First Alert
A disease may announce its presence on the skin
Diagnosing a serious condition early--whether skin changes or other symptoms give the alert--often prevents worse damage from occurring and at least lets the doctor and patient get to work managing the disease. Obviously, it's better to know sooner than later if you've got an infected heart valve, before part of the infection lodges in your brain. One young woman who consulted Cleveland Clinic dermatologist Wilma Bergfeld because of hair loss turned out to be on a drastic diet, and her electrolytes had fallen to the point where she was at risk for heart failure. After an adjustment to her diet to reduce the risk to her heart, the woman's hair is filling in again. Young, thin women who come in frantic about their hair loss are often malnourished, Bergfeld says. Hair loss can also be a warning sign of an underactive thyroid--a condition that can make you depressed, cold, forgetful, and listless but is easily treated.
Autoimmune diseases can't be cured. But the symptoms can be controlled with drugs that rein in the faulty immune system. Untreated lupus can cause kidney failure, heart failure, and death, for example, but early diagnosis can help prevent the direst outcomes. "We try to hit it at the arthritis stage," says Joan Merrill, medical director of the Lupus Foundation of America and a lupus specialist practicing in Oklahoma. Although most cases of scleroderma are mild, left unchecked, the disease can be fatal.
Chronic clues. People who already know they've got a chronic condition sometimes get notice from the skin that a flare-up is starting. In Crohn's disease and ulcerative colitis, autoimmune disorders that affect the digestive system, a bout of intestinal distress may be preceded by red, tender, swollen lumps, often on the shins, as if you'd walked into the coffee table. "So when these bumps start coming up, the patient and physician say, 'Uh-oh, there's probably going to be a flare of the bowel,' " says William Tremaine, a gastroenterologist at the Mayo Clinic. The symptoms include abdominal pain, diarrhea, and fever; in the case of Crohn's disease, the whole gastrointestinal tract, from the mouth on down, can be involved. By taking drugs to control inflammation, for example, people with Crohn's can often improve their symptoms. The bonus: "You treat the bowel, and the skin gets better," says Tremaine.
How worried should you be if your skin speaks up? Even stress and poor shampoo choices can cause hair loss. "It is true that most things people have are not signs of internal diseases," says Brodell, the Ohio dermatologist. But certainly you'll want an opinion from a dermatologist or your primary-care doctor if a bump or rash is rapidly changing or growing, he says. "Just think of it common-sense-wise--you don't want to see how big it's going to get or what it's going to turn into."
And you'll want to take stock of how you feel otherwise. "If you came in and your eyes were sallow, you'd recently lost 20 pounds, your skin was itching, and you had lumps and bumps," Bergfeld says, she'd figure you were sick. On the other hand, in an otherwise healthy person, a rash may well be just a rash.
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