The skin in general medicine

Editor – Dhoat and Rustin reviewed an important but often neglected part of general medicine in their article (Clin Med August 2009 pp 379–84). We would like to add that xanthomatoses, especially xanthelasmas, are also an important marker for diabetes, propensity to coronary artery disease (CAD)¹ and gout² apart from cholestasis and hyperlipidemia as mentioned. Besides xanthaelasma and xanthoma, presence of arcus juvenilis in young people (age ≤40 years) may also be considered as a clinical sign for premature CAD.³ Premature graying and/or balding in chronic smokers has also been shown to be associated with premature CAD.⁴ Other cutaneous signs like ear lobe crease, ear canal hair, and nicotine staining should also be considered as valuable clinical markers of CAD.¹ Recently, hyperpigmented palm and digits of hand associated with central obesity in betel quid sellers has been shown to predispose to early CAD.⁵ There may be a clinical scenario where one sibling in the family has xanthoma, another has xanthelasma or arcus juvenilis and some suffer from CAD. The clinical implication of such a finding is that one must actively look for such signs in all family members for early identification of persons predisposed to premature CAD.

• © 2010 Royal College of Physicians