Additional Information
Book Details
Abstract
Identify, treat, and manage the full range of skin diseases with guidance from Clinical Dermatology: A Color Guide to Diagnosis and Therapy – the world’s leading dermatology manual. Clean formatting, easy indexing, and exceptional color images make this an indispensable source for definitive, state-of-the-art answers on every aspect of dermatologic care.
- Presents outstanding photographs for virtually every common skin disorder.
- Organizes disease information with a Disorders Index on the inside front cover, allowing for quick access to specific guidance, and a brand new Regional Diagnosis Atlas in chapter 1.
- Uses a consistent format in every chapter to present information in a logical, easy-reference fashion.
- Make rapid, confident decisions on diagnosis and treatment by comparing your clinical findings to over 1,000 of the highest quality color images—including hundreds of original, never-before-published photographs—depicting virtually any skin condition.
- Apply the newest developments in diagnosis and treatment thanks to thorough updates throughout including an extensive section on the management of acne, eczema, and psoriasis as well as expanded coverage of arthropod disease.
- Prescribe effective dermatologic treatment with an expanded formulary to the most commonly used drugs; detailed guidance on the use of antibiotics; and the inclusion of the latest drug treatment options.
- Quickly access vital, up-to-date information from new tables throughout summarizing "need to know" diagnostic and therapeutic evidence.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Disorders index | es | ||
| Quick reference formulary | ii | ||
| Front matter | ix | ||
| Clinical dermatology | ix | ||
| Copyright | x | ||
| Preface | xi | ||
| Rapid access to the text | xi | ||
| Electronic version | xi | ||
| PMID numbers (PubMed identification numbers) | xi | ||
| How to use this book | xi | ||
| Students in the classroom | xi | ||
| Students in the clinic | xi | ||
| The non-dermatologist provider | xi | ||
| The dermatologist | xi | ||
| Production | xii | ||
| Contents | xiii | ||
| Skin anatomy | xvi | ||
| 1 Principles of diagnosis and anatomy | 1 | ||
| Skin anatomy | 1 | ||
| Epidermis | 1 | ||
| Dermis | 1 | ||
| Dermal nerves and vasculature | 1 | ||
| Diagnosis of skin disease | 2 | ||
| A methodical approach | 2 | ||
| Examination technique | 2 | ||
| Approach to treatment | 2 | ||
| Primary lesions | 2 | ||
| Secondary lesions | 2 | ||
| Primary skin lesions—macules | 3 | ||
| Macule | 3 | ||
| Hypopigmented | 3 | ||
| Brown | 3 | ||
| Blue | 3 | ||
| Red | 3 | ||
| Primary skin lesions—papules | 4 | ||
| Papule | 4 | ||
| Flesh colored, yellow, or white | 4 | ||
| Brown | 4 | ||
| Red | 4 | ||
| Blue or violaceous | 4 | ||
| Primary skin lesions—plaques | 6 | ||
| Plaque | 6 | ||
| Primary skin lesions—nodules | 8 | ||
| Nodule | 8 | ||
| Primary skin lesions—pustules | 9 | ||
| Pustule | 9 | ||
| Primary skin lesions—vesicles and bullae | 10 | ||
| Vesicle | 10 | ||
| Bulla | 10 | ||
| Primary skin lesions—wheals (hives) | 11 | ||
| Wheal (hive) | 11 | ||
| Secondary skin lesions—scales | 12 | ||
| Scales | 12 | ||
| Fine to stratified | 12 | ||
| Scaling in sheets (desquamation) | 12 | ||
| Secondary skin lesions—crusts | 13 | ||
| Crust | 13 | ||
| Secondary skin lesions—erosions and ulcers | 14 | ||
| Erosion | 14 | ||
| Ulcer | 14 | ||
| Secondary skin lesions—fissures and atrophy | 15 | ||
| Fissure | 15 | ||
| Atrophy | 15 | ||
| Secondary skin lesions—scars | 16 | ||
| Scar | 16 | ||
| Special skin lesions | 17 | ||
| Excoriation | 17 | ||
| Comedone | 17 | ||
| Milia | 17 | ||
| Cyst | 17 | ||
| Petechia | 18 | ||
| Purpura | 18 | ||
| Burrow | 18 | ||
| Lichenification | 18 | ||
| Telangiectasia | 18 | ||
| Regional differential diagnosis atlas | 19 | ||
| Anus | 20 | ||
| Areola (breast) | 21 | ||
| Arms and forearms | 22 | ||
| Axillae | 24 | ||
| Back | 26 | ||
| Beard | 28 | ||
| Buttocks | 29 | ||
| Ear | 30 | ||
| Elbows and knees | 31 | ||
| Face | 32 | ||
| Finger | 35 | ||
| Foot (dorsa and sides) | 36 | ||
| Foot (sole) | 38 | ||
| Groin | 40 | ||
| Hands (dorsa) | 41 | ||
| Hands (palms) | 44 | ||
| Inframammary | 46 | ||
| Legs | 47 | ||
| Legs (lower) | 47 | ||
| Lips | 51 | ||
| Neck | 52 | ||
| Neck (back) | 52 | ||
| Nose | 54 | ||
| Oral cavity | 55 | ||
| Penis | 56 | ||
| Scrotum | 56 | ||
| Perioral | 60 | ||
| Periorbital | 62 | ||
| Scalp | 63 | ||
| Thigh (inner surface and inguinal groove) | 65 | ||
| Trunk | 66 | ||
| Chest | 66 | ||
| Vulva | 72 | ||
| Wrist | 74 | ||
| 2 Topical therapy and topical corticosteroids | 75 | ||
| Topical therapy | 75 | ||
| Emollient creams and lotions | 75 | ||
| Severe dry skin (xerosis) | 75 | ||
| Wet dressings | 76 | ||
| Topical corticosteroids | 77 | ||
| Strength | 77 | ||
| Megapotent topical steroids (group I) | 78 | ||
| Concentration. | 78 | ||
| Compounding. | 78 | ||
| Generic versus brand names. | 78 | ||
| Vehicle | 78 | ||
| Steroid-antibiotic mixtures | 79 | ||
| Amount of cream to dispense | 79 | ||
| Application | 79 | ||
| Frequency | 79 | ||
| Tachyphylaxis. | 79 | ||
| Intermittent dosing | 80 | ||
| Group I topical steroids. | 80 | ||
| Groups II through VII topical steroids. | 80 | ||
| Methods | 80 | ||
| Simple application. | 80 | ||
| Occlusion. | 80 | ||
| Method of occlusion. | 81 | ||
| Systemic absorption | 81 | ||
| Avoid weaker, “safe” preparations. | 82 | ||
| Children. | 82 | ||
| Adults. | 82 | ||
| Adverse reactions | 82 | ||
| Steroid rosacea and perioral dermatitis (figures 2-7 to 2-11) | 82 | ||
| Management. | 82 | ||
| Atrophy | 84 | ||
| Occlusion. | 86 | ||
| Mucosal areas. | 86 | ||
| Steroid injection sites. | 87 | ||
| Long-term use. | 87 | ||
| Alteration of infection | 87 | ||
| Tinea incognito. | 87 | ||
| Infestations and bacterial infections. | 87 | ||
| Contact dermatitis | 89 | ||
| Topical steroid allergy | 89 | ||
| Management. | 89 | ||
| Patch testing. | 89 | ||
| Glaucoma | 89 | ||
| 3 Eczema and hand dermatitis | 90 | ||
| Stages of eczematous inflammation | 90 | ||
| Acute eczematous inflammation | 90 | ||
| Subacute eczematous inflammation | 93 | ||
| Adult-onset recalcitrant eczema and malignancy | 96 | ||
| Chronic eczematous inflammation | 97 | ||
| Hand eczema | 99 | ||
| Irritant contact dermatitis | 103 | ||
| Atopic hand dermatitis | 103 | ||
| Allergic contact dermatitis | 104 | ||
| Nummular eczema | 104 | ||
| Recurrent focal palmar peeling | 104 | ||
| Hyperkeratotic eczema | 105 | ||
| Fingertip eczema | 106 | ||
| Pompholyx | 109 | ||
| Id reaction | 109 | ||
| Eczema: Various presentations | 110 | ||
| Asteatotic eczema | 110 | ||
| Nummular eczema | 111 | ||
| Chapped fissured feet | 113 | ||
| Self-inflicted dermatoses | 114 | ||
| Lichen simplex chronicus | 114 | ||
| Prurigo nodularis | 117 | ||
| Neurotic excoriations | 118 | ||
| Psychogenic parasitosis | 119 | ||
| Stasis dermatitis and venous ulceration: Postphlebitic syndromes | 120 | ||
| Stasis dermatitis | 120 | ||
| Types of eczematous inflammation | 120 | ||
