Hyperpigmentation – a sign of systemic disease – skin disease

Increased pigmentation of the skin is seen in a number of systemic diseases. In porphyria cutanea tarda Hyperpigmentation occurs in the face and arms, probably because of the effects of photosensitizing porphyrins. E 'accompanied by hirsutism on the face with the fragility of the skin or blistering of the hands back. Often there are laboratory tests of liver disease. Elevated levels of urinary uroporphyrin and coproporphyrin are diagnostic. If suspicious lesions of porphyriaLate skin symptoms are gastrointestinal, neurological or psychiatric problems associated changes would Stool porphyrins are obtained to assess the possible presence of porphyria variegata.

In Addison's disease, hyperpigmentation is carried throughout the body, but there is accentuation of the brown in old scars and in skin folds. The oral mucosa and nail beds may also be hyperpigmented. Hyperpigmentationin Addison's disease is due to increased production ofPituitary hormones such as melanocyte-stimulating hormone (MSH) and ACTH (ACTH), which are both capable of stimulating the production of pigment. SEMM low levels of cortisol are present, and the diagnosis is established by the collapse of the cortisol levels increase after a corresponding stimulation of the adrenal glands. For patients whose Addison's disease occurs as part of a syndrome of deficiency multiglandular, vitiligo also be present.

In scleroderma, hyperpigmentation is generalized,but there is accentuation of the brown on the dorsal side of the arms and hands. From time to time, vitiligo, like layer of hypopigmentation in areas of dark skin are interrupted. The mechanism for the pigmentation is not known. The diagnosis is supported by the simultaneous presence of Raynaud's phenomenon, sclerodactyly, decreased motility of the esophagus, and in advanced cases, lung, heart and kidney disease. The skin biopsy to determine the degree of sclerosis, helps confirmclinical diagnosis.

Hyperpigmentation generalized hemochromatosis is slate-colored or bronze Brown. Jaundice may also be present. The mucous membranes are hyperpigmented in 20% of patients. The pathogenesis of the pigmentation is unknown. Abnormalities of glucose are present, and the diagnosis is confirmed by biopsy, which shows appropriate staining liver iron.

Hyperpigmentation associated malignants is very classicalfound with squamous cell carcinoma of the lung. The pigmentation occurs because of the MSH-like activity of polypeptides produced by these tumors. Generalized melanosis can be seen even with modern, wide-spread melanoma, in this case, the color is due to the direct production of pigmented compounds by the malignant cells.

The pigmentation in acanthosis nigricans, though widespread, particularly in areas where intertriginous pigmentation is due to the presence of strong, velvety accompanyRidges. These changes are highlighted, in particular, on the side of the neck, armpits and groin. Increased pigmentation of mucous membranes is also often present. The mechanism responsible for the pigmentation is unknown, but an increase in scope MSH is assumed. Acanthosis nigricans is most commonly as an irrelevant aspect of obesity, but its presence in children and adults with normal weight should raise a question of malignancy associated. Central nervous system areoften the cause of acanthosis nigricans in children, whereas gastrointestinal tumors are usually found in adults with this disease.

Most patients with neurofibromatosis show serious signs of a generalized hyperpigmentation, besides the presence of cafe-au-lait spots.

Diffuse hyperpigmentation sometimes occurs because of chemotherapy drugs administered to patients with various types of cancer. In such situations, pigmented bands on the nails may alsoNote.

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