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Chapter 1

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Histological reminder of the structure of human skin

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Skin from the axillary region
The three constituents are, from top to bottom, the epidermis (coloured in red), the dermis (coloured in blue) and the hypodermis (or subcutaneous adipocytic tissue) packed with sudoriparous glands which are either small (eccrine glands) or large (apocrine glands). Hairs and small sebaceous glands are identifiable in the dermis (coloration : Masson blue trichromatic; enlargement : x 25).

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Skin from the forehead region
It nicely illustrates the regional varieties of the integument, compared to the axillary skin. The three constituents are clearly recognisable from top to bottom : the epidermis (thin red border), the dermis (coloured in orange) and the subcutaneous adipocytic tissue. The fine hairs and the sebaceous glands are very numerous in the dermis, but one finds only a small number of sudoriparous glands (coloration : haemalun-eosinesafran; enlargement : x 25).

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All the signs of physiological lightageing are present : disorganised epidermis, elastic transformation of the collagen fibres of the dermis. Under a thin strip of normal subepidermal collagen tissue (coloured in yellow) there appear large degenerated elastic collagen fibres (coloured in red), (coloration : haemalun-eosine-safran; enlargement : x 100).

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Skin from the face of an elderly subject

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Histological reminder of the structure of human skin

page: 4

Structure of the epidermis
Close-up of the epidermis. This includes three cell types : the keratinocytes, the melanocytes and the cells of Langerhans. Two are recognisable on this photo : the keratinocytes very coherent among one another, and in the basal stratum several melanocytes surrounded by a light halo (coloration : haemalun-eosinesafran; enlargement : x 250).

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Structure of the epidermis
continued

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Close-up of the epidermis. Melanin coloured by the Fontana method. The melanocytes appear like crazed, dendritic cells in the basal stratum of the epidermis. They transfer the melanin to the keratinocytes, which are diffusely tattooed with it (enlargement: x 250).

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Histological reminder of the structure of human skin

page: 6

Structure of the epidermis
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Close-up of the epidermis. Highlighting of the cells of Langerhans, which appear like dendritic cells covering all of the living epidermis. These cells belong to the line of histiocytic cells and play the immunological role of antigen-presenting cells (immunomarking OKT6 in peroxidase; enlargement : x 250).

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Histological reminder of the structure of human skin

page: 7

Chapter 2:

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Basic lesions

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page: 8

2.1

Macules
Erythematous macule
A macule is a non-infiltrated mark which differs in colour from adjacent skin. The skin coloration varies from pale pink to dark red and disappears on vitropression. It is the result of more or less intense vasodilation (e.g. blushing from modesty).

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page: 9

Vascular macule
These permanent marks, which disappear partially or completely on vitropression, result from the presence of an abundant network of dilated vessels in the superficial dermis (e.g. telangiectasia).

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Purpuric macule
The red macules do not disappear on vitropression. They are the result of extravasation of blood into the dermis (e.g. Bateman's purpura). Their colour changes in time from red to ochre.

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Pigmentary macules
varying in size, their colour ranging from ochre to dark brown, corresponding to melanin hyperpigmentation in the epidermis (e.g. freckles).

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Pigmented macules

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Macules

page: 12

Pigmentary macules
Blueish-grey macules

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are the result of melanin deposits extending more or less deeply into the dermis. (e.g. paresthetic notalgia)

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Macules

page: 13

Pigmentary macules
Achromic macules

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are white marks, varying in shape and size, which result from a decrease in the melanin content of the epidermis (e.g. vitiligo).

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Basic lesions

Macules

page: 14

2.2

Papules
Papules are more or less well demarcated elevations of varying size. There are 3 papule types.

Epidermal papules
These correspond to global thickening of the epidermis (e.g. plane warts).

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Dermal papules
These correspond to oedematous, inflammatory, or proliferative thickening of the dermis (e.g. the weal of urticaria).

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Dermo-epidermal papules
These correspond to a mixed thickening of the epidermis and dermis. (e.g. lichen planus)

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page: 17

2.3

Nodules
Nodules are hemispherical elevations caused by inflammatory and oedematous infiltrations of the deep dermis and subcutis (e.g. rheumatoid nodule).

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page: 18

2.4

Tubercles
Tubercles are solid, prominent, circumscribed formations, superficially encased in the dermis. They sometimes ulcerate in the course of their development (e.g. lupus vulgaris [tuberculosis]).

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page: 19

2.5

Vegetations
Vegetations are filiform or lobulate excrescences, generally of soft consistency (e.g. condylomata acuminata).

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Vegetations

page: 20

2.6

Warts
Warts are vegetations covered with a more or less thick horny layer (e.g. common wart).

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page: 21

2.7

Keratoses
Keratoses consist of epidermal lesions characterized by a localized accumulation of keratin (e.g. cutaneous horn).

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page: 22

2.8

Vesicles
Vesicles are small cutaneous protuberances with a central cavity containing clear liquid. They are often hemispherical and their centre can be depressed (e.g. varicella).

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Vesicles

page: 23

2.9

Bullae
Bullae are more voluminous elevations with a central cavity containing a clear, cloudy, or haemorrhagic liquid. They vary in dimensions and in tension: flaccid of firm bullae (e.g. bulla of a thermal burn).

