Preface

xxiii

Acknowledgment

xxv

Introduction

xxvii

Approach to Dermatologic Diagnosis

xxviii

Outline of Dermatologic Diagnosis

xxviii

Special Clinical and Laboratory Aids to Dermatologic Diagnosis

xxxvi

PART I

DISORDERS PRESENTING IN THE SKIN AND MUCOUS MEMBRANES

SECTION 1

DISORDERS OF SEBACEOUS AND APOCRINE GLANDS

2

Acne Vulgarls (Common Acne) and Cystic Acne

2

Rosacea

8

Perioral Dermatitis

12

Hidradenitis Suppurativa

14

Fox Fordyce Disease

17

SECTION 2

ECZEMA/DERMATITIS

18

Contact Dermatitis

18

Irritant Contact Dermatitis (ICD)

18

Acute Irritant Contact Dermatitis

19

Chronic Irritant Contact Dermatitis

21

Special Forms of ICD

23

Allergic Contact Dermatitis

24

Special Forms of ACD

28

Allergic Contact Dermatitis Due to Plants

28

Systemic ACD

30

Airborne ACD

30

Atoplc Dermatitis

31

Suggested Algorithm of AD Management

39

Lichen Simplex Chronicus (LSC)

39

Prurigo Nodularis (PN)

41

Dyshidrotic Eczematous Dermatitis

42

Nummular Eczema

43

Autosensitization Dermatitis

44

Seborrheic Dermatitis

45

Asteatotic Dermatitis

48

SECTION 3

UNH PSORIASIS AND PSORIASIFORM DERMATOSES

49

Psoriasis

49

Psoriasis Vulgaris

49

Pustular Psoriasis

56

Palmoplantar Pustulosis

56

Generalized Acute Pustular Psoriasis (Von Zumbusch)

57

Psoriatic Erythroderma

59

Psoriatic Arthritis

59

Management of Psoriasis

59

Pityriasis Rubra Pilaris (PRP)

62

Pityriasis Rosea

65

Parapsoriasis en Plaques (PP)

67

Pityriasis Lichenoides (Acute and Chronic) {PL)

70

SECTION 4

ICHTHYOSES

72

Dominant Ichthyosis Vulgaris (DIV)

72

X-Linked Ichthyosis (XLI)

75

Lamellar Ichthyosis (LI)

77

Epidermolytic Hyperkertosis (EH)

78

Ichthyosis in the Newborn

80

Collodion Baby

80

Harlequin Fetus

81

Syndromic Ichthyoses

82

Acquired Ichthyoses

84

Inherited Keratodermas of Palms and Soles

84

SECTION 5

MISCELLANEOUS EPIDERMAL DISORDERS

87

Acanthosis Nigrieans (AN)

87

Darier Disease (DD)

89

Graver Disease (GD)

91

Hailey-Hailey Disease (Familial Benign Pemphigus)

92

Disseminated Superficial Actinic Porokeratosis (DSAP)

93

SECTION.6

GENETIC AND ACQUIRED BULLOUS DISEASES

94

Hereditary Epidermolysis Bullosa (EB)

94

Pemphigus

101

Bullous Pemphigoid (BP)

107

Cicatricial Pemphigoid

109

Pemphigeid Gestationis (PG)

110

Dermatitis Herpetif ormis (DH)

111

Linear IgA Dermatosis (LAD)

113

Epidermolysis Bullosa Acquisita (EBA)

114

SECTION 7

NEUTROPHIL-MEDIATED DISEASES

116

Pyoderma Gangrenosum (PG)

116

Sweet Syndrome (SS)

120

Granuloma Faciale (GF)

122

Erythema Nodosum (EN) Syndrome

122

Other Panniculitides

125

SECTION 8

SEVERE AND LIFE-THREATENING SKIN ERUPTIONS K2FL IN THE ACUTELY ILL PATIENT

127

Exfoliative Erythroderma Syndrome (EES)

127

Rashes in the Acutely III Febrile Patient

133

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

137

SECTION 9

BENIGN NEOPLASMS AND HYPERPLASIAS

141

Disorders of Melanocytes

141

Acquired Nevomelanocytic Nevi (NMN)

141

Halo Nevomelanocytic Nevus

146

Blue Nevus

148

Nevus Spilus

149

Spitz Nevus

151

Mongolian Spot

152

Nevus of Ota

153

Vascular Tumors and Malformations

154

Vascular Tumbrs

155

Hemangioma of Infancy (HI)

