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 note

When the presenting complaint is generalized itching of the skin, always stroke the skin on the forearm with your nail or a tongue depressor. After 5 minutes or so, if there is a wheal reaction at the stroking site, you have a diagnosis of dermographism. This is a common problem that is easily overlooked. Senile pruritus is a resistant form of generalized pruritus in the elderly patient. It can occur at any time of the year and may or may not be associated with dry skin. There is some evidence...

Sauer notes

It is important to tell the patient that depigmented spots may remain after the tinea versicolor is cured. These can be tanned by gradual exposure to sunlight or ultraviolet light. 2. A topical imidazole cream (clotrimazole, econazole, ketoconazole, miconazole) twice a day topically for 2 weeks with or without a sulfur soap can be used. Terbinafine spray (Lamisil) twice a day for 1 week. 3. Ketoconazole (Nizoral) orally in various short term regimens and itraconazole (Sporanox) 200 mg orally...

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...

Summary

HIV infection is characterized by a wide variety of mucocutaneous manifestations. Several of these skin diseases, such as Kaposi's sarcoma and oral hairy leukoplakia, are very frequently associated with HIV infection. The majority of the patients, however, develop common dermatoses that are distinguished by their persistence, frequent recurrence, or poor response to therapy. As treatment modalities to prevent the development of opportunistic infections and for HIV infection become available,...

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 and Cavernous Hemangiomas

(see Fig 3-1D and Fig 33-11) The familiar bright-red, raised strawberry tumor has been seen by all physicians. Strawberries have to grow, and they start from a small beginning. The parents are usually the first to notice the small, red, pinhead-sized, flat lesions. They are noticed at, or soon after, birth. These red tumors can occur on any area of the body and can begin as small lesions and stay that way, remaining as superficial hemangiomas, or they can enlarge and extend into 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...

Treatment

Small arsenical keratoses can be removed by electrosurgery larger lesions can be excised and skin grafted if necessary. Leukoplakia Leukoplakia is an actinic keratosis of the mucous membrane. DESCRIPTION. A flat, whitish plaque occurs localized to the mucous membranes of lips, mouth, vulva, and vagina. Single or multiple lesions may be present. COURSE. Progression to squamous cell carcinoma occurs in 20 to 30 of chronic cases. ETIOLOGY. Smoking, sunlight, and chronic irritation are 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...

Vitiligo

Figure 24-2. Pigmentary dermatoses. (Neutrogena Skin Care Institute) CLINICAL LESIONS. Irregular areas of depigmented skin are occasionally seen with a hyperpigmented border. There is a segmental variety that has pigment loss in a dermatomal (especially trigeminal) distribution. DISTRIBUTION. Most commonly the lesions occur on the face and the dorsum of hands and feet, but they can occur on all body areas. COURSE. The disease is slowly progressive, but...

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...

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

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...

Fungal infections

This disease is caused by Histoplasma capsulatum. Found throughout the world in temperate areas, Histoplasma capsulatum is a saprophytic fungus that grows in the soil, prevalently in soil of caves inhabited by bats. The disease is transmitted by the inadvertent inhalation of the spores. Epidemics have occurred through exploring infested caves or cleaning sites where chicken excrement (guano) may be present. A benign clinical form that may leave a calcified nodule in...

Localized pruritic dermatoses

Lichen Simplex Chronicus Scrotum

Other common terms for lichen simplex chronicus include localized neurodermatitis and lichenified dermatitis. There are pros and cons for all the terms. Lichen simplex chronicus (Fig 11-1 and Fig 11,-2) is a common skin condition characterized by the occurrence of single or, less frequently, multiple patches of chronic, itching, thickened, scaly, dry skin in one or more of several classic locations. It is unrelated to atopic eczema. Figure 11-1. Localized lichen simplex chronicus of the leg....

Basic immunology

Historically, the immune system was divided into two basic branches humoral immunity and cellular immunity. In fact, the immune response is an active interplay of both humoral and cellular immunity, along with cytokines (Table 10-1) made by a multitude of cells including lymphocytes, Langerhans' cells, macrophages, and Humoral immunity is mediated by antibodies produced by B lymphocytes. When activated by antigen, antigen-presenting cells, and helper T lymphocytes, the B lymphocytes...

