Dermatologist Dr Dray links cutaneous signs to hidden systemic disease

Dr Dray

Visible skin, nail, and hair changes act as vital cutaneous warning signs of underlying systemic conditions like insulin resistance, lipid disorders, and organ failure rather than being purely cosmetic issues.

AI-assisted summary of 7 Skin Signs That Could Reveal a Health Problem | Dermatologist Explains — original source. Check the original for full context.

Source published: 2026-08-26

Key ideas

Dark, velvety skin patches known as acanthosis nigricans are driven by hyperinsulinemia binding to epidermal receptors, serving as an early cutaneous marker of insulin resistance rather than poor hygiene. (0:28)
Eruptive xanthomas and xanthelasma can signal severe dyslipidemia and dangerously high triglycerides, a risk that spikes when medications like isotretinoin are paired with high-fat diets. (2:49)
Bilirubin buildup in jaundice stains mucous membranes and the sclera yellow, clearly distinguishing serious hepatobiliary and hemolytic disease from harmless dietary carotenoderma. (5:21)
Spoon-shaped nails (koilonychia) reflect systemic iron deficiency, a risk increasingly relevant for patients experiencing reduced caloric and nutrient intake on GLP-1 receptor agonists. (11:10)

Detailed notes

## Background Published on YouTube by dermatologist Dr. Dray on August 26, 2026, this video explores seven skin, hair, and nail changes that can provide clues about internal systemic health conditions. According to the page description, the guide covers how visible signs like dark velvety skin patches, yellow eye deposits, and nail distortions relate to underlying metabolic, autoimmune, organ, and nutritional disorders.

## TL;DR Dr. Dray details seven visible cutaneous clues that indicate systemic disease, including acanthosis nigricans tied to insulin resistance, xanthomas signaling dyslipidemia, and jaundice resulting from hepatobiliary issues or hemolysis. She also reviews nail clubbing linked to heart and lung disease, heliotrope rashes and Gottron papules characteristic of dermatomyositis, koilonychia from iron deficiency, and generalized intractable pruritus associated with renal, hepatic, or hematologic conditions. Throughout the discussion, she stresses that these manifestations are diagnostic clues rather than definitive diagnoses and advises patients to seek professional medical exams without concealing their nails under polish.

## Atmosphere & style The presentation is clinical, grounded, and engagingly candid, balancing serious medical insights with Dr. Dray's characteristic dry humor and relatable analogies. Her delivery feels practical and no-nonsense, employing vivid comparisons—such as likening full-body itching to being kicked in the stomach and playfully referring to the uvula as the 'little hangy ball thingy'—to demystify complex pathology. The overarching mood is educational and cautious, steering viewers away from panic and self-diagnosis toward informed, proactive healthcare consultations.

## Bulletin - [00:28](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=28s) Dark, velvety skin patches known as acanthosis nigricans are driven by hyperinsulinemia binding to epidermal receptors, serving as an early cutaneous marker of insulin resistance rather than poor hygiene. - [02:49](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=169s) Eruptive xanthomas and xanthelasma can signal severe dyslipidemia and dangerously high triglycerides, a risk that spikes when medications like isotretinoin are paired with high-fat diets. - [05:21](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=321s) Bilirubin buildup in jaundice stains mucous membranes and the sclera yellow, clearly distinguishing serious hepatobiliary and hemolytic disease from harmless dietary carotenoderma. - [11:10](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=670s) Spoon-shaped nails (koilonychia) reflect systemic iron deficiency, a risk increasingly relevant for patients experiencing reduced caloric and nutrient intake on GLP-1 receptor agonists.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=0s) Changes in the skin, hair, and nails serve as an external diagnostic window into systemic metabolic, autoimmune, and organ dysfunction. - [00:28](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=28s) Acanthosis nigricans occurs when elevated circulating insulin binds to keratinocyte and IGF receptors, triggering abnormal cell proliferation that cannot be resolved through scrubbing or cosmetic exfoliants. - [00:28](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=28s) Addressing underlying insulin resistance is the primary therapy for acanthosis nigricans, as off-label topicals like tretinoin and lactic acid offer only modest improvements and can irritate body folds. - [02:49](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=169s) Xanthelasma around the inner eye and eruptive xanthomas across the body represent focal dermal lipid deposits that warrant thorough blood lipid and triglyceride testing. - [02:49](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=169s) Isotretinoin therapy inherently elevates blood lipids, and combining it with a high-fat diet can trigger rapid outbreaks of eruptive xanthomas. - [05:21](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=321s) Jaundice stems from liver clearance failure, bile duct obstruction, or hemolytic anemia, and is clinically confirmed by checking the sclera, tongue, and uvula for yellow bilirubin staining. - [05:21](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=321s) Carotenoderma from heavy consumption of carotenoid-rich foods colors the skin orange but spares the sclera and mucous membranes, carrying zero systemic health risk. - [07:37](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=457s) Nail clubbing alters the normal Lovibond angle at the nail fold and often signals chronic hypoxia linked to serious lung, heart, or congenital conditions. - [09:23](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=563s) Wearing nail polish or artificial nails during a dermatology appointment impedes the clinical exam by hiding vital systemic diagnostic clues and potential nail unit cancers. - [09:23](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=563s) Purplish heliotrope eyelid rashes, Gottron papules on the knuckles, and ragged periungual nail capillaries are classic markers of dermatomyositis. - [09:23](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=563s) Dermatomyositis often impairs proximal muscle groups needed for basic tasks like combing hair or standing, though the amyopathic variant presents with cutaneous signs without muscle weakness. - [11:10](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=670s) Koilonychia produces concave, spoon-shaped nail depressions that typically point to iron deficiency in adults, though it is often a benign physiological variant in newborns. - [11:10](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=670s) GLP-1 receptor agonist medications can induce or worsen nutritional deficiencies like iron deficiency by drastically lowering caloric intake and slowing gastric emptying. - [12:50](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=770s) Severe generalized pruritus without a primary rash warrants immediate medical workup for underlying systemic conditions, including renal failure, liver disease, and thyroid dysfunction. - [12:50](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=770s) Aquagenic pruritus that reliably flares right after stepping out of the shower can be an early clinical warning sign of an underlying hematologic malignancy. - [14:17](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=857s) Cutaneous manifestations represent diagnostic clues rather than definitive home diagnoses, making professional medical evaluation preferable to unverified direct-to-consumer testing.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=0s) Skin as a Window into Internal Health and Acanthosis Nigricans

Dr. Dray introduces one of her core mantras: "your skin is a window to what is going on internally." The condition of skin, hair, and nails can yield vital clues about lurking systemic health issues. Rather than being purely cosmetic problems, visible changes often alert patients and clinicians to underlying disorders.

