Complexion

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Abnormalities of complexion may be tirst noticed by patients or by their friends or relations. Tile colour of the face depends upon variations in oxyhaemoglobin, reduced haemoglobin, melanin and, to a lesser extent. carotene-Unusual skin colours, excluding those which have been applied externally, are due to abnormal pigments such as the sallow brownish tinge seen in uraemia. The bluish tinge

MACLEOD'S CLINICAL EXAMINATION

Brownish Tinge Uraemia

Fig. 2.2 Bilateral Dupuytren's contracture wilh thickening and shortening of palmar fascia resulting in flexion deformities.

TABLE 2.2 Examples of abnormal facial expressions

Features

Diagnosis

TAB LE 2.1 Some information available from a normal handsha ke

Features

Diagnosis

Large hands with excessive sweating Hot and sweaty hands Cold and sweaty hands Dry and coarse skin Delayed relaxation of grip

Acromegaly Thyrotoxicosis Anxious Hypothyroidism Dystrophia myotonica

Fig. 2.2 Bilateral Dupuytren's contracture wilh thickening and shortening of palmar fascia resulting in flexion deformities.

TABLE 2.2 Examples of abnormal facial expressions

Features

Poverty ol expression Startled

Apathy and poverty of expression

Agitation

Peering

Apparent indifference

Diagnosis

Parkinsonism

Hyperthyroidism

Depression

Hypomania

Myopia

Dissociative (conversion) disorder

TAB LE 2.1 Some information available from a normal handsha ke

Features

Diagnosis

Large hands with excessive sweating Hot and sweaty hands Cold and sweaty hands Dry and coarse skin Delayed relaxation of grip

Acromegaly Thyrotoxicosis Anxious Hypothyroidism Dystrophia myotonica of 'enterogenous' cyanosis, produced by abnormal haemoglobins such as sulphaemoglobin and methaemoglobin, may he caused by drugs such as dapsone and some sulphonamides.

The pink colour characteristic of carbon monoxide poisoning from coal gas is due to excessive carboxy-haemoglobin in the blood. Metabolites of some drugs cause striking abnormal coloration of the skin, for example mepacrine (yellow), clofazamine (red) and phenothiazines (slate grey on exposed areas) (fig. 2..HA). The appearance of skin complexion may be influenced by artificial lighting.

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