Combined disorders of the skin and the musculoskeletal system

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

The skin and the musculoskeletal system of the human body share far more similarities and physiological interconnections than may appear at first glance. Having comparable composition, functions, and regulatory mechanisms, the skin and the musculoskeletal system are closely linked in terms of both physiological interactions and pathophysiological processes. In addition to their anatomical and physiological relationships, the skin and the musculoskeletal system are often affected simultaneously, forming part of the symptom complex of several hereditary syndromes, which further indicates a close biological relationship between these organs. The skin and bone tissue may also be concurrently involved as a result of a primary dermatological or orthopedic condition. The study of the anatomical, physiological, and clinical relationship between the skin and the musculoskeletal system may have substantial practical importance in addressing both dermatological and orthopedic conditions. Rational interdisciplinary collaboration between dermatologists and orthopedic surgeons can facilitate faster achievement of positive clinical outcomes, reduce rehabilitation time, prevent the development of comorbid disorders, and prolong disease remission. Altogether, this may lead to shorter overall patient management, recovery, and improvement in quality of life. This article presents data on the relationship and interactions between the skin and the musculoskeletal system under normal and pathological conditions and attempts to classify combined disorders, describing dermatologic–orthopedic disorders in both hereditary syndromes and diseases as well as acquired conditions of various etiologies. In addition, the term orthopedic dermatology is proposed to denote an interdisciplinary field of medical knowledge aimed at addressing clinical problems associated with the combined involvement of the skin and bone tissue.

Full Text

Restricted Access

About the authors

Roman V. Saranyuk

Society of Integrative Dermatology; Dermatology and Venereology Office "Derma Expert"

Email: roman.saranuk@gmail.com
ORCID iD: 0000-0001-9676-1581
SPIN-code: 5120-9250
Russian Federation, Kursk; Kursk

Roman V. Bodio

Healthy Foot Center “BODYO”

Email: bodyorv@mail.ru
ORCID iD: 0009-0006-1246-8489
Russian Federation, Moscow

Tatyana A. Gosteva

Society of Integrative Dermatology; Kurchatov Center of Modern Medicine

Author for correspondence.
Email: gosteva.t.tatyana@yandex.ru
ORCID iD: 0000-0003-0059-9159
Russian Federation, Kursk; Kurchatov

