Introduction To The Patient

A careful history from the patient taken by the physician (1) is important medically, (2) impresses the patient with your concern, and (3) establishes early on a necessary favorable rapport between you and the patient. After the usual conversation introducing yourself to the new patient, the following may transpire physician What can I do for you, Mrs. Jones MRS. jones I have a bad breaking out on my hands. physician (Writes on his chart under Present Complaint, hand dermatitis) How long have...

Treatment

An acute vesicular, pustular fungal infection of 2 weeks' duration is present on the soles of the feet and between the toes in a 16-year-old boy. This clinical picture is usually due to the organism T. mentagrophytes. 1. The fear of the infectiousness of athlete's foot should be minimized but normal cleanliness emphasized, including the wearing of slippers over bare feet, wiping the feet last after a bath (not the groin last), and changing socks daily (white socks are not...

Granulomatous slack skin syndrome see Slack Skin syndrome

Variable immunodeficiency associated with partial albinism. Characteristic histology of hair and skin is seen. Grover's disease. See Acantholytic dermatosis, transient Hallermann-Streiff syndrome. Usually mutational, rare, craniofacial dysostoses with bird-like facies, facial telangiectasias, face and scalp atrophy, alopecia (characteristically along suture lines), skeletal and ocular abnormalities. Hamartoma, congenital smooth muscle. Rare, usually present at birth,...

Dermatologic Diagnosis

Secondary.Lesions PrimaixLesions Diagnosis. .by. Location Seasonal Skin. .Diseases M.ilitary.Dermatoses Dermatoses. .o.f. fri.ca.n-A.me.ric.ans Bibliography To aid in determining the diagnosis of a presenting skin problem, this chapter contains discussions of primary and secondary lesions and also of diagnosis by location. Included are lists of seasonal skin diseases, military dermatoses, and dermatoses of African-Americans. 1. One of the dermatologist's tools of the trade is a...

Info

Warts. (Reed & Carnrick Pharmaceuticals) Moist warts are quite characteristic, single or multiple, soft, nonhorny masses that appear in the anogenital areas and, less commonly, between the toes and at the corners of the mouth. They are not always of a venereal nature. However, moist warts in the anal orifice or on the genitalia of a child can be a sign of sexual abuse. Genital and anal warts are predominantly induced by HPV types 6, 11, 16, 18, and 31. Types 16 and 18 are...

Bibliography

Skin cancer and UV radiation. 1997. Bleicher PA. Chronic UVA induces photodamage. Journal Watch for Dermatology 1996 4 2. Caldiron B. Thinning of the ozone layer Facts and consequences. J Am Acad Dermatol 1992 27 653. DeLeo VA. Photoallergic contact dermatitis. Arch Dermatol 1992 128 1513. Fitzpatrick TB. The validity and practicality of sunreactive skin types I through VI. Arch Dermatol 1988 124 869. Gilchrest BA. Photodamage. Boston, Blackwell Science, 1995....

Epidemiology

AIDS is the end result of infection with HIV, a retrovirus that is transmitted either by sexual contact, sharing contaminated needles, or transfusion of infected blood or blood products. After inoculation, HIV enters cells of the immune systemic through the CD4 receptor on T-helper lymphocytes. Once inside the cells, the virus may remain latent or proliferate and divide. Patients begin to manifest signs and symptoms of HIV infection months to years after exposure, although infected individuals...

Melanocytic Nevi

Intradermal (resting) nevus *3. Dysplastic nevus syndrome 4.Lentigines. These are to be differentiated from freckles (ephelides). A freckle histologically shows hyperpigmentation of the basal layer but no elongation of the rete pegs and no increase in the number of clear cells and dendritic cells. Juvenile lentigines (lentigo simplex) begin to appear in childhood and occur on all parts of the body. Senile lentigines (see Fig 34-2), also known as liver spots,...

Sauer notes

To diagnose syphilis, the physician must have a high index of suspicion for it. 2. Syphilis is the great imitator and can mimic many other conditions. Figure 16-1. Primary syphilis with a chancre of the penis. This chancre is accompanied by marked edema of the penis. ( J.E. Moore and The Upjohn Company) Figure 16-1. Primary syphilis with a chancre of the penis. This chancre is accompanied by marked edema of the penis. ( J.E. Moore and The Upjohn Company) The first stage of acquired syphilis...

Amebiasis Including Free Living Amebas And Entamoeba Histolytica Free living amebas are usually associated with disease

The infection is acquired by swimming in ponds and streams with still water. There are two types of meningoencephalitis produced by these organisms. The Naegleria species cause an acute form, with no skin manifestions. The subacute, granulomatous form is produced by two families, Acanthamoeba and Balamuthia. Infection by Acanthamoeba species is known to induce chronic ulcerative lesions in AIDS patients and, rarely, isolated, centrofacial plaques in immunocompetent...

Candidiasis

(Fig 19-12, Fig 19-13 and Fig 19-14 see Fig 18-7, Fig 33-4A-B, and Fig 33-17) Candidiasis (moniliasis) is a fungal infection caused by Candida albicans that produces lesions in the mouth, the vagina, the skin, the nails, the lungs, or the gastrointestinal tract or occasionally a septicemia. The latter condition is seen in patients who are on long-term, high-dose antibiotic therapy and in those who are immunosuppressed. Because C. albicans exists commonly as a harmless skin inhabitant, the...

Primary exfoliative dermatitis

These cases develop in apparently healthy persons from no ascertainable cause. SKIN LESIONS. Clinically, it is impossible to differentiate this primary form from the one in which the etiology is known or suspected. Various degrees of scaling and redness are seen, ranging from fine, generalized, granular scales with mild erythema to scaling in large plaques, with marked erythema (generalized erythroderma) and lichenification. Widespread lymphadenopathy is usually present. The nails become thick...

Neurology

NEUROFIBROMATOSIS. (See Chap 31.) Neuro-fibromatosis (.Fig 26-1.3.) is inherited in an autosomal dominant fashion. It comprises congenital and hamartomatous lesions of the central nervous system, bone, endocrine glands, eyes, and skin. Cafe-au-lait macules develop soon after birth and may be found anywhere on the body. These skin lesions can be seen in normal individuals, but individuals having six or more lesions 1.5 cm or greater have nearly always been found to have neurofibromatosis....

