Skin disorders and thyroid diseases
Tóm tắt
Thyroid disorders have a high prevalence in medical practice; they are associated with a wide range of diseases with which they may or may not share etiological factors. One of the organs which best show this wide range of clinical signs is the skin. This review is an attempt to approach most of the dermopathies reflecting several degrees of harmfulness, coming directly or indirectly from thyroid abnormalities, as well as to update current knowledge on the relationship between the thyroid and skin. We have proposed a primary classification of skin disorders, regarding thyroid involvement, into two main groups: 1) dermopathies associated with thyroid abnormalities, mainly with autoimmune thyroid diseases, like melasma, vitiligo, Sjögren’s syndrome, alopecia, idiopathic hirsutism, pre-menstrual acne, bullous diseases, connective tissue diseases, hamartoma syndrome, atopy, leprosy and DiGeorge anomaly; and 2) dermopathies depending on the nature of the thyroid disorder, in which the evolution and outcome of the skin disorder depend on the thyroidal treatment in most cases, such as trophism and skin blood flow, myxedema, alopecia, onychodystrophy, hypo- and hyperhidrosis, xanthomas, intraepidermal bullae, carotenodermia, pruritus, flushing, pyodermitis, palmoplantar keratoderma, ecchymosis, etc. In some other cases, the skin disease which developed as a consequence of the thyroid abnormality can remain unaltered despite functional treatment of the thyroid problem, such as pretibial myxedema, thyroid acropachy and some cutaneous manifestations of multiple endocrine neoplasia types 2A and 2B.
Tài liệu tham khảo
Niepomniszcze H., Huaier Amad R. Skin disorders associated with and dependent on thyroid abnormalities. Thyroid International 1998 (Suppl. 1): 1–11.
Lutfi R.J., Fridmanis M., Misiunas A.L., Pafume O., González E.A., Villemur J.A., Mazzini M.A., Niepomniszcze H. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J. Clin. Endocrinol. Metab. 1985, 61: 28–31.
Diven D.G., Gwinup G., Newton R.C. The thyroid. Dermatol. Clin. 1989, 7: 547–558.
Kemp E.H., Gawkrodger D.J., MacNeil S., Watson P.F., Weetman A.P. Detection of tyrosinase autoantibodies in patients with vitiligo using 35S-labeled recombinant human thyrosinase in a radioimmunoassay. J. Invest. Dermatol. 1997, 109: 69–73.
Kemp E.H., Waterman E.A., Gawkrodger D.J., Watson P.F., Weetman A.P. Autoantibodies to tyrosinase-related protein-1 detected in the sera of vitiligo patients using a quantitative radiobinding assay. Br. J. Dermatol. 1998, 139: 798–805.
Kemp E.H., Gawkrodger D.J., Watson P.F., Weetman A.P. Autoantibodies to human melanocyte-specific protein pmel 17 in the sera of vitiligo patients: a sensitive and quantitative radioimmunoassay (RIA). Clin. Exp. Immunol. 1998, 114: 333–338.
Niepomniszcze H. Estudios interdisciplinarios de las enfermedades tiroideas. Rev. Argent. Endocrinol. Metab. 1993, 30 (Suppl.): 6–7.
Niepomniszcze H., Lutfi R.J., Misiunas A.L., Mazzini M., Fridmanis M. Diferencias entre varones y mujeres en la asociación de tiroideopatías con vitiligo. Rev. Argent. Endocrinol. Metab. 1989, 26: 48.
Hegedus L., Heidenheim M., Gervil M., Hjalgrim H., Hoier-Madsen M. High frequency of thyroid dysfunction in patients with vitiligo. Acta Derm. Venereol. 1994, 74: 120–123.
Behrens-Williams S.C., Peters E.M., Schallreuter K.U. In vivo delayed-type hypersensitivity in 109 patients with vitiligo. Int. J. Dermatol. 2000, 39: 593–598.