References

  1. Morimoto T, Hirata H, Sugita K, et al. A view on the skin-bone axis: unraveling similarities and potential of crosstalk. Front Med (Lausanne). 2024;11:1360483. doi: 10.3389/fmed.2024.1360483
  2. Ross FP, Christiano AM. Nothing but skin and bone. J Clin Invest. 2006;116(5):1140–9. doi: 10.1172/JCI28605
  3. Matsuura-Hachiya Y, Arai KY, Muraguchi T, et al. Type IV collagen aggregates promote keratinocyte proliferation and formation of epidermal layer in human skin equivalents. Exp Dermatol. 2018;27(5):443–448. doi: 10.1111/exd.13328
  4. Aurégan JC, Bosser C, Bensidhoum M, et al. Correlation between skin and bone parameters in women with postmenopausal osteoporosis: A systematic review. EFORT Open Rev. 2018;3(8):449–460. doi: 10.1302/2058-5241.3.160088
  5. Liang W, Chen Q, Cheng S, et al. Skin chronological aging drives age-related bone loss via secretion of cystatin-A. Nat Aging. 2022;2(10):906–922. doi: 10.1038/s43587-022-00285-x
  6. Yuan W, Song C. Crosstalk between bone and other organs. MedRev. 2022;2:331–48. doi: 10.1515/mr-2022-0018
  7. Atzeni IM, Boersema J, Pas HH, et al. Is skin autofluorescence (SAF) representative of dermal advanced glycation endproducts (AGEs) in dark skin? A pilot study. Heliyon. 2020;6(11):e05364. doi: 10.1016/j.heliyon.2020.e05364
  8. Verzijl N, DeGroot J, Thorpe SR, et al. Effect of collagen turnover on the accumulation of advanced glycation end products. J Biol Chem. 2000;275(50):39027–31. doi: 10.1074/jbc.M006700200
  9. Ritchlin CT, Haas-Smith SA, Li P, et al. Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest. 2003;111(6):821–31. doi: 10.1172/JCI16069
  10. Uluçkan Ö, Wagner EF. Role of IL-17A signalling in psoriasis and associated bone loss. Clin Exp Rheumatol. 2016;34(4 Suppl 98):17–20.
  11. Gladman DD, Shuckett R, Russell ML, et al Psoriatic arthritis (PSA) — an analysis of 220 patients. Q J Med. 1987;62(238):127–41.
  12. Binotto M, Guilherme L, Tanaka A. Rheumatic Fever. Images Paediatr Cardiol. 2002;4(2):12–31.
  13. Pope V, Dupuis L, Kannu P, et al. Buschke–Ollendorff syndrome: a novel case series and systematic review. British Journal of Dermatology. 2016;174(4):723–729. doi: 10.1111/bjd.14366
  14. Riyaz N, Riyaz A, Chandran R, et al. Focal dermal hypoplasia (Goltz syndrome). Indian J Dermatol Venereol Leprol. 2005;71(4):279–81. doi: 10.4103/0378-6323.16624
  15. Pol CA, Ghige SK, Kalaskar RR, et al. Gorlin-Goltz syndrome: A rare case report. Contemp Clin Dent. 2013;4(4):547–50. doi: 10.4103/0976-237X.123085
  16. Sharma D, Lamba S, Pandita A, et al. Klippel-trénaunay syndrome — a very rare and interesting syndrome. Clin Med Insights Circ Respir Pulm Med. 2015;9:1–4. doi: 10.4137/CCRPM.S21645
  17. Berk DR, Bentley DD, Bayliss SJ, et al. Cutis laxa: a review. J Am Acad Dermatol. 2012;66(5):842.e1–17. doi: 10.1016/j.jaad.2011.01.004
  18. Hong JK, Han HS, Seo SJ, et al. A case of Conradi-Hünermann-Happle syndrome with typical clinical manifestations confirmed by genetic mutation analysis. Indian J Dermatol Venereol Leprol. 2021 Nov–Dec;87(6):892. doi: 10.25259/IJDVL_876_20
  19. Sweeney E, Fryer A, Mountford R, et al. Nail patella syndrome: a review of the phenotype aided by developmental biology. J Med Genet. 2003;40(3):153–62. doi: 10.1136/jmg.40.3.153
  20. Doshi D. Touraine-Solente-Gole syndrome. Orbit. 2018;37(2):97–101. doi: 10.1080/01676830.2017.1383459
  21. Elston JB, Payne WG. Maffucci syndrome. Eplasty. 2014;14:ic11.
  22. de Palma L, Carloni S, Rapali S, et al. Sporadic ulcerative-mutilating acropathy of the foot. Features and therapeutic indications. Rev Rhum Engl Ed. 1999;66(6):319–22.
  23. George AE, Yogirajan K. Letterer siwe disease. Indian J Dermatol Venereol Leprol. 2001;67:334–335.
  24. Duchatelet S, Hovnanian A. Olmsted syndrome: clinical, molecular and therapeutic aspects. Orphanet J Rare Dis. 2015;10:33. doi: 10.1186/s13023-015-0246-5
  25. Lipsitz PJ, Suser F, Weinberg S, Valderrama E. Congenital unilateral ichthyosis in a newborn. Am J Dis Child. 1979;133(1):76–8. doi: 10.1001/archpedi.1979.02130010082016