155

Pyogenic Granuloma

159

Glomus Tumor

160

Angiosarcoma

161

Vascular Malformations

161

Capillary Malformations

162

Port-Wine Stain

162

Spider Angioma

164

Venous Lake

165

Cherry Angioma

166

Angiokeratoma

167

Lymphatic Malformation

169

“Lymphangioma”

169

Capillary/Venous Malformations (CVMs)

170

Miscellaneous Cysts and Pseudocysts

172

Epidermoid Cyst

172

Trichilemmal Cyst

173

Epidermal Inclusion Cyst

173

Milium

174

Digital Myxoid Cyst

175

Miscellaneous Benign Neoplasms and Hyperplasias

176

Seborrheic Keratosis

176

Becker Nevus (BN)

179

Trichoepitheiioma

180

Syringoma

181

Sebaceous Hyperplasia

182

Nevus Sebaceous

182

Epidermal Nevus

183

Benign Dermal and Subcutaneous Neoplasms and Hyperplasias

184

Lipoma

184

Dermatofibroma

185

Hypertrophic Scars and Keloids

186

Infantile Digital Fibromatosis

189

Skin Tag

190

SECTION 10

GHI PHOTOSENSITIVITY, PHOTO-INDUCED DISORDERS, AND DISORDERS BY IONIZING RADIATION

191

Skin Reactions to Sunlight

191

Acute Sun Damage (Sunburn)

193

Drug-/Chemical-lnduced Photosensitivity

195

Phototoxic Drug-/Chemical-lnduced Photosensitivity

196

Systemic Phototoxic Dermatitis

196

Topical Phototoxic Dematitis

199

Phytophotodermatitis (PPD)

199

Photoallergic Drug/Chemical-lnduced Photosensitivity

201

Polymorphous Light Eruption (PMLE)

204

Solar Urticaria

206

Photo-Exacerbated Dermatoses

207

Metabolic Photosensitivity—the Porphyrias

207

Porphyria Cutanea Tarda

208

Variegate Porphyria

212

Erythropoietic Protoporphyria

213

Chronic Photodamage

215

Dermatoheliosis (“Photoaging”)

215

Solar Lentigo

217

Chondrodermatitis Nodularis Helicis

218

Actinic Keratosis

219

Skin Reactions to Ionizing Radiation

222

Radiation Dermatitis

222

SECTION 11

PRECANCEROUS LESIONS AND CUTANEOUS CARCINOMAS

226

Epidermal Precancers and Cancers

226

Cutaneous Horn

227

Arsenical Keratoses

228

Squamous Cell Carcinoma In Situ

228

Invasive Squamous Cell Carcinoma

232

Keratoacanthoma

239

Basal Cell Carcinoma (BCC)

240

Basal Cell Nevus Syndrome (BCNS)

247

Malignant Appendage Tumors

248

Merkel Cell Carcinoma

248

Dermatof ibrosarcoma Protuberans (DFSP)

250

Atypical Fibrosarcoma (AFX)

251

SECTION 12

MELANOMA PRECURSORS AND PRIMARY CUTANEOUS MELANOMA

252

Precursors of Cutaneous Melanoma

252

Dysplastic Melanocytic Nevus

252

Congenital Nevomelanocytic Nevus (CNMN)

256

Cutaneous Melanoma

259

Melanoma in Situ (MIS)

262

Lentigo Maligna Melanoma (LMM)

263

Superficial Spreading Melanoma

266

Nodular Melanoma

271

Desmoplastic Melanoma (DM)

274

Acral Lentiginous Melanoma

275

Amelanotic Melanoma

277

Malignant Melanoma of the Mucosa

278

Metastatic Melanoma

279

Staging of Melanoma

282

Prognosis of Melanoma

282

Management of Melanoma

282

SECTION 13

PIGMENTARY DISORDERS

284

Vitiligo

285

Oculocutaneous Albinism

291

Melastna

293

Pigmentary Changes Following Inflammation of the Skin

294

Hyperpigmentation

294

Hypopigmentation

297

PART II

DERMATOLOGY AND INTERNAL MEDICINE

SECTION 14

THE SKIN IN IMMUNE, AUTOIMMUNE, AND RHEUMATIC DISORDERS

302

Systemic Amyloidosis

302

Systemic AL Amyloidosis

302

Systemic AA Amyloidosis

304

Localized Cutaneous Amyloidosis

305

Urticaria and Angioedema

306

Erythema Multif orme (EM) Syndrome

314

Cryopyrinopathies (CAPS)

319

Lichen Planus (LP)