Histiocytoma and dermatofibroma

Histiocytoma, on leg. (Syntex Laboratories, Inc.) Histiocytomas and dermatofibromas are common, usually single, flat or only slightly elevated, tannish, reddish, or brownish nodules, less than l cm in size, that occur mainly on the anterior tibial area of the leg. These tumors have a characteristic clinical appearance and firm button-like feel that establishes the diagnosis. They often dimple when firm pressure is applied from both sides. They occur in adults and are...

Port Wine Hemangioma

The port wine hemangioma is commonly seen on the face as a reddish purple, flat, disfiguring facial mark. It can occur elsewhere in a less extensive form. Faint reddish lesions are often found on infants on the sides of the face, the forehead, the eyelids, and the extremities. The color increases with crying and alarms the mother, but most of these faint lesions disappear shortly after birth. When located above the palpebral tissue it can be associated with underlying hemangioma at the meninges...

Molluscum contagiosum

Molluscum contagiosum. (Glaxo Dermatology) Figure 17-8. Molluscum contagiosum. (Glaxo Dermatology) Molluscum contagiosum is a common viral infection of the skin that is characterized by the occurrence, usually in children or sexually active young adults, of one or multiple small skin tumors. These growths occasionally develop in the scratched areas of patients with atopic eczema. The causative agent is a large DNA-containing pox-virus. Multiple facial...

Arachnidism

Latrodectus mactans are small, dark spiders also called black widows. They have a black or brown underside with a red, orange, or white hourglass marking on the back. They are commonly found in fields, under stones, and in outhouses. Their venom is neurotoxic, and they bite usually on the genitalia or buttocks. Pain develops within about an hour, with accompanying reddening and swelling. Systemic symptoms include muscle cramping, rigidity, and later weakness, sweating,...

German measles rubella

Although German measles is a benign disease of children, it is serious if it develops in a pregnant woman during the first trimester, because it causes anomalies in a low percentage of newborns. The incubation period is around 18 days, and, as in measles, there may be a short prodromal stage of fever and malaise. The rash also resembles measles, because it occurs first on the face and then spreads. However, the redness is less intense and the rash disappears within 2 to 3 days. Enlargement of...

Disease Caused by Nigua

Most common location by toenail. Tungiasis is a human infestation produced by Tunga penetrans, a sand flea that thrives in moist sandy ground near pigsties and cow sheds. It is widely distributed in tropical and subtropical areas of South America and Africa. It is known by various names (pique, nigua, bicho dos pes). It is commonly fertilized with cattle manure. The infection is produced by the female flea, which burrows into the skin of toeweb spaces and near the nail. The...

Noninfectious miscellaneous dermatoses

This is very common in children and consists of hypopigmented, poorly defined, scaly macules and plaques found on the face and upper outer arms. It is believed to be a mild form of atopic eczema. Lesions are first noticed after exposure to sunshine, where the surrounding sun-affected skin appears quite tan. Treatment consists of topical 1 hydrocortisone cream at night and sunscreens during the day. PAPULAR URTICARIA. (Fig 35-22 see Fig 35-10). This term defines an exuberant...

Gastroenterology

Pseudoxan-thoma elasticum is a genetic disorder of connective tissue characterized by progressive mineralization of elastic fibers. The disease manifests as angioid streaks on the retina, retinal hemorrhages, gastrointestinal bleeds, hypertension, and occlusive vascular disease secondary to the progressive calcification and fragmentation of the elastic fibers in the eye and blood vessels. Characteristic skin lesions also occur and tend to involve flexural sites....

Pruritic Dermatoses

Pruri.t.i.s Senile, .Pruritis Lo.calized Pruritic Dermatose,s Lichen.nSimplex, .Chronicus Pruritus, or itching, brings more patients to the physician's office than any other skin disease symptom. Itchy skin is not easily cured or even alleviated. Many hundreds of proprietary over-the-counter and prescription drugs are touted as effective antiitch remedies, but none is 100 effective. However, many are partially effective, but it is unfortunate that the most effective locally applied...

Onycholysis

Onycholysis is the distal or lateral separation of the nail plate from the nail bed. Probably psoriasis, fungal infection, and trauma (physical and chemical) from overly vigorous manicuring are among the more common causes. An allergic or irritant reaction to nail cosmetics may also be a culprit (see Fig.28-3A.). Photosensitizing drug reactions (Fig. 28-15), hyperthyroidism, anemia, syphilis, and decreased circulation are among some of the systemic causes. Probably systemic causes are less...

First Visit

The patient is told that the acute flare-up (the blisters) can be cleared but that it will-be difficult and time-consuming to cure the chronic infection. If the toenails are found to be infected, the prognosis for cure is even poorer. (See Tinea of the Nails later in this chapter.) 2. The blisters are debrided and trimmed with manicure scissors. 3. Any of the antifungal creams, Sig Apply locally to soles b.i.d., or 1. Systemic antifungal therapy This type of oral therapy is not recommended for...

Helminthic Dermatosis Roundworm

This is a disease caused by hookworms, usually parasites of dogs and cats. The ova are excreted through the feces, and they remain viable in sandy, moist ground. The larva then penetrate the skin of bathers or people who walk on the contaminated ground. Usually the culprits are Ancylostoma duodenal, Necator americanus, and other hookworms. Clinically, the parasite causes a serpentine, erythematous, papular, pruritic skin eruption. The parasite is usually...

Nails

Isolated inherited disorders of nails are rare, and most abnormalities are part of syndromes. Pachyonychia congenital syndrome ( Fig. , 31-7) is a term used for two autosomal dominant conditions type 1, Jadassohn-Lewandowski syndrome, and type 2, Jackson-Lawler syndrome. In pachyonychia congenital syndrome, the nail plates are thickened or may be small or absent. Nail changes may appear within the first few years of life or not until later. Not all nails are necessarily involved. Other physical...