| Subacute inflammation | 120 | ||
| Acute inflammation | 120 | ||
| Chronic inflammation | 121 | ||
| Treatment of stasis dermatitis | 121 | ||
| Topical steroids and wet dressings. | 121 | ||
| Venous leg ulcers | 122 | ||
| Management of venous ulcers | 125 | ||
| Initial evaluation and treatment. | 125 | ||
| Treatment. | 125 | ||
| Inflammation surrounding the ulcer. | 125 | ||
| Compression. | 125 | ||
| 4 Contact dermatitis and patch testing | 126 | ||
| Severe occupational contact dermatitis | 127 | ||
| Irritant contact dermatitis | 128 | ||
| Allergic contact dermatitis | 129 | ||
| Phases | 129 | ||
| Sensitization phase | 129 | ||
| Elicitation phase | 129 | ||
| Cross-sensitization | 129 | ||
| Systemically induced allergic contact dermatitis | 129 | ||
| Clinical presentation | 131 | ||
| Allergic contact dermatitis in children | 133 | ||
| Rhus dermatitis | 133 | ||
| Natural rubber latex allergy | 135 | ||
| Types of reactions | 135 | ||
| Irritant contact dermatitis. | 135 | ||
| Allergic contact dermatitis (type IV allergy). | 135 | ||
| 5 Atopic dermatitis | 150 | ||
| Pathogenesis and immunology | 152 | ||
| Clinical aspects | 152 | ||
| Infant phase (birth to 2 years) | 154 | ||
| Childhood phase (2 to 12 years) | 157 | ||
| Adult phase (12 years to adult) | 161 | ||
| Associated features | 162 | ||
| Dry skin and xerosis | 162 | ||
| Ichthyosis vulgaris | 162 | ||
| Keratosis pilaris | 163 | ||
| Hyperlinear palmar creases | 165 | ||
| Pityriasis alba | 165 | ||
| Atopic pleats | 165 | ||
| Ocular complications | 165 | ||
| Triggering factors | 167 | ||
| Temperature change and sweating | 167 | ||
| Decreased humidity | 167 | ||
| Excessive washing | 167 | ||
| Contact with irritating substances | 167 | ||
| Contact allergy | 167 | ||
| Aeroallergens | 167 | ||
| Microbic agents | 167 | ||
| Staphylococcus aureus | 167 | ||
| Food | 167 | ||
| Emotional stress | 168 | ||
| Prevention of atopic dermatitis | 169 | ||
| Treatment of atopic dermatitis | 169 | ||
| Dry skin | 169 | ||
| Inflammation and infection | 169 | ||
| Pimecrolimus cream 1% (elidel) | 171 | ||
| 6 Urticaria, angioedema, and pruritus | 178 | ||
| Clinical aspects | 178 | ||
| Pathophysiology | 182 | ||
| Initial evaluation of all patients with urticaria | 182 | ||
| Acute urticaria | 183 | ||
| Chronic urticaria | 186 | ||
| Differential diagnosis | 187 | ||
| Treatment of urticaria | 189 | ||
| Approach to treatment | 189 | ||
| First-line therapy | 189 | ||
| Antihistamines. | 189 | ||
| Mechanism of action. | 189 | ||
| Initiation of treatment. | 189 | ||
| Side effects. | 189 | ||
| Long-term administration. | 189 | ||
| H1 and H2 antihistamines. | 189 | ||
| First-generation (sedating) H1 antihistamines. | 189 | ||
| Second-generation (low-sedating) H1 antihistamines. | 189 | ||
| Fexofenadine (allegra). | 189 | ||
| Cetirizine (zyrtec). | 189 | ||
| Loratadine (claritin). | 190 | ||
| Desloratadine (clarinex). | 190 | ||
| Tricyclic antihistamines (doxepin). | 190 | ||
| Epinephrine. | 190 | ||
| Second-line agents | 190 | ||
| Oral corticosteroids. | 190 | ||
| Leukotriene modifiers. | 190 | ||
| Dapsone. | 190 | ||
| Cyclosporine. | 190 | ||
| Mycophenolate mofetil. | 190 | ||
| Third-line agents | 190 | ||
| Intravenous immunoglobulin. | 190 | ||
| Methotrexate. | 190 | ||
| Topical measures. | 191 | ||
| Omalizumab. | 191 | ||
| Physical urticarias | 191 | ||
| Dermographism | 191 | ||
| Pressure urticaria | 192 | ||
| Cholinergic urticaria | 193 | ||
| Exercise-induced anaphylaxis | 194 | ||
| Cold urticaria | 194 | ||
| Heat, water, and vibration urticarias | 195 | ||
| Solar urticaria | 195 | ||
| Pathogenesis | 195 | ||
| Treatment. | 195 | ||
| Aquagenic pruritus | 195 | ||
| Angioedema | 196 | ||
| Acquired forms of angioedema | 196 | ||
| Acquired angioedema (C1 INH deficiency syndromes) | 200 | ||
| Hereditary angioedema | 200 | ||
| Contact urticaria syndrome | 202 | ||
| Dermatoses of pregnancy | 203 | ||
| Urticarial vasculitis | 206 | ||
| Serum sickness | 207 | ||
| Mastocytosis | 208 | ||
| Spectrum of disease | 208 | ||
| Cutaneous mastocytosis | 209 | ||
| Solitary mastocytoma. | 209 | ||
| Urticaria pigmentosa. | 209 | ||
| Telangiectasia macularis eruptiva perstans (TMEP). | 211 | ||
| Diffuse cutaneous types. | 211 | ||
| Systemic mastocytosis | 213 | ||
| Diagnosis. | 213 | ||
| Diagnostic criteria for systemic mastocytosis. | 213 | ||
| Diagnosis | 213 | ||
| Skin disease. | 213 | ||
| Urine N-methylhistamine. | 213 | ||
| KIT Asp816Val mutation analysis, blood or bone marrow. | 214 | ||
| Serum tryptase level. | 214 | ||
| Bone marrow histology. | 214 | ||
| Mast cell immunophenotyping. | 214 | ||
| Prognosis. | 214 | ||
| Management | 214 | ||
| Cutaneous disease. | 214 | ||
| Systemic disease treatment. | 214 | ||
| Chronic pruritus | 215 | ||
| 7 Acne, rosacea, and related disorders | 218 | ||
| Acne | 218 | ||
| Classification | 220 | ||
| Etiology and pathogenesis | 225 | ||
| Approach to acne therapy | 226 | ||
| Initial visit | 226 | ||
| History. | 226 | ||
| Pathogenesis and course. | 226 | ||
| Diet and family history. | 226 | ||
| Cosmetics and cleansers. | 226 | ||
| Oral contraceptives. | 226 | ||
| Initial evaluation | 226 | ||
| Type of lesions. | 226 | ||
| Degree of skin sensitivity. | 226 | ||
| Selection of therapy. | 226 | ||
| Course of treatment. | 227 | ||
| Acne treatment | 227 | ||
| Comedonal acne | 227 | ||
| Clinical presentation. | 227 | ||
| Treatment. | 227 | ||
| Mild inflammatory acne | 228 | ||
| Clinical presentation. | 228 | ||
| Treatment. | 228 | ||
| Moderate-to-severe inflammatory acne | 229 | ||
| Clinical presentation. | 229 | ||
| Treatment. | 229 | ||
| Severe: Nodulocystic acne | 231 | ||
| Clinical presentation. | 231 | ||
| Cystic acne | 231 | ||
| Pyoderma faciale. | 231 | ||
| Acne fulminans | 231 | ||
| Acne conglobata | 233 | ||
| Treatment of nodulocystic acne | 233 | ||
| Therapeutic agents for treatment of acne | 235 | ||
| Retinoids | 235 | ||
| Tretinoin. | 235 | ||
| Tazarotene. | 236 | ||
| Adapalene. | 236 | ||
| Azelaic acid. | 236 | ||
| Benzoyl peroxide | 236 | ||
| Benzoyl peroxide/antibiotic formulations. | 236 | ||
| Principles of treatment. | 236 | ||
| Allergic reaction. | 236 | ||
| Drying and peeling agents | 236 | ||
| Topical antibiotics | 237 | ||
| Oral antibiotics | 237 | ||
| Mechanism of action and dosage. | 237 | ||
| Antibiotic-resistant propionibacteria and long-term therapy. | 237 | ||
| Long-term treatment. | 237 | ||
| Dosage and duration. | 237 | ||
| Tetracycline antibiotics. | 237 | ||
| Tetracycline. | 237 | ||
| Dosing. | 237 | ||
| Adverse effects. | 237 | ||
| Doxycycline. | 238 | ||
| 8 Psoriasis and other papulosquamous diseases | 263 | ||
| Psoriasis | 263 | ||
| Pathogenesis | 264 | ||
| Clinical manifestations | 264 | ||
| Drugs that precipitate or exacerbate psoriasis | 265 | ||
| Lithium. | 265 | ||
| Beta-blocking agents. | 265 | ||
| Antimalarial agents. | 265 | ||
| Systemic steroids. | 265 | ||
| Comorbidities associated with psoriasis | 265 | ||
| Clinical presentations | 265 | ||
