Health what does rheumatism do to the skin augsburger allgemeine

Health: What does the rheumatism do on the skin?

As if one disease wasn't enough: Many rheumatism patients are not only tormented by their joint problems, but also by massive skin symptoms. It's the same the other way around – skin patients often have rheumatic complaints as well. But why is that? Rheumatic illnesses, says private lecturer Dr. Hans Starz, senior physician at the Clinic for Dermatology and Allergology at Augsburg Hospital, are also caused by a dysregulation of the immune system. Over the activation of the immune system again it comes also to skin diseases. Inflammation is the common denominator, so to speak.

Rheumatism patients torment themselves with skin symptoms

Rheumatologists and dermatologists would each have a different focus in their approach to the problem and could complement each other very well. The dermatologist can see the changes in the skin directly and can easily take samples from the skin for microscopic examinations; the rheumatologist can assess not only joints, tendons, muscles and ligaments, but also the internal organs as an internist. "It's good for the patient when the information flows together," Starz emphasizes. "Together we are strong and can help the patient better."

The "rheumatic diseases with skin involvement" include first and foremost rheumatoid arthritis, formerly also called polyarthritis, the most common inflammatory disease of the joints in this country. In Germany, it is amed that there are around 800,000 sufferers – the majority of whom are women. In connection with the disease, one sees now and then "rheumatic nodules" on the skin, says Starz. These are small nodules in the subcutaneous tie, preferably in areas that are exposed to mechanical stress, such as the extensor side of the elbow.

Rheumatism comes with different subtypes

But that is not all. Skin bleeding or a net-like drawing on the skin can also be associated with rheumatoid arthritis. A noticeable skin sign in another rheumatic disease, lupus erythematosus (LE), is "butterfly erythema" on the face: a butterfly-shaped, symmetrical redness of the skin on the nose, forehead and cheeks. LE itself is a rare autoimmune disease, which means that the immune system is misregulated and attacks one's own body.

There are various subtypes of the disease, some concentrated more on the skin and others on other organs, reports Starz, who recently lectured on "Skin and Rheumatism" in Augsburg, Germany. The skin forms are "quite uncomfortable" and tend to scar. "They are not so easy to treat", regrets the dermatologist, a therapy "only from the outside", i.e. by creams or similar, unfortunately does not work in most cases.

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LE patients are also sensitive to the sun and often have mucosal changes, for example in the mouth, he said. Microscopically, characteristic patterns of inflammation can be seen in the skin. A non-specific skin change that can occur in LE is Raynaud's syndrome, a circulatory disorder that causes fingers to turn white.

Psoriasis affects skin and joints

Probably one of the best-known diseases that affect both skin and joints is psoriasis, medically called. "People used to think it was just a skin disease," says the senior physician. Today we know: "It is already an immune disease of the skin, but it can also affect other organs."The risk of a psoriasis patient also suffering joint reactions in the form of arthritis in the course of his or her life is between ten and 20 percent.

Also quite well known is Lyme disease, an infectious disease caused by Borrelia and transmitted by ticks. A characteristic, early sign of an infection is erythema migrans on the skin, the "wandering redness" that spreads in a ring around the puncture site. In the later course of the disease, however, inflammatory changes in the skin of the extremities and – among other things – joint involvement may also occur. "These symptoms of disease are mediated through the immune system," Starz says.

Rheumatism drugs cause side effects

Another important area of concern for both rheumatologists and dermatologists is the skin side effects of rheumatic drugs, as well as rheumatic symptoms as a side effect of skin therapies, Starz explains. There is also a well-known example of this: the drug cortisone, which as a potent anti-inflammatory can help quickly and effectively against rheumatic diseases, but in the long term not infrequently also leads to unpleasant side effects. Possible symptoms include a puffy face, "steroid acne" or stretch marks on the skin.

The situation is similar with a dangerous skin disease, malignant melanoma, also known as black skin cancer: Here, the modern drugs that are now available for its treatment also "often have unpleasant side effects," as Starz explains. Interferon, for example, stimulates the immune system and in this way can lead to immune reactions, also in the joints. "This can sometimes be life-threatening," says the senior physician.

And the new drug vemurafenib, which has significantly advanced melanoma therapy, causes joint pain in about one in five patients, among others. "The joint problem then comes to the fore for some patients." The success of therapy could be significantly improved – even in the case of already existing metastases – but often at the price of rheumatism.

The connection between skin conditions and joint problems is something really common, Starz emphasizes. "The immune system is not concentrated on just one organ." Patients often don't realize this: for many sufferers, this connection comes as a surprise.

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