Dermatologic parasitology

As an epidemic in a nursing home, scabies can be a difficult management problem. The elderly, especially if mentally confused, present a challenge for basic hygiene. When they itch, this itch is usually attributed to dry skin or senile pruritus. Only when several residents in the nursing home, and the personnel, begin to itch does one think of scabies as a cause. Then the therapy is difficult because so many persons are affected (and for personnel, possibly their families) that a basic...

Figure 2615 Periungal fibromas Koenens tumor in tuberous sclerosis

In Sturge-Weber syndrome, a port wine stain (nevus flammeus) covers a large part of the face and scalp in a unilateral distribution. The lesion lies in the territory of the ophthalmic division of the trigeminal nerve. In this syndrome, the cutaneous involvement precedes the cerebral involvement, which appears later in childhood as a contralateral spastic hemiparesis, unilateral seizures, hemisensory defects, and homonymous hemianopia. SARCOIDOSIS. (See also Chap 20.)...

Where To Look For More Information About A Skin Disease

Doctor, I saw a patient yesterday who was diagnosed as having epidermolysis bullosa. I understand this is quite a rare condition. Where can I find the latest information on this subject This is a question frequently asked of any teaching dermatologist. A computer will give you references, and some data bases will provide information about a dermatosis. But, assuming these are not readily available, there are other sources. First, the inquiring physician or student should check out the...

Blistering Vesiculobullous Lesions

Blistering lesions can be mechanically induced or caused by infections. 1. Sucking blisters These are usually seen as oval bullae on the hands or forearm thought to be caused by sucking in utero. They resolve rapidly. 2. Epidermolysis bullosa (Fig 33,-.3.) (see Chap, 31) This refers to a group of inherited disorders with bullous lesions developing spontaneously or as a result of 3. Infections (Fig 33-4) Herpes simplex, congenital varicella, and candidiasis present as blisters in the newborn....

Lichen planus

(Fig 14-9, Fig 14-10, Fig 14-1 and Fig 1 12 see also Fig 3-1B) Figure 14-9. Lichen planus on the wrist and the dorsum of the hand in a black patient. Note the violaceous color of the papules and the linear Koebner phenomenon on the dorsum of the hand. (E.R. Squibb) Figure 14-10. Lichen planus. (Johnson & Johnson) Figure 14-10. Lichen planus. (Johnson & Johnson) Figure 14-11. Lichen planus. Note the Koebner reaction in the lower photograph. Figure 14-12. Lichen planus, unusual variations....

Brittle Nails

Brittle nails may affect up to 20 of the population overall and affect about 35 of the elderly population. Repetitive use of harsh detergents, nail-polish removers, and repeated wetting and drying are among the more common causes. Dry, cold environments lead to increased evaporation of water from the nail plate and cause brittleness. Normal water content of the nail is 18 , and when it is below 16 the nail is brittle. When the water content is above 25 the nail is soft. After soaking the hands...

Diseases Of The Mucous Membranes

GeographicTongue Differential Diagnosis Treatment Aphthous Stomatitis Differential Diagnosis Other Mucosal Lesions and Conditions Rarer .Conditions of G .n.i.tal. Mu.c.o.us.Mem.b.ranes Bibliography The mucous membranes of the body adjoin the skin at the oral cavity, nose, conjunctiva, penis, vulva, and anus. Histologically, these membranes differ from the skin in that the horny layer and the hair follicles are absent. Disorders of the mucous membranes are usually associated with existing skin...

Polymorphous Light Eruption

Polymorphous light eruption (PMLE) is included here, although opinion is divided as to whether it is in fact related to lupus erythematosus. PMLE is characteristically seasonal (spring or summer), implying a threshold or dose-response relationship. It most commonly affects children or young adults ( Fig.30-6). Figure 30-6. Photosensitivity dermatoses. Papular polymorphic light eruption off and on for 15 years. ( Texas Pharmaceutical) The skin lesions, as the name implies, are variable, with...

Sauer note

Dermographism is commonly overlooked as a cause of the patient's welts or vague itching. Inhalants. Nasal sprays, insect sprays, dust, feathers, pollens, and animal danders are some offenders. Infections. A focus of infection is always considered, sooner or later, in chronic cases of hives, and in unusual instances it is causative. The sinuses, the teeth, the tonsils, the gallbladder, and the genitourinary tract should be checked. Internal disease. Urticaria has been seen with liver disease,...

Fundamentals Of Cutaneous Surgery

Frank Custer Koranda,M.D* Instrument. S lection Types. ofStitches BuriedSubcutaneoUS Cor,n,er Stitc,h,. ITip Stitch,, Ha,lf-B,,uned, .Mattress) Suture Tying Hemostasis Patient Preparation Skin.Preparation Placement . of . Incisions Incisions Excisions Wound. Dressings S.uture Rem.o.va Wound. Dynamics WounlHeaNng Documentation .andAssessment Bibliography Attention to detail is the essence of surgical perfection. Disregard of or ignorance of any of the fundamentals of surgery is often the...

Life stages and the skin

A brief review of important life stages and their influence on the skin is as follows PUBERTY. In males, at puberty, the beard, the pubic hair, and other body hair begin to grow in characteristic patterns that differ from the hair growth in females. Both sexes at this time notice increased activity of the apocrine glands, with axillary perspiration and body odor and increased development of the sebaceous glands, with the formation of varying degrees of seborrhea and the comedones, papules, and...

Classification

The latest classification divides the superficial fungi into three genera Microsporum, Epidermo-phyton, and Trichophyton. Species of only two of these invade the hair Microsporum and Tricho-phyton. As seen in a KOH preparation, Micro- sporum species cause an ectothrix infection of the hair shaft, whereas Trichophyton species cause either an ectothrix or an endothrix infection. The ectothrix fungi cause the formation of an external spore sheath around the hair, whereas the endothrix fungi do...

