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The skin in general medicine

Shridhar Dwivedi and Amitesh Aggarwal
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DOI: https://doi.org/10.7861/clinmedicine.10-3-306a
Clin Med June 2010
Shridhar Dwivedi
University College of Medical Sciences University of Delhi, India
Roles: Professor of medicine/preventive cardiology
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Amitesh Aggarwal
University College of Medical Sciences University of Delhi, India
Roles: Lecturer
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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.

Footnotes

  • Please submit letters for the Editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk

  • © 2010 Royal College of Physicians

References

  1. ↵
    1. Chan HL
    . Cutaneous manifestations of cardiac diseases. Singapore Med J 1990; 31: 480–5.
    OpenUrlPubMed
  2. ↵
    1. Storey GO
    . Xanthomatosis, hyperlipoproteinaemia [type II, Fredrickson], gout, cardiac infarction. Proc R Soc Med 1971; 64: 59–60.
    OpenUrlPubMed
  3. ↵
    1. Chambless LE,
    2. Fuchs FD,
    3. Linn S,
    4. et al
    . The association of corneal arcus with coronary heart disease and cardiovascular disease mortality in the Lipid Research Clinics Mortality Follow-up Study. Am J Public Health 1990; 80: 1200–4.doi:10.2105/AJPH.80.10.1200doi:10.2105/AJPH.80.10.1200
    OpenUrlPubMed
  4. ↵
    1. Dwivedi S,
    2. Aggarwal A
    . Risk factors and cutaneous markers of coronary artery disease in young in north Indian population. Atherosclerosis Supplement 2009;10: e1406.doi:10.1016/S1567-5688(09)71365-0doi:10.1016/S1567-5688(09)71365-0
    OpenUrlCrossRef
  5. ↵
    1. Dwivedi S,
    2. Dwivedi G
    . Betel quid seller syndrome. Occup Environ J 2010; 67: 144.doi:10.1136/oem.2009.049809doi:10.1136/oem.2009.049809
    OpenUrlFREE Full Text
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The skin in general medicine
Shridhar Dwivedi, Amitesh Aggarwal
Clinical Medicine Jun 2010, 10 (3) 306; DOI: 10.7861/clinmedicine.10-3-306a

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The skin in general medicine
Shridhar Dwivedi, Amitesh Aggarwal
Clinical Medicine Jun 2010, 10 (3) 306; DOI: 10.7861/clinmedicine.10-3-306a
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