Systemic bacterial infections

Scarlet fever is a moderately common streptococcal infection characterized by a sore throat, high fever, and a scarlet rash. The eruption develops after a day of rapidly rising fever, headache, sore throat, and various other symptoms. The rash begins first on the neck and the chest but rapidly spreads over the entire body, except for the area around the mouth. Close examination of the pale scarlet eruption reveals it to be made up of diffuse pinhead-sized, or larger, macules. In untreated cases...

Geriatric dermatology

Although the entire body changes slowly with advancing years, aging of the skin is readily visible and readily noticed by both men and women. If the sale of cosmetics (e.g., moisturizing creams, age spot removers, wrinkle creams, wigs, hair dyes for men and women) is any sign, it would seem obvious that the constant search for the elixir of youth is mainly directed toward maintaining a youthful-looking skin. Consider the interest in retinoic acid (Retin-A, Renova),...

Psoriasis

Psoriasis Skin Diseases

(Fig 14-1, Fig 14-2, Fig 14-3 and Fig 14-4 see also Fig 33-23) Figure 14-1. Psoriasis of the border of the scalp. Psoriasis in this location is often difficult to distinguish from seborrheic dermatitis. ( Smith Kline & French Laboratories) Figure 14-2. Psoriasis on elbows of a 17-year-old girl. Moderately extensive psoriasis in classic distribution on back and knees. ( K.U.M.C. Roche Laboratories) Psoriasis is a common, chronically recurring, papulosquamous disease, characterized by various...

Miscellaneous disorders affecting the hair

This is probably the most common hair-shaft abnormality and is usually caused by traumatic hairdressing procedures. Clinically, one sees circumferential tiny white specks on the hair shaft. When viewed under the microscope these areas prove to be transverse fractures resembling the bristles of two brooms interlocked in appearance. These fracture points often lead to breaking off of the hairs and the complaint that the hair does not grow as long as it used to. There may be...

Erythema multiforme bullosum

Bullous dermatoses. (Roche Laboratories) Figure 22-3. Bullous dermatoses. (Roche Laboratories) Erythema multiforme bullosum has a clinical picture and course distinct from that of erythema multiforme (see Chap, 12). Many drugs can cause an erythema multiforme bullosum-like picture, but then this manifestation should be labeled a drug eruption. True erythema multiforme bullosum has no known cause. Clinically, one sees large vesicles and bullae usually overlying red, iris-like...

Melanin Hyperpigmentation or Melanoderma

Chloasma (melasma) (see Fig. i 24-1) a. Chronic discoid lupus erythematosus f. Many cases of dermatitis in African-Americans and other dark-skinned individuals (see Fig. 2.4 3.) h. Porphyria cutanea tarda (Fig 2.4 4) Figure 24-4. Pigmentary dermatoses. (Neutrogena Skin Care Institute) Porphyria cutanea tarda hyperpigmentation. i. Dermatitis herpetiformis 4. Secondary to external agents e. Photosensitizing chemicals, as in cosmetics, causing development of clinical entities labeled as Riehl's...

Mucocutaneous diseases associated with hiv infection

Skin Disorders Associated With Hiv

Annular scaling plaques on the nasolabial fold and cheeks. ( Drs. J. Rico and N. Prose). Infections and Infestations VIRAL INFECTIONS Herpes simplex virus (HSV) infections, and in particular chronic perianal herpes, was one of the first noted complications of HIV infection and remains a cause of significant morbidity. These patients may have persistent or recurrent painful ulcers, sometimes in the absence of vesicles, involving the genitalia, groin, perianal...

Abridged Dictionaryindex

(Note All page numbers included refer to the print version of Sauer's Manual of Skin Diseases.) The purpose of the dictionary portion of this index is to define and classify some of the rarer dermatologic terms not covered in the text. Some very rare or unimportant terms have purposely been omitted, but undoubtedly some terms that are not rare and are important have also been omitted. Most of the histopathologic terms have been defined. Suggestions or corrections from the reader will be...