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page: 24

2.10

Pustules
Pustules are protuberances which vary in size and have a central cavity containing a purulent liquid. They occur as primary lesions or develop from vesicles or bullae (e.g. palmoplantar pustulosis).

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page: 25

2.11

Scales
Scales are aggregates of more or less dry horny cells formed by the superficial layers of the epidermis. They detach in fragments of varying size (e.g. ichthyosis).

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page: 26

2.12

Crusts
Crusts are concretions of fairly hard consistency which result when exudative, haemorrhagic, or purulent lesions dry out (e.g. impetigo).

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page: 27

2.13

Excoriations (or ulcerations)
Excoriations are very superficial wounds. The dermis is exposed (e.g. excoriations caused by scratching).

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Excoriations (or ulcerations)

page: 28

2.14

Fissures
Fissures are linear ulcers, with or without marginal hyperkeratosis, which break through the superficial dermis (e.g. athlete's foot).

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page: 29

2.15

Ulcers
Ulcers are more serious losses of substance, which penetrate deep into the dermis (e.g. slough).

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page: 30

2.16

Gangrene
Gangrene is tissue necrosis associated with loss of arterial or arteriolar blood supply (e.g. frostbite).

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page: 31

2.17

Atrophy
Atrophy consists of a reduction in skin thickness with loss of its firmness and elasticity (e.g. senile atrophy).

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page: 32

2.18

Scars
Scars are due to modifications of the dermis or epidermis and are a sign of a variable degree of fibrosis. They are the evidence of repair of a wound or of a loss of substance (e.g. scar after a burn).

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page: 33

2.19

Sclerosis
Sclerosis means induration of the skin, which loses its normal suppleness. It is associated with coalescence of fibres in the dermis (e.g. morphoea).

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Sclerosis

page: 34

Chapter 3:

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Eczemas

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page: 35

3.1

Allergic contact dermatitis and irritation dermatitis
Acute exudative contact dermatitis
Acute exudative allergic contact dermatitis of the flexor surfaces of the forearms and arms after repeated application of an antiseptic lotion. Allergic reaction to hexamidine. Countless small translucent vesicles on a background of congestive erythema, rupturing and exuding a clear serous liquid.

Basic Lesions:

Erythematous Macule; Vesicles

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Chemical Agents last screen viewed back next

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Allergic contact dermatitis and irritation dermatitis

page: 36

Basic Lesions:

Erythematous Macule; Keratoses; Scales; Fissures Chemical Agents last screen viewed back next

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Slightly keratotic, cracked, and infected scaly erythematous lesions of the back of the fingers in a mason. Allergic reactions to chromium salts present in cements.

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Chronic occupational contact dermatitis

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Eczemas

Allergic contact dermatitis and irritation dermatitis

page: 37

Vesicular contact dermatitis
Acute erythematous papulovesicular allergic contact dermatitis of the backs of the hands in a physiotherapist. Allergic reaction to the lanolin contained in a massage cream. The right hand is more severely affected than the left.

Basic Lesions:

Erythematous Macule; Vesicles

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Chemical Agents last screen viewed back next

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Allergic contact dermatitis and irritation dermatitis

page: 38

Vesicular contact dermatitis
continued

Basic Lesions:

Erythematous Macule; Vesicles

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Chemical Agents last screen viewed back next

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The diffuse erythema, with an unsharp and fragmented margin, is covered with small translucent vesicles.

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Allergic contact dermatitis and irritation dermatitis

page: 39

Bullous contact dermatitis
Acute allergic contact dermatitis of the dorsal surface of the forefoot and toes. Allergic reaction to chromium salts used to tan shoe leather.

Basic Lesions:

Erythematous Macule; Vesicles; Bullae Chemical Agents last screen viewed back next

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Allergic contact dermatitis and irritation dermatitis

page: 40

Bullous contact dermatitis
continued

Bullae are formed on an erythematous vesicular background.

Basic Lesions:

Erythematous Macule; Vesicles; Bullae Chemical Agents last screen viewed back next

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Allergic contact dermatitis and irritation dermatitis

page: 41

Crusted eczema
Allergic contact dermatitis to the nickel in a jeans stud. At the point of contact there is a crusty greyish patch, partly eroded by excoriations caused by scratching.

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Erythematous Macule; Dermoepidermal Papules; Vesicles; Crusts; Excoriations (or Ulcerations) Chemical Agents last screen viewed back next

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Allergic contact dermatitis and irritation dermatitis

page: 42

Crusted eczema

continued

At the edges an erythematous papulovesicular eczema extends to an unclear margin.

Basic Lesions:

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Erythematous Macule; Dermoepidermal Papules; Vesicles; Crusts; Excoriations (or Ulcerations) Chemical Agents last screen viewed back next

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Eczemas

Allergic contact dermatitis and irritation dermatitis

page: 43

Allergic contact dermatitis of the eyelids caused by the use of an antiwrinkle cream. Allergic reaction to Kathon CG®, the cream's preservative. Diffused demarcated and itchy erythematous patches of eczema with fine scales.