320

Behcet Disease

325

Dermatomyositis

328

Lupus Erythematosus (LE)

332

Systemic Lupus Erythematosus

334

Subacute Cutaneous Lupus Erythematosus (SCLE)

338

Chronic Cutaneous Lupus Erythematosus (CCLE)

340

Chronic Lupus Panniculitis

343

Llvedo Reticularis

344

Raynaud Phenomenon

345

Scleroderma

347

Scleroderma-Like Conditions

351

Morphea

351

Lichen Sclerosus et Atrophicus (LSA)

355

Vasculitis

356

Hypersensitivity Vasculitis

357

Henoch-Schonlein Purpura

359

Polyarteritis Nodosa

359

Wegener Granulomatosis

360

Giant Cell Arteritis

362

Urticarial Vasculitis

363

Nodular Vasculitis

364

Pigmented Purpuric Dermatoses (PPD)

365

Kawasaki Disease

366

Reactive Arthritis (Reiter Syndrome)

369

Sarcoidosis

371

Granuloma Annulare (GA)

375

SECTION 15

ENDOCRINE, METABOLIC AND NUTRITIONAL DISEASES

377

Skin Dlseasesin Pregnancy

377

Cholestasis of Pregnancy (CP)

377

Pemphigoid Gestationis

377

Polymorphic Eruption of Pregnancy (PEP)

379

Prurigo of Pregnancy and Atopic Eruption of Pregnancy (AEP)

380

Pustular Psoriasis in Pregnancy

380

Skin Manifestations of Obesity

380

Skin Diseases Associated with Diabetes Mellitus

381

Diabetic Bullae

382

“Diabetic Foot” and Diabetic Neuropathy

383

Diabetic Dermopathy

384

Necrobiosis Lipoidica

385

Cushing Syndrome and Hypercorticism

386

Graves Disease and Hyperttiyroidism

387

Hypothyroidism and Myxedema

387

Addison Disease

389

Metabolic and Nutritional Conditions

390

Xanthomas

390

Xanthelasma

392

Xanthoma Tendineum

392

Xanthoma Tuberosum

392

Eruptive Xanthoma

394

Xanthoma Striatum Palmare

394

Normollpemic Plane Xanthoma

395

Scurvy

396

Acquired Zinc Deficiency and Acrodermatltls Enteropathica

397

Pellagra

399

Gout

400

SECTION 16

GENETIC DISEASES

401

Pseudoxanthoma Elasticum

401

Tuberous Sclerosis (TS)

402

Neurofibromatosis (NF)

405

Hereditary Hemorrhagic Telangiectasia

409

SECTION 17

SKIN SIGNS OF VASCULAR INSUFFICIENCY

410

Atherosclerosis, Arterial Insufficiency, and Atheroembolization

410

Thromboangiitis Obliterans (TO)

414

Thrombophlebitis and Deep Venous Thrombosis

415

Chronic Venous Insufficiency

417

Most Common Leg/Foot Ulcers

422

Livedoid Vasculitis (LV)

424

Chronic Lymphatic Insufficiency

425

Pressure Ulcers

426

SECTION 18

SKIN SIGNS OF RENAL INSUFFICIENCY

429

Classification of Skin Changes

429

Calciphylaxis

429

Nephrogenic Fibrosing Dermopathy (NFD)

431

Acquired Perforating Dermatosis

432

SECTIONS 19

SKIN SIGNS OF SYSTEMIC CANCERS

433

Mucocutaneous Signs of Systemic Cancers

433

Classification of Skin Signs of Systemic Cancer

433

Metastatic Cancer to the Skin

434

Mammary Paget Disease

438

Extramammary Paget Disease

440

Cowden Syndrome (Multiple Hamartoma Syndrome)

441

Peutz-Jeghers Syndrome

442

Glucagonoma Syndrome

443

Malignant Acanthosis Nigricans

445

Paraneoplastic Pemphigus (PNP)

445

SECTION 20

SKIN SIGNS OF HEMATOLOGIC DISEASE

446

Thrombocytopenic Purpura

446

Disseminated Intravascular Coagulation

447

Cryoglobulinemia

450

Leukemia Cutis

452

Langerhans Cell Histiocytosis

455

Mastocytosis Syndromes

459

SECTION 21

CUTANEOUS LYMPHOMAS AND SARCOMA

463

Adult T Cell Leukemia/Lympnoma

463

Cutaneous T Cell Lymphoma

464

Mycosis Fungoides (MF)

