Skin Signs of Systemic Disease

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45

Skin Signs of Systemic Disease

Gastrointestinal Disease and the Skin

Tables 45.345.5 and Figs. 45.3 and 45.4.

Table 45.5

Peristomal skin disorders.

Peristomal skin disorders are common and may limit use and efficacy of the stoma appliance. When the etiology is uncertain, evaluation can include KOH examination, microbial cultures, patch testing, and histologic examination.

Skin Disorder Comments
Irritant contact dermatitis Most common cause of peristomal dermatitis, especially in patients with an ileostomy. Primarily attributed to exposure to feces or urine
Pre-existing skin disease (e.g. psoriasis, seborrheic dermatitis, atopic dermatitis) Exclude primary contact dermatitis or infection or superimposed contact dermatitis
Cutaneous infection (Candida spp. dermatophyte, herpes-virus [primarily simplex], bacteria [especially Staphylococcus aureus]) Colonization with bacteria and/or yeast is common. Recent treatment with antibiotics predisposes to candidiasis. May initially improve and then worsen if treated inappropriately with topical corticosteroids
Allergic contact dermatitis Relatively uncommon. Potential allergens include adhesive pastes, adhesive ring or wafer of stoma bag, ostomy bag, epoxy resin, rubber, lanolin, and fragrances. Patch test with both standardized allergens and patient’s own products
Pyoderma gangrenosum Infrequent cause of peristomal dermatitis; most common in patients with inflammatory bowel disease (Fig. 45.4B)
Pseudo-verrucous papules and nodules Seen more commonly in association with urostomies; may be misdiagnosed as verrucae

Adapted from Lyon CC, Smith AJ, Griffiths CE, et al. The spectrum of skin disorders in abdominal stoma patients. Br. J. Dermatol. 2000;143:1248–1260.

Skin Signs of Internal Malignancy

Tables 45.8 and 45.9 and Figs. 45.6 and 45.7.

Skin Signs of Endocrine Disorders and Metabolic Disease

Tables 45.1045.14 and Figs. 45.845.12.

For further information see Ch. 53. From Dermatology, Third Edition.