all skin affections, must consist in the selection of a remedy which must be homoeopathic, not only to the character of those skin affections but also to the totality of symptoms which the patient present-in which case the general morbid state is removed along with the skin affection, proving that skin affection should be considered as an inseparable part of the whole, as one of the most considerable and striking symptoms of the whole disease.

The treatment of local maladies is mentioned in Aphrisms194-209. If local maladies are treated solely by means of external applications, it leads to the rousing of the internal disease and other symptoms that previously existed in a latent state side by side with the local affection and it will be driven back to the system or upon the nerves, thereby increasing the internal disease and canalizing the disease force through other channels leading to derangement of other parts of the body. Further treatment also becomes difficult, as the totality of symptoms, have become so distorted, obscure and vague, and it becomes impossible to individualize the patient and select a similimum.

The persistence of the local affection, even after the removal of the symptoms, shows that, the local malady, always arise from an internal malady or derangement of the vital force. Therefore, the treatment of skin symptoms should be done, only by the internal administration of suitable homoeopathic remedies, which will affect the annihilation and cure of the general malady. This is the only judicious, sure, efficacious and radical treatment for local maladies. 

BIBLIOGRAPHY

1. D.M. Thappa, “Essentials in Dermatology” 2^nd Edition, Jaypee Brothers Medical Publishers (P) Ltd,
2. Frederick M. Dearborn (AB, MD), “Diseases of the Skin.”
3. Freedberg and Irwin M, “Fitzpatrick’s Dermatology in General Medicine,” 6^th Edition, (2003), McGraw-Hill, Pg: 1196-1197.
4. Frederick M. Dearborn (AB, MD), “Diseases of the Skin.”
5. Samuel Hahnemann, translated by William Boericke (MD), “Organon of Medicine,” 6^th Edition, (2011), Jain publishers Pvt Ltd.
6. Dr. Hahnemann.S, “The Chronic Diseases- Their peculiar nature and their Homoeopathic cure,” Vol I, New Delhi- B. Jain Publishers Pvt Ltd, (2005)
7. J.H. Allen, “The Chronic Miasms,” Vol I and II, New Delhi- B. Jain Publishers Pvt Ltd, (2003)
8. S. Lilienthal. M.D “Homoeopathic Therapeutics,” New Delhi- B. Jain Publishers Pvt Ltd, (1986)

Dr Siddesha. G ,BHMS, MD (part1) homoeopathi psychiatry.
Father Muller homoeopathic medical college Mangalore
EMAIL ID – drsiddesh009@gmail.com
Guide : Dr. Girish Navada. U.K.