Figure 276 Hair loss alopecia due to alopecia cicatrisata scarring Neutrogena Skin Care Institute

Alopecia of the scalp is of considerable concern to both men and women. It is helpful in differentiating among the many causes of alopecia to examine the hair and scalp and observe whether the hair loss is diffuse or patchy and whether the scalp appears scarred. A careful history and physical examination of the hair and scalp is most important. Nonscarring hair loss is more common than scarring hair loss ( Table27 2). Table 27-2 Types of Nonscarring and Scarring Hair Loss

Sarcoidosis

Sarcoidosis. (Hoechst-Roussel Pharmaceuticals Inc.) Figure 20-1. Sarcoidosis. (Hoechst-Roussel Pharmaceuticals Inc.) Sarcoidosis is an uncommon systemic granulomatous disease of unknown cause that affects skin, lungs, lymph nodes, liver, spleen, parotid glands, and eyes. Less commonly involved organs indicative of more severe disease are the central nervous system, heart, bones, and upper respiratory tract. Any one of these organs or all of them may be involved with sarcoid...

Warts

Periungual warts in lymphoma patient. (Westwood Pharmaceuticals) Verrucae (warts) can occur anywhere on the body, but one of the most difficult warts to treat is the type that grows around the nail and under the nail plate. If a periungual wart is large and extends rather far under the nail, a deformed nail may result from the wart or its removal. One must be leery of cryotherapy or cautery of a wart on the proximal nail fold because the nail matrix is underneath...

Sauer notes dos and donts regarding nevi

Don't remove a nevus in a child by electrosurgery or laser remove only by surgical excision and submit nevus for histopathologic examination. 2. Do remember that in a child a benign junctional nevus may resemble a malignant melanoma histologically (Spitz nevus). Don't alarm the parents unnecessarily, because these nevi are no threat to life. 3. Don't remove a flat pigmented nevus, particularly on the palm, the sole, or the genitalia, by electrosurgery or laser. These should be excised...

Secondary exfoliative dermatitis

Figure 23-1. Ex liative dermatitis. Most patients with secondary exfoliative dermatitis have had a previous skin disease that became generalized because of overtreatment or for unknown reasons. There always remain a few cases of exfoliative dermatitis in which the cause is unknown but suspected. SKIN LESIONS. The clinical picture of this secondary form is indistinguishable from the primary form unless some of the original dermatitis is present.

Sig Apply locally tid 12 hour pc aphthous stomatitis

I-1 t VlJ I J.r ikYl-J 5 kj- -. .(H ' MPI OJUIfl Figure 29-2. Mucous membrane diseases. (Neutro gena Corp.) I-1 t VlJ I J.r ikYl-J 5 kj- -. .(H ' MPI OJUIfl Figure 29-2. Mucous membrane diseases. (Neutro gena Corp.) Canker sores are extremely common, painful, superficial ulcerations of the mucous membranes of the mouth. COURSE. One or more lesions develop at the same time and heal without scarring in 5 to 10 days. They can recur at irregular intervals. ETIOLOGY. The cause is unknown, but...

Sporotrichosis see Chap35

Sporotrichosis is a granulomatous fungal infection of the skin and the subcutaneous tissues. Characteristically, a primary chancre precedes more extensive skin involvement. Invasion of the internal viscera is rare (see Chap.35). PRIMARY LESION. A sporotrichotic chancre develops at the site of skin inoculation, which is commonly the hand and less commonly the face or the feet. The chancre begins as a painless, movable, subcutaneous nodule that eventually softens and breaks down to form an ulcer....

Stasis venous dermatitis and ulcers

(Fig 12-4 see also Fig 34-12) Figure 12-4. Vascular dermatosis. Stasis dermatitis. (Dermik Laboratories, Inc.) Stasis dermatitis is a common condition due to impaired venous circulation in the legs of older patients. Almost all cases are associated with varicose veins, and because the tendency to develop varicosities is a familial characteristic, stasis dermatitis is also familial. The medial malleolus area of the ankle is the most common location. Stasis ulcers can develop in the impaired...

Sun protection factor SPF

Twin elevated plaques or tumors on the dorsa of the feet and below the knees from trauma on surfboard. Sutton's disease. See Leukoderma acquisitum centrifugum and Periadenitis mucosa necrotica recurrens Sweet syndrome. See Neutrophilic dermatosis, acute febrile Swimming pool granuloma, 394, 394f. A slow-healing granulomatous lesion on the nose, the elbows, or the knees that follows a swimming pool injury, caused by Mycobacterium balnei. Syndrome, basal cell nevus. See Basal cell...

Sunburn

A sunburn can be mild and desired or severe and feared. The most severe reactions come from prolonged exposure at swimming areas or when the unfortunate person falls asleep under an ultraviolet lamp. The degree of reaction depends on several factors, including length and intensity of exposure, the patient's complexion, and previous conditioning of the skin. Sun-reactive skin typing of white-skinned persons became necessary when psoralens and ultraviolet light therapy were developed for the...

Superficial fungal infections

The superficial fungi live on the dead horny layer of the skin and elaborate an enzyme that enables them to digest keratin, causing the superficial skin to scale and disintegrate, the nails to crumble, and the hairs to break off. The deeper reactions of vesicles, erythema, and infiltration are presumably due to the fungi liberating an exotoxin. Fungi are also capable of eliciting an allergic or id reaction. When a skin scraping, a hair, or a culture growth is examined with the microscope in a...

Terrys Nails and Halfand Half Nails

A nail exhibiting a red, pink, or brown transverse distal band occupying 20 to 60 of the total nail length with the remaining proximal portion exhibiting a dull whitish ground-glass appearance may be a sign of renal disease and has been termed the half-and-half nail. If the distal band is less than 20 of the total nail length the patient has Terry's nails, classically seen with cirrhosis of the liver. However, 25 of some hospital patient populations have been shown to have this problem. These...

Tinea of the Feet

(Fig 19-1, Fig 192 and Fig 19-3) Figure 19-1. Tinea of the foot. This dry, scaly form of fungus infection is usually due to T. rubrum. (Smith Kline & French Laboratories) IJti* tn * br rt bM + J Lii l , i id- -v- j-.vi ra IJti* tn * br rt bM + J Lii l , i id- -v- j-.vi ra Figure 19-2. Tinea of the foot. (Schering Corp.) Tinea of the feet (athlete's foot, fungal infection of the feet, ringworm of the feet) is a very common skin infection. Many persons have the disease and are not even aware...

