Skip to Main Content


Endocrine and metabolic disorders originate from internal glands and organs and produce mainly metabolic and biochemical abnormalities. Expectedly, these are detected and confirmed by laboratory investigations and managed primarily by the endocrinologist. However, skin manifestations associated with these disorders are common and may present first to the dermatologist. A dermatologist, therefore, needs to have a good foundation in internal medicine and appreciate the association between the various characteristic cutaneous signs and systemic diseases.

The cutaneous manifestations of internal malignancy include the infiltration of malignant cells into the skin due to metastatic spread of disease or deposition of circulating tumor cells, as well as benign dermatoses that occur in association with malignancy. The latter group is known as paraneoplastic dermatoses. Knowing the association with an underlying malignancy will prompt the clinician to evaluate for the associated pathology when patients present first with such skin lesions. For example, a confirmation of dermatomyositis warrants a thorough search for an underlying malignancy (e.g., nasopharyngeal, breast, lung, ovarian, and gastrointestinal) which occurs in about one-third of cases.

This chapter is broadly divided into two sections. The first highlights cutaneous manifestations of endocrine and metabolic disorders, and the latter paraneoplastic dermatoses and cutaneous manifestations of other systemic diseases.


Diabetes and thyroid diseases have many florid cutaneous manifestations (Figures 14–1, 14–2, 14–3, 14–4, 14–5, 14–6, 14–7, 14–8, 14–9, 14–10, 14–11, 14–12, 14–13, 14–14, 14–15, 14–16, 14–17, 14–18, 14–19, 14–20, 14–21, 14–22, 14–23, 14–24). Cutaneous features of diabetes include diabetic dermopathy, necrobiosis lipoidica diabeticorum, and neuropathic ulcers (Figures 14–1, 14–2, 14–3, 14–4, 14–5, 14–6, 14–7, 14–8, 14–9, 14–10, 14–11, 14–12). Thyroid disease may give characteristic skin signs, e.g., pretibial myxedema and thyroid acropachy (Figures 14–14, 14–15, 14–16). Patients who are on long-term systemic corticosteroid therapy invariably develop Cushingnoid features (Figure 14–17). Hyperlipidemia may present with various types of cutaneous xanthomas (Figures 14–18, 14–19, 14–20, 14–21, 14–22, 14–23, 14–24).

Figure 14-1

Diabetic foot ulcer

This patient has a characteristic punched-out neuropathic diabetic foot ulcer. These ulcers occur on pressure areas of decreased sensation due to peripheral neuropathy. The surrounding skin is hyperkeratotic. As diabetics also often have concomitant peripheral vascular disease, these ulcers are prone to secondary bacterial infection.

Figure 14-2

Bullous diabeticorum

Bullous diabeticorum refers to recurrent blisters spontaneously occurring on the lower extremities with a preference for the pretibial region and sites of trauma. No treatment is required and the blisters heal spontaneously over a period of weeks without scarring.


Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.