| Chronic plaque psoriasis | 265 | ||
| Guttate psoriasis | 265 | ||
| Generalized pustular psoriasis | 268 | ||
| Erythrodermic psoriasis | 268 | ||
| Light-sensitive psoriasis | 269 | ||
| Psoriasis of the scalp | 269 | ||
| Psoriasis of the palms and soles | 269 | ||
| Pustular psoriasis of the palms and soles | 270 | ||
| Keratoderma blennorrhagicum (Reiter syndrome) | 271 | ||
| Psoriasis of the penis and Reiter syndrome | 272 | ||
| Pustular psoriasis of the digits | 272 | ||
| Human immunodeficiency virus (HIV)–induced psoriasis | 272 | ||
| Psoriasis inversus (psoriasis of the flexural or intertriginous areas) | 273 | ||
| Psoriasis of the nails | 274 | ||
| Psoriatic arthritis | 275 | ||
| Defining psoriatic arthritis (PsA) | 275 | ||
| Differentiating PsA and rheumatoid arthritis (RA) | 276 | ||
| Differentiating PsA from osteoarthritis (OA) and gout | 278 | ||
| Treatment of psoriasis | 279 | ||
| Topical therapy | 282 | ||
| Topical steroids | 282 | ||
| Intralesional steroids | 283 | ||
| Topical calcineurin inhibitors | 283 | ||
| Vitamin D analogues (calcipotriene, calcitriol) | 283 | ||
| Tazarotene | 283 | ||
| Coal tar | 284 | ||
| Nonmedicated topical moisturizers | 284 | ||
| Ultraviolet light therapy | 284 | ||
| Photochemotherapy | 284 | ||
| Tape or occlusive dressings | 284 | ||
| Treating the scalp | 284 | ||
| Removing scale. | 284 | ||
| Mild-to-moderate scalp involvement. | 285 | ||
| Treatment of diffuse and thick scalp psoriasis. | 285 | ||
| Tar and oil. | 285 | ||
| Etanercept. | 285 | ||
| Treatment of inverse/intertriginous psoriasis and genital psoriasis | 285 | ||
| Systemic therapy | 285 | ||
| Rotational therapy | 285 | ||
| Combination therapy of systemic and biologic agents | 285 | ||
| Treatment of pregnant or lactating women. | 287 | ||
| Methotrexate | 287 | ||
| Indications and use. | 287 | ||
| Mechanism of action. | 289 | ||
| Dosing. | 289 | ||
| Monitoring. | 289 | ||
| Side effects. | 289 | ||
| Folate supplementation. | 289 | ||
| Hepatotoxicity | 289 | ||
| Lung toxicity. | 289 | ||
| Recall of sunburn. | 289 | ||
| Pregnancy. | 290 | ||
| Drug interactions. | 290 | ||
| Retinoids | 290 | ||
| Acitretin. | 290 | ||
| Indications. | 290 | ||
| Dosing strategy. | 290 | ||
| Acitretin and ultraviolet light B and PUVA. | 290 | ||
| Laboratory changes. | 290 | ||
| Side effects. | 291 | ||
| Isotretinoin | 291 | ||
| Cyclosporine | 293 | ||
| Baseline monitoring. | 293 | ||
| Managing nephrotoxicity. | 293 | ||
| Managing hypertension. | 293 | ||
| Liver function. | 293 | ||
| Other chemistries. | 294 | ||
| Other side effects. | 294 | ||
| Dosage. | 294 | ||
| Low-dose approach. | 294 | ||
| High-dose approach. | 295 | ||
| Intermittent short courses. | 295 | ||
| Weekend therapy. | 295 | ||
| Response to treatment. | 295 | ||
| Contraindications. | 295 | ||
| Drug interactions. | 295 | ||
| Combination therapy. | 295 | ||
| Rotational therapy | 295 | ||
| Other systemic drugs for psoriasis | 295 | ||
| Biologic therapy for psoriasis | 295 | ||
| Vaccines | 295 | ||
| TNF-α inhibitors for the treatment of psoriasis | 296 | ||
| Adalimumab. | 296 | ||
| Etanercept. | 297 | ||
| Pediatric psoriasis. | 297 | ||
| Infliximab | 298 | ||
| Biologics that target cytokines interleukin-12 and interleukin-23 | 298 | ||
| Ustekinumab. | 298 | ||
| Phosphodiesterase 4 inhibitor. | 298 | ||
| Pityriasis rubra pilaris | 299 | ||
| Seborrheic dermatitis | 302 | ||
| Infants (cradle cap) | 302 | ||
| Young children (tinea amiantacea and blepharitis) | 303 | ||
| Adolescents and adults (classic seborrheic dermatitis) | 304 | ||
| Acquired immunodeficiency syndrome | 304 | ||
| Treatment of seborrheic dermatitis | 304 | ||
| Shampoos. | 304 | ||
| Topical antifungal agents. | 304 | ||
| Topical steroids. | 305 | ||
| Calcineurin inhibitors. | 305 | ||
| Oral antifungals. | 305 | ||
| Other topicals. | 306 | ||
| Scalp scale. | 306 | ||
| Oral treatments. | 306 | ||
| Pityriasis rosea | 307 | ||
| Lichen planus | 310 | ||
| Localized papules | 312 | ||
| Generalized lichen planus and lichenoid drug eruptions | 312 | ||
| Hypertrophic lichen planus | 312 | ||
| Lichen planus of the palms and soles | 312 | ||
| Follicular lichen planus | 314 | ||
| Oral mucous membrane lichen planus | 314 | ||
| Erosive vaginal lichen planus | 316 | ||
| Nails | 316 | ||
| Diagnosis | 316 | ||
| Treatment | 316 | ||
| Therapy for cutaneous lichen planus | 316 | ||
| Therapy of mucous membrane lichen planus | 318 | ||
| Lichen sclerosus | 321 | ||
| Pityriasis lichenoides | 326 | ||
| Grover’s disease | 328 | ||
| 9 Bacterial infections | 329 | ||
| Skin infections | 329 | ||
| Impetigo | 329 | ||
| Bullous impetigo | 330 | ||
| Clinical manifestations. | 330 | ||
| Nonbullous impetigo | 332 | ||
| Laboratory findings. | 332 | ||
| Prevention of impetigo | 332 | ||
| Recurrent impetigo | 332 | ||
| Treatment of impetigo | 332 | ||
| Oral antibiotics. | 336 | ||
| Mupirocin (bactroban). | 336 | ||
| Retapamulin (altabax). | 336 | ||
| Cellulitis and erysipelas | 336 | ||
| Diagnosis of cellulitis | 336 | ||
| Cellulitis versus deep vein thrombosis. | 336 | ||
| Cultures. | 337 | ||
| Treatment of cellulitis | 337 | ||
| Preventing recurrent cellulitis | 340 | ||
| Prophylactic antibiotics to prevent recurrence. | 340 | ||
| Children. | 340 | ||
| Cellulitis of specific areas | 340 | ||
| Cellulitis and erysipelas of the extremities | 340 | ||
| Treatment. | 340 | ||
| Facial erysipelas and cellulitis in adults | 341 | ||
| Erysipelas. | 341 | ||
| Recurrence. | 342 | ||
| Treatment. | 342 | ||
| Perianal cellulitis | 342 | ||
| Necrotizing skin and soft tissue infections | 342 | ||
| Necrotizing fasciitis | 342 | ||
| Clinical manifestations | 343 | ||
| Bacteria | 343 | ||
| Monomicrobial form. | 343 | ||
| Polymicrobial form. | 343 | ||
| Diagnosis. | 343 | ||
| Treatment | 343 | ||
| Gas gangrene | 344 | ||
| Folliculitis | 345 | ||
| Staphylococcal folliculitis | 345 | ||
| Pseudofolliculitis barbae (razor bumps) | 346 | ||
| Prevention and treatment | 346 | ||
| Shaving techniques. | 346 | ||
| Laser. | 347 | ||
| Keratosis pilaris with folliculitis | 347 | ||
| Sycosis barbae | 348 | ||
| Acne keloidalis | 349 | ||
| Treatment | 349 | ||
| Furuncles and carbuncles | 350 | ||
| Location | 350 | ||
| Bacteria | 350 | ||
| Predisposing conditions | 350 | ||
| Clinical manifestations | 350 | ||
| Differential diagnosis | 351 | ||
| Treatment of furuncles | 352 | ||
| Incision, drainage, and packing. | 352 | ||
| Culture and gram stain. | 352 | ||
| Antibiotics. | 352 | ||
| Recurrent furunculosis | 352 | ||
| Management | 352 | ||
| Erysipeloid | 353 | ||
| Blistering distal dactylitis | 355 | ||
| Staphylococcal scalded skin syndrome | 355 | ||
| Epidermolytic toxin | 355 | ||
| Incidence | 355 | ||
| Clinical manifestations | 356 | ||
| Pathophysiology | 356 | ||
| Diagnosis | 356 | ||
| Treatment | 356 | ||
| Pseudomonas aeruginosa infection | 358 | ||
| Pseudomonas folliculitis | 358 | ||
| Clinical manifestations | 358 | ||
| Pathophysiology | 358 | ||
| Management | 358 | ||
| Pseudomonas cellulitis | 360 | ||
