Skin, bronze

Skin, bronze: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)

The result of excessive circulating melanin, a bronze skin tone tends to appear at pressure points—such as the knuckles, elbows, toes, and knees—and in creases on the palms and soles. Eventually, this hyperpigmentation may extend to the buccal mucosa and gums before covering the entire body. Because bronzing develops gradually, it’s sometimes mistaken for a suntan. However, the hyperpigmentation can affect the entire body, not just sun-exposed areas: Sun exposure deepens the bronze color of exposed areas, but this effect fades. In fair-skinned patients, the bronze tone can range from light to dark. The tone also varies with the disorder.

History and physical examination

Begin by asking the patient when the hyperpigmentation first appeared. Has its hue changed? When was he last exposed to the sun or artificial tanning source? Also, ask about a history of infection, illness, surgery, or trauma. Does he have abdominal pain, weakness, fatigue, diarrhea, or constipation? Has he recently lost weight? If the patient is receiving maintenance therapy for adrenal insufficiency, has his dosage been increased?

Examine the mucosa, gums, and scars for hyperpigmentation. Check for signs of dehydration and for abdominal distention, loss of body hair, and tissue and muscle wasting. Palpate for hepatosplenomegaly.

Medical causes

Adrenal hyperplasia

The skin assumes a dark bronze tone within a few months. Other findings include visual field deficits and headache (from an expanding pituitary lesion), and signs of masculinization in females.

Biliary cirrhosis

This disorder causes bronze skin from melanosis of exposed areas of jaundiced skin: eyelids, palms, neck, and chest or back. The patient may also experience generalized pruritus, weakness, fatigue, jaundice, dark urine, pale stools with steatorrhea, decreased appetite with weight loss, and hepatomegaly.

Chronic renal failure

The skin becomes pallid, yellowish bronze, dry, and scaly. Other findings include ammonia breath odor, oliguria, fatigue, decreased mental acuity, seizures, muscle cramps, peripheral neuropathy, bleeding tendencies, pruritus and, occasionally, uremic frost and hypertension.

Hemochromatosis

An early sign is progressive, generalized bronzing accentuated by metallic gray-bronze skin on sun-exposed areas, genitalia, and scars. Mucous membranes are affected less often. Early associated effects include weakness, lethargy, weight loss, abdominal pain, loss of libido, polydipsia, and polyuria.

Malnutrition

As weight loss depletes body nutrients, bronzing develops along with apathy, lethargy, anorexia, weakness, and slow pulse and respiratory rates. Patients may develop paresthesia in the extremities; dull, sparse, dry hair; brittle nails; dark, swollen cheeks; dry, flaky skin; red, swollen lips; muscle wasting; and gonadal atrophy in males.

Primary adrenal insufficiency

Bronze skin is a classic sign. Other findings include axillary and pubic hair loss, vitiligo, progressive fatigue, weakness, anorexia, nausea and vomiting, weight loss, orthostatic hypotension, weak and irregular pulse, abdominal pain, irritability, diarrhea or constipation, amenorrhea, and syncope.

Wilson’s disease

Kayser-Fleischer rings—rusty brown rings of pigment around the corneas—characterize this disease, which may cause skin bronzing. Other effects include incoordination, dysarthria, chorea, ataxia, muscle spasms and rigidity, abdominal distress, fatigue, personality changes, hypotension, syncope, and seizures.

Other causes

Drugs

Prolonged therapy with high doses of a phenothiazine may cause gradual bronzing of the skin.

Special considerations

Prepare the patient for the adrenocorticotropic stimulation test, thyroid function studies, complete blood count, electrolyte analysis, electrocardiography, and a computed tomography scan of the pituitary gland.

Pediatric pointers

Celiac disease can cause bronze skin in young children. Bronzing begins with the introduction of cereals and usually subsides later in childhood or adolescence. It also stems from adrenoleukodystrophy, a rare but life-threatening X-linked recessive disorder that affects boys and young men.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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