First Alert
A disease may announce its presence on the skin
Women tend to get all hung up on their skin's cosmetic attributes. Is that a new wrinkle? How can I make my elbows smoother? Will this self-tanner turn me orange? But their concern with skin as upholstery ignores a larger truth: Skin is a big organ that you can see. Because the skin is connected to the rest of the machinery--blood vessels feed it, nerves tell it what to do--diseases that affect the systems of the body often give an early warning on the skin. "You pick the disease, and I'll tell you the skin manifestation," says Bob Brodell, a dermatologist in Warren, Ohio. He remembers seeing an 8-year-old girl with hives when he was a young resident in the emergency room who a few weeks later was diagnosed with leukemia--which has been known to trigger hives.
Indeed, doctors--especially dermatologists like Brodell--keep their eyes on the skin for all manner of clues to underlying disease and other conditions affecting a woman's health. If you have an infected heart valve, bits of the infection can break off, get stuck in tiny vessels, and show up as streaks under your fingernails. Pregnancy makes some women itch all over; anemia can cause the hair to fall out. One morning in 1988, when Birmingham, Ala., nurse Susan McNaughton and her husband, a doctor, were standing at the double sinks in their bathroom, he looked at her in the mirror and announced, "You have lupus." The clue: the disease's characteristic butterfly rash, spreading light pink across the top of her cheeks and the bridge of her nose.
Heads up. Rashes and hives and dark spots under the nails are usually not a sign of serious illness, of course. That butterfly-shaped discoloration might just be acne; you can get marks under your nails during an energetic round of gardening or housework. But combined with other signs such as weight loss or fatigue, symptoms on the skin can give doctors a hint of what is going on below. McNaughton's illness, systemic lupus erythematosus, is one of a group--autoimmune diseases--that stands out for affecting women in particular and showing up on their skin. These diseases happen when the body's attack mechanism goes awry: Your immune system mistakes your own tissues for foreign invaders and turns its wrath on them.
And often, the skin takes a beating. In most people with lupus, the self-attack inflames joints, causing arthritis. The liver and kidney can become inflamed, too, and stop working as well as they should. Meantime, the proteins that cause inflammation travel through the blood vessels to the skin, where they can cause rashes like McNaughton's. Her skin has become so sensitive to sunlight that she now leaves her apartment in the daytime only for doctors' appointments.
Likewise, one of the first signs of the autoimmune disorder scleroderma is tight, thick skin. In most people, the thickening stops at the skin. But the systemic form of scleroderma can cause serious harm below the surface, when the tightening proceeds in internal organs and essentially replaces vital tissues with scars. In the lungs, for example, the thickening can impede the exchange of oxygen and carbon dioxide. Many people develop gastrointestinal woes.
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.
This story appears in the November 14, 2005 print edition of U.S. News & World Report.