Basic Lesions:

Erythematous Macule; Scales

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Scaly dry erythematous contact dermatitis

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Eczemas

Allergic contact dermatitis and irritation dermatitis

page: 44

Acute irritant dermatitis
Acute irritant dermatitis of the back of the hand and fingers, caused by contact with detergents. Diffuse itchy erythema. The margins of the erythema are distinct, corresponding to the zone of contact with the irritants.

Basic Lesions:

Erythematous Macule

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Allergic contact dermatitis and irritation dermatitis

page: 45

Basic Lesions:

Erythematous Macule; Keratoses; Scales; Fissures Chemical Agents last screen viewed back next

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Chronic irritant dermatitis of the back of the hand and fingers caused by contact with detergents. Scaly keratotic and chapped erythema causing pruritus and pain.

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Cumulative insult dermatitis or chronic irritant dermatitis

alphabetical

Eczemas

Allergic contact dermatitis and irritation dermatitis

page: 46

Basic Lesions:

Keratoses; Fissures

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Mechanical Factors; Chemical Agents last screen viewed back next

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Thick greyish or blackish keratotic patches, which are fissured and chapped. The clinical picture results from the combination of physical (friction, microtraumata) and chemical factors.

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Chronic palmar irritant dermatitis

alphabetical

Eczemas

Allergic contact dermatitis and irritation dermatitis

page: 47

3.2

Constitutional eczema or atopic dermatitis
Atopic dermatitis of the face in an infant
Bright red oedematous patches of eczema with weeping vesicles. The margins are poorly defined. The lesions predominate on the convex areas of the face: forehead, cheeks, chin.

Basic Lesions:

Erythematous Macule; Vesicles

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Constitutional eczema or atopic dermatitis

page: 48

Itchy exudative erythematous lesions of the retro-auricular groove, centred on a fissure at the base of the fold. Yellowish crusts are the sign of a microbial infection. These lesions, classical in childhood, can persist into adulthood.

Basic Lesions:

Erythematous Macule; Crusts; Fissures None specific last screen viewed back next

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Infected retro-auricular dermatitis

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Eczemas

Constitutional eczema or atopic dermatitis

page: 49

Very itchy exudative eczematous lesions of the eyelids and atopic angular cheilitis.

Basic Lesions:

Erythematous Macule; Fissures

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Atopic dermatitis of childhood

alphabetical

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Constitutional eczema or atopic dermatitis

page: 50

Lichenified and very itchy patches in the knee flexures, transversed by scratch lines. In the present case similar lesions are present in other folds (e.g. of elbows, behind the ears, under the buttocks). The lesions can persist into adulthood.

Basic Lesions:

Excoriations (or Ulcerations)

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Atopic dermatitis of the folds in a child

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Constitutional eczema or atopic dermatitis

page: 51

Eczema of the nipples picture
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Sign of atopic dermatitis in adulthood Acute exudative eczematous lesions of the nipple, the areola, and the periareolar region. The lesion margins are indefinite, the pruritus intense, and the course chronic. This is a classical sign of atopy in adulthood.

Basic Lesions:

Erythematous Macule; Dermoepidermal Papules; Vesicles None specific last screen viewed back

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Constitutional eczema or atopic dermatitis

page: 52

Atopic cheilitis
Atopic cheilitis affects the upper and lower lips and extends over the perioral region. Dry eczematous lesions causing chronic desquamation.

Basic Lesions:

Scales; Fissures

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Constitutional eczema or atopic dermatitis

page: 53

Basic Lesions:

Dermo-epidermal Papules; Excoriations (or Ulcerations) Mechanical Factors last screen viewed back next

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basic lesion

Very particular polymorphism of the lesions: skin dry and rough (xerosis), lichenified patches. There are also papules of various sizes, very strongly infiltrated, hard in consistency and often excoriated. These are prurigo papules (which used to be called "Besnier's prurigo").

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Atopic dermatitis in the adult: xerosis, lichenification and prurigo

alphabetical

Eczemas

Constitutional eczema or atopic dermatitis

page: 54

Atopic conjunctivitis
Atopic conjunctivitis associated with blepharitis. This inflammation of the conjunctiva is embarrassing, sometimes painful, and often distressingly chronic. It is not unusual in the atopic adult.

Basic Lesions:

Erythematous Macule

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Constitutional eczema or atopic dermatitis

page: 55

Basic Lesions:

Erythematous Macule; Scales; Fissures None specific last screen viewed back next

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Chronic scaly erythematous eczema of the back of the hands. One quite characteristic feature is the irregular distribution (patchy pattern) of the lesions. Some fingers are affected, whereas others are not. The back of the hands is irregularly affected. This "disordered" topography of the lesions is frequently found in atopic dermatitis.

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Atopic dermatitis of the hands in the adult

alphabetical

Eczemas

Constitutional eczema or atopic dermatitis

page: 56

Pityriasis alba
Rounded patch of dry scaly erythematous eczema on the cheek of a child. Spontaneous healing with a tendency to transient residual depigmentation, whence the name pityriasis alba. It occurs more frequently in atopic patients.

