Hello Muddah, Hello Faddah: Twenty reasons to keep an eye on your skin

Allan Sherman attained fame with his humorous song “Hello Muddah, Hello Fadduh” about a child’s experiences, bad and good, at camp. You may recall that Joe Spivey, one of the tune’s subjects, suffered from poison ivy, an unpleasant affliction which hinted at another of Sherman’s songs, “You Gotta Have Skin.” 

As the ditty goes, without our skin it would be rather problematic to walk around and, that aside, this largest of organ systems protects us from drying up like a prune, moderates heat loss, and provides a canvas for bodily adornments.

Last month I enumerated 20 ways that observant pilots (although that is rather redundant; all pilots are observant!) could use their nails as a window into bodily functions. Continuing that theme, let’s explore how our skin can be similarly informative. If the eyes are the window to the soul, our skin can be a window into, well, everything! Numerous diseases afflict the skin, and I shall touch on those, but there are some fascinating clues to deeper, darker secrets that a skin spot check – please forgive the awful puns – can uncover. So, what I thought would be fun (I know, I need to get out more often) would be to look at some of the internal diseases skin problems can hint at. If you notice one of these issues, take your skin – and the rest of you – to a doctor as early intervention is always a smart move.

  1. As alluded to above, Joe Spivey contracted poison ivy while hiking, doubtless in the woods. It's one of a family of plants capable of inducing profound and intense itching, and the slightest exposure can trigger an attack. Characterized by red, raised lines, if exposed, immediately wash thoroughly in warm soapy water, dab dry, isolate the afflicted area with a dressing, and immediately wash your towel. Treatment with anti-itch hydrocortisone cream or even a steroid dose pack may be required to defeat the itch. Why does one refer to people as happy campers when this activity involves sleeping on rough ground, being exposed to biting cold, biting insects, and poison ivy? Surely unhappy campers is more appropriate!
  2. Foraging for fabulous forest fungi (avoiding poison ivy, sumac, and oak, of course) is a fun and rewarding pursuit. Finding fungus on your body is quite the opposite. Usually found in warm, moist areas of the body, it causes skin redness, irritation, and swelling. Avoidance is always preferable – good and regular hygiene, keeping weight in check, and wearing loose-fitting clothes helps. Treatment with antifungal creams or even tablets may be needed and it can take many months to render your skin fungus-free.
  3. There are many infections that show signs on the skin; the rash of measles is well known but 2–3 days before it declares itself, tiny Koplik’s spots are seen inside the mouth. Resembling tiny grains of white sand surrounded by a red ring, they are pathognomic (meaning they are unique to measles), and their presence allows healthcare professionals to predict outbreaks and isolate patients as measles is highly infectious.
  4. Chickenpox causes multiple small blisters all over the body and, combined with a general feeling of malaise, this is no fun, especially when it strikes older people. In fact, the causative virus can remain dormant inside nerves and reappear months, or even years, later when one is tired or otherwise debilitated and it produces a red, intensely painful rash called shingles. This is characterized by having a clearly defined boundary and it does not cross the midline of the body. Hence, sufferers may see this appear on just one side of their face or body.
  5. Every year people die needlessly from meningitis, a nasty infectious disease causing swelling of the membranes surrounding the brain. Before things get really serious, a telling rash with small, red pin-sized dots appears. So, if one has an unremitting or worsening headache, sensitivity to light, pain on moving the head and neck, and a rash, firewall your throttle and get to the doctor. Since meningitis is common in situations where people live in close proximity, it astonishes me that colleges do not demand vaccination prior to enrollment – the military certainly, and appropriately to my mind, does.
  6. I have written in the past about bedbugs and there is no harm mentioning them again. These little monsters having a nocturnal nosh fest on your skin while you sleep will present you with multiple, phenomenally itchy red bite marks. A prior article in this series referenced a number of other mites that bite.
  7. Erysipelas, otherwise known as St. Anthony’s Fire, is a nasty skin infection characterized by a red inflamed rash on the face, limbs, or body. Caused by Streptococcus bacteria, it is accompanied by a fever, shaking, and feeling ill. If you or someone you know experiences these symptoms, get to a doctor now! All I need say to encourage you is that one possible sequel if this is left untreated is the awful – but accurate – flesh-eating bacterial infection occurring.
