SKIN COLOR CHANGES BASICS OF DERMATOLOGY (4) DERMATOLOGY FOR THE USMLE

DERMATOLOGY FOR THE USMLE

BASICS OF DERMATOLOGY (4)

SKIN COLOR CHANGES

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SKIN COLOR CHANGES The skin color may provide quick clues to the underlying pathological process. Red Skin Hyperpigmented Skin (Blue-Gray or Brown) Purple/Black Skin √ Acute sunburn √ Acanthosis nigricans √ Bruises (ecchymosis) √ Carbon monoxide and cyanide poisoning √ Addison disease √ Infections »Cutaneous anthrax »Ecthyma gangrenosum (pseudomonas) »Mucormycosis »Necrotizing fasciitis √ Carcinoid syndrome and VIpoma √ Arsenic and mercury exposure √ Ischemic skin necrosis (embolic occlusion) »Antiphospholipid syndrome (APL) »Antithrombin III deficiency »Factor V Leiden »Heparin-induced thrombocytopenia (HIT) »Protein C and S deficiency »Warfarin-induced skin necrosis √ Cutaneous lymphoma √ Chronic stasis dermatitis √ severe vasospasm (frostbite) √ Dermatomyositis and lupus erythematosus √ Chronic UV-light exposure √ Tattoos √ Drug eruptions »Beta-lactams, sulfonamides, tetracyclines and vancomycin (“red man” syndrome) √ Dermal melanosis (Mongolian spot) √ Vasculitis »Buerger disease (thromboangiitis obliterans) »Cryoglobulinemia »Eosinophilic granulomatosis with polyangiitis (Churg Strauss) »Granulomatosis with polyangiitis (Wegener) »Henoch-Schönlein purpura »Polyarteritis nodosa (PAN) »Takayasu arteritis √ Drugs side effects »Calcium channel blockers (CCBs) »Nicotinic acid √ Drugs »Antiarrhythmics (eg, amiodarone) »Antimalarials (eg, hydroxychloroquine) »Antipsychotics (eg, chlorpromazine) »Chemotherapy (eg, bleomycin, busulfan and daunorubicin) »Estrogens (eg, oral contraceptive pills) »Tetracyclines (also brown teeth) √ Eczema (eg, atopic dermatitis) √ Hemochromatosis and wilson disease √ fever √ McCune-Albright syndrome √ Hemangioma, angiosarcoma and Kaposi sarcoma √ Melanocytic disorders (eg, freckles, melasma, lentigines and nevi) √ Hemorrhagic lesions (eg, petechiae) √ Melanoma √ Hot flashes (menopause) √ Nelson syndrome √ Polycythemia √ Ochronosis (alkaptonuria) √ Raynaud disease √ Peutz-Jeghers syndrome √ Scabies √ Post-inflammatory hyperpigmentation √ Urticaria √ silver intoxication (argyria) √ Vasculitis (eg, Henoch-Schönlein purpura) √ Viral and bacterial exanthems (eg, measles)

Yellow Skin		Blue Skin (Cyanosis)		Hypopigmented Skin (White)
√	Beta-carotenemia (excessive consumption of orange vegetables such as carrots, sweet potato and squash)	√	Cardiovascular disease »Congenital heart disease »Congestive heart failure and cardiac arrest	√	Albinism (eg, Hermansky-Pudlak syndrome)
√	Chronic renal failure (CRF)	√	pulmonary disease »Chronic obstructive pulmonary disease (COPD) »Pulmonary embolism (PE) »Respiratory foreign body »Restrictive lung disease (RLD) »Pneumonia, croup and epiglottitis	√	Iatrogenic (eg, laser, bleaching agents)
√	excessive circulating bilirubin (jaundice) »Biliary cirrhosis »Bilirubin metabolism disorders (eg, Gilberts and Crigler-Najjar syndromes) »Hemolytic and microangiopathic anemia »Hepatitis (eg, infectious, toxic, autoimmune or drug-induced)	√	Vasospasm »Hypothermia »Raynaud disease	√	Leprosy
√	Hypothyroidism	√	Ventilatory depression »Drug overdose (eg, heroin, benzodiazepines) »Prolonged seizures (eg, tonic clonic seizure)	√	Lichen sclerosus
√	Necrobiosis lipoidica			√	Pityriasis alba
√	sepsis			√	Post-inflammatory hypopigmentation
√	Xanthomas			√	Raynaud disease (blanching)
√				√	scleroderma
				√	Tinea versicolor
				√	Tuberous sclerosis (“ash leaf” spots)
				√	Vitiligo (depigmented skin)