Skin discoloration

Skin color changes may include:

• The skin acquires a peculiar pale coffee-colored hue (the color of “coffee with milk”) in case of untreated subacute infective endocarditis.
• In uremia, the skin has a pale greenish color (anemia combined with retention of urochrome pigments in the skin).
• Jaundice of the skin can be observed as a result of increased bilirubin levels in the blood, with jaundice appearing first on the sclera, then spreading to the mucous membrane of the oral cavity (primarily the sublingual region, frenulum of the tongue), skin of the face, palms, and other areas. The color of the skin can be lemon, saffron; with prolonged severe hyperbilirubinemia, jaundiced skin can acquire a greenish or dark (earthy) tint. Hyperbilirubinemia occurs with:
  • liver diseases (parenchymal, or hepatic, jaundice);
  • diseases of the biliary tract (most often with obstructive ones - mechanical, or subhepatic, jaundice);
  • the breakdown of red blood cells (hemolytic, or suprahepatic, jaundice).
• When consuming large quantities of certain foods (for example, tomatoes, carrots, which contain carotenes), the skin also takes on a yellowish tint (especially in the area of the palms and feet), which must be taken into account when questioning the patient.
• Taking certain medications can also cause changes in skin color (for example, amiodarone can cause a gray-blue coloration of the skin).
• Hyperpigmentation of the skin (tan color) occurs with adrenal insufficiency and hemochromatosis (impaired metabolism of iron-containing pigments with iron retention in tissues). However, a patient with hyperpigmentation should be asked whether he or she visits a solarium.

Limited changes in skin color

Various skin rashes acquire great diagnostic significance. Thus, in a number of infectious diseases they often "reveal" the diagnosis, and in many cases help differentiate diseases.

The following terms are used to describe the elements of the rash.

• A spot (macule) is an element on the skin or mucous membrane in the form of an area with a changed color.
• Roseola is a small inflammatory spot (up to 1 cm).
• Erythema is a large-spotted limited hyperemia (redness) of the skin (larger than 1 cm in size).
• Petechia (synonyms - petechial hemorrhage, point hemorrhage) - a spot with a diameter of 1-2 mm on the skin or mucous membrane caused by capillary hemorrhage, purple-red in color, not rising above the surface of the skin.
  • Purpura - usually multiple small hemorrhagic spots.
  • Ecchymosis is a large hemorrhagic spot of irregular shape on the skin or mucous membrane of a bluish or purple color.
• Papule (synonym - nodule) is a dense formation with a diameter of less than 1 cm, rising above the skin level.
• Vesicle (vesicula: synonym - bubble) is an element of the rash in the form of a bubble (up to 5 mm in diameter) filled with serous exudate.
• A bubble (bulla; synonym - bulla) is a thin-walled cavity (more than 5 mm in diameter) filled with exudate.
• A pustule (synonym - abscess) is a blister filled with pus.

If there is a spot on the skin, it is necessary to determine its origin - whether it is caused by the expansion of small blood vessels of the skin or is due to damage to the vessels with the release of blood cells into the perivascular space (hemorrhagic rash). A simple test is useful for differential diagnostics - pressing on the spot with a glass slide (or other); another technique is stretching the skin around the spot: with damaged vessels, the spot does not fade, unlike spots caused by local expansion of small blood vessels of the skin. For diagnostics, it is very important to identify hemorrhagic rashes - primary (Schönlein-Henoch disease) or secondary (in chronic liver diseases, tumors, drug intolerance).

Limited skin changes

• Vitiligo - depigmented (white) spots of various sizes and shapes with a surrounding zone of moderate hyperpigmentation that tends to increase. This condition is benign, but often leads to cosmetic problems.
• A common cause of the appearance of depigmented (in areas of tanning) and hyperpigmented spots measuring 0.5-1 cm on the front and back surfaces of the chest, as well as in the armpits, is pityriasis versicolor (a skin mycosis caused by the fungus Pityrosporum orbiculare).
• Moles. Any so-called mole that has appeared relatively recently should be considered a tumor formation (melanoma, basalioma, other rare tumors, metastases of various tumors to the skin). Particular attention should be paid to such changes in moles as bleeding, growth (risk of malignancy).
• The facial skin of many patients who chronically abuse alcohol acquires a characteristic appearance: the skin of the nose and cheeks has a purple-blue tint, there is a pronounced dilation of the vessels of the sclera, skin of the face, and upper body. Similar changes can occur in people who are frequently exposed to sudden changes in the weather (i.e., when constantly working outdoors).
• Hemorrhages and small hemorrhagic rashes occur due to blood clotting disorders (for example, in disseminated intravascular coagulation syndrome - DIC syndrome, trimbocytopenia), as well as in vasculitis of various origins (Schonlein-Henoch purpura, idiopathic thrombocytopenic purpura, drug-induced vasculitis, chronic liver disease, tumors). Damage to small vessels can occur in septicemia, infective endocarditis.
• Large-spotted redness of the skin (erythema).
  • Nodular erythema on the anterior surface of the shins and in the area of the knee and ankle joints with painful thickening of the hyperemic area of the skin most often occurs with:
    • tuberculosis;
    • sarcoidosis;
    • rheumatism;
    • drug intolerance (sulfonamides, antibiotics, iodine preparations, etc.);
    • infectious diseases: infection caused by Chlamydia pneumoniae, yersiniosis, salmonellosis;
    • hormonal changes in the body: use of hormonal contraceptives, hormonal therapy.
  • Erythema infectiosum occurs with Lyme disease.
  • Fixed erythema is a manifestation of hypersensitivity to drugs. In this case, after taking a drug, single or multiple red spots and sometimes even blisters appear on the skin, which tend to recur in the same place each time with repeated contact with the drug. Pigment spots remain at the site of the lesions, persisting for several months, sometimes for life.
• Trophic disorders (disorders of trophism, i.e. “nutrition”, of peripheral tissues).
  • A bedsore is a necrosis of soft tissues (skin with subcutaneous tissue, mucous membrane) that occurs as a result of ischemia caused by prolonged continuous mechanical pressure on them. Bedsores most often form in patients on bed rest in those areas of the body that are subject to the most intense pressure from the bed (elbows, cruciate area, etc.). The first manifestation is a focus of hyperemia of the skin with the gradual formation of erosions, and then ulcers due to tissue necrosis.
  • Chronic trophic disorders are characterized by dry skin, hair loss, prolonged healing of any injuries, as well as the formation of trophic ulcers, up to gangrenous changes. Trophic disorders occur with insufficient blood supply (arterial insufficiency, varicose veins of the lower extremities), as well as with peripheral neuropathies, especially often with diabetes mellitus (in combination with macroangiopathy).
  • Scars on the skin can be the result of surgical opening of abscesses or removal of any skin formations, as well as a consequence of fistula tracts (for example, a “star-shaped” scar on the neck as a result of a long-existing fistula of a caseous lymph node with tuberculous damage).
  • Traces of small burns on the skin are often found in people suffering from alcoholism.
  • When examining the palmar surfaces of the hands, gross cicatricial changes in the tendons of the fingers and aponeurosis can be detected - Dupuytren's contracture, which often occurs in people who have abused alcohol for a long time, although such deformations can be associated with injuries.
  • If you have a tattoo, you must take into account the possible risk of infection with hepatitis B and C viruses and the human immunodeficiency virus (HIV).