Tinea of the Groin

Dermagrams for comparison of tinea of crural area and candidiasis of crural area. (Left) Tinea of crural area. Note sharp border of lesions. (See also Fig. 19-18). (Right) Candidiasis of crural area. Note indefinite border with satellite pustule-like lesions as edge. Candiadiasis can also involve the scrotum. (See also Fig 19-14.) Tinea of the groin is a common, itching, annoying fungal infection appearing usually in men and often concurrently with tinea of the feet. Home remedies...

Tinea of the Nails

Tinea of fingernails, due to T. rubrum. (Duke Laboratories, Inc.) Tinea of the toenails is very common, but tinea of the fingernails is uncommon. Tinea of the toenails is almost inevitable in patients who have recurrent attacks of tinea of the feet. Once developed, the infected nail serves as a resistant focus for future skin infection. PRIMARY LESIONS. Distal and lateral detachment of the nail occurs with subsequent thickening and deformity. SECONDARY LESIONS. Bacterial infection...

Tinea of the Scalp

(Fig 19-10 see also Fig 33-30AJB) Figure 19-10. Tinea of the scalp. (See also Fig.33-30.) Figure 19-10. Tinea of the scalp. (See also Fig.33-30.) Tinea of the scalp is the most common cause of patchy hair loss in children ( Fig 19-10). Endemic cases are with us always, but epidemics, usually due to the human type, were, until the discovery of griseofulvin, the real therapeutic problem. Griseofulvin orally finds its greatest therapeutic usefulness and triumph in the management of tinea of the...

Trematodes Dermatosis Flukes

Cercaria dermatitis or swimmer's itch is caused by the penetration of the skin by schistosoma of birds or mammals. The cercaria are found in bodies of water. They can penetrate the skin of mammal and, if the host is receptive, reach the bloodstream and spread to other organs. In humans, who are not the definitive host, the cercaria are unsuccessful in reaching the blood they are retained in the epithelial layers of skin and finally destroyed, resulting in dermatitis....

Venous Lake Varix

Another vascular lesion that occurs in older persons is a venous lake. Clinically, it is a soft, compressible, flat or slightly elevated, bluish-red, 3- to 6-mm lesion, usually located on the lips or the ears. Lack of induration and rapid growth distinguish it from a melanoma. Lack of pulsation distinguishes a venous lake on the lower lip from a tortuous segment of the inferior labial artery. Treatment is usually not desired, only reassurance concerning its nonmalignant nature. Angiokeratomas...

Warts verrucae

(Fig 17-5 see Fig 28-10) Figure 17-5. Warts. (Reed & Carnrick Pharmaceutricals) Figure 17-5. Warts. (Reed & Carnrick Pharmaceutricals) Warts, or verrucae, are very common small tumors of the skin. It is doubtful if any human escapes this viral infection. Warts have been played with for centuries, and cures have been attributed to burying a dead black cat in the graveyard at midnight and other such feats. The interesting fact is that these examples of psychotherapy do work. Physicians...

Whether it is primary endogenous Exogenous Photosensitivity Internal Agents

Most systemic photosensitizers produce dose-proportionate, nonimmunologic phototoxic reactions (see Fig 9-1 and Fig 30-1). This means that virtually all, except possibly the most darkly pigmented persons, who take the drug will be potentially photosensitized. The most frequent offenders are demeclocycline (Declomycin HCL) (see Fig 28-15), doxycycline (Vibramycin, Monodox), chlorpromazine (Thorazine), sulfonamides, thiazides, and sulfonylureas. (In the drug eruption section of Cha.pter 9. there...

Exostosis subungual See Subungual

Fat necrosis, subcutaneous, with pancreatic disease, 110. Histologic picture is quite characteristic. Fatal granulomatous disease of childhood. A very rare, X-linked disease of mainly males characterized by eczematous lesions in infancy with progressive chronic granulomatous bacterial infections. Favre-Racouchot syndrome. 375, 378f. The term for multiple comedones on the high cheek and temple areas in older persons due to chronic sun exposure. Fibrokeratoma, acquired digital. Tumor occurring in...

Hematologyoncology

There are many different skin changes that can occur with internal malignancies. Some of these changes can be markers for many different malignancies, whereas other changes may be more specific markers for certain malignant neoplasms. Acquired ichthyosis ( Fig 2.6 -Z), a hyperkeratosis or excessive scaling of the skin, is most often associated with lymphoma and has been reported in association with Hodgkin's lymphoma, mycosis fungoides, multiple myeloma, Kaposi's sarcoma,...

Lymphogranuloma venereum

Lymphogranuloma venereum is an uncommon venereal disease characterized by a primary lesion on the genitals and secondary changes involving the draining lymph channels and glands. The primary erosion or blister is rarely seen, especially on the female patient. Within 10 to 30 days after exposure, the inguinal nodes, particularly in the male patient, enlarge unilaterally. This inguinal mass may rupture if treatment is delayed. In the female patient the lymph drainage most commonly is toward the...

Radiodermatitis

Radiodermite Acuta

Dermatoses due to radiation. (Schering Corp.) Figure 30-3. Dermatoses due to radiation. (Schering Corp.) X-rays and other forms of radiation therapy are established as unique therapeutic modalities. As with all potent medicinal agents, they must be administered intelligently. When they are not so administered, the result is varying degrees of damage to the skin and the underlying organs. We are concerned here with the skin changes known as radiodermatitis. Rarely, even diagnostic...

Hypopigmentation

Waardenburg syndromes I and II and piebaldism (Fig 31-4A) share in common white patches of skin, a white forelock, premature graying of the hair, and autosomal dominant inheritance. All are due to a failure of migration and invasion of melanocytes into the epidermis. Individuals with Waardenburg syndrome I also have dystrophia canthorum and heterochromia irides. Those with Waardenburg syndrome I or II may be deaf. Hirschsprung's disease occurs in approximately 10 . Waardenburg syndrome I and...

Figure 3522 Papular urticaria

Also known as prickly heat, sudamina, or lichen tropicus, this condition results from the obstruction of the sweat ducts caused by a combination of extreme heat and humidity. Depending on the level of obstruction, different clinical pictures can be seen. In the so-called miliaria crystallina, obstruction is very superficial in miliaria rubra, the obstruction is deeper and clinically more pruritic. The lesions have an erythematous base and consist of tiny, follicular,...