| Treatment | 360 | ||
| External otitis | 360 | ||
| Eczematous external otitis | 361 | ||
| Treatment. | 361 | ||
| Cleansing and debridement. | 361 | ||
| Topical therapy | 361 | ||
| Topical steroids. | 361 | ||
| Topical antibiotics. | 362 | ||
| Tacrolimus. | 362 | ||
| Acidification. | 362 | ||
| Wicks. | 362 | ||
| Systemic antimicrobial therapy. | 362 | ||
| Prevention | 362 | ||
| Treating eczema | 362 | ||
| Malignant external otitis | 362 | ||
| Imaging studies | 363 | ||
| Management | 363 | ||
| Toe web infection | 364 | ||
| Treatment | 364 | ||
| Ecthyma gangrenosum | 364 | ||
| Clinical presentation | 364 | ||
| Management (septicemic form) | 365 | ||
| Meningococcemia | 365 | ||
| Transmission | 365 | ||
| Incidence | 365 | ||
| Pathophysiology | 366 | ||
| Clinical manifestations | 366 | ||
| Fulminant disease and purpura fulminans | 368 | ||
| Diagnosis | 368 | ||
| Differential diagnosis | 368 | ||
| Treatment | 372 | ||
| Antibiotics. | 372 | ||
| Management of shock. | 373 | ||
| Vaccines | 373 | ||
| Chemoprophylaxis | 373 | ||
| Nontuberculous mycobacteria | 374 | ||
| M. marinum | 375 | ||
| M. ulcerans, M. fortuitum, M. chelonae, and M. avium-intracellulare | 375 | ||
| Laboratory diagnosis | 375 | ||
| Treatment | 375 | ||
| 10 Sexually transmitted bacterial infections | 377 | ||
| Sexually transmitted disease presentations | 377 | ||
| Genital ulcers | 377 | ||
| Developed countries | 377 | ||
| Syndromic management of sexually transmitted diseases | 381 | ||
| Syphilis | 390 | ||
| Incidence | 390 | ||
| Stages | 390 | ||
| Risk of transmission | 390 | ||
| Treponema pallidum | 392 | ||
| Primary syphilis | 392 | ||
| Secondary syphilis | 394 | ||
| Lesions | 394 | ||
| Latent syphilis | 396 | ||
| Tertiary syphilis | 396 | ||
| Syphilis and human immunodeficiency virus | 396 | ||
| Congenital syphilis | 396 | ||
| Early congenital syphilis | 397 | ||
| Late congenital syphilis | 397 | ||
| Syphilis serology | 398 | ||
| Conventional testing | 398 | ||
| Initial screening by syphilis IgG assay | 399 | ||
| Syphilis antibody response | 399 | ||
| Reverse algorithm screening | 399 | ||
| Venereal disease research laboratory and rapid plasma reagin tests | 401 | ||
| Quantitative testing. | 401 | ||
| False-positive reactions. | 401 | ||
| Prozone phenomenon. | 401 | ||
| Fluorescent treponemal antibody absorption and T. pallidum particle agglutination tests | 401 | ||
| Tests for neurosyphilis | 402 | ||
| Patients with human immunodeficiency virus | 402 | ||
| Treatment of syphilis | 402 | ||
| Jarisch-Herxheimer reaction | 403 | ||
| Management of the patient with a history of penicillin allergy | 403 | ||
| Posttreatment evaluation of syphilis | 403 | ||
| Serologic response to treatment | 403 | ||
| Late latent syphilis | 403 | ||
| Frequency of follow-up serologic tests | 403 | ||
| Reinfection in primary, secondary, and latent syphilis | 403 | ||
| Rare sexually transmitted diseases | 404 | ||
| Lymphogranuloma venereum | 404 | ||
| Primary lesions | 404 | ||
| Inguinal stage | 404 | ||
| Genitoanorectal syndrome | 405 | ||
| Diagnosis | 405 | ||
| Management | 405 | ||
| Lesion management. | 405 | ||
| Chancroid | 406 | ||
| Bacteria | 406 | ||
| Primary state | 406 | ||
| Lymphadenopathy | 406 | ||
| Diagnosis | 406 | ||
| Treatment | 407 | ||
| Donovanosis (granuloma inguinale) | 408 | ||
| Clinical presentation | 408 | ||
| Diagnosis | 408 | ||
| Treatment | 408 | ||
| Diseases characterized by urethritis and cervicitis | 409 | ||
| Urethritis | 409 | ||
| Etiology | 410 | ||
| Confirmed urethritis | 410 | ||
| Nongonococcal urethritis | 410 | ||
| Diagnosis | 410 | ||
| Treatment | 410 | ||
| Follow-up | 410 | ||
| Recurrent and persistent urethritis | 411 | ||
| Cervicitis | 411 | ||
| Etiology | 411 | ||
| Diagnosis | 411 | ||
| Treatment | 411 | ||
| Gonorrhea | 411 | ||
| Neisseria gonorrhoeae | 412 | ||
| Diagnostic considerations | 412 | ||
| Genital infection in males | 413 | ||
| 11 Sexually transmitted viral infections | 418 | ||
| Genital warts | 418 | ||
| Virus types | 418 | ||
| Incidence | 418 | ||
| Regression and persistence | 418 | ||
| Risk | 419 | ||
| Transmission | 419 | ||
| Clinical presentation | 419 | ||
| Oral condyloma in patients with genital human papillomavirus infection | 422 | ||
| Pearly penile papules | 422 | ||
| Genital warts in children | 422 | ||
| Diagnosis | 422 | ||
| Treatment | 423 | ||
| Management of sexual partners | 423 | ||
| Pregnancy | 423 | ||
| Children | 424 | ||
| Patient-applied therapies | 424 | ||
| Imiquimod. | 424 | ||
| Podofilox. | 424 | ||
| Green tea sinecatechins (veregen ointment). | 424 | ||
| Provider-administered therapies | 424 | ||
| Cryosurgery. | 424 | ||
| Surgical removal and electrosurgery. | 424 | ||
| Trichloroacetic acid. | 425 | ||
| Podophyllum resin. | 425 | ||
| Warning. | 425 | ||
| Alteration of histopathology. | 425 | ||
| 5-Fluorouracil cream. | 425 | ||
| Carbon dioxide laser. | 425 | ||
| Bowenoid papulosis | 426 | ||
| Molluscum contagiosum | 426 | ||
| Clinical manifestations | 426 | ||
| Diagnosis | 428 | ||
| Treatment | 428 | ||
| Over-the-counter treatments | 428 | ||
| Curettage | 428 | ||
| Cryosurgery | 428 | ||
| Antiviral and immunomodulatory therapies | 428 | ||
| Cantharidin | 428 | ||
| Potassium hydroxide | 428 | ||
| Oral cimetidine | 428 | ||
| Laser therapy | 428 | ||
| Trichloroacetic acid peel | 428 | ||
| Genital herpes simplex | 429 | ||
| Prevalence | 429 | ||
| Risk factors | 429 | ||
| Rate of transmission | 429 | ||
| Previous herpes simplex virus type 1 infection | 431 | ||
| Human immunodeficiency virus infection | 431 | ||
| Primary and recurrent infections | 431 | ||
| First-episode infections | 431 | ||
| Signs and symptoms. | 431 | ||
| Recurrent infection | 431 | ||
| Clinical signs and symptoms. | 431 | ||
| Frequency of recurrence. | 436 | ||
| Anatomic site. | 436 | ||
| Asymptomatic transmission. | 436 | ||
| Asymptomatic shedding. | 436 | ||
| Prevention | 436 | ||
| Laboratory diagnosis | 437 | ||
| Polymerase chain reaction | 437 | ||
| Culture | 437 | ||
| Histopathologic studies | 437 | ||
| Serology | 437 | ||
| Subtyping | 437 | ||
| Herpes simplex virus type 1. | 437 | ||
| Type-specific serologic tests | 437 | ||
| Indications to test | 438 | ||
| Pregnant women. | 438 | ||
| Monogamous couples. | 438 | ||
| Diagnosis of recurrent genital eruptions. | 438 | ||
| Identifying herpes simplex virus as a risk factor for human immunodeficiency virus transmission. | 438 | ||
| Psychosocial implications | 438 | ||
| Treatment of genital herpes (CDC guidelines) | 438 | ||
| Drugs | 438 | ||
| First clinical episode of genital herpes | 440 | ||
| Cool compresses | 440 | ||
| Counseling | 440 | ||
| Recurrent episodes of herpes simplex virus disease | 440 | ||
| Daily suppressive therapy | 440 | ||
| Lubrication | 440 | ||
| Genital herpes simplex during pregnancy | 441 | ||
| Pregnancy complications | 441 | ||
| Prenatal screening and management | 441 | ||
| Prevention | 441 | ||
| Antiviral therapy | 441 | ||
| Viral cultures | 441 | ||
| Management at labor | 441 | ||