  26. Ivanov OL, editor. Skin and Venereal Diseases: Handbook. Moscow: Medicine; 1997. 352 р. (In Russ.)
  27. Flynn P, Aird RB. A neuroectodermal syndrome of dominant inheritance. J Neurol Sci. 1965;2(2):161–82. doi: 10.1016/0022-510x(65)90078-x
  28. Oshima J, Sidorova JM, Monnat RJ Jr. Werner syndrome: Clinical features, pathogenesis and potential therapeutic interventions. Ageing Res Rev. 2017;33:105–114. doi: 10.1016/j.arr.2016.03.002
  29. Thomas J, Ragavi BS, Raneesha P, et al. Hallermann-streiff syndrome. Indian J Dermatol. 2013;58(5):383–4. doi: 10.4103/0019-5154.117311
  30. Rozhinskaya LYa, Sardaeva DG, Kalinchenko NY, et al. McCune-Albright syndrome: description of three clinical cases, features of diagnostics and treatment. Osteoporosis and Bone Diseases. 2021;24(3):19–32. doi: 10.14341/osteo12932 EDN: PSREEM
  31. Carol WLL, Godfried EG, Prakken JR, Prick JJG. Recklinghausensche Neurofibromatosis, Atrophodermia vermiculata und kongenitale Herzanomalie als Hauptkennzeichen eines familiär-hereditären Syndroms. Dermatologica. 1940;81(6):345–365. doi: 10.1159/000253817
  32. Tran TA. Muckle-Wells syndrome: clinical perspectives. Open Access Rheumatol. 2017;9:123–129. doi: 10.2147/OARRR.S114447
  33. Ryu YH, Kyun Chae J, Kim JW, Lee S. Lacrimo-auriculo-dento-digital syndrome: A novel mutation in a Korean family and review of literature. Mol Genet Genomic Med. 2020;8(10):e1412. doi: 10.1002/mgg3.1412
  34. Milewicz DM, Braverman AC, De Backer J, et al. Marfan syndrome. Nat Rev Dis Primers. 2021;7(1):64. doi: 10.1038/s41572-021-00298-7
  35. Li SWS, Roberts E, Hedrich C. Treatment and monitoring of SAPHO syndrome: a systematic review. RMD Open. 2023;9(4):e003688. doi: 10.1136/rmdopen-2023-003688
  36. Wilson FC, Icen M, Crowson CS, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61(2):233–9. doi: 10.1002/art.24172
  37. Christophers E, Barker JN, Griffiths CE, et al. The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol. 2010;24(5):548–54. doi: 10.1111/j.1468-3083.2009.03463.x
  38. Eder L, Haddad A, Rosen CF, et al. The Incidence and Risk Factors for Psoriatic Arthritis in Patients With Psoriasis: A Prospective Cohort Study. Arthritis Rheumatol. 2016;68(4):915–23. doi: 10.1002/art.39494
  39. Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973;3(1):55–78. doi: 10.1016/0049-0172(73)90035-8
  40. Peeling RW, Hook EW 3rd. The pathogenesis of syphilis: the Great Mimicker, revisited. J Pathol. 2006;208(2):224–32. doi: 10.1002/path.1903
  41. Pradhan S, Madke B, Singh AL, Kabra P. Less-known clinical signs in dermatology. Indian Dermatol Online J. 2016;7(5):421–423. doi: 10.4103/2229-5178.190517
  42. Pavithran K. Acquired syphilis in a patient with late congenital syphilis. Sex Transm Dis. 1987;14(2):119–21. doi: 10.1097/00007435-198704000-00014
  43. Frangos CC, Lavranos GM, Frangos CC. Higoumenakis’ sign in the diagnosis of congenital syphilis in anthropological specimens. Med Hypotheses. 2011;77(1):128–31. doi: 10.1016/j.mehy.2011.03.044
  44. Grigoriev PS. Textbook of Skin and Venereal Diseases. USSR People’s Commissariat of Health, Medgiz; 1938. 730 р. (In Russ.)
  45. Jagadeesan S, Shenoy P. Arthropathy in Dermatology: A Comprehensive Review. Indian Dermatol Online J. 2017;8(2):79–93. doi: 10.4103/idoj.IDOJ_25_17
  46. Chauhan S, Wakhlu A, Agarwal V. Arthritis in leprosy. Rheumatology (Oxford). 2010;49(12):2237–42. doi: 10.1093/rheumatology/keq264
  47. Haroon N, Agarwal V, Aggarwal A, et al. Arthritis as presenting manifestation of pure neuritic leprosy — a rheumatologist’s dilemma. Rheumatology (Oxford). 2007;46(4):653–6. doi: 10.1093/rheumatology/kel367
  48. Cheeti A, Chakraborty RK, Ramphul K. Reactive Arthritis. In: StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499831/ Accessed: Jan 2, 2023.
  49. Stavropoulos PG, Soura E, Kanelleas A, et al. Reactive arthritis. J Eur Acad Dermatol Venereol. 2015;29(3):415–24. doi: 10.1111/jdv.12741
  50. O’Brien JP, Goldenberg DL, Rice PA. Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore). 1983;62(6):395–406.