Ito M., Kojima T., Miyata M., Saka M., Kokubun M., Ohira H., Ishikawa H., Kuroda M., Sato Y., Takagi T. Primary biliar cirrhosis (PBC) CREST overlap syndrome complicated by Sjögrens syndrome and arthritis. Intern. Med. 1995, 34: 451–454.
Nogita T., Aramoto Y., Terajima S., Akimoto K., Kawashima M., Hidano A., Matsugami K., Mochizuki T. The coexistence of psoriasis vulgaris, Sjögrens syndrome and Hashimoto’s thyroiditis. J. Dermatol. 1992, 19: 302–305.
Chi H.I., Furue M., Ishibashi Y. Vogt-Koyanagi-Harada’s syndrome associated with Hashimoto’s thyroiditis. J. Dermatol. 1994, 21: 683–686.
McDonagh A.J., Messenger A.G. The pathogenesis of alopecia areata. Dermatol. Clin. 1996, 14: 661–670.
Sterzl I., Vavrejnova V., Matucha P. Extra-thyroid autoantibodies in autoimmune tiroiditis. Vnitr. Lek. 1996, 42: 733–737.
Asanuma N., Sakurai A., Aizawa T., Hashizume K. Alopecia universalis with remission during pregnancy and prednisolone therapy. Am. J. Med. Sci. 1997, 313: 67–69.
Niepomniszcze H., Lutfi R.J., Mazzini M., Fridmanis M., González E., Villemur J. High prevalence of subclinical thyroid abnormalities in patient with idiopathic hirsutism, acne or diffuse alopecia. Rev. Argent. Endocrinol. Metab. 1988, 25 (Suppl.): 20.
Dix J.H., Levy W.J., Fuenning C. Remission of acanthosis nigricans, hypertrichosis, and Hashimoto’s thyroiditis with thyroxine replacement. Pediatr. Dermatol. 1986, 3: 323–326.
Zettinig G., Weissel M., Flores J., Dudczak R., Vogelsang H. Dermatitis herpetiformis is associated with atrophic but not with goitrous variant of Hashimoto’s thyroiditis. Eur. J. Clin. Invest. 2000, 30: 53–57.
Coleman R., Hay R.J. Chronic mucocutaneous candidosis associated with hypothyroidism: a distinct syndrome? Br. J. Dermatol. 1997, 136: 24–29.
González-Gay M.A., Cereijo M.J., Agüero J.J., Alonso M.D., Fernández Sueiro J.L., Vidal J.I. Seronegative systemic lupus erythematosus and autoimmune thyroiditis. An. Med. Interna 1993, 10: 393–394.
Ibañez Estella J.A., Izquierdo Clemente C., Malumbres Juarros P., Rubio Montanes M.L., Sánchez Ibañez A. The CREST syndrome and Hashimoto’s thyroiditis, apropos a case seen in our primary care center. An. Med. Interna 1993, 10: 99–100.
Molnar I., Balazs C., Szabo E., Czirjak L. Evaluation of thyroid function and anti-thyroid autoantibodies in systemic sclerosis. Acta Derm. Venereol. 1992, 72: 112–114.
Yamamoto T., Yokoyama A. Association of generalized pustular psoriasis, Sjogren’s syndrome and Hashimoto’s thyroiditis. J. Dermatol. 1996, 23: 64–65.
Tornfohrde J., Silverman A., Barnes R., Fernández-Vina M.A., Young M., Lory D., Morris L., Wuepper K.D., Statsny P., Menter A. Gene for familial psoriasis susceptibility mapped to the distal end of human chromosome 17q. Science 1994, 264: 1141–1145.
Torma H., Karlsson T., Michaelsson G., Rollman O., Vahlquist A. Decreased mRNA levels of retinoic acid receptor alpha, retinoid X receptor alpha and thyroid hormone receptor alpha in lesional psoriatic skin. Acta Derm. Venereol. 2000, 80: 4–9.
Cox N.H., McCrea J.D. A case of Sjögren’s syndrome, sarcoidosis, previous ulcerative colitis and gastric autoantibodies. Br. J. Dermatol. 1996, 134: 1138–1140.