| Neonatal herpes simplex virus infection | 442 | ||
| Clinical signs | 442 | ||
| Diagnosis | 442 | ||
| Prognosis | 442 | ||
| Treatment | 443 | ||
| HIV infection | 443 | ||
| The initial human immunodeficiency virus infection | 443 | ||
| Dermatologic diseases associated with human immunodeficiency virus infection | 443 | ||
| 12 Warts, herpes simplex, and other viral infections | 448 | ||
| Warts | 448 | ||
| Clinical infection | 448 | ||
| Immunologic response | 448 | ||
| Treatment | 448 | ||
| Warts: The primary lesion | 449 | ||
| Common warts | 451 | ||
| Treatment of recalcitrant warts | 451 | ||
| Imiquimod. | 451 | ||
| Apple cider vinegar. | 451 | ||
| Filiform and digitate warts | 451 | ||
| Flat warts | 452 | ||
| Plantar warts | 453 | ||
| Differential diagnosis | 454 | ||
| Treatment. | 455 | ||
| Debridement. | 455 | ||
| Combination therapy. | 455 | ||
| Keratolytic therapy (salicylic acid liquid). | 455 | ||
| Keratolytic therapy (40% salicylic acid plasters). | 456 | ||
| Apple cider vinegar. | 456 | ||
| 5-Fluorouracil (5-FU). | 456 | ||
| Blunt dissection. | 456 | ||
| Imiquimod. | 456 | ||
| Suggestive therapy. | 456 | ||
| Cantharidin. | 456 | ||
| Laser. | 456 | ||
| Chemotherapy. | 456 | ||
| Formalin. | 456 | ||
| Cryosurgery. | 456 | ||
| Subungual and periungual warts | 457 | ||
| Molluscum contagiosum | 458 | ||
| Herpes simplex | 460 | ||
| Primary infection | 460 | ||
| Lesions | 460 | ||
| Recurrent infection | 461 | ||
| Oral-labial herpes simplex | 462 | ||
| Primary infection | 462 | ||
| Recurrent infection | 462 | ||
| Treatment. | 463 | ||
| Combination treatment. | 463 | ||
| Topical treatment. | 463 | ||
| Cutaneous herpes simplex | 464 | ||
| Eczema herpeticum | 466 | ||
| Varicella | 468 | ||
| Chickenpox in the immunocompromised patient | 470 | ||
| Chickenpox and HIV infection | 471 | ||
| Chickenpox during pregnancy | 471 | ||
| Congenital and neonatal chickenpox | 471 | ||
| Maternal varicella | 471 | ||
| First trimester. | 471 | ||
| Second trimester. | 471 | ||
| Near birth. | 471 | ||
| Laboratory diagnosis | 471 | ||
| Varicella vaccine | 471 | ||
| Treatment | 472 | ||
| Acyclovir | 472 | ||
| Gamma-globulin. | 473 | ||
| Herpes zoster | 473 | ||
| Herpes zoster after varicella immunization | 477 | ||
| Herpes zoster and HIV infection | 477 | ||
| Herpes zoster during pregnancy | 477 | ||
| Syndromes | 477 | ||
| Ophthalmic zoster | 477 | ||
| Clinical presentation. | 477 | ||
| Eye involvement. | 477 | ||
| Ramsay Hunt syndrome. | 478 | ||
| Sacral zoster (S2, S3, or S4 dermatomes). | 479 | ||
| Complications | 479 | ||
| Pregnancy | 481 | ||
| Differential diagnosis | 481 | ||
| Laboratory diagnosis | 482 | ||
| Varicella-zoster vaccine. | 482 | ||
| Infection control | 482 | ||
| Treatment | 482 | ||
| Treatment strategy. | 482 | ||
| Topical therapy. | 482 | ||
| Antiviral therapy | 483 | ||
| Treating acute pain | 483 | ||
| Prevention of postherpetic neuralgia | 483 | ||
| Treatment of postherpetic neuralgia | 484 | ||
| Treatment of herpes zoster and postherpetic neuralgia | 485 | ||
| 13 Superficial fungal infections | 487 | ||
| Dermatophyte fungal infections | 487 | ||
| Tinea | 490 | ||
| Tinea of the foot | 490 | ||
| Clinical presentations. | 491 | ||
| Interdigital tinea pedis (toe web infection). | 491 | ||
| Two feet–one hand syndrome | 492 | ||
| Treatment. | 492 | ||
| Chronic scaly infection of the plantar surface. | 492 | ||
| Acute vesicular tinea pedis. | 492 | ||
| Pitted keratolysis | 494 | ||
| Tinea of the groin | 495 | ||
| Differential diagnosis | 496 | ||
| Intertrigo. | 496 | ||
| Erythrasma. | 496 | ||
| Treatment for tinea of the groin. | 496 | ||
| Tinea of the body and face | 497 | ||
| Round annular lesions. | 497 | ||
| Tinea corporis (tinea gladiatorum) | 497 | ||
| Deep inflammatory lesions. | 497 | ||
| Treatment. | 500 | ||
| Invasive dermatophyte infection. | 501 | ||
| Tinea of the hand | 501 | ||
| Tinea incognito | 503 | ||
| Tinea of the scalp | 504 | ||
| Organism and transmission. | 504 | ||
| Hair shaft infection. | 504 | ||
| Endothrix pattern of invasion. | 505 | ||
| Ectothrix pattern of invasion. | 505 | ||
| Microscopic patterns of hair invasion. | 505 | ||
| Clinical patterns of infection. | 505 | ||
| Diagnosis. | 505 | ||
| Trichophyton tonsurans | 509 | ||
| Four patterns of infection. | 509 | ||
| Noninflammatory black dot pattern. | 509 | ||
| Inflammatory tinea capitis (kerion). | 510 | ||
| Seborrheic dermatitis type. | 510 | ||
| Pustular type. | 511 | ||
| Differential diagnosis. | 511 | ||
| Id reaction to therapy. | 511 | ||
| Treatment. | 511 | ||
| Tinea of the beard | 512 | ||
| Superficial infection. | 512 | ||
| Deep follicular infection. | 512 | ||
| Treatment. | 512 | ||
| Treatment of fungal infections | 514 | ||
| Systemic agents (see tables 13-2 to 13-4) | 514 | ||
| Griseofulvin. | 514 | ||
| Adverse reactions. | 515 | ||
| Allylamines. | 515 | ||
| Terbinafine. | 515 | ||
| Indications. | 515 | ||
| Triazoles. | 515 | ||
| Itraconazole (sporanox). | 515 | ||
| Fluconazole (diflucan). | 515 | ||
| Ketoconazole (nizoral). | 515 | ||
| Candidiasis (moniliasis) | 516 | ||
| Candidiasis of normally moist areas | 518 | ||
| Vulvovaginitis | 518 | ||
| Vaginal discharge | 518 | ||
| Non–sexually-acquired discharge. | 518 | ||
| Bacterial vaginosis. | 518 | ||
| Sexually acquired discharge. | 518 | ||
| Syndromic management. | 518 | ||
| Optional tests. | 518 | ||
| Vulvovaginal candidiasis | 520 | ||
| Uncomplicated vulvovaginal candidiasis. | 520 | ||
| 14 Exanthems and drug eruptions | 534 | ||
| Exanthems | 535 | ||
| Measles | 535 | ||
| Typical measles | 536 | ||
| Eruptive phase. | 537 | ||
| Management of measles | 538 | ||
| Vitamin A treatment. | 538 | ||
| Immunity. | 538 | ||
| Individuals exposed to disease. | 538 | ||
| Use of human immunoglobulin. | 538 | ||
| Revaccination risks. | 538 | ||
| Pregnancy. | 538 | ||
| Hand-foot-and-mouth disease | 538 | ||
| Scarlet fever | 540 | ||
| Rubella | 543 | ||
| Erythema infectiosum (parvovirus B19 infection) | 544 | ||
| Roseola infantum (human herpesvirus 6 and 7 infection) | 547 | ||
| Enteroviruses: Echovirus and coxsackievirus exanthems | 549 | ||
| Kawasaki disease | 552 | ||
| Superantigen toxin-mediated illnesses | 558 | ||
| Toxic shock syndrome | 558 | ||
| Cutaneous drug reactions | 560 | ||
| Drug eruptions: Clinical patterns and most frequent causal drugs (box 14-8) | 562 | ||
| Exanthems (maculopapular) | 562 | ||
| Urticaria | 567 | ||
| Pruritus | 567 | ||
| Drug eruptions | 568 | ||
| Severe cutaneous adverse drug reactions | 568 | ||
| DRESS syndrome | 569 | ||
| Erythema multiforme and toxic epidermal necrolysis | 569 | ||
| Acute generalized exanthematous pustulosis | 569 | ||
| Acneiform (pustular) eruptions | 571 | ||
| Eczema | 571 | ||
| Fixed drug eruptions | 572 | ||
| Blistering drug eruptions | 574 | ||
| Exfoliative erythroderma | 574 | ||
| Lichenoid (lichen planus–like drug eruptions) | 574 | ||
| Lupus erythematosus–like drug eruptions | 575 | ||
| Chemotherapy-induced acral erythema | 575 | ||
