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Not an everyday occurrence
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Some conditions you might not see every day in your clinic:
Onycholysis: A lifting of the nail bed as seen in this photo. There are many conditions in which this might occur, but the endocrinologist is most likely to see this in patients with hyperthyroidism. There does not seem to be an association between the severity of the thyroid disease and these nail bed changes, and it has been suggested that if you see these changes in asymptomatic patients — screening for hyperthyroidism should be done. My patient was unusual as far as I can gather in that her thyroid disease was a papillary carcinoma. It had been treated surgically almost 10 years ago and she was on thyroid replacement therapy. Unfortunately, my examination revealed a palpable lymph node high up in the neck near the angle of the jaw. Thyroid-stimulating hormone and free thyroxine (T4) were normal. Evaluation of the lymph node is still in progress.
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Photos courtesy of Michael Kleerekoper, MD |
Eruptive xanthomas: These photos were taken on a patient I had reported in an earlier blog with a triglyceride level >7,500 mg/dL. He is responding well to treatment with his last triglyceride level at 1,050 mg/dL. His “rash” is subsiding.
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Scleroderma diabeticorum: This uncommon dermatologic complication of diabetes is the so called “peau d’orange” (orange peel) appearance. These skin changes are not unique to diabetes and the etiology is uncertain. However, if you do see this in your patient with sub–optimally controlled diabetes there does not appear to be any indication to seek out all the other potential causes. My patient had no symptoms associated with this lesion occupying most of his back. Management consists of improving glycemic control.
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