  8. The endocrine system refers to those organs that make hormones, chemical messengers vital to good health. When not functioning properly, the thyroid, the human equivalent of an aircraft throttle, causes some noticeable changes to the skin and its appendages. For instance, if not enough thyroid hormone is produced, the skin will become dry, nails brittle, and hair will be lank and may well fall out.
  9. When he was elected to office in 1960, JFK’s opponents claimed he had Addison’s disease. Kennedy’s people responded with a tricky statement proclaiming that he did not have this adrenal gland disease caused by tuberculosis, and thus implying he did not have the condition. Well, he may not have had TB, but he certainly had Addison’s disease (and thyroid problems) and he took steroids to control this. The condition causes many symptoms, and was probably behind a couple of collapses the President suffered, but darkening of the skin occurs and is quite characteristic.
  10. Another manifestation of an endocrine disease affecting the adrenal gland is Cushing’s disease or syndrome. One sees a range of signs and symptoms but the most visible is the development of a “buffalo hump” on the upper back. This also occurs with steroid medication.
  11. Dimples are said to be a sign of beauty, but if one develops a circumscribed area with multiple dimples doctors will be concerned that there is a cancer lurking directly underneath, tethering the skin and creating small pits.
  12. Small patches of darker skin with velvety little tags suggest Acanthosis nigricans. Often seen in skin creases or the armpit, it is found in those with diabetes and those about to develop diabetes, and may suggest there is a cancer somewhere in the body, most notably the stomach.
  13. Another example of a skin change suggesting something odd going on elsewhere in the body is the presence of small, dark spots in and around the mouth, near the nose and mouth, and around the anus. This hints that the person may have Peutz-Jeghers syndrome, a condition where polyps develop throughout the gut that may bleed and may eventually become malignant.
  14. Another gut and mouth association is seen in Osler-Weber-Rendu Syndrome, a hereditary condition with multiple aberrant tangles of blood vessels throughout the intestine that have a tendency to suddenly bleed. The presence of thin webs of red blood vessels (telangiectasia) around the mouth suggests this problem may be hiding in plain sight.
  15. Osler’s nodes are tender, raised, red bumps that tend to have a pale center. The pain often comes before the lump is seen and they are frequently seen on fingers and toes. Worthy of notice, they suggest there is a potentially really dangerous heart infection going on and they should not be ignored.
  16. Butterflies are beautiful, delicate, and a sight that suggests peaceful summer afternoons in the country to me. However, if I see a rash on the face that has the shape of a butterfly, it suggests something entirely different – Systemic Lupus Erythematosis, or “SLE.” This is one of the “connective tissue disorders,” more common in women, and it affects multiple parts of the body.
  17. Small red skin dots can mean many different processes are going on; one that merits inclusion here is due to platelets, blood components involved in clotting, being consumed in the spleen. Such a rash should be addressed quickly as the underlying condition can otherwise lead to massive bleeding if not treated.
  18. As if a sore throat is not problematic enough, when the causative organism is a Streptococcus bug, one may also develop Erythema nodosum, small painful red lumps originating in the fat below the skin. It can also be caused by various cancers or inflammation of the bowel in Crohn’s disease or ulcerative colitis.
  19. Another of the red rashes is Erythema multiforme. As its name suggests, it can have many appearances. Caused by similar triggers to Erythema nodosum, it also merits medical review to rule out serious illness.
  20. Doctors do not see too much scurvy or other vitamin deficiency–induced diseases these days unless someone is sick from other causes, such as Pernicious anemia or cancer. However, if a person is short of one of these vital amines it can manifest itself with a range of skin rashes, as well as changes to the hair and nails.

There are certainly many things that can go wrong with your body and the above is a mere sampling. So eat well, exercise, and laugh often, and if you see something odd, don’t contact your muddah or faddah, but call the doctor. As Sherman said:

So whether you’re fat, tall, big, small, chubby or thin, 
Ain’t ya glad you’ve got skin?

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification

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