Seborrheic dermatitis

(Fig 13-1, Fig 13-2 and Fig 13-3 see also Fig 33-27) Figure 13-1. Seborrheic dermatitis. (Owen Laboratories, Inc.) Figure 13-1. Seborrheic dermatitis. (Owen Laboratories, Inc.) Seborrheic dermatitis, in our opinion, is a synonym for dandruff. The former is the more severe manifestation of this dermatosis. Seborrheic dermatitis is exceedingly common on the scalp but less common on the other areas of predilection ears, face, sternal area, axillae, intergluteal area, and pubic area. It is well to...

Tinea of the Hands

Tinea of the hand usually affects only one hand, but both feet. Thus, it is called one-hand, two-foot syndrome. ( Duke Laboratories, Inc.) A primary fungal infection of the hand or hands is quite rare. In spite of this fact, the diagnosis of fungal infection of the hand is commonly applied to cases that in reality are contact dermatitis, atopic eczema, pustular bacterid, or psoriasis. The best differential point is that tinea of the hand usually is seen only on...

Malignant melanoma

The incidence of malignant melanoma has increased considerably in the past 2 decades. Predisposing factors for the development of malignant melanoma include heredity, complexion (fair skin, red or blonde hair, blue eyes), ultraviolet exposure (the incidence of melanoma in the United States is increased in those states nearer the equator or with milder winters so people are outside more with less clothing), and the presence of large bathing-trunk congenital nevi (greater than 20 cm). The person...

Anesthesia

Most cutaneous surgery requires only local infiltrative or regional block anesthesia. The standard agent, 1 lidocaine, is an effective and safe anesthetic in which allergic reactions are exceedingly rare. By the addition of epinephrine, systemic absorption of lidocaine is lessened, the duration of action is markedly prolonged, and a local hemostatic effect is achieved. It usually takes 15 minutes to achieve optimal vasoconstriction. The available commercial preparations usually combine...

Infectious disease

LYME DISEASE. (See also Chap 16.) Lyme borreliosis (Fig 26-10), a vector-borne infection, can affect several organ systems. Cutaneous manifestations include erythema chronicum migrans (ECM), borrelial lymphocytoma (BL), and acrodermatitis chronica atrophicans (ACA). ECM is the principal cutaneous hallmark of Lyme disease. An initially homogenous erythema starts at the site of the tick bite and spreads in centrifugal fashion. The center may fade or clears leaving an annular erythema. BL, also...

Nail Biting Onychophagia

Onychotillomania

The common nervous habit of nail biting of some children and fewer adults is very difficult to stop. About 50 of children at some time bite their nails, but usually it is a transient problem. Nail biting actually hastens the growth of nails. It is a good way to spread warts. If nail biting or nail picking (onychotillomania, Fig.28-2.) are persistent or severe, one should consider that this may be a manifestation of obsessive-compulsive disorder or an obsessive- compulsive spectrum disorder....

Dermatologic allergy

Contact Dermatitis Differential Diagnosis Occupational .Dermatoses Management.ot .Industrial. .Dermatitis AtopicE.cz.ema DifferentialnDniagnosis General.Management. for At.opic Ecz.ema Treatment .o.f Infantile Form Treatment. .o.f.A.d.u.lt Fo.rm Drugs and. .the .Dermatoses The,Y Cause Dermatoses and. the DiMgs That ,Caus,e. Them Course,. .of Drug. .Eruptions Treatment Contact dermatitis, industrial dermatoses, atopic eczema, and drug eruptions are included in this chapter because of their...

Differential Diagnosis

Candidiasis No sharp border fine scales, oozing, redness, satellite pustule-like lesions at edges more common in obese females Candida found (see later in this chapter and Fig 19-12, Fig 19-13, Fig 19-14 and Fig 19-15). I r. 11 'Ilm nrlh iMHttltuhtl MIIH rtLftttnlA- Figure 19-12. Candidal infections. (Herbert Laboratories) Figure 19-12. Candidal infections. (Herbert Laboratories) Figure 19-14. Candidal infections. (Herbert Laboratories) Figure 19-14. Candidal infections. (Herbert Laboratories)...

Twenty Nail Dystrophy

Twenty-nail dystrophy is characterized by lackluster appearance with longitudinal striations, roughness, and some pitting, which may be seen in all 20 nails, usually in children. This may improve spontaneously over some years. Although this problem was described as a primary nail disease, many authors believe these are the nail changes of psoriasis, lichen planus, or alopecia areata that are seen without other manifestations of the disorder. Less commonly, IgA deficiency and autoimmune...

Papulosquamous Lesions

Ichthyosis (Fig 33-1.2) associated with dry, fish-like, adherent scaling. The rarer lamellar form and congenital ichthyosiform erythroderma, both bullous and nonbullous types, are present at birth. Ichthyosis vulgaris types are not present at birth. 2. Neonatal lupus erythematosus (Fig 33-13) characterized by heart block and annular papulosquamous skin lesions on forehead and cheeks. Skin lesions usually fade by 6 to 7 months of age, while the heart block persists. This is the most common cause...

Atopic eczema

(Fig 9-7, Fig 9-8, Fig 9-9, Fig 9-10 and Fig 9-11) Figure 9-7. Atopic eczema (infant). (Dome Chemicals) Figure 9-7. Atopic eczema (infant). (Dome Chemicals) Figure 9-8. Atopic eczema (infant). (Roche Laboratories) Figure 9-8. Atopic eczema (infant). (Roche Laboratories) Figure 9-9. Atopic eczema. The bottom photograph, by the use of a mirror, demonstrates the undersurface of the toes. (Sandoz Pharmaceuticals) Figure 9-9. Atopic eczema. The bottom photograph, by the use of a mirror, demonstrates...

Melanonychia Striata

Longitudinal hyperpigmented bands are most common in African-Americans but also occur in Asians as a normal finding. A solitary longitudinal streak in a Caucasian patient is cause for worry because, although it may just be caused by a nevus involving the nail matrix, it may also be caused by a melanoma. Factors that make one more suspicious of an underlying subungual melanoma when evaluating a longitudinal hyperpigmented band in the nail are involvement of one nail rather than multiple nails,...