Acquired atrophies

Often associated with senile pruritus and winter itch. Linear atrophy, striae albicantes or distensae stretch marks. On abdomen, thighs, and breasts associated with pregnancy, obesity, adolescence, and rapid weight gain. Secondary atrophy from sunlight, x-radiation, injury, and nerve diseases. Macular atrophy (anetoderma of Schweninger-Buzzi). Characterized by the presence of small, oval, whitish depressions or slightly elevated papules, which can be pressed back into the...

Congenital triangular alopecia Brauer nevus temporally limited alopecia

An intravenous test used to diagnose generalized amyloidosis. red. Very rare permanent triangular patches on one or both frontotemporal scalp regions An intradermal skin test using Congo red solution will stain localized amyloid nodules Corn. A corn or clavus is a small, sharply circumscribed, often painful hyperkeratotic lesion that may be either hard with a central horny core or soft, as commonly seen between the toes. Underlying bone protuberances are causative (can be very...

Primary bacterial infections pyodermas

The most common causative agents of the primary skin infections are the coagulase-positive micrococci staphylococci and the b-hemolytic streptococci. Superficial or deep bacterial lesions can be produced by these organisms. In managing the pyodermas certain general principles of treatment must be initiated. Improve the bathing habits More frequent bathing and the use of bactericidal soap, such as Dial, is indicated. Any pustules or crusts should be removed during the bathing to facilitate...

Papulosquamous Dermatoses

DifferentialD.jagnosis Treatment Pityriasis Rosea LichenPlanus Differentia ,. Diagnosis Treatment Bibliography The papulosquamous dermatoses include several specific entities that predominantly affect the chest and the back with clinically similar macular, papular, and scaly lesions. The most common diseases in the group are psoriasis, pityriasis rosea, tinea versicolor, lichen planus, seborrheic dermatitis, secondary syphilis, and drug eruptions. The last three conditions are considered...

Classification of geriatric dermatoses

The elderly patient is subject to the regular skin ills. However, as with the other age extreme, the child, there can be a different reaction by the aged skin to a given skin problem by virtue of the presence of fragility, dryness, and atrophy. It is unusual to see certain skin problems in the aged, such as atopic eczema, acne, pityriasis rosea, impetigo, primary and secondary syphilis, herpes simplex, warts, exanthems, chloasma, and sunburn Fig 34-7 . if L lt jr- E-mm ri Tfn-ju rinr w rWJM M...

Dermatologic Therapy

Types, ofjopical Dermatologic Medications LocalTherapy. .Rules of. Thumb Quantity.of., Cream or.ointment to Prescribe Specific. Internal. .Drugs for. .Specific.Diseases Many hundreds of medications are available for use in treating skin diseases. Most physicians, however, have only a few favorite prescriptions that are prescribed day in and day out. These few prescriptions may then be altered slightly to suit an individual patient or disease. For commonly used preparations, pretyped...

Photosensitivity dermatoses

Pityriasis Rubra Pilaris Face Treatment

Photosensitivity problems are rarely seen unless triggered by drugs. The genetic inheritance of the person has considerable influence on the aging of the skin, including wrinkling, the effect of sunlight, the activity of the oil and sweat glands, and hair changes. Seborrheic Keratoses see Fig 32-1, Fig 34-4 . As mentioned earlier, these are common, seen in almost every elderly person. The number of these lesions is Pedunculated Fibromas. Such fibromas of the neck and axilla are quite common,...

Dermatitis

Contact, 29, 66-73, 67-70f, 71f, 101, 370, 371f diaper area, 194 exfoliative, 88, 238-240 factitial, 388 herpetiformis, 19f, 38, 94, 229, 233, 235-236, 236f, 362-365 housewives', 72-73 industrial, 73 infectious eczematoid, 110, 53f, 155-156, 155f poison ivy, 66, 67f, 68f, 71-72, 71f, 93 seborrheic, 18f, 101, 114-117,115-116f, 123, 132, 134, 195, 230, 231, 370, 382 soap, 66, 67f, 70f, 72-73 stasis, 82, 110-112 venenata, 66-73, 67-70f, 71f Dermatolysis, 316. Also known as cutis laxa. This is a...