| Hyperthyroidism. | | | | to 2 cm in diameter. They vary in number from |
| Autoimmune thyroid disease of the | | | | several to hundreds and are distributed randomly |
| hypermetabolic type (Graves disease) is reflected | | | | over the trunk and extremities. Patients with the |
| by several visible changes. The skin is soft and | | | | most severe forms of neurofibromatosis may |
| moist. Scalp hair is thin in diameter, and evidence | | | | develop large, grotesque, sack-like plexiform |
| of diffuse alopecia may be present. Vitiligo occurs | | | | neuromas. A small proportion of these latter |
| in 5% to 10%, and alopecia areata occurs in 1 % | | | | lesions undergo sarcomatous degeneration. |
| or 2% of the patients. Onycholysis of the | | | | Tuberous Sclerosis |
| fingernails is sometimes seen. Late in the course | | | | The earliest sign of tuberous sclerosis is generally |
| of the disease a few patients develop a peculiar | | | | the presence of small, faint white, oval patches |
| form of clubbing (thyroid acropachy) or pretibial | | | | (ash leaf spots) scattered randomly on the trunk |
| myxedema. The latter consists of thickened, | | | | and extremities . These lesions may be present |
| pebbly, skin-colored plaques over the lower | | | | at birth or may develop in early childhood. One or |
| anterior shins. These plaques are usually | | | | more thickened skin-colored plaques (shagreen |
| asymptomatic. | | | | plaques) may appear on the lower back in late |
| Diabetes Mellitus | | | | childhood. Towards puberty, pinhead-sized, |
| Patients with diabetes mellitus may develop a | | | | smooth, red, dome-shaped papules (adenoma |
| number of cutaneous changes. The yellow plaques | | | | sebaceum) begin to emerge on the central portion |
| of necrobiosis lipoidica diabeticorum most often | | | | of the face. The upper lip is spared. Such lesions |
| located on the anterior shins, are the most | | | | are easily mistaken for acne papules. Finally, in |
| distinctive of these changes.Small, hypopigmented, | | | | adult life, small, firm, skin-colored, subungual or |
| slightly depressed scars (diabetic dermopathy) are | | | | periungual fibromas may be noted. |
| also occasionally found on the anterior lower legs. | | | | Peutz-Jeghers Syndrome. |
| These lesions probably represent obliterative small | | | | This dominantly inherited condition is characterized |
| vessel disease in an area prone to trauma. Bullous | | | | by the presence of small brown or blackfreckles |
| lesions somewhat similar in appearance to those | | | | that appear in clusters on and around the lips and |
| of pemphigoid may arise from otherwise | | | | on the fingertips. These pigmentary changes are |
| normal-appearing skin around the feet and ankles. | | | | accompanied by the development of intestinal |
| The cause of these blisters is unknown. Eruptive | | | | polyps. Carcinomatous degeneration of these |
| xanthomas consisting of small, smooth, pink, | | | | polyps is not common but does occur. |
| dome-shaped papules may appear in a sudden | | | | Osler-Weber-Reudu Syndrome |
| shower of lesions in those whose diabetes is | | | | This dominantly inherited condition, also known as |
| grossly out of control. Staphylococcal bacterial | | | | hereditary hemorrhagic telangiectasia, is |
| infections and candidal yeast infections are seen | | | | characterized by the presence of small, dusky |
| with increased frequency in diabetic persons. | | | | red, clustered manlles on the fingertips, lips, and |
| Diabetes is also associated with a variety of other | | | | mucosal surfaces. These macules are composed |
| cutaneous and medical conditions. | | | | of multiple telangiectatic vessels that blanch on |
| Neurofibromatosis | | | | pressure. Lesions similar to these may also .occur |
| The presence of sharply marginated, light brown | | | | in patients with the CRST (calcification, Raynaud's |
| patches (cafe-au-lait patches) is often the first | | | | phenomenon, scleroderma, and telangiectasia) |
| clue to the presence of von Recklinghausen's | | | | variant of scleroderma. Patients with this disease |
| disease . In late childhood or during the teenage | | | | have recurrent episodes of epistaxis and |
| years, axillary freckling and cutaneous | | | | gastrointestinal bleeding. Arteriovenous fistulae are |
| neurofibromas begin to develop. The latter are | | | | sometimes present in the lungs and liver. |
| soft, smooth-surfaced, peduncuated papules 0.5 | | | | |