Basic Lesions:

Erythematous Macule; Achromic macules; Scales None specific last screen viewed back next

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Constitutional eczema or atopic dermatitis

page: 57

Juvenile plantar dermatosis
This condition, the site of which is generally the anterior third of the sole, always bilateral, and often symmetrical, is characterized by the triad of erythema, hyperkeratosis, and fissures.

Basic Lesions:

Erythematous Macule; Scales; Fissures None specific last screen viewed back next

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Constitutional eczema or atopic dermatitis

page: 58

Juvenile plantar dermatosis
continued

Basic Lesions:

Erythematous Macule; Scales; Fissures None specific last screen viewed back next

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The skin often has a shiny collodion-like appearance. It often becomes worse in winter and is perhaps more common in atopic patients ("atopic winter feet").

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Constitutional eczema or atopic dermatitis

page: 59

3.3

Nummular dermatitis (discoid eczema)
Exudative variety Round erythematous plaque (nummulus = coin) covered with numerous weeping vesicles which develop into small crusts.

Basic Lesions:

Erythematous Macule; Vesicles; Crusts None specific last screen viewed back next

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Nummular dermatitis (discoid eczema)

page: 60

continued

Dry variety of nummular dermatitis Several round or oval erythematous plaques, well demarcated and isolated from each other. Their diameter varies from one to several centimetres and they are covered in fine dry scales.

Basic Lesions:

Erythematous Macule; Scales

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Nummular dermatitis (discoid eczema)

alphabetical

Eczemas

Nummular dermatitis (discoid eczema)

page: 61

3.4

Gravitational eczema
Patches of itchy erythematous dry eczema, often accompanied by scratches. The lesions are sometimes situated along the course of varicose vessels.

Basic Lesions:

Erythematous Macule; Scales

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Gravitational eczema

page: 62

3.5

Seborrhoeic dermatitis
Seborrhoeic dermatitis of the trunk
Red circinate plaques in the presternal and/or interscapular region, covered in slightly itchy greasy scales. Very slight depigmentation occurs in the centre of the lesion.

Basic Lesions:

Erythematous Macule; Achromic macules; Scales None specific last screen viewed back next

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Seborrhoeic dermatitis

page: 63

Basic Lesions:

Erythematous Macule; Scales

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None specific last screen viewed back next

basic lesion

On the scalp it is characterized by diffuse itchy erythema covered in greasy scales. The lesions sometimes spread to the forehead, as in the present case, where they form what is commonly known as the corona seborrhoeica: erythematous patches dotted with steatoid scales, which, following the hairline, show scalloped and arched margins.

cause

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Seborrhoeic dermatitis of the hairline

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Eczemas

Seborrhoeic dermatitis

page: 64

Basic Lesions:

Erythematous Macule; Scales

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None specific last screen viewed back next

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The scaly erythematous lesions are well demarcated and have characteristic sites: hairline, nasolabial folds, vertical mediofrontal fold, and the free edges of the lower eyelids.

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Seborrhoeic dermatitis of the face

alphabetical

Eczemas

Seborrhoeic dermatitis

page: 65

3.6

Pompholyx
Pompholyx of the fingers
The vesicles of pompholyx are arranged in groups on the lateral sides of the fingers. They are hard to the touch, encased in the epidermis, translucent, and classically compared to grains of sago or to cooked tapioca. They are accompanied by intense itching.

Basic Lesions:

Vesicles

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Pompholyx

page: 66

Basic Lesions:

Vesicles; Bullae

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The vesicles encased in the palmar epidermis coalesce to form true bullae, which are sometimes haemorrhagic.

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Bullous pompholyx of the palms (cheiro-pompholyx)

alphabetical

Eczemas

Pompholyx

page: 67

Eczematous pompholyx represents an association of pompholyx vesicles with scaly erythematous patches with diffuse margins. The itching is fierce and the course is characterized by successive, even subintrant episodes.

Basic Lesions:

Erythematous Macule; Vesicles; Scales None specific last screen viewed back next

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Eczematous pompholyx of the palms

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Eczemas

Pompholyx

page: 68

3.7

Asteatotic eczema
(or winter eczema, eczéma craquelé, or erythema craquelé) Dry eczema with imprecise margins reminiscent of crazy paving. The cracks in the "paving" correspond to fissures of variable depth, with pinpoint bleeding. The name "erythema craquelé" is nowadays preferred to "eczéma craquelé".

Basic Lesions:

Erythematous Macule; Fissures

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Asteatotic eczema

page: 69

Chapter 4:

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Urticarias

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page: 70

4.1

Contact urticarias
Latex contact urticaria
Urticarial weals occurring within minutes of putting on surgical latex gloves. These weals can spread beyond the actual site of contact because this is an immunoallergic urticaria (specific IgE are sometimes present). Generalized urticaria with systemic symptoms can therefore occur: allergic rhinitis, conjunctivitis, asthma-like attacks, anaphylactic shock, etc.

Basic Lesions:

Dermal Papules

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Urticarias

Contact urticarias

page: 71

Prick test with latex
Diagnosis of latex contact urticaria: the prick test is performed with a lancet, using incubation liquid from the suspected latex gloves.