Papules Nodules

Warts caused by the human papilloma virus are transmitted by contact. They may dissipate without therapy. When they are noted in the genitalia sexual abuse should be considered. b. Molluscum contagiosum a viral disease caused by a member of the pox virus group. Discrete single or multiple dome-shaped umbilicated papules may be found all over the body. It is contagious with a tendency for auto inoculation and may dissipate without therapy. c. Keratosis pilaris an autosomal dominant disorder...

Dermatologic Bacteriology

Primary Bacterial In.fe.ctio,ns ,(.Py.o.d.e,r.mas) Impetigo Superficial . . Folliculitis Folliculitis. ofMthe ScalpJSuper i.cial Form) Folliculitis . of . the. . Scalp . . (Deep. Form) Folliculitis of. the Beard Stye (.Hordeolum.) Secondary Bacterial Infections Cutaneous Diseases with. .Secondary Infection Infected Ulcers Infectious Ec.ze.m3.loid Dermatitis Systemic. Bac.teri3l In.fectio.n.s Scarlet Fever Bacteria exist on the skin as normal nonpathogenic resident flora or as pathogenic...

Dermatitis herpetiformis

Bullous dermatoses. (Roche Laboratories) Figure 22-2. Bullous dermatoses. (Roche Laboratories) Dermatitis herpetiformis is a rare, chronic, markedly pruritic, papular, vesicular, and bullous skin disease of unknown etiology. It is probably an autoimmune disease and activated via the alternate complement pathway. The patient describes the itching of a new blister as a burning itch that disappears when the blister top is scratched off. The severe scratching results in the formation...

Erythema infectiosum

Also known as fifth disease, erythema infectiosum occurs in epidemics and is believed to be caused by parvovirus B19. It affects children primarily, but in a large epidemic many cases are seen in adults. The incubation period varies from 1 to 7 weeks. In children the prodromal stage lasts from 2 to 4 days and is manifested by low-grade fever and occasionally by joint pains. When the red macular rash develops, it begins on the arms and the face and then spreads to the body. The rash in children...

Vascular Dermatoses

Stasis. (Venous) Dermatitis.and Ulcers DifferentialDiagnosis Treatment ofstasis, Dermatitis Treatment of.Stasis, Ulcer Purpuric Dermatoses Pi.gment.ed PMr.p.M.ric Eruptions Treatment Telangiectases Urticaria, erythema multiforme and its variants, and erythema nodosum are included under the heading of vascular dermatoses because of their vascular reaction patterns. Stasis dermatitis is included because it is a dermatosis due to venous insufficiency in the legs.

Eczematous Lesions

Atopic dermatitis (Fig.SS- ) a hereditary disorder usually beginning around 1 to 4 months of age. In infants the involvement is usually of the face, scalp, trunk, and extremities. Toddlers have involvemennt of flexural skin and adolescents have involvement of hands and feet. There may also be hypopigmented scaly lesions on cheeks and arms referred to as pityriasis alba. 2. Seborrheic dermatitis (Fig 33-25) a scaly, crusting eruption noted in the seborrheic areas of the scalp (cradle cap), face,...

Tinea of the Smooth Skin

(Fig 19-8 and Fig 19-9 see Fig 33-30C) Figure 19-8. Tinea of the smooth skin. This infection on the buttocks had spread from the crural region. ( Smith Kline & French Laboratories) Figure 19-9. Tinea of smooth skin. (Ortho Pharmaceutical Corp.) Figure 19-9. Tinea of smooth skin. (Ortho Pharmaceutical Corp.) The familiar ringworm of the skin is most common in children partially because of their intimacy with animals and other children. The lay public believes that most skin conditions are...

Onychomycosis

(Fig 28-9 and see Fig 28-14) Figure 28-7. Nail disorders. Medial canaliform dystrophy. Figure 28-9. Nail disorders. Tinea due to T. rubrum. (Westwood Pharmaceuticals) Figure 28-14. Nail disorders. Onychogryphosis in a patient with onychomycosis. Fungal infections of the nails account for at least half of all nail diseases. Prevalence increases with aging and in AIDS. Dermatophytes account for most fungal infections of the nail but Candida species and a host of saprophytes may also cause...

HI J I if i

Contact dermatitis in a nurse due to chlorpromazine. The hands and face were involved most severely. This eruption was aggravated following exposure to sunlight. (K.U.M.C. Burroughs Wellcome Co.) Figure 9-4. Contact dermatitis of the hand. This common dermatitis is usually due to continued exposure to soap and water. (K.U.M.C. Burroughs Wellcome Co.) Contact dermatitis, or dermatitis venenata, is a very common inflammation of the skin caused by the exposure of the skin either to...

Eczematous Eruptions of the Nail Unit

The nail becomes involved when dermatitis affects the nail matrix. A multiplicity of nail changes including pitting, roughness, grooving, ridging, onycholysis, onychomadesis, and koilonychia may occur with any dermatitis (eczema) that involves the nail unit. When the dermatitis heals, the nail heals also, but the mark of the dermatitis on the nail takes much longer to resolve. An unusual reaction of the nail is the development of highly polished nail surface in some patients with severe itching...

Dermatosis caused by arthropods

Fig 35-9 see Fig 22-1). This disease is usually transmitted through prolonged personal contact with infected people and less often by clothing and bed linens. The mite's location is in a burrow in the stratum corneum where it deposits its eggs. An allergic sensitization to the mite and or its products causes the clinical picture. Itching appears 2 to 4 weeks after the infestation and is classically more severe at night. As a clinical finding the burrow is pathognomonic and...

Malignant Melanoma Melanocytic Nevi

(Fig 32-18A-E and Fig, 34-16) Figure 32-18. Nevus cell tumors. (The Upjohn Company) Figure 32-18. Nevus cell tumors. (The Upjohn Company) Nevi are pigmented or nonpigmented tumors of the skin that contain nevus cells. Nevi are present on every adult, but some persons have more than others. There are two main questions concerning nevi or moles When and how should they be removed What is the relationship between nevi and malignant melanomas Histologically, it is possible to divide benign nevi...