The first major finding to monitor is the appearance of dark, velvety, thickened patches. These characteristically occur on the back of the neck, under the arms, along the sides of the face, and across the backs of the hands. Patients often mistakenly believe the discoloration is caused by accidental sun exposure, lack of hygiene, or embedded dirt. Consequently, they attempt to vigorously scrub the area, apply heavy chemical exfoliants, or use vitamin C serums, only to find the condition completely unchanged. Dr. Dray emphasizes that this is neither dirt nor standard hyperpigmentation, but rather epidermal thickening known as acanthosis nigricans, which should never be ignored. It serves as an overt cutaneous warning sign of underlying insulin resistance, a state that can progress to diabetes and trigger serious cardiometabolic damage.

```mermaid flowchart LR accTitle: Mechanism of Acanthosis Nigricans accDescr: Flowchart illustrating how insulin resistance leads to epidermal thickening. subgraph S1["Systemic State"] A["Insulin Resistance"] --> B["Sky-high Circulating Insulin"] end subgraph S2["Cutaneous Response"] B --> C["Stimulation of Keratinocyte Receptors"] C --> D["Abnormal Proliferation of Keratinocytes"] D --> E["Acanthosis Nigricans"] end ```

The underlying biological mechanism involves keratinocytes (skin cells), which bear receptors for insulin and insulin-like growth factor. When circulating insulin levels become excessively elevated due to receptor resistance throughout the body, the excess insulin stimulates these epidermal receptors, driving keratinocytes to proliferate abnormally and rapidly. Intervening against insulin resistance as soon as possible is critical to stop the progression of these lesions and protect overall health. However, even after metabolic parameters normalize, acanthosis nigricans can linger and prove stubborn to resolve. While topicals like tretinoin, lactic acid formulations (such as AmLactin), and newer options are used off-label to smooth the skin, they offer only modest improvement and can easily irritate sensitive body folds. Resolving the root metabolic dysfunction remains the essential therapy.

- Common anatomical locations: posterior neck, axillae (underarms), lateral face, and dorsal hands. - Pathophysiology: hyperinsulinemia binds insulin and IGF receptors on keratinocytes, inducing rapid cellular proliferation. - Topical management attempts: tretinoin, AmLactin (lactic acid), though both risk fold irritation and cannot replace metabolic correction.

---

[02:49](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=169s) Xanthomas, Xanthelasma, and Lipid Metabolism

The second warning sign involves firm, yellow, flat-topped bumps that commonly crop up around the eyes. The skin on the eyelid is exceptionally thin and delicate, making it a frequent site for xanthelasma—a localized form of xanthoma. These yellowish plaques, concentrated especially around the inner canthi of the eyelids, represent focal collections of lipid and fat deposits within the skin tissue.

While xanthelasma palpebrarum around the eyes is not an absolute, "slam down guarantee" of high cholesterol—as some individuals demonstrate normal serum lipids—its discovery warrants thorough blood testing. Elsewhere on the body, xanthomas correlate strongly with severe lipid metabolism disorders. In particular, eruptive xanthomas can suddenly appear as multiple firm yellow papules in response to a sudden, dramatic spike in circulating blood lipids or dangerously high triglycerides. Dr. Dray recalls a published medical case of a patient consuming an extreme butter-and-cheese diet who subsequently erupted in widespread xanthomas.

Treatments exist to clear these lesions locally, including clinic-based electrocautery, but eyelid skin is prone to scarring, requiring extreme caution. Fortunately, controlling systemic lipids often allows xanthomas to regress naturally. Dr. Dray highlights a specific clinical trap for younger patients prescribed isotretinoin (Accutane) for acne: isotretinoin inherently raises blood lipid levels mildly. If a patient combines that treatment with a diet heavy in fried, high-fat foods, this synergistic spike can overwhelm lipid clearance and induce extensive eruptive xanthomas.

- Nature of lesions: localized dermal accumulations of lipids and cholesterol esters. - Typical distribution: inner corners of eyelids (xanthelasma) or widespread across the body (eruptive xanthomas). - Clinical association: dyslipidemia, marked hypertriglyceridemia, and dietary extremes. - Medication risk factor: combining isotretinoin (Accutane) therapy with a high-fat/fried food diet. - Removal options: in-office electrocautery (with scarring risk) or resolution secondary to systemic lipid management.

---

[05:21](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=321s) Jaundice, Scleral Icterus, and Carotenoderma

The third critical sign is a yellowish discoloration affecting the skin and the whites of the eyes (scleral icterus). In individuals with deeper complexions, yellowing of the skin can be difficult to appreciate, frequently manifesting instead as a subtle greenish, sallow, or unwell undertone. In such cases, clinicians inspect the conjunctival sclera, the undersurface of the tongue, or the uvula (humorously dubbed the "little hangy ball thingy" at the back of the throat), which visibly pick up the yellow hue.

This discoloration indicates jaundice, caused by the systemic accumulation of bilirubin, a breakdown product of hemoglobin from red blood cells. Normally, the liver metabolizes, conjugates, and excretes bilirubin via bile ducts into the digestive tract. Jaundice arises when: 1. Hepatobiliary disease disrupts clearance—either hepatocellular dysfunction or a physical plumbing blockage within the gallbladder and bile duct systems. 2. Hemolytic anemia overloads the system—red blood cells break down prematurely at rates exceeding normal hepatic processing capacity ("basically, your blood cells, for whatever reason, are just blowing up and leaking stuff out").

Dr. Dray clarifies the vital distinction between true jaundice and benign carotenoderma. People who consume large quantities of carotenoid-rich vegetables—most commonly carrots—can develop orange-tinted skin. However, in carotenoderma, the whites of the eyes and mucous membranes remain completely white and unaffected because carotenoids do not exhibit the same affinity for elastic tissues as bilirubin. Carotenoderma carries zero systemic danger and clears as dietary intake drops.

---

[07:37](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=457s) Nail Clubbing and the Importance of the Cutaneous Exam

The fourth warning sign focuses on the digits: swelling at the tips of the fingers combined with downward curving of the nail plates, a physical finding known as clubbing. In clubbing, the distal phalanges become bulbous, and the normal anatomical angle between the nail plate and the proximal nail fold—known as Lovibond's angle—becomes flattened or reversed into an abnormal prominence.

Clubbing represents an abnormal tissue proliferation response typically linked to chronic low blood oxygen levels or vascular changes. It frequently signals serious underlying internal conditions, including chronic lung disease, structural heart conditions, and certain congenital anomalies. Any new-onset clubbing requires prompt medical workup. Poking fun at the term, Dr. Dray quips that she means changes in the finger, "not going out in, you know, the roof is on fire style, which I don't even think people do that much anymore."

This phenomenon demonstrates why a comprehensive dermatologic evaluation goes far beyond simple cosmetic work. Acknowledging the cynical stereotype that dermatologists merely focus on "filling and billing," Dr. Dray notes that high-volume cosmetic procedures help clinics "keep the lights on," but proper medical dermatology requires meticulous examination of the skin, hair, mucous membranes, and nails. Because systemic diseases stamp patterns across the nail apparatus, Dr. Dray emphasizes a crucial takeaway: patients should never attend a dermatology visit wearing opaque nail polish or artificial nails, as hiding the nail beds conceals vital diagnostic clues.

[09:23](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=563s) Nail Polish at the Dermatologist and Recognizing Dermatomyositis

Dr. Dray emphasizes why showing up to a skin exam with painted nails is a major obstacle for a clinician. She compares it to arriving at an appointment "wrapped up in a bag the entire time" and expecting the doctor to examine your skin—it simply cannot be done. Nails covered in polish or artificial adornments prevent dermatologists from evaluating crucial clues underneath, including nail unit cancers.

Moving to more subtle clinical presentations, Dr. Dray warns about an easily overlooked yet critical warning sign: an unusual rash appearing on the knuckles, the eyelids, or both. This purplish-red discoloration is often described clinically as "heliotrope-like." When accompanied by reddish, violaceous bumps directly over the knuckles—known as Gottron papules—it serves as a classic hallmark of the autoimmune condition dermatomyositis. Beyond the rash, patients may notice that their fingernails appear ragged. When evaluated under a dermatoscope, clear abnormalities and microvascular changes emerge in the periungual capillaries surrounding the nail bed.