Basic Lesions:

Dermal Papules

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Chemical Agents last screen viewed back next

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Urticarias

Contact urticarias

page: 72

Basic Lesions:

Erythematous Macule; Dermal Papules Chemical Agents last screen viewed back next

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basic lesion

In cases of doubt (prick test difficult to interpret), a provocation test can be performed, if necessary with the suspected glove. This will always be done initially with a finger-stall, which is slipped onto a moistened finger for 10 min. The provocation test must always be done in a hospital environment.

cause

picture

Provocative use test with latex gloves

alphabetical

Urticarias

Contact urticarias

page: 73

4.2

Physical urticarias
Dermographism
Drawing on the skin with a blunt tip produces a linear erythema with an oedematous component. The dermographism appears 5 to 10 min after the rubbing. It can be isolated or associated with chronic idiopathic urticaria.

Basic Lesions:

Erythematous Macule; Dermal Papules Mechanical Factors last screen viewed back next

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Urticarias

Physical urticarias

page: 74

Pressure urticaria
Very itchy deep oedema occurring several hours (6 to 12 hours) after strong pressure on a precise area, e.g. on palmar side. Feet can be affected after walking, as can buttocks after prolonged sitting.

Basic Lesions:

Dermal Papules

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Mechanical Factors last screen viewed back next

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Urticarias

Physical urticarias

page: 75

Cold urticaria
Eruption triggered by cold: the application of an ice-cube for 3 to 10 min systematically reproduces an urticarial weal. Nevertheless, in the present case it would be appropriate to perform a second test to eliminate aquagenic urticaria (with immersion of one hand in water at ambient temperature).

Basic Lesions:

Erythematous Macule; Dermal Papules Cold last screen viewed back next

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Urticarias

Physical urticarias

page: 76

Solar urticaria
This very rare variant of urticaria occurs within minutes on exposure to sunlight. The eruption can persist for three to four hours. Photobiological investigation very easily confirms the diagnosis (photosensitivity test positive with UVA and/or UVB).

Basic Lesions:

Dermal Papules

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Urticarias

Physical urticarias

page: 77

4.3

Common urticarias (medicines, food, idiopathic)
Urticated weals
Eruption of oedematous urticated weals which can coalesce into broad patches. Itching is constant and can prevent sleep. This urticaria can be the first sign of anaphylactic shock.

Basic Lesions:

Dermal Papules

Causes: search contents print

Chemical Agents last screen viewed back next

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Urticarias

Common urticarias (medicines, food, idiopathic)

page: 78

Papular urticaria
Urticarial weals spread symmetrically over the body, most often blamed on medicines. Specific foods can sometimes trigger this type of urticaria (acute urticaria). Strawberries, shellfish, fish, certain cereals, milk, eggs, and some particular food additives are most frequently the cause. The diagnosis is based mainly on provocation tests (withdrawal and reintroduction of the suspected medicine or food).

Basic Lesions:

Erythematous Macule; Dermal Papules Chemical Agents last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Urticarias

Common urticarias (medicines, food, idiopathic)

page: 79

Figured urticaria
The urticarial papules describe curlicues or geographical shapes. In this case, the cause would most often be a drug (aspirin, codeine, penicillin, etc.). Again, a withdrawal test with reintroduction, if appropriate, makes it possible to reach an exact diagnosis.

Basic Lesions:

Erythematous Macule; Dermal Papules Chemical Agents last screen viewed back next

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basic lesion

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picture

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Urticarias

Common urticarias (medicines, food, idiopathic)

page: 80

Hereditary angio-oedema
Not particularly itchy, deep urticaria mainly affecting the face (particularly eyelids and lips), the glottis, and even the larynx. This is an emergency which requires rapid therapeutic intervention (adrenaline and corticosteroids in particular). Iatrogenic causes are not uncommon.

Basic Lesions:

Dermal Papules

Causes: search contents print

None specific last screen viewed back next

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Urticarias

Common urticarias (medicines, food, idiopathic)

page: 81

Urticarial vasculitis
Combination of urticaria with lesions of leucocytoclastic vasculitis. The urticarial lesions are more fixed than in classical urticaria. They last for 2 to 3 days and are frequently accompanied by joint pains and by fever. Reduced complement levels in blood are observed.

Basic Lesions:

Erythematous Macule; Dermal Papules None specific last screen viewed back next

Causes: search contents print

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Urticarias

Common urticarias (medicines, food, idiopathic)

page: 82

Chapter 5:

Infectious viral diseases

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page: 83

5.1

Herpes virus group
Type I herpes
Multiple vesicles arranged in a cluster on an erythematous background. The lesions are usually painful and in most cases preceded by a burning or itching sensation. The vesicles rupture spontaneously after a few days and drying occurs later. Recurrences are typical (recurrent herpes), usually at the same site.

Basic Lesions:

Erythematous Macule; Vesicles

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Herpes of the face

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Infectious viral diseases

Herpes virus group

page: 84

Type II herpes (genital)
There are lesions which correspond to two stages of development: vesicles on an erythematous base on the prepuce (recent attack) and black crusts on the shaft (old attack). The lesions are itching and painful. The diagnosis is confirmed with liquid from a vesicle: smear for immunological diagnostics with the aid of monoclonal antibodies and culture.