464

Mycosis Fungoides Variants

470

Sezary Syndrome

472

Lymphomatoid Papulosis

472

Cutaneous Anaplastic Large Cell Lymphomas (CALCLs)

474

Cutaneous B Cell Lymphoma

475

Kaposi Sarcoma (KS)

476

SECTION 22

SKIN DISEASES IN ORGAN AND BONE MARROW TRANSPLANTATION

481

Most Common Infections Associated with Organ Transplantation

481

Skin Cancers Associated with Organ Transplantation

482

Graft-Versus-Host Disease

483

Acute Cutaneous GVHR

483

Chronic Cutaneous GVHR

486

SECTION 23

ADVERSE CUTANEOUS DRUG REACTIONS

488

Adverse Cutaneous Drug Reactions

488

Exanthematous Drug Reactions

493

Pustular Eruptions

495

Drug-Induced Acute Urticaria, Angioedema, Edema, and Anaphylaxis

497

Fixed Drug Eruption

498

Drug Hypersensitivity Syndrome

500

Drug-Induced Pigmentation

501

Pseudoporphyria

504

ACDR-Related Necrosis

505

ACDR-Related to Chemotherapy

508

SECTION 24

DISORDERS OF PSYCHIATRIC ETIOLOGY

511

Body Dysmorphic Syndrome (BOS)

511

Delusions of Parasitosis

511

Neurotic Excoriations and Trichotillomania

513

Factitious Syndromes (Munchhausen Syndrome)

515

Cutaneous Signs of Injecting Drug Use

516

PART III

DISEASES DUE TO MICROBIAL AGENTS

SECTION 25

BACTERIAL COLONIZATIONS AND INFECTIONS OF SKIN AND SOFT TISSUES

520

Erythrasma

520

Pitted Keratolysis

521

Trichomycosis

522

Intertrigo

523

Impetigo

525

Abscess, Furuncle, Carbuncle

529

Soft-Tissue Infection

534

Cellulitis

534

Necrotizing Soft-Tissue Infections

541

Lymphangitis

542

Wound Infection

543

Disorders Caused by Toxin-Producing Bacteria

547

Staphylococcal Scalded-Skin Syndrome

547

Toxic Shock Syndrome

549

Scarlet Fever

550

Cutaneous Anthrax

551

Cutaneous Diphtheria

553

Tetanus

553

Cutaneous Nocardia Infections

554

Rickettsial Disorders

556

Tick Spotted Fevers

556

Rocky Mountain Spotted Fever

558

Rickettsialpox

559

Infective Endocarditis

560

Sepsis

562

Meningococcal Infection

563

Bartonella Infections

564

Cat-Scratch Disease (CSD)

565

Bacillary Angiomatosis

566

Tularemia

567

Cutaneous Pseudomonas Aeruginosa Infections

568

Mycobacterlal Infections

568

Hansen Disease (Leprosy)