```mermaid flowchart TD accTitle: Clinical Features of Dermatomyositis accDescr: Visual mapping of cutaneous and muscular presentations associated with dermatomyositis variants.

subgraph Cutaneous ["Cutaneous Signs"] H["Heliotrope Rash (Purplish-red eyelids)"] G["Gottron Papules (Violaceous knuckle bumps)"] N["Ragged Nails & Capillary Changes"] end

subgraph Systemic ["Musculoskeletal Presentations"] C["Classic Dermatomyositis (With Proximal Muscle Weakness)"] A["Amyopathic Variant (Skin findings without weakness)"] end

Cutaneous --> C Cutaneous --> A ```

Dermatomyositis frequently manifests with profound proximal muscle weakness, which targets the muscles closest to the body's trunk. Patients often recognize this when everyday movements become exhausting: - Struggling to comb hair because lifting the arms overhead feels impossible. - Feeling utterly wiped out simply trying to transition from a seated position to standing up. - Dr. Dray highlights a crucial exception: *amyopathic dermatomyositis*. In this clinical variant, individuals exhibit the signature cutaneous findings on the eyelids, knuckles, or nail folds without experiencing any muscle weakness. Therefore, the absence of physical fatigue should never deter someone from getting these rashes evaluated.

[11:10](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=670s) Spoon-Shaped Nails (Koilonychia), Nutrition, and GLP-1 Medications

Nails represent an intricate specialty within dermatology, and another finding worth noting is unusually thin, spoon-shaped nails—a condition medically termed koilonychia. In this presentation, the lateral edges of the nail flare outward while the center sinks inward, creating a distinct depression shaped like a tiny cup. Dr. Dray notes you could practically place a little drop of water right in the middle of it.

Koilonychia is a classic warning sign of iron deficiency, which remains the single most common nutritional deficiency worldwide. Dr. Dray connects this finding to the modern rise of GLP-1 receptor agonist medications used for weight management. Because these medications slow gastric emptying and drastically curb caloric intake, they can inadvertently cause or worsen nutritional deficits. She cautions against assuming that individuals carrying excess weight or dealing with obesity are automatically well-nourished; many patients enter treatment "over-calorie, undernourished," placing them in a "nutritionally tenuous zone" before their absorption and food volume drop further on medication.

- **Pediatric Context**: Spoon-shaped nails can be a completely benign, normal finding in newborn babies. While parents should mention it during routine pediatric visits for reassurance, it does not typically carry the same nutritional implications as it does in adults.

[12:50](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=770s) Generalized Intractable Pruritus: When Itching Signals Internal Disease

