10th July 2023

Metabolic Disorders

The Porphyrias

The classic skin manifestations of porphyrias are blister formation, photosensitivity, scarring with milia and hypertrichosis.

Table 1: Types of porphyrias

Diabetes

Diabetes can often present with a wide range of cutaneous signs, such as necrobiosis lipoidica, granuloma annulare, diabetic rubeosis, diabetic dermopathy, candidiasis, vitiligo, and neuropathic foot ulcers.

• Diabetic dermopathy presents with dark red papules that eventually become atrophic and is associated with a long duration of diabetes mellitus.
• Necrobiosis lipoidica (waxy yellow lesions) mainly affects the shins and is associated with telangiectasia
• Granuloma annulare present as papules with central depression.

Acanthosis nigricans

Often described as dark, thick, velvety patches that present in skin folds, namely the underarms, neck, and groin. It often indicates an underlying health concern, such as internal malignancy, acromegaly, Cushing syndrome, obesity, insulin resistant diabetes or hypothyroidism. It can also be seen in those that take the oral contraceptive pill. Acanthosis nigricans can be familial.

Thyroid disease

Table 2: Thyroid disease and its cutaneous manifestations