| Pigmentation | 576 | ||
| Photosensitivity | 576 | ||
| Vasculitis | 576 | ||
| Lymphomatoid drug eruptions | 576 | ||
| Skin eruptions associated with specific drugs | 576 | ||
| Interstitial granulomatous drug reaction | 576 | ||
| 15 Infestations and bites | 577 | ||
| Scabies | 577 | ||
| Anatomic features, life cycle, and immunology of the mite | 577 | ||
| Anatomic features | 577 | ||
| Infestation and life cycle. | 577 | ||
| Immunology. | 579 | ||
| Clinical manifestations | 579 | ||
| Primary lesions | 579 | ||
| Burrow. | 579 | ||
| Vesicles and papules. | 579 | ||
| Secondary lesions | 580 | ||
| Distribution | 580 | ||
| Infants | 582 | ||
| The elderly | 582 | ||
| Crusted (Norwegian) scabies | 583 | ||
| Diagnosis | 583 | ||
| Burrow identification | 583 | ||
| Sampling techniques and slide mount preparation | 584 | ||
| Mineral oil mounts. | 584 | ||
| Potassium hydroxide wet mounts. | 584 | ||
| Adhesive tape. | 584 | ||
| Dermoscopy | 584 | ||
| Treatment and management | 584 | ||
| Permethrin | 584 | ||
| Lindane | 584 | ||
| Application technique for permethrin and lindane. | 584 | ||
| Benzyl benzoate | 585 | ||
| Crotamiton (eurax lotion) | 585 | ||
| Sulfur | 585 | ||
| Ivermectin (stromectol) | 585 | ||
| Scabies in long-term care facilities | 587 | ||
| Eradication program for nursing homes | 587 | ||
| Management of complications | 587 | ||
| Eczematous inflammation and pyoderma. | 587 | ||
| Post-scabietic pruritus. | 587 | ||
| Nodular scabies. | 587 | ||
| Environmental management. | 587 | ||
| Pediculosis | 587 | ||
| Biology and life cycle | 587 | ||
| Nits | 588 | ||
| Clinical manifestations | 588 | ||
| Pediculosis capitis | 588 | ||
| Pediculosis corporis | 589 | ||
| Eyelash infestation. | 589 | ||
| Pediculosis pubis | 589 | ||
| Diagnosis | 589 | ||
| Combing | 589 | ||
| Treatment | 590 | ||
| Head, body, and pubic lice | 590 | ||
| Permethrin. | 590 | ||
| Pyrethrin. | 591 | ||
| Malathion (ovide). | 591 | ||
| Lindane. | 591 | ||
| Ivermectin. | 591 | ||
| Ivermection lotion (sklice). | 591 | ||
| Spinosad. | 591 | ||
| Trimethoprim/sulfamethoxazole (bactrim, septra). | 591 | ||
| Nit removal | 591 | ||
| Wet combing (bug busting). | 591 | ||
| Pomades. | 592 | ||
| Hot air. | 592 | ||
| Fomite control. | 592 | ||
| “No nit” policies | 592 | ||
| Eye infestation | 592 | ||
| Spiders | 592 | ||
| Black widow spider | 592 | ||
| Clinical manifestations | 593 | ||
| Treatment | 594 | ||
| Immediate first aid. | 594 | ||
| Antivenin. | 594 | ||
| Muscle relaxants. | 594 | ||
| Analgesics. | 594 | ||
| Brown recluse spider | 595 | ||
| Clinical manifestations | 595 | ||
| Management | 596 | ||
| Moderate to severe skin necrosis. | 596 | ||
| Dapsone. | 596 | ||
| Steroids. | 596 | ||
| Surgery. | 596 | ||
| Antivenin. | 596 | ||
| Ticks | 597 | ||
| Lyme disease and erythema migrans | 598 | ||
| Geographic distribution | 598 | ||
| Cutaneous manifestations | 599 | ||
| Borrelia lymphocytoma. | 599 | ||
| Acrodermatitis chronica atrophicans. | 599 | ||
| Erythema migrans. | 599 | ||
| Early and late disease. | 599 | ||
| Three stages of infection | 601 | ||
| Early localized disease (erythema migrans and flulike symptoms). | 601 | ||
| Early disseminated disease (cardiac and neurologic disease). | 602 | ||
| Cardiac disease. | 602 | ||
| 16 Vesicular and bullous diseases | 635 | ||
| Blisters | 635 | ||
| Autoimmune blistering diseases | 635 | ||
| Major blistering diseases | 636 | ||
| Classification | 636 | ||
| Epidermis | 638 | ||
| The basement membrane zone (see figure 16-2) | 638 | ||
| Basement membrane antigens and diseases. | 638 | ||
| Diagnosis of bullous disorders | 639 | ||
| Dermatitis herpetiformis and linear IgA bullous dermatosis | 641 | ||
| Gluten-sensitive enteropathy | 644 | ||
| Lymphoma | 644 | ||
| Diagnosis of dermatitis herpetiformis | 644 | ||
| Treatment | 645 | ||
| Bullae in diabetic persons | 646 | ||
| Pemphigus | 647 | ||
| Pathophysiology | 647 | ||
| Desmoglein | 647 | ||
| Dsg1 and Dsg3 autoantibodies. | 647 | ||
| Pemphigus vulgaris | 647 | ||
| Pemphigus foliaceus, IgA pemphigus, and pemphigus erythematosus | 649 | ||
| Pemphigus erythematosus | 649 | ||
| Pemphigus foliaceus | 650 | ||
| Fogo selvagem | 650 | ||
| Diagnosis of pemphigus | 650 | ||
| Treatment | 651 | ||
| Approach to treatment | 652 | ||
| Prednisone. | 652 | ||
| Course and remission | 653 | ||
| Risk of relapse | 653 | ||
| Conclusions | 653 | ||
| Determining remission and when to stop treatment. | 653 | ||
| Pemphigus in association with other diseases | 653 | ||
| Drug-induced versus drug-triggered pemphigus | 654 | ||
| Paraneoplastic pemphigus (neoplasia-associated pemphigus) | 654 | ||
| Laboratory diagnosis of paraneoplastic pemphigus | 655 | ||
| Histologic studies. | 655 | ||
| Direct immunofluorescence. | 655 | ||
| Indirect immunofluorescence. | 655 | ||
| The pemphigoid group of diseases | 655 | ||
| Bullous pemphigoid | 655 | ||
| Localized pemphigoid | 660 | ||
| Diagnosis | 661 | ||
| Treatment | 661 | ||
| Plan of therapy. | 661 | ||
| Topical therapy | 661 | ||
| Oral cavity. | 661 | ||
| Eyes. | 661 | ||
| Intralesional therapy. | 661 | ||
| Systemic therapy | 661 | ||
| Dapsone. | 661 | ||
| Corticosteroids. | 661 | ||
| Immunosuppressive agents (adjuvant therapy). | 661 | ||
| Antibiotics. | 661 | ||
| Other medications. | 661 | ||
| Surgical therapy. | 661 | ||
| Localized vulvar pemphigoid | 662 | ||
| Benign chronic bullous dermatosis of childhood | 662 | ||
| Herpes gestationis (pemphigoid gestationis) | 662 | ||
| Pemphigoid-like disease | 663 | ||
| Epidermolysis bullosa acquisita | 663 | ||
| Benign familial chronic pemphigus | 664 | ||
| Epidermolysis bullosa | 666 | ||
| The newborn with blisters, pustules, erosions, and ulcerations | 667 | ||
| 17 Connective tissue diseases | 673 | ||
| Autoimmune diseases | 673 | ||
| Connective tissue diseases | 673 | ||
| Diagnosis | 674 | ||
| Antinuclear antibody screening | 674 | ||
| Connective tissue laboratory screening tests | 678 | ||
| Lupus erythematosus | 680 | ||
| Clinical classification | 680 | ||
| Subsets of cutaneous lupus erythematosus | 682 | ||
| Chronic cutaneous lupus erythematosus (discoid lupus erythematosus) | 684 | ||
| Subacute cutaneous lupus erythematosus | 686 | ||
| Systemic lupus erythematosus | 688 | ||
| Overview of SLE | 688 | ||
| Definition. | 688 | ||
| Clinical presentation. | 688 | ||
| Laboratory findings. | 688 | ||
| Diagnosis. | 688 | ||
| Treatment. | 688 | ||
| Hydroxychloroquine. | 688 | ||
| Belimumab. | 688 | ||
| Cutaneous disease | 689 | ||
| Other cutaneous signs of lupus erythematosus | 690 | ||
| Diagnosis and management of cutaneous lupus erythematosus | 690 | ||
| Neonatal lupus erythematosus | 693 | ||
| Drug-induced lupus erythematosus | 694 | ||
| Dermatomyositis and polymyositis | 694 | ||
| Polymyositis | 695 | ||
| Dermatomyositis | 695 | ||
| Scleroderma | 702 | ||
| Systemic sclerosis | 702 | ||
| Chemically induced scleroderma | 702 | ||
| Diffuse scleroderma | 702 | ||
| Initial signs and symptoms. | 702 | ||
| Skin. | 702 | ||
| Raynaud’s phenomenon. | 705 | ||