The next symptom Dr. Dray addresses is impossible to brush aside: generalized intractable pruritus, the medical term for severe, unrelenting itch. She remarks that trying to ignore an all-over, full-body itch is "kind of like if I were to kick you in the stomach and say, 'Ignore it,'" because both sensations share high-misery neural signaling pathways in the body and brain.

```mermaid flowchart LR accTitle: Systemic Etiologies of Generalized Intractable Pruritus accDescr: Mapping systemic conditions that present with generalized intractable pruritus.

P["Generalized Intractable Pruritus (No Rash)"] --> Hem["Hematologic"] P --> Ren["Renal"] P --> Hep["Hepatic / Biliary"] P --> End["Endocrine"]

Hem --> H1["Blood Cancers (e.g., Post-shower itch)"] Ren --> R1["Kidney Disease & Kidney Failure"] Hep --> Hep1["Liver Failure & Bile Flow Obstruction"] End --> E1["Thyroid Disorders"] ```

When someone experiences intense, insufferable itching from head to toe without any primary rash or obvious skin explanation, it warrants prompt medical evaluation: - **Aquagenic Pruritus**: An intense itch that reliably flares up right after stepping into the shower should prompt an immediate call to the doctor, as it can be a warning sign of an underlying hematologic malignancy (such as blood cancer). - **Kidney and Thyroid Disease**: Both kidney failure and thyroid dysfunction can trigger pervasive systemic itching. - **Hepatic and Biliary Disorders**: Severe itching frequently pairs with jaundice. When combined with yellowing of the skin, eyes, or uvula ("the hangy ball thing"), intractable pruritus points toward liver disease or biliary outflow obstruction. - **Sleep Impact**: The severity of the sensation directly wrecks sleep and daily functioning, making medical intervention vital.

[14:17](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=857s) Caveats, Self-Diagnosis Traps, and Final Takeaways

Dr. Dray closes with an essential warning about navigating health concerns: cutaneous signs are clinical clues, not definitive home diagnoses. She strongly cautions viewers against going down internet rabbit holes, ordering direct-to-consumer lab panels from third-party companies, or attempting to self-treat unverified conditions.

Many skin manifestations are nonspecific, and untrained individuals can easily misinterpret what they are seeing. Primary care providers, family medicine physicians, and internists are well-equipped to conduct initial screenings; however, when clarity is needed, a formal referral to a dermatologist is the gold standard for a head-to-toe examination. Dr. Dray encourages viewers to check out her dedicated playlist, *Skin Warning Signs of Health Not to Miss*, for deeper clinical dives into specific systemic disorders, and leaves the audience with her signature sign-off: "don't forget sunscreen and subscribe."

## Notable quotes > [00:00](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=0s) your skin is a window to what is going on internally — Dr Dray

> [05:21](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=321s) little hangy ball thingy — Dr Dray

> [05:21](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=321s) basically, your blood cells, for whatever reason, are just blowing up and leaking stuff out — Dr Dray

> [07:37](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=457s) not going out in, you know, the roof is on fire style, which I don't even think people do that much anymore. — Dr Dray

> [07:37](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=457s) filling and billing — Dr Dray

> [07:37](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=457s) keep the lights on — Dr Dray

> [09:23](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=563s) wrapped up in a bag the entire time — Dr Dray

> [11:10](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=670s) over-calorie, undernourished — Dr Dray

> [11:10](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=670s) nutritionally tenuous zone — Dr Dray

> [12:50](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=770s) kind of like if I were to kick you in the stomach and say, 'Ignore it,' — Dr Dray

> [14:58](https://www.youtube.com/watch?v=QKDlc1r8fQk&t=898s) don't forget sunscreen and subscribe. — Dr Dray

## Mentioned Dr Dray, Tretinoin, AmLactin, Isotretinoin, Accutane, Skin Warning Signs of Health Not to Miss

## Video description What can your skin reveal about your overall health?

In this video, dermatologist Dr. Dray explains 7 skin, hair, and nail changes that can sometimes provide clues about what is happening inside the body. While these findings are not diagnoses on their own, certain changes can be associated with underlying metabolic, hormonal, nutritional, autoimmune, liver, kidney, thyroid, heart, or lung conditions.

From dark, velvety skin on the neck and insulin resistance to yellow skin and jaundice, Dr. Dray explains what dermatologists look for when examining the skin, nails, and other visible signs of systemic health.

The video covers:

• Acanthosis nigricans and its connection to insulin resistance, diabetes, and metabolic health • Skin tags and their association with insulin resistance and metabolic syndrome • Xanthelasma, xanthomas, cholesterol, and triglycerides • Yellowing of the skin and eyes and possible causes of jaundice • Nail clubbing and potential associations with heart and lung disease • Dermatomyositis, heliotrope rash, and Gottron papules • Spoon-shaped nails and possible iron deficiency • Generalized itching without a rash and potential systemic causes involving the kidneys, liver, thyroid, and blood

Dr. Dray also explains why these findings should be viewed as clues rather than diagnoses, and why a new, persistent, or rapidly changing skin or nail finding deserves medical attention.

TIMESTAMPS

0:00 Can your skin reveal what's happening inside your body? 0:28 Dark, velvety skin on the neck 2:49 Yellow bumps around the eyes 5:21 Yellow skin or whites of the eyes 7:37 Swollen fingers and curved nails 9:46 Purple or red rashes on the eyelids or knuckles 11:10 Spoon-shaped or unusually thin nails 12:50 Intense itching with little or no rash 14:17 Important caveats 14:58 Final takeaways

Disclaimer: This video is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Skin changes can have many different causes, and viewers should consult an appropriate healthcare professional for evaluation of new, persistent, or concerning symptoms.

#Dermatologist #SkinHealth #SkinSigns #AcanthosisNigricans #InsulinResistance #Jaundice #SkinCare #HealthSigns #Dermatology #drdray

FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=QKDlc1r8fQk)

中文简报

