Skin, bronze
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
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?
Physical assessment
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
With 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 such as clitoral enlargement, and male distribution of hair, fat, and muscle mass.
Biliary cirrhosis
Biliary cirrhosis 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.
Hemochromatosis
An early sign of hemochromatosis 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.
CULTURAL CUE:Hereditary hemochromatosis is the most common genetic disorder in whites, affecting 1 in 200 to 300 people of Northern European descent.
Malnutrition
As weight loss, which occurs from malnutrition, 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 of primary adrenal insufficiency. 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.
Renal failure (chronic)
With 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.
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.
Patient counseling
Encourage the patient to discuss his concerns about changes in body image. Encourage frequent rest periods if fatigue is a problem. A referral for nutritional counseling may be needed if the patient experiences weight loss, nausea, or vomiting.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Flaking skin
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- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Skin, mottled
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Skin, scaly
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- SKIN MASS
- "Differential Diagnosis in Primary Care" (2007)
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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Flaking skin
» Next page: Skin, clammy (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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