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    Skin may provide first clues to systemic illness

    Experts discuss keys to recognizing symptoms of internal disease and treatment tips

    Courtney Reynolds Schadt, M.D., F.A.A.D.Dermatologists have an opportunity to play a pivotal role in the fast, accurate identification and diagnosis of systemic diseases, according to Courtney Reynolds Schadt, M.D., F.A.A.D., assistant professor of dermatology at the University of Louisville in Louisville, Ky.

    "The skin can be the presenting symptom of an internal disease,” Dr. Schadt says.  “There is a very broad differential for rashes and nodules. Having the appropriate differential diagnosis and doing a biopsy guides the diagnosis and management of patients." She spoke to colleagues at the 73rd annual meeting of the American Academy of Dermatology (San Francisco, 2015)

    READ: Psychological problems impact skin disease

    Conditions that are primarily systemic can have dermatological manifestations, with symptoms such as erythema and pruritus, points out Dr. Schadt. Chronic cutaneous graft-vs.-host disease (GVHD), for example, is a condition that can be treated with systemic therapies like extracorporeal photophoresis or psoralen ultraviolet A (PUVA) therapy. One study demonstrated that topical tacrolimus ointment can be effective for the itching and erythema in patients with steroid-refractory disease1.

    Cardiac sarcoidosis

    The noncaseating granulomas of sarcoidosis can mask a variety of underlying problems. Nearly any organ in the body can be involved when sarcoidosis is present, including the eyes and the heart. Approximately 25% of patients with sarcoidosis have dermatologic symptoms and, in some cases, the cutaneous symptoms are the only expressions of the condition. About 20% of patients with sarcoidosis have cardiac involvement, and the condition can be fatal, Dr. Schadt notes. Cardiac sarcoidosis is, in fact, one of the most common causes of sudden death in African-American men.

    "It is important for us as dermatologists to be aware of the potential cardiac complications in patients with cutaneous sarcoidosis," says Dr. Schadt, noting that cardiac sarcoidosis can present as complete heart block. She advises that patients with cardiac sarcoidosis undergo cardiac evaluations that include an electrocardiogram and echocardiogram.2

    READ: Top 10 dermatologic pearls

    In a recent study, 32% of patients without known sarcoidosis presenting with unexplained Mobitz type II or third degree AV block were diagnosed with cardiac sarcoidosis.3

    Treatments for sarcoidosis include steroids, doxycycline, isotretinoin, thalidamide, and the biologic agent adalimumab, Dr. Schadt notes.

    NEXT: Cutaneous lymphoma

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