Perriard J., Saurat J.H., Harms M. An overlap of Cowden’s disease and Bannayan-Riley-Ruvalcaba syndrome in the same family. J. Am. Acad. Dermatol. 2000, 42: 348–350.
Marsh D.J., Coulon V., Lunetta K.L., et al. Mutation spectrum and genotype-phenotype analyses in Cowden disease and Bannayan-Zonana syndrome, two hamartoma syndromes with germline PTEN mutation. Hum. Mol. Genet. 1998, 7: 507–515.
Arch E.M., Goodman B.K., Wesep R.A., Liaw D., Clarke K., Parsons R., McKusick V.A., Geraghty M.T. Deletion of PTEN in a patient with Bannayan-Riley-Ruvalcaba syndrome suggests allelism with Cow-den’s disease. Am. J. Med. Genet. 1997, 71: 489–493.
Gorlin R.J., Cohen M.M.Jr., Condon L.M., Burke B.A. Bannayan-Riley-Ruvalcaba syndrome. Am. J. Med. Genet. 1992, 44: 307–314.
Gorlin R.J. Skin test for medullary thyroid carcinoma. N. Engl. J. Med. 1971, 284: 983–984.
Turktas I., Gokcora N., Demirsoy S., Cakir N., Onal E. The association of chronic urticaria and angioede- ma with autoimmune thyroiditis. Int. J. Dermatol. 1997, 36: 187–190.
Rumbyrt J.S., Katz J.L., Schocket A.L. Resolution of chronic urticaria in patients with thyroid autoimmunity. J. Allergy Clin. Immunol. 1995, 96: 901–905.
Garg R., Agarwal J.K., Singh G., Bajpai H.S. Thyroid function in leprosy. Indian J. Lepr. 1990, 62: 215–218.
Ishida Y., Obara A., Yoshino M., Harada N. A case of type 1 lepra reaction accompanied by secondary diabetes mellitus and hypothyroidism. Nippon Rai Gakkai Zasshi 1988, 57: 199–204.
Kalmus Y., Kovatz S., Shilo L., Ganem G., Shenkman L. Sweets syndrome and subacute thyroiditis. Postgrad. Med. J. 2000, 76: 229–230.
el-Fouly M.H., Higgins J.V., Kapur S., Sankey B.J., Matisoff D.N., Costa-Fox M. DiGeorge anomaly in an infant with deletion of chromosome 22 and dup (9p) due to adjacent type II disjunction. Am. J. Med. Genet. 1991, 38: 569–573.
Weiss M., Milman B., Rosen B., Zimlichman R. Quantitation of thyroid hormone effect on skin perfusion by Laser Doppler flowmetry. J. Clin. Endocrinol. Metab. 1993, 76: 680–682.
Dolu N., Süer C., Özesmi C., Kelestimur F., Özcan Y. Electrodermal activity in hypothyroid patients and healthy subjects. Thyroid 1999, 9: 787–790.
Pazos-Moura C.C., Moura E.G., Breitenbach M.M., Bouskela E. Nailfold capillaroscopy in hypothyroidism and hy-perthyroidism: blood flow velocity during rest and post-occlusive reactive hyperemia. Angiology 1998, 49: 471–476.
Itin P.H., Lautenschlager S. Palmoplanta keratoderma and associated syndrome. Semin. Dermatol. 1995, 14: 152–161.
Ohtsuka T., Yamakage A., Yamazaki S. Dermal mucinosis and musculoskeletal symptoms simulating polymyositis as a presenting sign of hy-pothyroidism. Eur. J. Dermatol. 1999, 9: 227–229.
Gambichler T., Linhart C., Wolter M. Mid-dermal elastolysis associated with Hashimoto’s thyroiditis. J. Eur. Acad. Dermatol. Venereol. 1999, 12: 245–249.
Velasco J.A., Santos J.C., Villabona V., Santana J. Reticular erythematous mucinosis and acral papu-lokeratotic lesions associated with myxoedema due to Hashimoto thyroiditis. Dermatology 1992, 184: 73–77.