| Telangiectasias. | 705 | ||
| Gastrointestinal tract. | 705 | ||
| Lungs. | 706 | ||
| Kidneys. | 706 | ||
| Other organs. | 706 | ||
| Prognosis. | 706 | ||
| CREST syndrome | 706 | ||
| Diagnosis of diffuse scleroderma | 707 | ||
| Autoantibodies. | 707 | ||
| Other studies. | 707 | ||
| Office nailfold capillary microscopy | 707 | ||
| Normal. | 708 | ||
| Overlap syndromes (scleroderma, dermatomyositis). | 708 | ||
| Mixed connective tissue disease. | 708 | ||
| Lupus. | 708 | ||
| Treatment | 708 | ||
| Systemic therapy. | 708 | ||
| Management of cutaneous disease. | 708 | ||
| Morphea (localized scleroderma) | 709 | ||
| Classification | 709 | ||
| Lesion progression. | 709 | ||
| Differentiation from systemic sclerosis. | 710 | ||
| Systemic manifestations. | 710 | ||
| Autoimmunity and family history. | 711 | ||
| Biopsy. | 711 | ||
| Treatment. | 711 | ||
| Methotrexate and corticosteroids. | 711 | ||
| Linear scleroderma | 711 | ||
| Laboratory findings. | 712 | ||
| Treatment. | 712 | ||
| En coup de sabre | 712 | ||
| 18 Hypersensitivity syndromes and vasculitis | 713 | ||
| Hypersensitivity syndromes | 713 | ||
| Erythema multiforme | 713 | ||
| Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum of disease | 717 | ||
| Stevens-Johnson syndrome | 718 | ||
| Toxic epidermal necrolysis | 720 | ||
| Treatment | 722 | ||
| Erythema nodosum | 723 | ||
| Vasculitis | 725 | ||
| Vasculitis of small vessels | 731 | ||
| Hypersensitivity vasculitis | 732 | ||
| Henoch-Schönlein purpura | 735 | ||
| Neutrophilic dermatoses | 739 | ||
| Sweet’s syndrome (acute febrile neutrophilic dermatosis) | 739 | ||
| Erythema elevatum diutinum | 741 | ||
| Pyoderma gangrenosum | 742 | ||
| Schamberg’s disease | 745 | ||
| 19 Light-related diseases and disorders of pigmentation | 746 | ||
| Photobiology | 746 | ||
| Sun-damaged skin | 748 | ||
| Suntan and sunburn | 752 | ||
| Sun protection | 752 | ||
| Polymorphous light eruption | 756 | ||
| Hydroa aestivale and hydroa vacciniforme | 758 | ||
| Porphyrias | 760 | ||
| Porphyria cutanea tarda | 760 | ||
| Treatment | 764 | ||
| Phlebotomy. | 764 | ||
| Chloroquine. | 764 | ||
| Pseudoporphyria | 765 | ||
| Phototoxic reactions | 766 | ||
| Photoallergy | 769 | ||
| Disorders of hypopigmentation | 770 | ||
| Vitiligo | 770 | ||
| Guidelines for the treatment of vitiligo | 772 | ||
| Children. | 772 | ||
| Adults. | 773 | ||
| Corticosteroids. | 774 | ||
| Topical calcineurin inhibitors. | 774 | ||
| Vitamin D3 analogues. | 774 | ||
| Narrow-band UVB. | 774 | ||
| Monochromatic excimer laser (308 nm). | 774 | ||
| Response to treatment. | 775 | ||
| Photochemotherapy. | 775 | ||
| Topical therapy. | 775 | ||
| Grafting and transplantation. | 775 | ||
| Systemic steroids. | 775 | ||
| Camouflage. | 775 | ||
| Depigmentation of remaining normal skin. | 775 | ||
| Idiopathic guttate hypomelanosis | 776 | ||
| Nevus anemicus | 776 | ||
| Tuberous sclerosis | 777 | ||
| Pityriasis alba | 777 | ||
| Disorders of hyperpigmentation | 777 | ||
| Freckles | 777 | ||
| Lentigo in children | 778 | ||
| Lentigo in adults | 778 | ||
| Melasma | 779 | ||
| Café-au-lait spots | 782 | ||
| Diabetic dermopathy | 783 | ||
| Erythema ab igne | 783 | ||
| 20 Benign skin tumors | 784 | ||
| Seborrheic keratosis | 784 | ||
| Stucco keratoses | 792 | ||
| Skin tags (acrochordon) and polyps | 792 | ||
| Dermatosis papulosa nigra | 794 | ||
| Cutaneous horn | 794 | ||
| Dermatofibroma | 795 | ||
| Hypertrophic scars and keloids | 796 | ||
| Keratoacanthoma | 797 | ||
| Epidermal nevus | 800 | ||
| Nevus sebaceous | 802 | ||
| Chondrodermatitis nodularis helicis | 803 | ||
| Epidermal cyst | 804 | ||
| Pilar cyst (wen) | 806 | ||
| Senile sebaceous hyperplasia | 807 | ||
| Syringoma | 808 | ||
| 21 Premalignant and malignant nonmelanoma skin tumors | 809 | ||
| Basal cell carcinoma | 809 | ||
| Pathophysiology | 810 | ||
| Histologic characteristics | 810 | ||
| Clinical types | 810 | ||
| Management and risk of recurrence | 816 | ||
| Recurrent basal cell carcinoma | 817 | ||
| Clinical presentation | 817 | ||
| Histologic type. | 817 | ||
| Location. | 817 | ||
| Size. | 817 | ||
| Treatment of basal cell carcinoma | 818 | ||
| Actinic keratosis | 819 | ||
| Lesion-directed therapy | 824 | ||
| Field-directed therapy | 824 | ||
| Treatment technique (5-FU) and expected results | 825 | ||
| Topical chemotherapy with imiquimod. | 825 | ||
| Inflammatory response and physician supervision. | 825 | ||
| Ingenol mebutate. | 826 | ||
| Photodynamic therapy. | 826 | ||
| Topical steroids. | 826 | ||
| Actinic keratosis of the face. | 826 | ||
| Actinic keratoses of the upper and lower extremities. | 826 | ||
| Actinic cheilitis. | 826 | ||
| Contact allergy to 5-FU. | 826 | ||
| Prognosis. | 826 | ||
| Squamous cell carcinoma in situ | 827 | ||
| Bowen’s disease | 828 | ||
| Erythroplasia of queyrat | 829 | ||
| Arsenical keratoses and other arsenic-related skin diseases | 829 | ||
| Squamous cell carcinoma | 830 | ||
| Leukoplakia | 835 | ||
| Verrucous carcinoma | 836 | ||
| Primary cutaneous lymphomas | 837 | ||
| Cutaneous T-cell lymphoma | 837 | ||
| Mycosis fungoides | 837 | ||
| Clinical criteria | 840 | ||
| Histopathologic criteria | 840 | ||
| Molecular biologic criteria | 840 | ||
| Immunopathologic criteria | 840 | ||
| Staging procedures. | 842 | ||
| Staging. | 842 | ||
| Prognosis. | 842 | ||
| Clinical presentations | 842 | ||
| Sézary syndrome | 846 | ||
| Paget’s disease of the breast | 850 | ||
| Extramammary Paget’s disease | 851 | ||
| Merkel cell carcinoma | 852 | ||
| Cutaneous metastasis | 852 | ||
| 22 Nevi and malignant melanoma | 855 | ||
| Melanocytic nevi | 855 | ||
| Common moles | 856 | ||
| Management | 858 | ||
| Suspicious lesions. | 858 | ||
| Nevi. | 858 | ||
| Recurrent previously excised nevi (pseudomelanoma). | 858 | ||
| Nevi with small dark spots. | 858 | ||
| Special forms | 858 | ||
| Atypical nevi | 865 | ||
| Classification of atypical melanocytic nevi | 866 | ||
| Clinical classification | 866 | ||
| Clinical features of atypical moles | 866 | ||
| Morphology. | 866 | ||
| Surface characteristics. | 866 | ||
| Development and distribution. | 866 | ||
| Histologic characteristics. | 868 | ||
| Management. | 868 | ||
| Surgical excision and reexcision. | 868 | ||
| Malignant melanoma | 868 | ||
| Superficial spreading melanoma | 871 | ||
| Nodular melanoma | 874 | ||
| Lentigo maligna melanoma | 876 | ||
| Acral-lentiginous melanoma | 878 | ||
| Benign lesions that resemble melanoma | 879 | ||
| Lesion examination | 879 | ||
| Observation plus magnification plus dermoscopy. | 879 | ||
| Screening for melanoma. | 879 | ||
| Progression of melanoma | 880 | ||
| Radial growth phase tumors. | 880 | ||
| Vertical growth phase tumors. | 880 | ||
| Management of melanoma | 881 | ||
| Biopsy | 881 | ||
| Staging workup and follow-up | 881 | ||
| Surgical management | 884 | ||
| Staging and prognosis | 887 | ||
| Medical treatment | 889 | ||
| Dermoscopy | 889 | ||
| 23 Vascular tumors and malformations | 901 | ||
| Congenital vascular lesions | 901 | ||