皮肤科医生Dr Dray解析皮肤体征背后的潜在系统性疾病皮肤、指甲和毛发的肉眼可见改变并非单纯的美容问题，而是胰岛素抵抗、脂质代谢异常及器官衰竭等潜在系统性疾病的重要皮肤预警信号。 Dr. Dray详细介绍了提示系统性疾病的七种肉眼可见皮肤线索，包括与胰岛素抵抗相关的黑棘皮病、提示血脂异常的黄色瘤，以及由肝胆问题或溶血引起的黄疸。她还梳理了与心肺疾病相关的杵状指、皮肌炎特征性的淡紫色眼睑皮疹和Gottron丘疹、缺铁导致的匙状甲，以及与肾脏、肝脏或血液系统疾病相关的全身顽固性瘙痒。在讨论中，她强调这些表现是诊断线索而非最终诊断，并建议患者寻求专业医学检查，就诊时切勿涂抹指甲油遮盖指甲。被称为黑棘皮病的深色天鹅绒样皮肤斑块，是由高胰岛素血症结合表皮受体所致，是胰岛素抵抗的早期皮肤标志，而非个人卫生不良引起。 (0:28) 发疹性黄色瘤和睑黄疣可能提示严重的血脂异常及危险的高甘油三酯水平，若在使用异维A酸等药物的同时摄入高脂饮食，该风险会急剧上升。 (2:49) 黄疸中积聚的胆红素会使黏膜和巩膜黄染，这能将严重的肝胆及溶血性疾病与无害的饮食性胡萝卜素血症明确区分开来。 (5:21) 匙状甲反映了全身性缺铁，对于因使用GLP-1受体激动剂而导致热量和营养摄入减少的患者，这一风险尤为值得关注。 (11:10)

Reading summary

Dr. Dray emphasizes that changes in the skin, hair, and nails frequently serve as direct windows into underlying systemic health issues rather than purely cosmetic concerns. Identifying these cutaneous warning signs enables earlier medical intervention for serious metabolic, organ, and autoimmune disorders. Metabolic and Lipid Dysregulation Markers (0:00) Dark, velvety, thickened patches known as acanthosis nigricans commonly appear on the posterior neck, axillae, lateral face, and dorsal hands. Dr. Dray explains that this condition is neither dirt nor standard hyperpigmentation, but epidermal thickening driven by hyperinsulinemia. When systemic insulin resistance drives circulating insulin levels upward, the hormone binds to insulin and insulin-like growth factor receptors on keratinocytes, inducing rapid cellular proliferation. While topical agents like tretinoin or lactic acid formulations are used off-label, they provide only modest improvement and can irritate body folds, making systemic metabolic correction the necessary therapy. Similarly, firm yellow plaques known as xanthelasma palpebrarum around the inner eyelids, or eruptive xanthomas appearing across the body, represent focal accumulations of lipids and cholesterol esters. While xanthelasma is not an absolute guarantee of high cholesterol, widespread eruptive papules correlate strongly with marked hypertriglyceridemia. Dr. Dray notes this can be triggered by dietary extremes or a combination of lipid-elevating medications—such as isotretinoin—with high-fat, fried foods. Controlling systemic blood lipids often allows xanthomas to regress naturally, avoiding scarring risks associated with in-office electrocautery. Jaundice, Biliary Obstruction, and Intractable Itching (5:21) Yellow discoloration of the skin and conjunctival sclera indicates jaundice, which results from the accumulation of bilirubin when red blood cell breakdown overwhelms the body or hepatobiliary disease prevents normal excretion. In deeper complexions where yellowing can present as a subtle greenish or sallow undertone, clinicians inspect the sclera, the underside of the tongue, or the uvula. Dr. Dray distinguishes true jaundice from benign carotenoderma, which is caused by high consumption of carotenoid-rich vegetables like carrots; carotenoderma spares the elastic tissue of the eyes and mucous membranes entirely and poses no health risks. Severe internal dysfunction can also present as generalized intractable pruritus in the absence of a primary rash. Unrelenting systemic itching accompanied by jaundice points to liver failure or biliary outflow obstruction, but generalized pruritus can also signal chronic kidney failure or thyroid disorders. Dr. Dray emphasizes that aquagenic pruritus—intense itching that reliably triggers immediately after stepping out of the shower—warrants immediate medical evaluation as an established warning sign of hematologic malignancies such as blood cancers. Nail Morphology and Nutritional Deficits (7:37) Structural alterations of the nail apparatus provide critical diagnostic clues for cardiovascular, respiratory, and nutritional disorders. Nail clubbing involves bulbous enlargement of the fingertip accompanied by the flattening or reversal of Lovibond's angle at the proximal nail fold. This tissue proliferation is linked to chronic low blood oxygen levels or vascular changes, signaling chronic pulmonary disease or congenital heart conditions. Because systemic conditions imprint on the nail bed, Dr. Dray stresses that patients should never wear opaque polish or artificial nails to dermatologic appointments, as covered nail beds obscure signs of systemic disease and localized nail unit cancers. In contrast, koilonychia presents as abnormally thin, spoon-shaped nails where the lateral edges flare outward and the center dips into a cup-like depression. While benign in newborns, spoon nails in adults classically indicate iron deficiency. Dr. Dray links this to the widespread use of GLP-1 receptor agonist medications; by slowing gastric emptying and significantly reducing food volume, these therapies can induce or worsen nutritional deficiencies in patients who enter treatment over-calorie but undernourished. Autoimmune Signatures in Dermatomyositis (9:23) Autoimmune conditions can display hallmark cutaneous presentations on the face and digits. Dermatomyositis is characterized by a purplish-red heliotrope rash over the eyelids and reddish, violaceous bumps over the knuckles termed Gottron papules. Patients may also exhibit ragged nail folds with microvascular abnormalities visible in the periungual capillaries under dermoscopy. While classic dermatomyositis produces profound proximal muscle weakness—making everyday tasks like lifting arms to comb hair or standing up from a chair exhausting—Dr. Dray highlights the amyopathic variant. In amyopathic dermatomyositis, patients exhibit the signature cutaneous findings on the eyelids, knuckles, or nail folds without experiencing any muscle weakness. Consequently, the absence of muscular fatigue should not deter individuals from seeking medical evaluation for characteristic knuckle or eyelid rashes. Dr. Dray emphasizes that cutaneous signs should serve as clues to prompt medical evaluation rather than definitive home diagnoses. Patients are cautioned against unguided self-treatment or ordering direct-to-consumer lab panels, as primary care screenings and formal dermatologic examinations remain the standard for diagnosing underlying systemic disease.

Source quotes

[0:00] Dr Dray: your skin is a window to what is going on internally [5:21] Dr Dray: little hangy ball thingy [5:21] Dr Dray: basically, your blood cells, for whatever reason, are just blowing up and leaking stuff out [7:37] Dr Dray: not going out in, you know, the roof is on fire style, which I don't even think people do that much anymore. [7:37] Dr Dray: filling and billing [7:37] Dr Dray: keep the lights on [9:23] Dr Dray: wrapped up in a bag the entire time [11:10] Dr Dray: over-calorie, undernourished [11:10] Dr Dray: nutritionally tenuous zone [12:50] Dr Dray: kind of like if I were to kick you in the stomach and say, 'Ignore it,' [14:58] Dr Dray: don't forget sunscreen and subscribe.

Original transcript

