Sometimes the first signs of serious conditions appear on the skin. Systemic diseases often have a wide range of cutaneous manifestations. Here are the skin signs of 5 major systemic diseases.

1. Kidney Disease

Uremic pruritus is the most common symptom of chronic renal disease, characterized by calcium deposits, purpura, plaques, hyperkeratotic papules or nodules (acquired perforating dermatitis), nail disorders, and bullous eruptions.

2. Hypothyroidism

Cold or pale color of the skin is a primary sign of hypothyroidism. Still, yellowing pseudojaundice is also common, as are edema of the hands and face and hair loss or changes to various parts of the body. Nails may grow slowly and become brittle and dull. Telangiectasia and purpura may also be observed. Myxedema is the most serious skin symptom, which in rare cases, can decompensate to a coma state.

3. Sarcoidosis

Sarcoidosis is a pulmonary disorder manifested by skin lesions in at least 25% of cases. It may accompany granulomatous involvement of the liver, spleen, eyes, lungs, and lymph nodes. Skin involvement can take many forms: infiltrated or sometimes erythrodermic plaques, maculopapular eruptions, ulcerations, changes to scar tissue (sarcoidosis), Lupus pernio, and ichthyosiform lesions.

4. Systemic Lupus Erythematosus (SLE)

The “butterfly rash” (an erythematous rash that spreads across the nose and cheeks) is a signature sign of SLE, reported in 25-40% of cases. The rash can be colored from pale red to purple, raised or flat, but it doesn’t usually cause discomfort other than possible itching. But the butterfly is not the only skin symptom. At least 80% of SLE patients experience some form of skin lesions that can be discoid or bulbar, vasculitis, alopecia, nail fold changes, oral erosions, hemorrhages, and ulcers.

5. Liver Disease

Early signs of liver disease can include pruritus, spider angiomas, and porphyria cutanea. The latter can signal liver disease in general but is often specific to hepatitis C. A common presentation of cirrhosis is the combination of spider angiomas, palmar erythema, and Dupuytren contracture.