Derm Cases · Dermatology / Internal medicine / Oncology
OSCE — skin as a window: map cutaneous signs to systemic disease
An 8-minute OSCE station on high-yield cutaneous markers of systemic disease — endocrine, autoimmune, gastrointestinal, haematologic and paraneoplastic — with focused investigation pathways for each presented sign.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on high-yield cutaneous markers of systemic disease — endocrine, autoimmune, gastrointestinal, haematologic and paraneoplastic — with focused investigation pathways for each presented sign.
Brief (to candidate)
Examiners present a rapid series of skin findings: velvety neck hyperpigmentation; yellow pretibial plaques; pruritic vesicles on elbows; heliotrope rash with Gottron papules; wood-grain erythema of the trunk; and velvet thickening of the palms. You have 8 minutes to name each marker, the systemic disease it signals, and the first investigation.
[12]Candidate instructions
- Map endocrine/metabolic skin signs (acanthosis nigricans, necrobiosis lipoidica).
- Link autoimmune/GI markers (DH–coeliac; pyoderma/EN–IBD; dermatomyositis).
- Identify paraneoplastic red flags (Leser-Trélat, tripe palms, erythema gyratum repens, necrolytic migratory erythema).
- Prioritise urgent malignancy pathways vs metabolic work-ups.
- Communicate that skin may be the first clue to internal disease.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Metabolic | Acanthosis nigricans → insulin resistance/metabolic syndrome (and malignant AN if rapid/oral/triad with weight loss); necrobiosis lipoidica → diabetes association and glycaemic assessment[2][4] |
| GI / coeliac | Dermatitis herpetiformis → coeliac disease (tTG-IgA; DIF granular IgA; gluten-free diet ± dapsone)[5] |
| IBD skin | EN and pyoderma gangrenosum as extraintestinal IBD markers — GI history and directed investigation[11] |
| Dermatomyositis | Heliotrope, Gottron papules, shawl sign → myositis work-up and age-appropriate cancer screen (esp. adult-onset)[3] |
| Paraneoplastic core | Erythema gyratum repens (wood-grain) highly paraneoplastic; tripe palms ± malignant acanthosis nigricans → upper GI/aerodigestive malignancy pathway; necrolytic migratory erythema → glucagonoma/glucagon assay and pancreatic imaging; explosive seborrhoeic keratoses (Leser-Trélat) → occult malignancy evaluation when classic context present[7][8][9] |
| Urgency triage | Rapid progressive signs + weight loss/older adult → expedited malignancy work-up (not watchful waiting) |
| Communication | Explain skin finding as a clue, not a complete diagnosis; arrange appropriate specialty referral |
Model key actions
- Pair each sign with its systemic partner (DH–coeliac, NL–diabetes, DM–malignancy risk, EGR/tripe palms–cancer, NME–glucagonoma).[3][5][7][9]
- Escalate paraneoplastic markers to urgent internal/oncologic investigation.[8]
- Use IBD-associated rashes to trigger GI assessment.[11]
Common errors
- Treating only the rash and missing the systemic diagnosis.
- Labelling all acanthosis nigricans as benign obesity without considering malignant AN red flags.
- Missing cancer screening in adult dermatomyositis.
- Confusing EN with infectious cellulitis without trigger search.
- Delaying work-up of erythema gyratum repens or tripe palms.
References9ShowHide
- [2]Ambalal SM. Metabolic Syndrome and Skin: Interactions and Implications. Indian journal of dermatology, 2022.PMID 36092223
- [3]DeWane ME, Waldman R, Lu J. Dermatomyositis: Clinical features and pathogenesis. Journal of the American Academy of Dermatology, 2020.PMID 31279808
- [4]Liu M, Li J. Necrobiosis Lipoidica. New England Journal of Medicine, 2024.PMID 38169491
- [5]García C, Araya M. Dermatitis herpetiformis and celiac disease. Revista medica de Chile, 2021.PMID 35319687
- [7]Votquenne N, Richert B. Erythema Gyratum Repens. JAMA Dermatology, 2020.PMID 32584932
- [8]Boyce M, Flower C. Tripe Palms. New England Journal of Medicine, 2022.PMID 35866753
- [9]Tolliver S, Graham J, Kaffenberger B. A review of cutaneous manifestations within glucagonoma syndrome: necrolytic migratory erythema. International journal of dermatology, 2018.PMID 29450880
- [11]Rogler G, Singh A, Kavanaugh A, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology, 2021.PMID 34358489
- [12]Vella J. Cutaneous Markers of Systemic Disease in the Lower Extremity Clin Podiatr Med Surg, 2016.PMID 27215161