Dermadrome jeweilige Hauterkrankung

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 22.02.2021

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Definition
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Indicative or pathological skin diseases or symptoms that are caused or significantly influenced by diseases and/or malfunctions of extracutaneous organs or organ systems. Knowledge of these monitoring signs and their correlations enables targeted and cost-saving diagnostics as well as appropriate targeted therapies.

Occurrence/Epidemiology
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When assessing the skin, the question of "dermadromas", i.e. important indicators for further organ diseases, must involuntarily be asked for each disease. Because this decision has a decisive influence on the entire medical thinking and acting.

Clinical features
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Skin diseases develop in the interplay of genetic predisposition (e.g. fair-skinnedness and carcinoma formation) with external influences (e.g. contact allergies; pollen allergies, environmental factors of other kinds) as well as systemic diseases and dysfunctions which have a secondary influence on the integument. From a differential diagnostic point of view, it is of fundamental importance to recognize and correctly evaluate these mechanisms.

The physician acting in the daily clinical routine should be able to make an ad hoc decision about these 3 different lines of evaluation and draw the necessary diagnostic and therapeutic consequences from them.

The following clinical constellations are possible:

  • Complicative organ diseases
  • Complicative skin diseases
    • Non-tumorous organ disease
    • Tumorous organ disease (paraneoplasia)
  • Skin changes in multiorgan disease
  • Skin changes in systemic diseases

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Complicative organdiseases: Complicative organ diseases that develop in the wake of or as a result of an (usually infectious) skin disease must be decided on a case-by-case basis. This constellation thus requires increased clinical attention in certain diseases. Examples of such complicating concomitant diseases are multiple organ involvement in Lyme disease, glomerulonephritis in streptococcal skin infections, bronchial asthma in atopic eczema, or herpes encephalitis in immunocompetent individuals.

Complicativeskin diseases: Complicative skin diseases which manifest themselves on the skin during a known organ disease due to the consequences of the organ disease. These include the following constellations:

Non-tumorous organ disease whose pathological metabolites cause indicator phenomena: Examples: Icterus in hepatitis; gynecomastia and palmar erythema in liver cirrhosis; pruritus in renal insufficiency, necrobiosis lipoidica in diabetes mellitus, warm moist skin and diffuse effluvium in hyperthyroidism.

Tumorous organ disease causing indicative phenomena on the skin due to metabolic products or immunological effects ( paraneoplastic syndrome). Cutaneous metastases of a malignant visceral tumor are not referred to as paraneoplasia.

Skin lesions in multiorgan diseases: In "multiorgan diseases" the skin is often secondarily affected. In heart failure or hypertension, the skin may be affected by various phenomena such as skin pallor, cyanotic skin redness, lymphedema).

Involvement of the skin in systemic diseases: The situation is relatively simple when a systemic disease affects both skin and internal organs (e.g. lymphatic systemic disease; systemic granulomatoses such as sarcoidosis). More difficult is the constellation of a systemic disease that first appears on the skin and only later involves other organs (e.g. SLE, dermatomyositis; cold urticaria). This diagnostically difficult constellation is also present in a number of genodermatoses, e.g. neurofibromatosis, Osler's disease, Gardner 's syndrome, etc.).

Literature
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  1. Altmeyer P (2007) Dermatological differential diagnosis. Springer publishing house, Heidelberg

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Last updated on: 22.02.2021