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Skin Signs of Gastrointestinal Disease

»	List some of the hallmark skin signs seen with diseases of the digestive tract.
»	What is jaundice (icterus) and when is it apparent in the skin?
»	What can a jaundice color spectrum tell me about the types of liver disease in a patient?
»	List the top ten skin findings suggestive of hepatic and biliary tract disease.
»	What is the most common skin symptom associated with liver disease?
»	What diseases associated with intestinal bleeding may also leave clues in the skin?
»	What is pyoderma gangrenosum?
»	A patient presents with anemia, blood in the stool, and red macules on his lips/tongue. What diagnosis should I first consider?
»	What other diagnoses should I consider when seeing a patient with macules on the lips?
»	What is the best treatment for patients with Peutz-Jeghers syndrome?
»	What is pseudoxanthoma elasticum (PXE)? How does this cause GI bleeding?
»	What is Gardner’s syndrome?
»	How can cancer of the gastrointestinal tract present in the skin?
»	What is “malignant” acanthosis nigricans (AN)?
»	What is superficial migratory thrombophlebitis (SMT)?
»	How is inflammation of the fat (panniculitis) associated with pancreatic disease?
»	What chronic liver disease associated with photosensitivity causes blistering and scarring of the skin?
»	What chronic skin disease is associated with a gluten-sensitive enteropathy?
»	How is dermatitis herpetiformis treated?

List some of the hallmark skin signs seen with diseases of the digestive tract.

Cirrhosis: Jaundice, ascites, purpura, spider angiomas
Peutz-Jeghers syndrome (PJS): Lip lentigo
Inflammatory bowel disease: Pyoderma gangrenosaum on legs
Gardner’s syndrome: Osteomas, epidermoid inclusion cysts

It is logical that many diseases of the skin also involve the oral and anal mucosa because, embryologically, the foregut (forming the oral epithelium) and the hindgut (creating the anal mucosa) share a common ectodermal component in the first few weeks of fetal development. Therefore, the skin becomes a “mirror” of underlying pathology, both obvious and occult, in the gastrointestinal (GI) system.

Fitzpatrick JE: Cutaneous manifestations of gastrointestinal disease. In McNally PR, editor: Gastroenterology secrets, ed 3, Philadelphia, 2006, Elsevier Mosby.