Rheumatology

Dermatomyositis is an inflammatory myopathy with associated cutaneous manifestations. Progressive weakness is the major clinical finding and usually affects the muscles of the trunk and limb girdles more frequently than the peripheral muscles. There is an increased risk of internal malignancy. The cutaneous manifestations of dermatomyositis are pathognomonic and help one to make the diagnosis with confidence. Gottron's sign is the most specific skin finding Macular or papular...

Hypertrichosis

Hypertrichosis may be congenital or acquired. Congenital generalized types are very rare and have been described as being inherited and occurring sporadically. Some of the dog-faced or monkey-faced persons in circus sideshows probably had this condition. A host of rare syndromes may have congenital hypertrichosis as a feature. Congenital localized hypertrichosis has been noted on the margin of the pinna in infants of diabetic mothers. Localized congenital hypertrichosis over the base of the...

Classification of Tumors Based on Location

Scalp seborrheic keratosis, epidermal cyst (pilar cyst), nevus, actinic keratosis (bald males), wart, trichilemmal cyst, basal cell carcinoma, squamous cell carcinoma, nevus sebaceous, proliferating trichilemmal tumor, cylindroma, syringocystadenoma papilliferum. Ear seborrheic keratosis, actinic keratoses, basal cell carcinoma, nevus, squamous cell carcinoma, keloid, epidermal cyst, chondrodermatitis nodularis helicis, venous lakes (varix), gouty tophus. Face seborrheic keratosis, sebaceous...

Chloasma melasma

Pigmentary dermatoses. (Neutrogena Skin Care Institute) Cloasma of face. CLINICAL LESIONS. An irregular hyperpigmentation of the skin that varies in shades of brown is seen. DISTRIBUTION. The lesions usually occur on the sides of the face, the forehead, and the sides of the neck. COURSE. The disorder is slowly progressive, but remissions do occur. It is more obvious in the summer. ETIOLOGY. The cause is unknown, but some cases appear during pregnancy (called mask of pregnancy) or...

Neonatal Lupus Erythematosus see Fig3318

Polycyclic or psoriasiform lesions are present, mainly on the face, but disappear around 6 months of age. It is associated with cardiac conduction defects in 50 of cases and is the most common cause of neonatal heart block. Anti-Ro(SS-A) antibodies are found. Most mothers have or will have signs of lupus erythematosus or Sjogren's syndrome. scleroderma (Fig 25-4, Fig 25-5. and Fig 25 6) Figure 25-4. Scleroderma. Diffuse scleroderma of hands. (Burroughs Wellcome Co.) * Jtj Hi J iUT> if ML...

Rosacea

Rosacea. (Hoechst-Roussel Pharmaceuticals, Inc.) Figure 13-9. Rosacea. (Hoechst-Roussel Pharmaceuticals, Inc.) A common pustular eruption with flushing and telangiectasias of the butterfly area of the face may occur in adults in the 40- to 60-year-old age group. PRIMARY LESIONS. Diffuse redness, papules, pustules, and, later, dilated venules, mainly of the nose, the cheeks, and the forehead, are seen. SECONDARY LESIONS. Severe, longstanding cases eventuate in the bulbous, greasy,...

Koilonychia Spoon Nails

Koilonychia is a concavity of the nail plate classically associated with iron-deficiency anemia, but it may be seen in about half of the patients with hemochromatosis. Thyroid disease (hyperthyroidism and hypothyroidism), polycythemia, syphilis, and impaired circulation are among the many disease states that may be associated with koilonychia. Koilonychia may be seen as part of many other skin diseases such as lichen planus or psoriasis. There is an autosomal dominant variety that has no...

Diffuse Nonscarring Alopecia

Loss of up to one half of the scalp hair may occur without clinically obvious hair loss. Among the more common causes of nonscarring hair loss are androgenic hair loss, telogen effluvium, alopecia areata, and tinea. An appropriate history and laboratory testing are necessary ( Iable.27-3). Table 27-3 Laboratory Studies to Evaluate Nonscarring Alopecia One must exclude syphilis, thyroid disease, iron deficiency, drug-induced ( Ta.b e ,.27.-.4) and toxin-induced (thallium, boric acid, heavy...

Differential Diagnosis of Epidermal and Trichilemmal Cysts

Lipoma Difficult to differentiate clinically more firm, lobulated no cheesy material extrudes on incision removal is by complete excision or by liposuction clinically similar to hibernoma. Dermoid cyst Clinically similar can also be found internally usually a solitary skin tumor histologically, contains hairs, eccrine glands, and sebaceous glands. Mucous cysts (Fig 3.2.-6) Translucent pea-sized or smaller lesions on the lips, treated by cutting off top of the lesion and carefully lightly...

Acne

Severe acne vulgaris. (Hoechst-Roussel Pharmaceuticals, Inc.) Acne vulgaris is a common skin condition of adolescents and young adults. It is characterized by any combination of comedones (blackheads), pustules, cysts, and scarring of varying severity. Severe cystic acne is called acne conglobata. When accompanied by systemic symptoms such as arthralgia, leukocytosis, and fever, the term acne fulminans can be used. Hidradenitis suppurativa, also termed acne inversa, is a...

Squamous Cell Carcinoma

Squamous cell carcinoma. (Westwood Pharmaceuticals) Figure 32-13. Squamous cell carcinoma. (Westwood Pharmaceuticals) This rather common skin malignancy can arise primarily or from an actinic keratosis or leukoplakia. The grade of malignancy and metastasizing ability varies from grade I (low) to grade IV (high). Other terms for this tumor include prickle cell epithelioma and epidermoid carcinoma. The incidence has increased significantly in the DESCRIPTION. The most common...

Porphyria Cutanea Tarda

Photosensitivity dermatoses. Porphyria cutanea tarda with blisters and hyperpigmentation. ( Texas Pharmaceutical) The most common porphyria with cutaneous manifestations is symptomatic porphyria or porphyria cutanea tarda (PCT). Patients with this disorder usually are older than 40 years, drink heavily, and are unaware that they are sensitive to sunlight. Diabetes mellitus is found in 25 of cases of PCT 90 or more have hepatic siderosis. Nearly all untreated patients with PCT show...