Skin discoloration

The change in skin color can be as follows:

• A peculiar pale-coffee tint (the color of "coffee with milk") the skin acquires with an untreated subacute infective endocarditis.
• With uremia, the skin has a pale green color (anemia in combination with a delay in the skin of the pigments of urochromes).
• Jaundice coloration of the skin can be observed as a result of an increase in the blood content of bilirubin, with the most yellow jaundice appears on the sclera, then it spreads to the mucous membrane of the oral cavity (primarily the sublingual region, the tongue bridle), the skin of the face, palms, and other areas. The color of the skin can be lemon, saffron; with prolonged severe hyperbilirubinemia, icteric skin can acquire a greenish or dark (earthy) hue. Hyperbilirubinemia occurs when:
  • liver diseases (parenchymal, or hepatic, jaundice);
  • diseases of the biliary tract (most often with obstructive - mechanical, or podpechenochnaya, jaundice);
  • decay of erythrocytes (hemolytic, or suprahepatic, jaundice).
• When you consume a large number of certain foods (for example, tomatoes, carrots containing carotenes), the skin also acquires a yellowish gauze (especially in the palm and foot area), which must be taken into account when asking the patient.
• Taking certain medications can also cause discoloration (for example, amiodarone may cause skin coloring in a gray-blue color).
• Hyperpigmentation of the skin (tan color) occurs with adrenal insufficiency and hemochromatosis (impaired metabolism of iron-containing pigments with a delay in iron tissues). Nevertheless, in a patient with hyperpigmentation, it is necessary to ask whether he is attending a solarium.

Limited skin color changes

A great diagnostic value is acquired by various skin rashes. So, with a number of infectious diseases, they often "discover" the diagnosis, and in many cases help differentiate the disease.

In describing the elements of the rash, the following terms are used.

• Spot (macule) - an element on the skin or mucous membrane in the form of a patch with a changed color.
• Roseola (roseola) - an inflammatory spot of small size (up to 1 cm).
• Erythema (erythema) - large-spotted limited hyperemia (redness) of the skin (larger than 1 cm).
• Petechia (petechia) synonyms - petechial hemorrhage, pinpoint hemorrhage) - spot caused by capillary hemorrhage 1-2 mm in diameter on the skin or mucous membrane of a purple-red color, not towering above the surface of the skin.
  • Purpura (purpura) - usually multiple hemorrhagic spots of small sizes.
  • Ecchymosis (ecchymosis) - a large hemorrhagic spot of irregular contours on the skin or mucous membrane of bluish or violet
• Papula (papula, synonym - nodule) - dense formation with a diameter of less than 1 cm, which is higher than the level of the skin.
• Vesicula (vesicula: a synonym for a vesicle) is an element of a rash in the form of a vial (up to 5 mm in diameter) filled with serous exudate.
• The bubble (bulla; synonym - bulla) is a thin-walled cavity (more than 5 mm in diameter) filled with exudate.
• Pustula (pustula; synonym - pustular) - a vial filled with pus.

If there is a spot on the skin, it is necessary to find out its origin - it is caused by the enlargement of small vessels of the skin or caused by damage to blood vessels with the release of blood cells (hemorrhagic rash) into the circulatory space. For differential diagnosis, a simple test is useful - pressing on the stain with a subject (or other) glass; another method is stretching the skin around the spot: with damaged vessels, the stain does not turn pale, unlike spots caused by local expansion of small vessels of the skin. For diagnosis, it is important to identify hemorrhagic eruptions - primary (Shenlaine-Henoch disease) or secondary (with chronic liver disease, tumors, drug intolerance).