| Hemangiomas of infancy | 902 | ||
| Superficial hemangiomas | 902 | ||
| Management | 904 | ||
| Nonintervention. | 904 | ||
| Topical propranolol. | 904 | ||
| Topical timolol gel. | 904 | ||
| Propranolol. | 904 | ||
| Corticosteroids. | 904 | ||
| Intralesional steroids. | 905 | ||
| Treating ulcers and rapidly proliferating lesions. | 905 | ||
| Local wound care. | 905 | ||
| Infection. | 905 | ||
| Lasers. | 905 | ||
| Topical imiquimod. | 906 | ||
| Surgery. | 906 | ||
| Interferon alfa-2b. | 906 | ||
| Deep hemangiomas | 906 | ||
| Kasabach-Merritt syndrome. | 906 | ||
| Hemangiomas associated with congenital abnormalities. | 907 | ||
| Malformations | 908 | ||
| Nevus flammeus (port-wine stains) | 908 | ||
| Systemic syndromes. | 912 | ||
| Sturge-Weber syndrome. | 912 | ||
| Klippel-Trénaunay syndrome. | 912 | ||
| Treatment. | 913 | ||
| Lasers. | 913 | ||
| Cosmetics. | 913 | ||
| Salmon patches | 913 | ||
| Acquired vascular lesions | 914 | ||
| Cherry angioma | 914 | ||
| Angiokeratomas | 914 | ||
| Venous lake | 915 | ||
| Lymphangioma circumscriptum | 915 | ||
| Pyogenic granuloma (lobular capillary hemangioma) | 916 | ||
| Bacillary angiomatosis | 916 | ||
| Kaposi’s sarcoma | 917 | ||
| Telangiectasias | 920 | ||
| Spider angiomas | 920 | ||
| Hereditary hemorrhagic telangiectasia | 921 | ||
| Scleroderma | 922 | ||
| Unilateral nevoid telangiectasia syndrome | 922 | ||
| Generalized essential telangiectasia | 922 | ||
| 24 Hair diseases | 923 | ||
| Anatomy | 923 | ||
| Physiology | 925 | ||
| Evaluation of hair loss | 927 | ||
| Generalized hair loss | 930 | ||
| Localized hair loss | 932 | ||
| Androgenetic alopecia in men (male pattern baldness) | 932 | ||
| Dutasteride | 934 | ||
| Hair transplants. | 934 | ||
| Scalp reduction and flaps. | 934 | ||
| Hair weaves. | 934 | ||
| Adrenal androgenic female pattern alopecia | 934 | ||
| Hirsutism | 936 | ||
| Alopecia areata | 942 | ||
| Prevalence | 942 | ||
| Clinical presentation. | 943 | ||
| Psychologic implications. | 944 | ||
| Nail changes. | 944 | ||
| Prognosis. | 944 | ||
| Differential diagnosis. | 944 | ||
| Etiology. | 944 | ||
| Immunologic factors. | 945 | ||
| Pathology. | 945 | ||
| Treatment. | 945 | ||
| Observation. | 945 | ||
| Topical steroids. | 945 | ||
| Intralesional injections. | 945 | ||
| Minoxidil (topical solution or foam). | 945 | ||
| Anthralin. | 947 | ||
| Topical immunotherapy. | 947 | ||
| Systemic corticosteroids. | 947 | ||
| Cyclosporine. | 947 | ||
| Hair weaves and wigs. | 947 | ||
| Trichotillomania | 948 | ||
| Traction (cosmetic) alopecia | 949 | ||
| Scarring alopecia | 950 | ||
| Chronic cutaneous lupus erythematosus | 951 | ||
| Lichen planopilaris | 952 | ||
| Lichen planopilaris with frontal sclerosing alopecia | 953 | ||
| Pseudopelade | 954 | ||
| Folliculitis decalvans | 955 | ||
| Dissecting cellulitis | 956 | ||
| Acne keloidalis | 957 | ||
| Tufted folliculitis. | 958 | ||
| Acne necrotica | 959 | ||
| Erosive pustular dermatosis | 959 | ||
| Trichomycosis | 959 | ||
| 25 Nail diseases | 960 | ||
| Anatomy and physiology | 960 | ||
| Normal variations | 961 | ||
| Nail disorders associated with skin disease | 964 | ||
| Acquired disorders | 966 | ||
| Bacterial and viral infections | 966 | ||
| Fungal nail infections | 969 | ||
| Treatment | 972 | ||
| Oral agents: Terbinafine, itraconazole, fluconazole. | 972 | ||
| Continuous terbinafine. | 972 | ||
| Prognostic factors. | 972 | ||
| Response to treatment. | 974 | ||
| Preventing recurrence. | 974 | ||
| Drug interactions. | 974 | ||
| Laboratory monitoring. | 974 | ||
| Safety of oral agents. | 974 | ||
| Recurrence rates. | 974 | ||
| Laser and light therapy. | 974 | ||
| Mechanical reduction of infected nail plate. | 974 | ||
| Surgical removal. | 974 | ||
| Nonsurgical avulsion of nail dystrophies. | 974 | ||
| Topical medication. | 974 | ||
| Trauma | 975 | ||
| Onycholysis | 975 | ||
| Treatment | 975 | ||
| Photoonycholysis | 975 | ||
| Nail and cuticle biting | 976 | ||
| Nail plate excoriation | 976 | ||
| Hangnail | 976 | ||
| Ingrown toenail | 976 | ||
| Treatment | 976 | ||
| Ingrown nail without inflammation. | 976 | ||
| Ingrown nail with inflammation. | 976 | ||
| Recurrent ingrown nail. | 976 | ||
| Subungual hematoma | 977 | ||
| Nail hypertrophy | 977 | ||
| White spots or bands | 977 | ||
| Distal plate splitting (brittle nails) | 977 | ||
| Habit-tic deformity | 977 | ||
| Median nail dystrophy | 978 | ||
| Pincer nails (curvature) | 978 | ||
| The nail and internal disease | 979 | ||
| Color and drug-induced changes | 981 | ||
| Congenital anomalies | 981 | ||
| Tumors | 982 | ||
| 26 Cutaneous manifestations of internal disease | 986 | ||
| Cutaneous manifestations of diabetes mellitus | 986 | ||
| Necrobiosis lipoidica | 986 | ||
| Granuloma annulare | 988 | ||
| Acanthosis nigricans | 990 | ||
| Xanthomas and dyslipoproteinemia | 992 | ||
| Neurofibromatosis | 995 | ||
| Neurofibromatosis 1 | 995 | ||
| Clinical manifestations | 995 | ||
| Café-au-lait spots. | 995 | ||
| Presumptive evidence of neurofibromatosis | 995 | ||
| Neurofibromas. | 996 | ||
| Lisch nodules. | 996 | ||
| Systemic manifestations. | 996 | ||
| Natural history. | 997 | ||
| Diagnosis. | 997 | ||
| Segmental neurofibromatosis (NF5). | 998 | ||
| Genetic counseling. | 998 | ||
| Management. | 998 | ||
| Tuberous sclerosis | 999 | ||
| Internal cancer and skin disease | 1002 | ||
| Cutaneous paraneoplastic syndromes | 1002 | ||
| Familial cancer syndromes | 1002 | ||
| Cowden disease (multiple hamartoma syndrome) | 1002 | ||
| Muir-Torre syndrome | 1004 | ||
| Gardner’s syndrome | 1005 | ||
| Birt-Hogg-Dubé syndrome and renal carcinoma | 1006 | ||
| Chronic itch | 1006 | ||
| Central neuropathic itch | 1006 | ||
| 27 Dermatologic surgical procedures | e | ||
| Antibiotic prophylaxis | e | ||
| Mohs’ micrographic surgery—indications for antibiotics | e | ||
| Local anesthesia | e | ||
| Hemostasis | e | ||
| Wound healing | e | ||
| Postoperative wound care | e | ||
| Partial- and full-thickness open wounds | e | ||
| Sutured wounds | e | ||
| Office. | e | ||
| Home. | e | ||
| Excess granulation tissue. | e | ||
| Scarlet red gauze. | e | ||
| Scar formation. | e | ||
| Skin biopsy | e | ||
| Punch biopsy | e | ||
| Shave biopsy and shave excision | e | ||
| Simple scissor excision | e | ||
| Electrodesiccation and curettage | e | ||
| Curettage | e | ||
| Blunt dissection | e | ||
| Cryosurgery | e | ||
| Extraction of cysts | e | ||
| Mohs’ micrographic surgery | e | ||
| Chemical peels | e | ||
| Dermal and subdermal fillers | e | ||
| Liposuction | e | ||
| Lasers | e | ||
| Intense pulsed light | e | ||
| Botulinum toxin | e | ||
| Index | I- | ||
| A | I- | ||
| B | I- | ||
| C | I- | ||
| D | I- | ||
| E | I- | ||
| F | I- | ||
| G | I- | ||
| H | I- | ||
| I | I- | ||
| J | I- | ||
| K | I- | ||
| L | I- | ||
| M | I- | ||
| N | I- | ||
| O | I- | ||
| P | I- | ||
| Q | I- | ||
| R | I- | ||
| S | I- | ||
| T | I- | ||
| U | I- | ||
| V | I- | ||
| W | I- | ||
| X | I- | ||
| Y | I- | ||
| Z | I- | ||
| Corticosteroids (topical) | es |