Representational image. Wikimedia Commons
Skin is a mirror of internal health, and a variety of respiratory diseases can cause changes in the skin. Knowledge of these signs helps not only the physician but the patient too with early diagnosis and management. Some of the signs are classical and leads to a diagnosis that is obvious on a glance whereas many of the times it helps the doctor in narrowing the differential causes running through his/her mind or at times it is an indicator of the severity or stage of the disease.
Skin changes are easily visible and are of paramount importance in evaluation of any person with health issue. Some of the common symptoms of skin that are seen with respiratory disease are described below.
o Cyanosis: A bluish or purplish discoloration of the skin and mucous membrane due to poor oxygenation of blood is called ‘cyanosis’. Cyanosis leads to change in colour of tongue, inside of lips, around the mouth when central and skin of fingertips, toes, and palms when its peripheral. Any medical condition that prevents oxygen-rich blood from reaching parts of the body can cause this and major group among these are lung diseases. Hence anyone experiencing such a symptom shall seek medical attention.
o Eczema: is a skin condition that makes the skin itchy and flaky and can turn it into red to dark brown or purple in colour. It often happens in people who have allergies and can run in families. It usually affects the sides of the neck, the elbow creases, and the backs of the knees. This condition can be seen with people who are prone to develop other allergic conditions such as asthma or allergic sinusitis.
o Erythema nodosum: Red, firm bumps which are painful on touch and are usually found symmetrically on the shins. It is usually a sign of some other infection, disease, or sensitivity to a drug. Lung diseases such as tuberculosis, sarcoidosis, fungal or bacterial infections can lead to this manifestation.
o Clubbing: causes thickening of nails, which lose their form and shape and become soggy. The ends of the fingers become thicker, giving the appearance of bulbs and this is commonly seen in lung related diseases like lung cancer, tuberculosis, lung abscess, bronchiectasis, cystic fibrosis, or pulmonary fibrosis.
o Engorged veins: Markedly dilated veins on the upper chest and arms with other signs such as swelling of face, hoarseness of voice, exaggerated redness of face and neck are signs of obstruction of blood flow in a major vein and is caused mostly by lung cancer but can be due to some severe infections too. This is known as superior vena cava syndrome and lung cancer is the most common cause for this.
o Dermatomyositis: These are itchy or scaly painful rashes usually appearing on the areas of skin that are exposed to the sun. The rash can be red or purple and are most commonly found on your face and eyelids or on your knuckles, elbows, knees, chest and back. This condition is usually accompanied by marked muscle weakness of your hips, thighs, shoulders, upper arms, and neck. Among the lung disorders it can be seen with interstitial lung disease (or fibrosis of lung) caused by autoimmune diseases and lung cancer.
o COVID-19 and skin: A rose-red flat (macular) or slightly elevated (maculopapular) eruption, showing circular or elliptical lesions most commonly seen on trunk is many a times seen with COVID 19 infection. It is mostly seen during the recovery phase or rarely can be seen at onset of disease too. Another common symptom seen are ‘COVID toes’. These are usually seen in children, are small patches of inflamed skin seen on fingers, elbows, or toes. They are also seen in the post viral or recovery phase and can last up to 1-4 weeks. Other symptoms such as itching all over the body, redness, or rashes on any part of the body with/without swelling can also be seen with coronavirus infection.
o Purplish thick plaques particularly on face and nose are known as Lupus pernio and is one of the signs of a respiratory disease called Sarcoidosis. It is an autoimmune disease which can affect multiple organs but most commonly affects lungs. Lupus pernio causes major cosmetic effects such as scarring and dark patches which is distressing to the patient. Sarcoidosis can also cause skin growth on scars or tattoos. It can also lead to red brown to purple bumps or acne-like lesions on the skin which are typically seen on face or arms and legs.
o Yellow nail syndrome: Yellow (or occasionally green) nail discoloration is the most obvious clue to diagnosis. The nails are characteristically thick with horizontal ridging on an otherwise smooth surface and with a slow growth rate. Also seen with this are swelling of the legs and is due to obstruction of lymph flow. It is a rare condition but when present demands immediate medical attention.
o Herpes labialis: Rash of the skin and mucous membranes visible around the lips is seen in this condition. The rash can develop into blisters and cause a burning pain on the skin. It is a non-specific sign which can be seen in severe bacterial infections of lung.
There are many other signs or symptoms that can be noticed on the skin associated with respiratory diseases such as painless nodules on the skin, raised red rashes, very itchy raised rash/patches or change in the size or colour of already existing scar. Such changes on skin are commonly ignored but we should remember that our skin is a gateway and indicator of the well-being of our body’s internal organs. Hence it is advisable to seek your doctor’s help if you notice any of the above signs or symptoms for a timely diagnoses and early treatment of the disease.
The author is a Consultant, Pulmonary Medicine at Sir HN Reliance Foundation Hospital. Views expressed are personal.
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