Basic Lesions:

Erythematous Macule; Vesicles; Crusts Infection last screen viewed back next

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Herpes of the penis

alphabetical

Infectious viral diseases

Herpes virus group

page: 85

Varicella
Varicella and herpes zoster are associated with infection by the virus Herpes varicellae. Vesicles on a background of healthy skin or surrounded by an erythematous ring, distinctly separated from each other, whose contents become cloudy secondarily.

Basic Lesions:

Erythematous Macule; Vesicles; Crusts Infection last screen viewed back next

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Infectious viral diseases

Herpes virus group

page: 86

Varicella

continued

Basic Lesions:

Scars

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cause

The central umbilication is classical. They develop to form an adhesive crust which sometimes leaves a depressed scar when it detaches.

picture

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Infectious viral diseases

Herpes virus group

page: 87

Zoster of the trunk
Herpes zoster is associated with infection by the virus Herpes varicellae. Vesiculobullous dermatosis preceded and very often accompanied by considerable pain (especially in old people). The lesions are strictly unilateral and correspond to the tract of a nerve root. In the present case an intercostal nerve is involved ("fiery half-girdle").

Basic Lesions:

Erythematous Macule; Vesicles; Bullae Infection last screen viewed back next

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Infectious viral diseases

Herpes virus group

page: 88

Ophthalmic nerve zoster
In the present case the topography of the lesions makes it possible to say that two branches are affected by the infectious process: the ophthalmic branch and the superior maxillary branch. The third branch, the inferior maxillary, is spared. The presence of vesicles on the nostril shows that the nasociliary nerve is involved.

Basic Lesions:

Erythematous Macule; Vesicles

Causes: search contents print

Infection last screen viewed back next

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Infectious viral diseases

Herpes virus group

page: 89

5.2

Papillomavirus group
The papillomaviruses are responsible for the occurrence of various types of benign tumour, viral warts.

Common warts
Small greyish keratotic tumours, rough to the touch, on the backs of the fingers. Common warts are contagious and autoinoculable.

Basic Lesions:

Epidermal Papules; Warts; Keratoses Infection last screen viewed back next

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Infectious viral diseases

Papillomavirus group

page: 90

Plane warts
These warts are mainly located on the face and on the back of the hands or fingers. They are orange very slightly raised papules.

Basic Lesions:

None specific

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Papillomavirus group

page: 91

Plane warts

continued

The linear disposition is typical (Koebner's phenomenon caused by autoinoculation along scratch lines).

Basic Lesions:

None specific

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Infectious viral diseases

Papillomavirus group

page: 92

Condylomata acuminata
Fleshy reddish formations on the genital organs. Condylomata acuminata are contagious (sexually transmitted disease) and can spread rapidly. The maceration is sometimes considerable.

Basic Lesions:

Vegetations

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Papillomavirus group

page: 93

Plantar wart
Distinctly demarcated keratotic formation which is often deeply embedded in the skin of the sole. The disappearance of dermatoglyphics all over the surface of plantar warts is typical and makes it possible to distinguish this lesion from a corn. A single plantar wart is classically known as myrmecia.

Basic Lesions:

Keratoses

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Papillomavirus group

page: 94

Mosaic warts
Juxtaposition of numerous plantar warts forming a hyperkeratotic patch by spreading by degrees. These mosaic plantar warts are often painful (sensitivity to pressure during walking).

Basic Lesions:

Warts

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Infectious viral diseases

Papillomavirus group

page: 95

Horny filiform wart
Small pedunculate papilloma mainly affecting the face (nose, side of the neck, and cheeks). Horny filiform warts are typically found in men (shaving, especially with a razor rather than an electric shaver, contributes to dissemination).

Basic Lesions:

Warts

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Infectious viral diseases

Papillomavirus group

page: 96

5.3

Epstein-Barr virus
Hairy leucoplakia
Appearance of fine whitish striations on the sides of the tongue. Oral hairy leucoplakia is most often encountered in homosexual men suffering from AIDS. The term "hairy" is purely descriptive. The hairy appearance is associated with linear hyperplasia.

Basic Lesions:

Epidermal Papules

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Infectious viral diseases

Epstein-Barr virus

page: 97

5.4

Pox and parapox virus groups
Molluscum contagiosum
Small round papule with a smooth surface, often shiny, a few millimetres in diameter. There is often a small central depression (crater, often filled with creamy whitish material). These lesion most frequently affect children and can be secondarily accompanied by eczema around the lesion. Molluscum contagiosum is caused by a poxvirus.

Basic Lesions:

Epidermal Papules

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Infectious viral diseases

Pox and parapox virus groups

page: 98

Multiple mollusca contagiosa
Illustration of the phase of dissemination of the lesions. The topographical predilection for the axilla is characteristic. In some cases the mollusca contagiosa can become inflamed and there can be a superimposed infection. In adults molluscum contagiosum is often found in the genital area. An immunological status check is indispensable in the case of very numerous lesions (especially if found on the face).

Basic Lesions:

Epidermal Papules

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Infectious viral diseases

Pox and parapox virus groups

page: 99

ORF
Red to violet pseudovesicular papule appearing on the dorsal face of a finger. The incubation period varies from three days to two weeks after contact with a sick animal (usually sheep). Regression without complications in about two weeks. A superimposed bacterial infection is not uncommon. ORF is caused by a parapoxvirus.