Limited skin change

• Vitiligo - depigmented (white) spots of various sizes and shapes with a surrounding zone of moderate hyperpigmentation, showing a tendency to increase. This condition is benign, but often leads to problems of the cosmetic plan.
• A frequent reason for the appearance of depigmented (in tanning spots) and hyperpigmented spots 0.5-1 cm in size on the anterior and posterior surfaces of the chest, as well as in the axillary regions is pityriasis (mycosis of the skin caused by the fungus Pityrosporum orbiculare).
• Moles. Any so-called birthmark, which has appeared relatively recently, should be considered as a tumor formation (melanoma, basalioma, other more rare tumors, metastasis of various tumors into the skin). Particular attention should be paid to such changes in moles as bleeding, growth (the risk of malignancy).
• A characteristic appearance is acquired by the facial skin of many patients who chronicly abuse alcohol: the skin of the nose and cheeks has a purplish-cyanotic hue, pronounced expansion of the vessels of the sclera, facial skin, upper parts of the trunk. Similar changes can occur in people who are prone to frequent changes in the weather (that is, when they are constantly working on the street).
• Hemorrhages and minor hemorrhagic eruptions occur due to impaired blood clotting (for example, in the syndrome of disseminated intravascular coagulation-DVS-syndrome, trimbozitopenia), as well as in vasculitis of various genesis (purpura Schonlein-Henoch, idiopathic thrombocytopenic purpura, drug vasculitis, chronic liver disease , tumors). The defeat of small vessels can occur with septicemia, infective endocarditis.
• Large patchy reddening of the skin (erythema).
  • Nodolum erythema on the anterior surface of the shins and in the region of knee and ankle joints with painful compaction of the hyperemia of the skin most often occurs when:
    • tuberculosis;
    • sarcoidosis;
    • rheumatism;
    • drug intolerance (sulfonamides, antibiotics, iodine preparations, etc.);
    • infectious diseases: infection caused by Chlamydia pneumoniae, yersiniosis, salmonellosis;
    • hormonal changes in the body: the use of hormonal contraceptives, hormone therapy.
  • Infectious erythema occurs with Lyme disease.
  • Fixed erythema is a manifestation of hypersensitivity to drugs. In this case, after taking the medicinal preparation, single or multiple red spots appear on the skin and sometimes even blisters which, when repeated contacts with the medicine, tend to repeat each time in the same place. On the spot lesions remain pigmented spots, persisting for several months, sometimes for life.
• Trophic disorders (trophic disorders, ie, "nutrition", peripheral tissues).
  • Carpal - necrosis of soft tissues (skin with subcutaneous tissue, mucous membrane), resulting from ischemia caused by prolonged continuous mechanical pressure on them. The most often bedsores are formed in bed-rest patients in those parts of the body that are subjected to the most intense compression of the bed (elbows, crust area, etc.). The first manifestation is the focus of skin hyperemia with gradual formation of erosion, and then ulceration due to tissue necrosis.
  • Chronic trophic disorders are characterized by dry skin, hair loss, prolonged healing of any lesions, and the formation of trophic ulcers, up to gangrenous changes. Trophic disorders occur with insufficient blood supply (arterial insufficiency, varicose disease of the lower extremities), as well as in peripheral neuropathies, especially in diabetes mellitus (in combination with macroangiopathies).
  • Scars on the skin can be the outcome of an operative dissection of abscesses or the removal of any cutaneous lesions, as well as a consequence of fistulous strokes (for example, a "star" scar on the neck as a result of the long-lasting fistula of a caseously altered lymph node in its tuberculous lesion).
  • Traces of small burns on the skin are often found in people with alcoholism.
  • When examining the palmar surface of the hand, rough cicatricial changes in the tendon of the fingers and aponeurosis, Dupuytren's contracture, often occurs in people who have long abused alcohol, although such deformations may be associated with injuries.
  • In the presence of tattoos, it is necessary to take into account the possible infection with the hepatitis B and C viruses, the human immunodeficiency virus (HIV).

• Livedo (Latin bruise, bruise: synonym - marble skin) - a special condition of the skin (mostly limbs, but often the trunk), characterized by its bluish-violet (cyanotic) coloring due to a mesh or tree-like pattern of translucent vessels through the skin (changes become more expressed after exposure to cold, for example immediately after removing clothing). Livedo is associated with stagnation of blood in dilated superficial capillaries or with micro-thrombosis of venules. The most frequent variant - reticulated livedo (livedo reticularis). It can occur with systemic lupus erythematosus, Sneddon's syndrome (a combination of recurrent thrombosis of the brain vessels and livedo reticularis), nodular periarteritis. In addition, livedo can appear in other diseases: dermatomyositis, systemic scleroderma, infections (tuberculosis, malaria, dysentery), but especially with antiphospholipid syndrome. It should be noted the importance of detecting in some cases livedo hyperproduction and antibodies (AT) to phospholipids (cardiolipin), which makes this sign important in the diagnosis of antiphospholinide syndrome, the leading manifestation of which are repeated thrombosis of vessels and thromboembolism, including cerebral vessels and small vessels blood circulation, as well as thrombi microcirculation of the channel (primarily the kidneys), miscarriage.
• Xanthomas and xanthelasms are signs of lipid metabolism disturbances (primarily cholesterol), which are of diagnostic importance for the detection of atherosclerosis, including familial, as well as those that arise in the pathology of the liver (primarily in primary biliary cirrhosis). Xanthomas - hummocky joints in the region of the joints, Achilles tendons. Xanthelasm - a different form of spots on the skin yellowish-orange, often towering, usually located on the skin of the eyelids, ear shells, mucous membrane of the mouth. Histologically, both xanthomas and xanthelases are clusters of phagocytes containing cholesterol and / or triglycerides. Another external sign of atherosclerosis is the senile arc of the cornea.
• Gouty knots (tofus) - dense (painless) tuberous formations in the region of the auricles, joints (with which their coarse deformations are often associated) consisting of deposits of amorphous uric acid salts, the disturbed metabolism of which underlies the development of gout.
• Teleangiectasia (teleangiectasia; synonym - "vascular star") - local excessive dilations of capillaries and small vessels. Most often they occur with chronic liver diseases (cirrhosis).

Skin changes with hypersensitivity to drugs

The following are the most common skin reactions.

• Erythema, including fixed and multiform exudative (recurring appearance of polymorphic mesh in the extensor surfaces of the limbs and mucous membranes in the form of erythema, papules, sometimes vesicles and blisters located in rings, exacerbations are accompanied by fever and arthralgia).
• Two extreme manifestations of drug multiforme exudative erythema are most often observed: Stevens-Johnson syndrome (formation of blisters and ulcers on the skin and mucous membranes) and Lyell's syndrome (sudden widespread necrosis of superficial skin and mucous membranes with the formation of large flaccid blisters against erythema, which quickly opened).
• Urticaria - the sudden occurrence of widespread eruptions of itchy blisters, surrounded by a zone of arterial hyperemia.
• Angioedema (edema) Quincke is a rapidly developing and often relapsing, 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, throat and larynx, which can lead to respiratory failure.
• Photosensitivity - increasing under the influence of drugs the sensitivity of the body to the action of solar radiation, usually expressed by the inflammation of exposed areas of the skin and mucous membranes. Photosensitivity is caused by some antibiotics, for example, ciprofloxacin.