[0:00] Well, hey guys. Welcome back. If you're [0:01] new here, I'm Dr. Dray. I'm a [0:03] board-certified dermatologist. And one [0:05] of my all-time favorite mantras on this [0:07] channel is your skin is a window to what [0:09] is going on internally. There are many [0:11] things that can pop up on your skin, as [0:13] well as your hair and your nails, that [0:15] provide clues to problems lurking [0:17] internally, things that are going on [0:19] with your health. So, in today's video, [0:20] I'm going to cover seven skin findings [0:23] that give you some clues to some things [0:25] that you might want to be aware of when [0:27] it comes to your overall health. Number [0:28] one is the presence of these dark, [0:30] velvety, thickened patches, usually on [0:33] the backs of the neck, under the arms, [0:35] the sides of the face, the back of your [0:37] hands. A lot of people think, "Oh, have [0:39] I gotten some unwanted sun exposure? [0:42] Have I not been cleaning in that area? [0:43] Is it dirty?" They try and scrub it [0:45] away, or they try and use a bunch of [0:47] exfoliants. They'll even try things like [0:49] the vitamin C serums, only to have it [0:52] remain. Well, here's the thing. It's not [0:55] dirt. It's not hyperpigmentation. It's [0:57] velvety skin thickening. This is a [0:59] condition known as acanthosis nigricans, [1:02] and you never, ever, ever want to ignore [1:04] it. If you're not sure if that's what [1:05] you have, see your healthcare provider. [1:07] They know how to diagnose it. Even [1:09] non-dermatologists can diagnose it. It's [1:11] a skin warning sign of insulin [1:14] resistance. Insulin resistance means [1:17] that you can progress to diabetes, very, [1:20] very damaging to your overall health. [1:23] The reason this happens is because the [1:25] skin cells, called keratinocytes, [1:27] actually have receptors for insulin and [1:30] insulin-like growth factor. So, when [1:32] your insulin levels are sky-high because [1:34] your body doesn't really respond to it, [1:36] it kind of bothers your skin cells, so [1:38] to speak, and causes them to proliferate [1:41] abnormally and at an increased rate, and [1:44] that's why you get acanthosis nigricans. [1:46] And so, it's a clue that you need to do [1:49] something about your insulin resistance [1:51] ASAP. Doing something about the insulin [1:53] resistance ASAP is not only paramount [1:55] for your overall health, but it'll help [1:57] put the brakes on this acanthosis [1:59] nigricans progressing to become even [2:01] more florid and obvious. It can be very [2:04] difficult, that being said, even when [2:06] the insulin resistance comes under [2:08] control to treat the acanthosis [2:10] nigricans, to get it to fully resolve. [2:12] It can, but it can be very difficult and [2:14] sometimes it lingers. There are a [2:16] variety of topicals that are tried, [2:18] topical tretinoin for example, to soften [2:20] and smooth lactic acid like AmLactin [2:23] lotion. And there's a new [2:28] might actually be useful for it as well. [2:31] But all of these things, you know, they [2:33] may modestly improve, sometimes it can [2:35] be too irritating, especially in the [2:37] skin folds. But at the end of the day, [2:39] you really need to prioritize that good [2:41] old-fashioned insulin resistance [2:43] treatment because otherwise, you can [2:46] really land yourself in a [2:47] cardiometabolic nightmare. Number two is [2:50] the formation of these yellow, firm, [2:52] flat-topped bumps, usually around the [2:55] eyes. Eyelid skin is very delicate. It's [2:57] an area where these things can pop up. [3:00] The appearance of these, however, [3:01] provides important clues that there's [3:03] something going on with your cholesterol [3:06] and your lipid metabolism. These are [3:08] called xanthoma, or more generally, they [3:11] are a type of xanthoma. Xanthoma are [3:13] yellowish plaques that commonly develop [3:16] around the eyelids, particularly toward [3:18] the inner corners. They're basically [3:19] little collections of lipid or fat [3:21] within the skin. Seeing xanthoma is not [3:24] a slam down guarantee that you have high [3:26] cholesterol, but it is concerning. Some [3:29] people, though, do have xanthoma without [3:32] any underlying blood lipid cholesterol [3:34] issues, but xanthomas, especially those [3:37] that appear on other body sites, can be [3:39] strongly, strongly associated and linked [3:42] to underlying lipid metabolism [3:44] abnormalities. For example, erupted [3:46] xanthomas can appear as multiple yellow, [3:48] firm bumps in the setting of a new onset [3:52] rise in blood lipids. Remember a few [3:55] years ago we saw that case reported the [3:57] individual eating all that butter and [3:58] cheese as most of their diet and they [4:00] developed xanthomas. They can also be [4:03] associated with very high triglycerides. [4:05] So it's an important distinction. It's [4:07] not just a cosmetic issue. It's really [4:09] heralding that there's something going [4:10] on with the blood lipids in many cases. [4:13] Now there are a variety of treatments to [4:15] get rid of these such as electrocautery [4:17] which is that little electrical tool [4:19] that we use in the office. The [4:21] unfortunate thing is that the area [4:23] around the eyes in particular is very [4:25] vulnerable to scarring. So the [4:27] dermatologist has to be careful but they [4:29] can resolve on their own once the lipids [4:32] come under control. Speaking of the [4:33] lipids going up and these appearing now [4:35] I want to draw your attention to a [4:36] circumstance where this might happen for [4:38] you if you are a young person and that [4:40] is if you are on isotretinoin Accutane [4:44] and you are eating a lot of fried foods, [4:46] a lot of fatty foods. Isotretinoin can [4:49] cause an increase in the um lipids in [4:51] the blood and usually the increase is [4:53] small and provided you're otherwise [4:55] healthy it's you know just a temporary [4:57] thing. But if you take that small rise [5:00] coupled with a high fat diet of fried [5:03] foods, well it really can push people [5:05] over the limit and they can develop [5:07] these eruptive xanthomas all over the [5:09] place. So it's something to be mindful [5:11] of if you are on isotretinoin for sure. [5:14] You don't want to be eating um fried [5:16] foods because it really can be too much [5:19] for the blood lipids to be eating a lot [5:21] of fried foods. Warning sign number [5:22] three that you absolutely never want to [5:25] ignore is if the whites of your eyes and [5:27] your skin become yellow. Sometimes this [5:29] can be difficult to note on the skin [5:31] depending on your background skin tone [5:33] and in very deep skin tones