Merck Manual

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Skin Manifestations of Internal Disease


Julia Benedetti

, MD, Harvard Medical School

Last full review/revision Feb 2019| Content last modified Feb 2019
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Topic Resources

The skin frequently serves as a marker for underlying internal disease. The type of lesion typically relates to a specific disease or type of disease.

Internal cancer

Acute onset of multiple seborrheic keratoses Seborrheic Keratoses Seborrheic keratoses are superficial, often pigmented, epithelial lesions that are usually warty but may occur as smooth papules. The cause of seborrheic keratosis is unknown, but genetic mutations... read more Seborrheic Keratoses (Leser-Trélat sign) may indicate underlying internal cancer, particularly adenocarcinoma. However, because of the high prevalence of seborrheic keratoses in healthy adults, this sign may be overdiagnosed.

Acanthosis nigricans that is associated with cancer can be of rapid onset and particularly widespread. Acquired ichthyosis or pruritus without a clearly associated dermatitis may indicate occult cancer, often lymphoma.

Paraneoplastic pemphigus is a relatively rare autoimmune blistering disease that has been associated with various cancers, including leukemias.

Erythema gyratum repens is a rare eruption consisting of concentric erythematous lesions, resembling wood grain, which has been associated with various cancers.


Gastrointestinal (GI) disorders

Skin conditions commonly associated with GI disorders include

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Lichen Planus
A 65-year-old man comes to the office because he has had an itchy rash for the past 6 weeks that is purple in color on the flexor aspect of each wrist. On physical examination, the lesions are flat and smooth. Biopsy is performed, and lichen planus is confirmed. Which of the following laboratory studies should be done? 
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