VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk
Pancreatic diseases can also manifest on the patient's skin. What skin changes may appear in the course of acute pancreatitis, and which ones in the course of oncological diseases of this gland? Find out how a diseased pancreas can manifest itself on the skin.
Symptoms of a diseased pancreas most often relate to ailments of the digestive system. The pancreas is a gland that plays an important role in the functioning of our body. It produces numerous hormones (between insulin and glucagon) and digestive enzymes. It happens, however, that a diseased pancreas also manifests itself on the skin.
Acute pancreatitis (acute pancreatitis) - what is it?
The essence of this disease is the destruction of the pancreas and surrounding tissues by premature activation of enzymes produced by this organ. The most common causes of acute pancreatitis are associated with diseases of the bile ducts, and more specifically - gallbladder stones and alcohol abuse. These two factors account for as much as 80% of PAD cases.
The most common symptoms of acute pancreatitis are:
- severe abdominal pain,
- nausea and vomiting,
- fever,
- increased abdominal wall tension,
- increased heart rate (tachycardia),
- in advanced cases, even: disturbed consciousness, drop in blood pressure.
Acute pancreatitis - skin symptoms
You should be aware that ACT can also manifest itself on the patient's skin. Skin symptoms in acute pancreatitis are:
- Gray-Turner symptom - results from the accumulation of hemorrhagic fluid in the subcutaneous tissue and takes the form of bluish-brown spots on the side surfaces of the trunk, this symptom does not occur often, because in about 5% of patients with acute pancreatitis,
- Cullen's symptom - in this situation, hemorrhagic lesions are located near the navel, it is worth being aware that this symptom is not only associated with acute pancreatitis, but may also occur in the course of ectopic pregnancy bleeding,
- symptom of Walzel - the occurrence of maruroid cyanosis in the skin of the trunk and abdomen, this symptom results from a disturbance of the venous circulation, and more specifically damage to the subcutaneous venous network,
- Fox symptom -a rare symptom in which hemorrhagic lesions are located below the inguinal ligament,
- subcutaneous tissue necrosis - is in the form of bumps or lumps located on the arms, trunk and buttocks, thighs and lower legs, these tumors can be painful and break, leaving scars. This symptom can also accompany pancreatic tumors. It should be differentiated from diseases such as erythema nodosum, periarteritis nodosa, and deep lupus.
Skin lesions in pancreatic cancer
When we talk about pancreatic cancer, we most often mean adenocarcinoma, which is responsible for 80% of pancreatic cancer cases. It is worth emphasizing that one of the symptoms of this cancer may be itchy skin - even without any skin changes. The skin may also take on a yellowish tinge (jaundice) due to the tumor pressing against the common bile duct.
What is more, pancreatic cancer, but also gastric cancer or colorectal cancer, can manifest as a tumor in the navel, called Sister Mary Joseph's tumor, which is a cancer metastasis to the peri-umbilical lymph nodes. It is named after the nurse who discovered the link first.
Pancreatic cancer may also be accompanied by the necrosis of the subcutaneous tissue described above. In addition, we can also meet with the Trousseau syndrome, or wandering, thrombophlebitis. It is manifested by the presence of swelling and redness in the vein, usually painful changes.
Skin lesions in hormonally active pancreatic tumors
We are talking about neuroendocrine neoplasms that arise from cells of the so-called diffuse endocrine system and are most often located in the pancreas, less often in the duodenum and stomach.
These neoplasms can secrete hormones, the action of which in turn predisposes to the appearance of skin changes.
Glukagonoma and Creeping Necrotic Erythema
This tumor arises from cells that produce the hormone glucagon. The hormone is primarily responsible for increasing blood glucose levels. The disease often develops diabetes, weight loss, diarrhea and anemia, i.e. a decrease in blood hemoglobin levels.
The most typical skin lesion for this neoplasm is the creeping necrotic erythema. It is characterized by oval-shaped redness in the center of which a blister appears. This blister breaks (ruptures) over time and a necrosis focus appears on the skin.
These changes are associated with the onset of pain and itching, and most often at the beginningare located on the skin of the lower extremities. Subsequently, they may also occupy other locations - primarily the perineum, the area around the mouth and the lower abdomen. Over time, the changes expand and take new locations.
Insulinoma
It is a tumor derived from insulin-producing cells, and therefore a hormone primarily responsible for lowering blood glucose levels. The symptoms of insulinoma form a characteristic triad called the Whipple triad, which includes:
- neurological symptoms resembling alcohol intoxication during fasting,
- these symptoms are accompanied by hypoglycaemia, i.e. a decrease in blood glucose levels,
- These symptoms disappear after the administration of carbohydrates - that is, when the blood glucose level rises.
The skin symptoms of this condition are not very specific and typically include pale skin accompanied by profuse sweating.
Gastrinoma - a gastrin tumor
It is derived from cells that produce gastrin - a substance that stimulates the production of hydrochloric acid by cells in the stomach.
The symptoms of the disease result primarily from the developing, resistant to treatment peptic ulcer disease (excess hydrochloric acid adversely affects the gastric mucosa and leads to its damage and ulcer formation).
The skin symptoms are similar to those of insulinoma, the skin is pale, drenched with sweat. Moreover, lipomas may appear on the skin.
Somatostatin tumor, or somatostatinoma
It is a tumor located in the pancreas that secretes somatostatin, a hormone that inhibits the secretion of other pancreatic hormones, which causes diabetes (insulin deficiency), as well as symptoms such as diarrhea, fatty stools, resulting from impaired secretion of digestive enzymes by the pancreas, which worsens the absorption and digestion of fats.
A typical skin lesion in a somatostatin tumor is yellowing of the skin, which results from the tumor pressing on the common bile duct.
VIPoma or Verner-Morrison syndrome
It is a tumor capable of producing VIP, or vasoactive intestinal hormone. It is associated with symptoms such as diarrhea as well as dehydration. The disease is accompanied by typical electrolyte disturbances (decrease in potassium levels, increase in chloride levels), which predisposes to abnormal heart function - more precisely, to arrhythmias.
Regarding the skin, this cancer mainly manifests itself as yellowing of the skin (jaundice) and also features of dehydration.
It is worth emphasizing that VIPoma may accompany the diseasegenetic - Recklinghausen disease, the symptoms of which include spots on the skin the color of "coffee with milk", as well as fibromas, neuromas and neurofibromas.
Pancreatic carcinoid tumor - carcinoid
This is a tumor that comes from cells that produce hormones such as prostaglandin and serotonin. It can be located in the pancreas, but also in the digestive tract - for example in the small intestine. The typical symptoms of a carcinoid tumor are related to the release of hormones and include:
- dizziness,
- increased heart rate (tachycardia),
- diarrhea,
- excessive sweating,
- bronchospasm,
- blood pressure rise or fall.
Regarding the skin, a carcinoid tumor typically presents as paroxysmal erythema in the face, neck, décolleté and chest area. Over time, paroxysmal skin changes last longer - they disappear more slowly. With time, telangiectasias appear on the skin, i.e. vascular spider veins.
To sum up, the skin can show us abnormalities concerning internal organs, so during diagnostics we should look at the patient as a whole and not be limited only to the area of the organism where the changes are present. The skin may show symptoms of pancreatic diseases, as well as heart, liver and respiratory diseases, so we should consult a doctor about any disturbing eruptions.