it actually [5:35] looks more greenish or sometimes they [5:38] just look kind of pale and unwell but [5:40] the clue is the yellowing of the eyes. [5:43] Another clue is if you look under the [5:45] tongue or at the back of the throat [5:47] where the little hangy ball thingy is, [5:49] called the uvula, that'll have this [5:50] yellowish hue. So, that's actually a [5:52] really good place to look if you're not [5:54] sure. And what the heck is going on [5:55] here? Well, this is a warning sign of [5:57] jaundice. Jaundice occurs when there's [5:59] an accumulation of something called [6:01] bilirubin. Bilirubin is what is produced [6:03] when the red blood cells get broken [6:05] down. And your liver normally is what [6:07] plays a role in handling that bilirubin [6:10] and eliminating it. But, if there's a [6:12] problem with your liver or if there's a [6:14] problem with the bile ducts and kind of [6:16] the plumbing, if you will, of the liver [6:19] and the bile and the gallbladder, well, [6:21] you can develop a buildup of bilirubin [6:25] and it can lead to jaundice. Bilirubin [6:27] can also accumulate if you have a [6:30] disorder of your red blood cells that [6:32] causes them to break apart too easily. [6:35] So, you have too much of the breakdown [6:37] of blood red blood cells above and [6:39] beyond the normal handling capacity. And [6:42] so, you get a backup of bilirubin and [6:45] jaundice. So, it's not always a sign of [6:47] liver disease, it could be a sign of a [6:49] what we call a hemolytic anemia. [6:51] Basically, your blood cells, for [6:53] whatever reason, are just blowing up and [6:56] leaking stuff out. And, you know, that's [6:58] where you get the accumulation of [6:59] bilirubin. Don't be confused though, if [7:01] you're someone who enjoys [7:04] carotenoid-rich vegetables, namely [7:06] carrots, you've probably heard of the [7:08] condition known as carotenoderma, where [7:10] if you eat a lot of carrots, it can [7:12] change your skin color to orange, turn [7:14] you orange. And that is different from [7:17] jaundice in that, yeah, the yellowing of [7:20] the skin can somewhat look the same, but [7:22] with carotenoderma, [7:24] you do not have yellowing of the eyes. [7:26] The whites of the eyes do not turn [7:28] yellow. Okay, so that's that's one way [7:30] to know. And the carotenoderma will just [7:32] resolve when you back down on the carrot [7:34] consumption. It's not dangerous if that [7:36] ever happens to you as a side note. All [7:38] right, here's something you don't want [7:39] to sleep on, and that is if you notice [7:41] that the tips of your fingers are [7:43] starting to get kind of swollen and the [7:45] nails are curved. This is something that [7:47] you definitely need to show a doctor. [7:49] It's called clubbing. The fingertips get [7:51] more bulbous, the nails get this um [7:53] curve to them. And when you look at the [7:55] profile, you'll notice that the nail The [7:59] angle between the nail and the skin [8:00] become a lot more prominent. That's [8:02] called Lovibond's angle. Clubbing can [8:04] actually happen secondary to a variety [8:06] of internal medical problems, namely [8:08] lung disease. But it also can happen in [8:10] association with certain disorders of [8:12] your heart and some congenital [8:14] disorders. Clubbing is kind of like this [8:16] abnormal response to the oxygen in your [8:18] body not being quite right. And again, [8:20] usually that's resulting from some sort [8:22] of problem either in your lungs or your [8:24] heart, which deal with oxygenating the [8:26] body. But new clubbing is something that [8:28] you definitely want to pay attention to. [8:30] And by clubbing, you know, we're talking [8:31] about this finger change, not going out [8:33] in, you know, uh the roof is on fire [8:35] style, which I don't even think people [8:37] do that much anymore. I digress. So, [8:39] this is a good example of, you know, [8:41] dermatologists, they get this bad rap [8:43] for filling and billing, as I joke, [8:44] which to be honest, a lot you know, a [8:46] lot focus primarily on that these days [8:48] cuz it is a way to keep the lights on. [8:50] But uh dermatologic exam involves uh not [8:53] just looking at the skin, but the hair, [8:55] the nails, the mucous membranes. And [8:57] you're starting to see why checking [8:58] these places is so important because [9:00] they provide a lot of really important [9:02] clues that help tie the whole skin [9:04] findings together as well. So, we're [9:06] looking at overall patterns in the [9:07] nails. A proper nail exam is key. As a [9:10] As a side bullet point here, okay? If [9:12] you're falling asleep, here's a side [9:14] bullet point. Don't go to the [9:15] dermatologist with nail polish or [9:18] artificial nails on because this is the [9:21] equivalent of going to the dermatologist [9:23] and insisting that you um remain [9:26] wrapped up in a um bag the entire time. [9:29] There's no way they're going to be able [9:30] to look at your skin. Well, if you have [9:32] your nails covered with polish or with [9:35] uh artificial adornments, they can't [9:37] look at them and there can be clues [9:39] looking under there and of course not [9:41] relevant to today's video, but you might [9:42] have an a cancer in the nail. So, [9:44] definitely don't go with nail polish on. [9:46] Now, here's something sneaky that is [9:49] important to recognize because it really [9:51] can get you the diagnosis a lot faster [9:54] and that's if you develop this weird [9:55] rash on your knuckles and or your [9:58] eyelids. It's kind of purplish red [9:59] almost looks heliotrope like as it's [10:02] called. This is actually a warning sign [10:04] of an autoimmune condition known as [10:05] dermatomyositis. [10:07] One of the characteristic findings of [10:09] this condition is this purplish reddish [10:11] heliotrope rash. And then as far as [10:13] what's going on with the knuckles, this [10:14] is another classic finding known as [10:16] Gottron's papules. These are reddish [10:18] violaceous bumps that happen over the [10:20] knuckles. And your fingernails can also [10:22] have some changes here as well. They can [10:24] look kind of ragged and the [10:25] dermatologist will take the special [10:27] dermatoscope and look at them and they [10:29] can see some pretty prominent changes to [10:31] the little capillaries around your nails [10:34] as well that are telltale clues of this. [10:37] But then another one is proximal muscle [10:39] weakness. Like you have difficulty, you [10:41] start noticing like you feel really weak [10:43] when you're trying to comb your hair, [10:44] lifting your arms up or you have a a [10:46] hard time, you feel exhausted