Thyroid problems are associated with a variety of skin-related symptoms and conditions.
The most common thyroid condition, hypothyroidism, is associated with a number of changes to the skin. These include:
- Skin that feels cold and dry to the touch
- Coarse, rough, itchy, and dry — or even very dry — skin, known as xerosis
- Dry, cracking elbows and heels
- A waxy-looking appearance to the skin
- A thickening of the skin on the soles of the feet and palms of the hands known as palmoplantar keratoderma
- Paleness in skin color
- A yellowish pigmentation of the skin called carotenemia
- Slow healing of skin wounds
Hair loss is another dermatological sign of hypothyroidism. The hair loss can be diffuse, from all over the body, or primarily from the head. A characteristic hypothyroidism sign is loss of hair from the outer edge of the eyebrows. The quality of the hair can also change and hair can become dry, coarse, brittle, and break easily. Hair also grows more slowly.
Swelling and puffiness is another common skin-related sign of hypothyroidism. The swelling is frequently seen in a number of areas, including:
- Around the eyes, under the eyes, and the eyelids
- The lips
- Facial skin
- Hands and feet
Hypothyroidism causes changes to the nails, including slow growth, thickening of nails, and more brittle nails that split or break easily.
Hypothyroidism can also cause a reduction or absence of sweating.
Hyperthyroidism has a number of skin-related signs and symptoms, including:
- Skin that is warm or hot and moist to the touch
- Skin that feels soft, velvety and very smooth
- Excessive sweating in the palms and hands
- Excessive sweating throughout the body
- Rashes in the folds of the skin
- Facial flushing
- Swelling in the palms
- Onchylosis, also known as Plummer’s nails — where the nails separate from the nail bed
Hair loss is also common in hyperthyroidism.
Autoimmune thyroid-related skin conditions
There are several thyroid-related skin conditions seen primarily in patients with autoimmune Graves’ disease, but can also develop in people with Hashimoto’s disease.
Pretibial myxedema involves the development of red or brownish thickened lesions, most commonly on the shins, and less commonly on the feet. Pretibial myxedema is also known as localized myxedema, thyroid dermopathy, and infiltrative dermopathy.
In pretibial myxedema, the skin may appear swollen, or with prominent hair follicles (sometimes described as appearing like the skin of an orange.) The skin often appears lumpy, thickened, or hardened, and the affected area is often itchy and may be painful. The skin may be discolored, ranging from violet to yellowish-brown. There is also frequently localized sweating and excessive hair growth over the affected skin.
Treatment of pretibial myxedema involves resolving the thyroid dysfunction as a key step. In some cases, topical, injected, or oral corticosteroids are used to reduce swelling and inflammation. The prognosis for pretibial myxedema is good. Most patients don’t need any treatment, as the condition frequently clears up when the thyroid imbalance is treated.
Thyroid acropachy is another dermatologic condition that is more common in autoimmune thyroid patients. In thyroid acropachy, fingers are clubbed, which means that they widen at the ends, and the nail bed raises. No specific treatment for acropachy of thyroid disease is available, but the condition usually resolves with proper thyroid treatment. Local corticosteroid therapy is sometimes used in more severe cases.
Chronic urticaria — also known as chronic hives — are swollen, pale red bumps or raised welts wheals on the skin. The hives are usually itchy. Chronic hives may resolve with normalization of thyroid function. In some cases, treatment with antihistamine drugs and/or topical anti-itch medications is needed.
Related skin conditions
There are several separate autoimmune skin conditions that are more common in people with autoimmune Hashimoto’s or Graves’ disease. These include:
- Alopecia Areata — which involves sudden loss of circular patches of hair, usually from the scalp, and less commonly, from the body.
- Vitiligo — where skin cells lose their pigment and show up as white patches. Vitiligo can appear anywhere but is most common over joints of the fingers, wrists, and knees.
There are no treatments that are proven effective against alopecia areata and vitiligo, but some results are seen with ultraviolet light therapy, steroid injections, and topical steroid treatment.