  51. Duffy J, Lidsky MD, Sharp JT, et al. Polyarthritis, polyarteritis and hepatitis B. Medicine (Baltimore). 1976;55(1):19–37. doi: 10.1097/00005792-197601000-00002
  52. Rowe IF, Forster SM, Seifert MH, et al. Rheumatological lesions in individuals with human immunodeficiency virus infection. Q J Med. 1989;73(272):1167–84.
  53. Keat A. Sexually transmitted arthritis syndromes. Med Clin North Am. 1990;74(6):1617–31. doi: 10.1016/s0025-7125(16)30498-9
  54. Sirufo, MM, De Pietro F, Bassino EM, et al. Osteoporosis in Skin Diseases. Int J Mol Sci. 2020;21:4749. doi: 10.3390/ijms21134749
  55. Mowad C, Cohen SF, Flandry Fussell N, et al. Referral patterns to an osteoporosis clinic for dermatology patients undergoing prolonged corticosteroid therapy. J Am Acad Dermatol. 2018;78(3):591–592. doi: 10.1016/j.jaad.2017.01.058
  56. Lin HH, Huang CY, Hwang LC. Association between metabolic syndrome and osteoporosis in Taiwanese middle-aged and elderly participants. Arch Osteoporos. 2018;13(1):48. doi: 10.1007/s11657-018-0467-z
  57. Pedreira CC, King E, Jones G, et al. Oral cyclosporin plus topical corticosteroid therapy diminishes bone mass in children with eczema. Pediatr Dermatol. 2007;24(6):613–20. doi: 10.1111/j.1525-1470.2007.00549.x
  58. Alshiyab DM, Al-Qarqaz FA, Heis LH, et al. Assessment of Serum Vitamin D Levels in Patients with Vitiligo in Jordan: A Case-Control Study. Dermatol Res Pract. 2019;2019:2048409. doi: 10.1155/2019/2048409
  59. Hsu DY, Brieva J, Nardone B, et al. Association of pemphigus and systemic corticosteroid use with comorbid health disorders: A case-control study. Dermatol Online J. 2017;23(12):13030/qt1vk2m30m.
  60. Akhtiamov IF, Aidarov VI, Khasanov ER. Features of rehabilitation of patients with rheumatoid arthritis after arthroplasty (review). N.N. Priorov Journal of Traumatology and Orthopedics. 2021;28(2):77–87. doi: 10.17816/vto61239 EDN: TGPALL
  61. Gall EP. General features. In: Schumacher HR, Gall EP, editors. Rheumatoid arthritis: An illustrated guide to pathology, diagnosis and management. Vol. 1. Philadelphia: JB Lippincott Co; 1988:28.
  62. Michel C, Cribier B, Sibilia J, et al. Nail abnormalities in rheumatoid arthritis. Br J Dermatol. 1997;137(6):958–62.
  63. Jorizzo JL, Gonzalez EB, Daniels JC. Red lunulae in a patient with rheumatoid arthritis. J Am Acad Dermatol. 1983;8(5):711–4. doi: 10.1016/s0190-9622(83)70085-x
  64. Daniel CR, Sams WM Jr, Scher RK. Nails in systemic disease. Dermatol Clin. 1985;3:465–83.
  65. Panush RS, Katz P, Longley S, et al. Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clin Rheumatol. 1983;2(4):321–30. doi: 10.1007/BF02041550
  66. Sienknecht CW, Urowitz MB, Pruzanski W, Stein HB. Felty’s syndrome. Clinical and serological analysis of 34 cases. Ann Rheum Dis. 1977;36(6):500–7. doi: 10.1136/ard.36.6.500
  67. Ziff M. The rheumatoid nodule. Arthritis Rheum. 1990;33(6):761–7. doi: 10.1002/art.1780330601
  68. Kremer JM, Lee JK. The safety and efficacy of the use of methotrexate in long-term therapy for rheumatoid arthritis. Arthritis Rheum. 1986;29(7):822–31. doi: 10.1002/art.1780290702
  69. Wollina U, Schönlebe J, Unger L, et al. Interstitial granulomatous dermatitis with plaques and arthritis. Clin Rheumatol. 2003;22(4-5):347–9. doi: 10.1007/s10067-003-0734-1
  70. Scherbenske JM, Benson PM, Lupton GP, Samlaska CP. Rheumatoid neutrophilic dermatitis. Arch Dermatol. 1989;125(8):1105–8.
  71. Powell FC, Su WP, Perry HO. Pyoderma gangrenosum: classification and management. J Am Acad Dermatol. 1996;34(3):395–409; quiz 410–2. doi: 10.1016/s0190-9622(96)90428-4
  72. Roure F, Elhai M, Burki V, et al. Prevalence and clinical characteristics of psoriasis in spondyloarthritis: a descriptive analysis of 275 patients. Clin Exp Rheumatol. 2016;34(1):82–7.
  73. Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis. 2017;76(4):701–707. doi: 10.1136/annrheumdis-2016-209853
  74. Ghoreschi K, Laurence A, Yang XP, et al. Generation of pathogenic T(H)17 cells in the absence of TGF-β signalling. Nature. 2010;467(7318):967–71. doi: 10.1038/nature09447