just going [10:49] from sitting to standing because that [10:50] requires you to engage those muscles [10:52] closer to your torso, right? So, those [10:56] those are important warning signs. That [10:57] being said, there are certain variants [10:59] of dermatomyositis known as amyopathic [11:02] dermatomyositis where you have the skin [11:04] findings but have the weakness. So, if [11:06] you don't feel weak, still get it [11:07] checked out in other words cuz you could [11:09] have this other variant of it. And then [11:11] here's another nail finding. I'm telling [11:13] you the nails they they're a whole [11:14] they're a whole branch of dermatology in [11:17] and of themselves. Spoon-shaped or [11:18] unusually thin nails. So, the spoon [11:20] shape looks like the the outer lateral [11:23] part of the nail is kind of flared [11:25] [clears throat] out. You can put a [11:25] little tiny drop of water there in the [11:27] center. It's like a little depression, a [11:29] cup. This is known as koilonychia and it [11:31] can be a warning sign of iron [11:32] deficiency, which if you watched any of [11:34] my diet and skin videos, you know is the [11:36] most common nutritional deficiency [11:38] worldwide. And nowadays, we have people [11:40] taking the GLP-1 family of medications [11:43] for weight management. And the way those [11:45] work, you know, or part of how they work [11:47] is they make it so that you don't take [11:49] in as much food, and you have very slow [11:51] digestion. So, you can run into a [11:54] variety of nutritional deficiencies. And [11:56] unfortunately, many patients start out [11:58] at a, you know, nutritionally tenuous [12:01] zone, if you will. You know, just [12:03] because somebody has excess body fat and [12:06] or obesity, it doesn't necessarily mean [12:08] that they are like nutritionally primed, [12:11] okay? They could just be, you know, [12:14] over over calorie undernourished, so to [12:17] speak. That that definitely happens. And [12:19] like I said, iron deficiency is very [12:20] common, and then we see it in patients [12:22] who end up on these meds, and they have, [12:24] you know, a decrease in absorption and [12:26] intake. So, it's definitely something [12:28] that if you, especially if you're on [12:29] these meds, but in general, you know, if [12:31] you start to notice, pay attention. Now, [12:33] this can be a completely normal finding [12:35] in newborn babies, okay? So, if you just [12:37] had a baby, and you're like, "Oh my [12:38] gosh." Probably fine, but of course, you [12:41] know, you're going to be taking your [12:42] baby into the pediatrician, right, for [12:44] their little exams and whatnot. So, show [12:47] them, and they'll hopefully be able to [12:49] reassure you that that's normal. The [12:51] next thing that [12:52] we should never ignore, and frankly, [12:54] it's very impossible to ignore because [12:57] it is very miserable, okay? Ignoring [12:58] this is kind of like if I were to kick [13:00] you in the stomach and say, "Ignore it." [13:02] Quite literally, because they're on the [13:04] same wavelength of pathways and [13:06] brain-body communication and misery. And [13:08] that is generalized intractable [13:11] pruritus, which is the medical term for [13:13] itch. When I'm talking about intractable [13:15] pruritus, I'm saying that you don't have [13:16] any underlying reason. You're just [13:18] incredibly itchy from head to toe. Total [13:22] body, just insufferable itch. Especially [13:24] if If notice that the itch gets really [13:26] bad when you get in the shower, that [13:28] right there, if you notice that when you [13:30] get in the shower you get really, really [13:32] itchy and this is a new thing for you, [13:34] maybe you haven't been feeling your [13:35] best, call your doc, okay? Call your doc [13:37] today because this can be a warning sign [13:40] of blood cancer. But in other cases, [13:42] itch all over the body, it can be caused [13:45] by kidney disease, kidney failure, [13:47] thyroid disease, other blood disorders, [13:50] also liver failure. You know, people who [13:53] have jaundice can also have intractable [13:55] pruritus. So remember the yellow eyes, [13:57] the yellow uvula, hangy ball thing, and [14:00] and now your itch you use itch all over, [14:03] could be liver disease, okay? Or bile [14:05] flow obstruction problems also cause [14:08] jaundice as well and intractable [14:10] pruritus. So it's not something you ever [14:12] want to sleep on and or can you, okay? [14:15] Because it's it it really disrupts your [14:17] sleep. Now, those are the signs, but an [14:19] important caveat, you know, just because [14:20] you have one of these things, don't go [14:21] self-diagnosing yourself and then go on [14:23] the internet and try and order a bunch [14:25] bunch of blood [14:27] company and the next thing you know [14:28] you're self-treating. Don't go doing [14:29] that, okay? These skin findings are [14:31] clues but they're not diagnostic, okay? [14:32] It could just be a non-specific finding, [14:35] maybe you're not the best at at [14:36] detecting them and you think you have [14:38] one thing and and that's really not what [14:39] you're looking at. So always show your [14:41] health care provider, a lot of these [14:43] things, you know, your family medicine [14:44] doc, your internist, they they they're [14:46] pretty skilled at at looking at, but you [14:48] know, when in doubt, refer, refer, refer [14:50] to the dermatologist. They can give you [14:53] a full exam and check for these other [14:55] associated findings if if they're there [14:57] and and you know, really work you up [14:58] there. But in summary, your skin, it [15:00] provides a lot of important clues to [15:02] potential underlying health problems [15:04] that you don't want to ignore. So I hope [15:07] today's video is helpful. Now, I have a [15:08] lot of videos on my channel about skin [15:10] warning signs of underlying health [15:12] problems. This is by no means the first [15:14] go around. I have a lot more serious, [15:15] serious deep dives into very specific [15:17] conditions. These are videos are all in [15:19] a playlist called skin warning signs of [15:21] health not to miss. This video will be [15:23] placed there, so check that playlist [15:25] down. I give a lot of tips and tricks [15:29] for things not to sleep on when it comes [15:32] to stuff popping up on your skin. I hope [15:33] today's video was informative, [15:35] educational, and that you learned [15:36] something. If you enjoyed it, give it a [15:38] thumbs up, share it with your friends, [15:39] and as always, don't forget sunscreen [15:41] and subscribe. I'll talk to you guys [15:42] tomorrow. Bye.