• Livedo (Latin for bruise, contusion: synonym - marbled skin) is a special condition of the skin (mainly of the extremities, but often of the trunk as well), characterized by its bluish-violet (cyanotic) color due to the reticular or tree-like pattern of vessels showing through the skin (changes become more pronounced after exposure to cold, for example, immediately after removing clothing). Livedo is associated with blood stagnation in dilated superficial capillaries or with microthrombosis of venules. The most common variant is reticular livedo (livedo reticularis). It can occur with systemic lupus erythematosus, Sneddon syndrome (a combination of recurrent thrombosis of the cerebral vessels and livedo reticularis), and nodular periarteritis. In addition, livedo can also appear in other diseases: dermatomyositis, systemic scleroderma, infections (tuberculosis, malaria, dysentery), but especially in antiphospholipid syndrome. It should be noted the significance of detection in a number of cases of livedo hyperproduction and antibodies (AT) to phospholipids (cardiolipin), which makes this sign important in the diagnosis of antiphospholipid syndrome, the leading manifestation of which is repeated vascular thrombosis and thromboembolism, including cerebral vessels and vessels of the pulmonary circulation, as well as thrombi of the microcirculatory bed (primarily kidneys), miscarriage.
• Xanthomas and xanthelasmas are signs of lipid metabolism disorders (primarily cholesterol), which have diagnostic value for detecting atherosclerosis, including familial, and also arising in liver pathology (primarily in primary biliary cirrhosis). Xanthomas are lumpy thickenings in the area of joints and Achilles tendons. Xanthelasmas are variously shaped yellowish-orange spots on the skin, often elevated, usually localized on the skin of the eyelids, auricles, and the mucous membrane of the oral cavity. Histologically, both xanthomas and xanthelasmas are represented by clusters of phagocytes containing cholesterol and/or triglycerides. Another external sign of atherosclerosis is the senile arcus of the cornea.
• Gouty nodes (tophi) are dense (painless) lumpy formations in the area of the auricles and joints (which is often associated with their gross deformation), consisting of deposits of amorphous uric acid salts, the disrupted metabolism of which underlies the development of gout.
• Telangiectasia (synonym - "spider vein") - local excessive dilation of capillaries and small vessels. They most often occur in chronic liver diseases (cirrhosis).

Skin changes in drug hypersensitivity

The most common skin drug reactions are:

• Erythema, including fixed and multiform exudative (recurrent appearance on the extensor surfaces of the extremities and mucous membranes of a polymorphic network in the form of erythema, papules, sometimes vesicles and blisters located in rings; exacerbations are accompanied by fever and arthralgia).
• The two most frequently observed extreme manifestations of drug-induced erythema multiforme exudative are Stevens-Johnson syndrome (formation of blisters and ulcers on the skin and mucous membranes) and Lyell's syndrome (sudden widespread violent necrosis of superficial areas of the skin and mucous membranes with the formation of large flaccid blisters against the background of erythema, which quickly open).
• Urticaria is a sudden, widespread rash of itchy blisters surrounded by a zone of arterial hyperemia.
• Angioedema (Quincke's edema) is an acutely developing and often recurring, usually spontaneously passing edema of the skin and subcutaneous tissue or mucous membranes. The most dangerous situations are when the edema is localized on the face, lips and spreads to the oral cavity, tongue, pharynx and larynx, which can lead to respiratory failure.
• Photosensitivity is an increase in the body's sensitivity to solar radiation under the influence of drugs, usually expressed by inflammation of the skin and mucous membranes exposed to light. Photosensitivity is caused by some antibiotics, such as ciprofloxacin.