569

Cutaneous Tuberculosis

574

Nontuberculous Mycobacterlal Infections

579

Mycobacterium Marlnum Infection

579

Mycobacterium Ulcerans Infection

581

Mycobacterium Fortuitum Complex Infections

582

Lyme Disease

585

SECTION 26

FUNGAL INFECTIONS OF THE SKIN, HAIR, AND NAILS

590

Introduction

590

Superficial Fungal Infections

590

Candidiasis

590

Cutaneous Candidlasis

591

Oropharyjpgeal Candldiasis

594

Genital Candidiasis

597

Chronic Mucocutaneous Candidiasis

598

Disseminated Candidiasis

600

Tinea Versicolor

601

Trichosporon Infections

605

Tinea Nlgra

605

Dermatophytoses

606

Tinea Pedis

610

Tinea Manuum

614

Tinea Cruris

616

Tinea Corporis

618

Tinea Facialis

620

Tinea Incognito

622

Dermatophytoses of Hair

622

Tinea Capitis

623

Tinea Barbae

626

Majocchi Granuloma

628

Invasive and Disseminated Fungal Infections

628

SECTION 27

VIRAL DISEASES OF SKIN AND MUCOSA

629

Introduction

629

Poxvirus Diseases

629

Molluscum Contagiosum

629

Human Orf

633

Milkers’ Nodules

635

Smallpox

635

Smallpox Vaccination

636

Human Pa pillomavirus Infections

638

Human Papillomavirus: Cutaneous Diseases

639

Systemic Viral Infections with Exanthems

647

Rubella

648

Measles

650

Enteroviral Infections

652

Hand-Foot-and-Mouth Disease

653

Herpangina

655

Erythema Infectiosum

656

Gianotti-Crosti Syndrome

657

Dengue

658

Herpes Simplex Virus Disease

660

Nongenital Herpes Simplex

663

Neonatal Herpes Simplex

666

Eczema Herpeticum

668

Herpes Simplex with Host Defense Defects

669

Varicella Zoster Virus Disease

672

VZV: Varicella

673

VZV: Herpes Zoster

675

VZV: Host Defense Defects

680

Human Herpesvirus-6 and -7 Disease

683

Human Immunodeficiency Virus Disease

684

Acute HIV Syndrome

687

Eosinophilc Folliculitis

688

Papular Pruritic Eruption of HIV

689

Photosensitivity In HIV Disease

690

Oral Hairy Leukoplakla

690

Adverse Cutaneous Drug Eruptions in HIV Disease

691

Variations in Common Mucocutaneous Disorders in HIV Disease

692

SECTION 28

ARTHROPOD BITES, STINGS, AND CUTANEOUS INFECTIONS

698

Cutaneous Reactions to Arthropod Bites

698

Pediculosis Capitis

704

Pediculosis Corporis

706

Pediculosis Pubis

707

Demodlcidosis

709

Scabies

710

Cutaneous Larva Migrans

716

Water-Associated Diseases

717

Schistosome Cercarial Dermatitis

718

Seabather’s Eruption

719

Cnidaria Envenomations

719

SECTION 29

SYSTEMIC PARASITIC INFECTIONS

721

Lelshmaniasis

721

Human American Trypanosomiasis

725

Human African Trypanosomiasis

726

Cutaneous Amebiasis

727

Cutaneous Acanthamebiasis

727

SECTION 30

SEXUALLY TRANSMITTED DISEASES

728

Human Papillomavirus: Anogenital Infections

728

Genital Warts

729

HPV: Squamous Cell Carcinoma in Situ (SCCIS) and Invasive SCC of Anogenital Skin

732

Herpes Simplex Virus: Genital Disease

736

Neisseria Gonorrhoeas Disease

742

Neisseria Gonorrhoeae: Gonorrhea

743

Syphilis

744

Primary Syphilis

745

Secondary Syphilis

747

Latent Syphilis

751

Tertiary/Late Syphilis

751

Congenital Syphilis

752

Lymphogranuloma Venereum

753

Chancroid

754

Danovanosis

756

PART IV

SKIN SIGNS OF HAIR, NAIL, AND MUCOSAL DISORDERS

SECTION 31

DISORDERS OF HAIR FOLLICLES AND RELATED DISORDERS

760

Biology of Hair Growth Cycles

760

Hair Loss: Alopecia

762

Pattern Hair Loss

762

Alopecia Areata

767

Telogen Effluvium

770

Anagen Effluvium

773

Cicatricial or Scarring Alopecia

774

Excess Hair Growth

781

Hirsutism

781

Hypertrichosis

784

Infectious Folliculitis

785

SECTION 32

DISORDERS OF THE NAIL APPARATUS

790

Normal Nail Apparatus

790

Components of the Normal Nail Apparatus

790

Local Disorders of Nail Apparatus

790

Chronic Paronychia

790

Onychoiysis

792

Green Nail Syndrome

793

Onychauxis and Onychogryphosis

793

Psychiatric Disorders

794

Nail Apparatus Involvement of Cutaneous Diseases

794

Psoriasis

794

Lichen Planus (LP)

796

Alopecia Areata (AA)

798

Darier Disease (Darier-White Disease, Keratosis Folllcularis)

798

Chemical Irritant or Allergic Damage or Dermatitis

799

Neoplasms of the Nail Apparatus

800

Myxoid Cysts of Digits

800

Longitudinal Melanonychla

800

Nail Matrix Nevi

801

Acrolentiglnous Melanoma (ALM)

801

Squamous Cell Carcinoma

802

Infections of the Nail Apparatus

803

Acute Paronychia

804

Felon

804

Candida Onychia

805

Tinea Unguium/Onychomycosis

806

Nail Signs of Multisystem Diseases

809

Transverse or Beau Lines

809

Leukonychia

810

Yellow Nail Syndrome

811

Periungual Fibroma

812

Splinter Hemorrhages

812

Nail Fold/Periungual Erythema and Telangiectasia

813

Koilonychia

815

Clubbed Nails

815

Drug-Induced Nail Changes

816

SECTION 33

DISORDERS OF THE MOUTH

817

Diseases of the Lips

817

Angular Cheilitis (Perleche)

817