  75. Gómez-Garcia I, García-Puga T, Font-Ugalde P, et al. Relationship between onset of psoriasis and spondyloarthritis symptoms with clinical phenotype and diagnosis: data from REGISPONSER registry. Ther Adv Musculoskelet Dis. 2022;14:1759720X221118055. doi: 10.1177/1759720X221118055
  76. Kim GK, Del Rosso JQ. Drug-provoked psoriasis: is it drug induced or drug aggravated?: understanding pathophysiology and clinical relevance. J Clin Aesthet Dermatol. 2010;3(1):32–8.
  77. Snider AA, Barsky S. Gouty panniculitis: a case report and review of the literature. Cutis. 2005;76(1):54–6.
  78. Weberschock T, Gholam P, Hartschuh W, Hartmann M. Gouty panniculitis in a 68-year-old man: case report and review of the literature. Int J Dermatol. 2010;49(4):410–3. doi: 10.1111/j.1365-4632.2010.04283.x
  79. Kalayciyan A, Aydemir EH, Kotogyan A. Experimental Koebner phenomenon in patients with psoriasis. Dermatology. 2007;215(2):114–7. doi: 10.1159/000104261
  80. Eskandar T, Chaudhary F, Agrawal DK. Orthopedic Dermatopathies: Skin Manifestations in Orthopedic Conditions. J Orthop Sports Med. 2024;6(3):171–183. doi: 10.26502/josm.511500157
  81. Berezhnoy SYu, Protsenko AI, Kostyukov VV. Potentialities of percutaneous technique in revision surgery of forefoot static deformities. N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(4):42–46. EDN: PUJIXT
  82. DeKoven JG, Warshaw EM, Reeder MJ, et al. North American Contact Dermatitis Group Patch Test Results: 2019–2020. Dermatitis. 2023;34(2):90–104. doi: 10.1089/derm.2022.29017.jdk
  83. HQ Li, Li PC, Wei XC, Shi JJ. Effectiveness of antibiotics loaded bone cement in primary total knee arthroplasty: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2022;108(5):103295. doi: 10.1016/j.otsr.2022.103295
  84. Pacheco KA. Allergy to Surgical Implants. Clin Rev Allergy Immunol. 2019;56(1):72–85. doi: 10.1007/s12016-018-8707-y
  85. Thomas P, Arenberger P, Bader R, et al. A literature review and expert consensus statement on diagnostics in suspected metal implant allergy. J Eur Acad Dermatol Venereol. 2024;38(8):1471–1477. doi: 10.1111/jdv.20026
  86. Phedy P, Djaja YP, Boedijono DR, et al. Hypersensitivity to orthopaedic implant manifested as erythroderma: Timing of implant removal. Int J Surg Case Rep. 2018;49:110–114. doi: 10.1016/j.ijscr.2018.06.011
  87. Azizian Z, Hesami Z, Mansouri P, et al. Skin Complications of Orthopedic Procedures and Devices. Iran J PublicHealth. 2018;47(12):1937–1944.
  88. Sreeja C, Priyadarshini A, Premika, Nachiammai N. Sarcoidosis — A review article. J Oral MaxillofacPathol. 2022;26(2):242–253. doi: 10.4103/jomfp.jomfp_373_21
  89. Parshikov MV, Bardyugov PS, Galstyan GR, et al. Surgical correction of foot deformities as a method for prevention and treatment of diabetic foot syndrome. N.N. Priorov Journal of Traumatology and Orthopedics. 2018;(3–4):47–7. doi: 10.17116/vto201803-04147 EDN: GRXEUO
  90. Saranyuk RV, Gosteva TA, Ilyukhina EV. Cutaneous metastases: case studies. RMJ. 2024;(5):38–40. EDN: FDBNZV

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Foot skin involvement in palmoplantar psoriasis: a, localized lesion; b, c, diffuse involvement of the skin of both feet.

Download (370KB)
Indexing metadata
3. Fig. 2. Psoriatic arthritis with involvement of the small joints of the fingers.

Download (284KB)
Indexing metadata
4. Fig. 3. Association of ankylosing spondylitis and psoriasis: a, restricted spinal mobility; b, psoriasis-associated onycholysis; c, cutaneous psoriatic lesions.

Download (268KB)
Indexing metadata
5. Fig. 4. Xerosis and callus formation of the foot skin associated with hallux valgus deformity.

Download (137KB)
Indexing metadata
6. Fig. 5. Focal plantar hyperkeratosis in varus deformity of the fifth toe.

Download (133KB)
Indexing metadata
7. Fig. 6. Plantar hyperkeratosis of the third toe associated with rigid flexion deformity.

Download (98KB)
Indexing metadata

Copyright (c) 2026 Eco-Vector

License URL: https://eco-vector.com/for_authors.php#07
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-76249 от 19.07.2019.