Basic Lesions:

Dermo-epidermal Papules

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Infectious viral diseases

Pox and parapox virus groups

page: 100

5.5

Other viruses
Erythema infectiosum
Maculopapular "butterfly-wing" eruption of the face giving a puffy appearance, like "butterfly wings". The biphasic development of the lesions on the face is typical.

Basic Lesions:

Erythematous Macule; Dermal Papules Infection last screen viewed back next

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Other viruses

page: 101

Erythema infectiosum

continued

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Erythematous Macule; Dermal Papules Infection last screen viewed back next

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After the second bout there are often numerous pink polycyclic or circinate maculopapules, describing curlicues on the limbs. The eruption disappears in about ten days and is caused by Parvovirus B19.

picture

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Infectious viral diseases

Other viruses

page: 102

Measles
Maculopapular eruption, very pronounced on the face. Enanthema is also present. Some healthy skin areas can always be seen. There is often a superimposed ENT bacterial infection and injection of the conjuctivae. Measles is caused by a paramyxovirus.

Basic Lesions:

Erythematous Macule; Dermal Papules Infection last screen viewed back next

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Infectious viral diseases

Other viruses

page: 103

Hand-foot-and-mouth-disease
Intraoral enanthema of the anterior part of the mouth, with small greyish vesicles which rupture very rapidly. The pain caused can make it difficult to eat.

Basic Lesions:

Erythematous Macule; Vesicles

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Infectious viral diseases

Other viruses

page: 104

Hand-foot-and-mouth-disease
continued

Basic Lesions:

Erythematous Macule; Vesicles

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Appearance of small oval vesicles about 3 to 4 millimetres in diameter on the hands and feet. The vesicles are greyish-white and surrounded by an erythematous halo.

picture

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Infectious viral diseases

Other viruses

page: 105

Hand-foot-and-mouth-disease
continued

Basic Lesions:

Erythematous Macule; Vesicles

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There is a vaguely painful sensation. Disappearance is rapid; disseminated lymphadenopathy can be present. Similar lesions are sometimes found on the buttocks. The condition is generally caused by the Coxsackie A16 virus. Other coxsackie viruses may also be responsible.

cause

picture

alphabetical

Infectious viral diseases

Other viruses

page: 106

Rubella
Relatively modest erythematous macular eruption accompanied by suboccipital lymphadenopathy with considerable swelling. The pale pink colour and the unobtrusive effect on general health are other features to be borne in mind. In adults and adolescents the symptoms are often more prominent (fever and more pronounced rash). The pathogen is a togavirus.

Basic Lesions:

Erythematous Macule

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Infectious viral diseases

Other viruses

page: 107

5.6

Signs of AIDS on skin and mucosa
Necrotic herpes zoster
Multiple ulcers developing from necrotic patches. These ulcerated lesions have spread considerably.

Basic Lesions:

Gangrene; Ulcers

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Signs of AIDS on skin and mucosa

page: 108

Necrotic herpes zoster

continued

After several weeks, the ulcerated lesions have left slightly atrophic cicatrized patches.

Basic Lesions:

Scars

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Infectious viral diseases

Signs of AIDS on skin and mucosa

page: 109

Seborrhoeic dermatitis
Seborrhoeic dermatitis, often severe and resistant to conventional treatments, can be seen in the course of an HIV infection. In the present case the involvement of the whole nasal pyramid was the first sign of HIV infection.

Basic Lesions:

Erythematous Macule; Scales

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alphabetical

Infectious viral diseases

Signs of AIDS on skin and mucosa

page: 110

Prurigo
In quite a number of cases prurigolike lesions (excoriated nodules) accompanied (or caused) by diffuse pruritus are observed. The involvement of the trunk is relatively typical.

Basic Lesions:

Nodules; Excoriations (or Ulcerations) Infection last screen viewed back next

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Infectious viral diseases

Signs of AIDS on skin and mucosa

page: 111

Gingivitis
The dentogingival junction is the site of a purulent erythema (presence of fusiform and spiral bacteria). This periodontitis is painful and shows no tendency to regress spontaneously.

Basic Lesions:

Erythematous Macule; Ulcers

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Infectious viral diseases

Signs of AIDS on skin and mucosa

page: 112

Molluscum contagiosum
Very numerous mollusca on the face, sometimes with a few lesions which are haemorrhagic in appearance, can be seen in AIDS. The mollusca are generally very deeply embedded in the skin. Curettage is relatively difficult. The mollusca show a marked tendency to multiply.

Basic Lesions:

Epidermal Papules

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Signs of AIDS on skin and mucosa

page: 113

Kaposi's sarcoma
Purplish angiomatous papular lesion. The preferred involvement of the face is typical in AIDS patients. In the present case Kaposi's nodules are observed side by side with mollusca contagiosa.

