Cutis
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Addison's disease is a potentially life-threatening endocrine disorder. The classic dermatologic sign of Addison's disease is diffuse hyperpigmentation of the skin with focal hyperpigmentation of scars, nails, and the oral mucosa. Recognition of these dermatologic manifestations in a patient with otherwise vague constitutional symptoms warrants a consideration of Addison's disease.
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For centuries, scurvy, or vitamin C deficiency, decimated crews of sailing ships on long sea voyages and populations deprived of fresh fruits and vegetables during times of war or famine. Today, scurvy is extremely rare in the United States, and its classic findings of perifollicular petechiae, edema and purpura of the lower extremities, corkscrew hairs, and hemorrhagic gingivitis may go unrecognized. ⋯ Both times, the patient underwent an extensive work-up and was diagnosed with numerous other conditions before his vitamin C deficiency was recognized. We discuss the clinical presentation, pathophysiology, diagnosis, and treatment of scurvy, with attention to specific findings that should alert the clinician to this diagnosis.