Le Brun V., Boulinguez S., Bouyssou-Gauthier M.L., Roux J., Labrousse F., Bonnetblanc J.M., Bedane C. Pretibial epidermolysis bullosa and hypothy-roidism. Ann. Dermatol. Venereol. 2000, 127: 184–187.
Kantor G.R., Bernhard J.D. Investigation of the pruritic patient in daily practice. Semin. Dermatol. 1995, 14: 290–296.
Willemsen M.J., de Coninck A.L., Jonckheer M.H., Roseeuw D.I. Autoimmune thyroiditis and generalized granuloma annulare: remission of the skin lesions after thyrox-ine therapy. Dermatologica 1987, 175: 239–243.
Vázquez-López F., González-López M.A., Raya-Aguado C., Pérez-Oliva N. Localized granuloma annulare and autoimmune thy-roiditis: a new case report. J. Am. Acad. Dermatol. 2000, 43: 943–945.
Willemsen M.J., de Coninck A.L., Jonckheer M.H., Roseeuw D.I. Autoimmune thyroiditis and generalized granuloma annulare: remission of the skin lesions after thyroxine therapy. Dermatologica 1987, 175: 239–243.
Ahsan M.K., Urano Y., Kato S., Oura H., Arase S. Immuno histochemical localization of thyroid hormone nuclear receptors in human hair follicles and in vitro effect of L-triiodothyronine on cultured cells of hair follicles and skin. J. Med. Invest. 1998, 44: 179–184.
Kvicala J. Status and selenium intake as related to the thyroid gland in the population of Znojmo. Vnitr. Lek. 1996, 42: 738–742.
Kriss J.P. Pathogenesis and treatment of pretibial myxedema. Endocrinol. Metab. Clin. North Am. 1987, 16: 409–415.
Hornstein O.P. The thyroid gland, the parathyroid gland and the skin. Z. Hautkr. 1984, 59: 1125–1126, 1129–1132, 1137–1143.
Shishiba Y., Takeuchi Y., Yokoi N., Ozawa Y., Shimizu T. Thyroid hormone excess stimulate the synthesis of proteoglycan in human skin fibroblasts in culture. Acta Endocrinol. (Kbh.) 1990, 123: 541–549.
Targovnik H.M., Fernández H.R., Niepomniszcze H., Bruno O.D. Enfermedad de Graves-Basedow con eutiroidismo, mixedema pretibial y oftalmopatía infiltrativa. Rev. Hospital (Hospital de Clínicas-Buenos Aires) 1978, 6: 54–58.
Yamazaki S., Katayama I., Satoh T., Yokozeki H., Nishioka K. Acral ichthyosiform mucinosis in association with Sjögrens syndrome: a peculiar form of pretibial myxedema? J. Dermatol. 1993, 20: 715–718.
Stratakis C.A., Courcoutsakis N.A., Abati A., Filie A., Doppman J.L., Carney J.A., Shawker T. Thyroid gland abnormalities in patients with the syndrome of spotty skin pigmentation, myxomas, endocrine overactivity, and schwannomas. J. Clin. Endocrinol. Metab. 1997, 82: 2037–2043.
Rivollier C., Emy P., Armingaud P., Buzacoux J., Cadenas D., Legoux A., Esteve E. Notalgie paresthetica et neoplasie endocrinienne multiple de type IIA (Síndrome de Sipple): 3 cas. Ann. Dermatol. Venereol. 1999, 126: 522–524.
Toyota N., Asaga H., Hirokawa M., Iizuka H. A case of skin metastasis from follicular thyroid carcinoma. Dermatology 1994, 188: 69–71.
Ordonez N.G., Samaan N.A. Medullary carcinoma of the thyroid metastatic to the skin: report of two cases. J. Cutan. Pathol. 1987, 14: 251–254.
Ribera M., Calderón P., Barranco C., Ferrandiz C. Multiple polimatrixomas associated with myotonic distrophy and medullary carcinoma of the thyroid. Med. Cutan. Ibero Lat. Am. (Portugal) 1989, 17: 395–398.