Basic Lesions:

Dermal Papules; Nodules

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Signs of AIDS on skin and mucosa

page: 114

Kaposi's sarcoma

continued

Basic Lesions:

Dermal Papules; Nodules

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Kaposi's nodules can occur in large numbers all over the skin. These nodules keep distinct margins with angular edges. Here again the violet colour is characteristic. The nodules are generally completely painless.

picture

alphabetical

Infectious viral diseases

Signs of AIDS on skin and mucosa

page: 115

Condylomata acuminata
Abnormally large or rapid spread of condylomata acuminata must always lead to a suspicion that the patient is seropositive for HIV. In the present case the condylomata spread all over the vulva and into the vaginal canal.

Basic Lesions:

Vegetations

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Infectious viral diseases

Signs of AIDS on skin and mucosa

page: 116

Chapter 6:

Bacterial infections diseases

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page: 117

6.1

Impetigo
Bullous impetigo
Bullae with cloudy contents, often surrounded by an erythematous halo. These bullae rupture easily and are rapidly replaced by extensive crusty patches. Bullous impetigo is classically caused by Staphylococcus aureus .

Basic Lesions:

Bullae; Crusts

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Impetigo

page: 118

Non-bullous impetigo
Erythematous patches covered by a yellowish crust. Lesions are most frequently around the mouth. Lesions around the nose are very characteristic and require prolonged treatment. ß-Haemolytic streptococcus is most frequently found in this type of impetigo.

Basic Lesions:

Erythematous Macule; Crusts

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Bacterial infections diseases

Impetigo

page: 119

6.2

Ecthyma
Slow and gradually deepening ulceration surmounted by a thick crust. The usual site of ecthyma are the legs. After healing there is a permanent scar. The pathogen is often a streptococcus. Ecthyma is very common in tropical countries.

Basic Lesions:

Crusts; Ulcers

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Ecthyma

page: 120

6.3

Folliculitis
Inflammatory papule with a follicular pustule at its centre. The pathogen is usually a staphylococcus. Folliculitis is frequently multiple and classically located on the buttocks, thighs, or the face.

Basic Lesions:

Erythematous Macule; Dermal Papules; Pustules Infection last screen viewed back next

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Bacterial infections diseases

Folliculitis

page: 121

6.4

Furuncle (BOIL)
Acute deep folliculitis starting with a painful erythematous papule with the appearance of a central pustule. After spontaneous or induced evacuation of the pus, the furuncle often leaves a permanent scar. The pathogen is Staphylococcus aureus .

Basic Lesions:

Dermal Papules; Pustules

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Bacterial infections diseases

Furuncle (BOIL)

page: 122

6.5

Carbuncle
By definition, carbuncles result from the coalescence of several juxtaposed furuncles. A large painful lump is strewn with small pustules which emerge on the skin surface.

Basic Lesions:

Nodules; Pustules

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Bacterial infections diseases

Carbuncle

page: 123

6.6

Erysipelas
Hot, painful, oedematous erythematous patches, accompanied by fever and malaise, typically caused by a streptococcus. Erysipelas can affect the face, and in this case the border against healthy skin is very distinct and raised: the "step" sign.

Basic Lesions:

Erythematous Macule

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Erysipelas

page: 124

Erysipelas

continued

Basic Lesions:

Erythematous Macule

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On the leg one observes extensive wide patches identical with those on the face but having a less accentuated margin. Again, the general health is affected, and there is always fever. A mixed infection is found in most cases (gram positive and/or gram negative bacteria). There is often a portal of entry, e.g. a lesion between the toes or a wound caused by trauma.

cause

picture

alphabetical

Bacterial infections diseases

Erysipelas

page: 125

6.7

Orbital cellulitis
Deep retro-orbital infection manifests itself on the skin with periorbital oedema accompanied by malaise and fever. This is evidently a serious condition, given the possibility of spreading towards the cavernous sinus.

Basic Lesions:

Nodules; Crusts

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Bacterial infections diseases

Orbital cellulitis

page: 126

6.8

Septic emboli
Small erythematous pustular lesions occurring simultaneously in a number of places. The general context depends on the starting point of these septic emboli (cardiac involvement in rheumatic fever, gonorrhoea in the process of dissemination, etc.).

Basic Lesions:

Erythematous Macule; Pustules

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Bacterial infections diseases

Septic emboli

page: 127

6.9

Borrelia infections
Erythema chronicum migrans or lyme disease
Broad erythematous patch spreading outwards with a false appearance of healing at the centre.

Basic Lesions:

Erythematous Macule

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Borrelia infections

page: 128

continued

Basic Lesions:

Erythematous Macule

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Sometimes a small scar is found in the middle (trace of a tick bite). Erythema chronicum migrans is caused by Borrelia infection.

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Erythema chronicum migrans or lyme disease

alphabetical

Bacterial infections diseases

Borrelia infections

page: 129

Borrelia pseudolymphoma
In some cases the Borrelia infection is clinically recognized by the presence of one or more pasty nodules, mainly on uncovered parts of the body, most typically on earlobes. This type of "pseudolymphoma" is also one of the Borrelia diseases. One can include this lesion among the forms of the old "lymphocytoma benigna cutis".

Basic Lesions:

Nodules

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Borrelia infections

page: 130

6.10

Proteus infection
In rare cases, if untreated contused lesions are present, a gram-negative microorganism such as Proteus or Pseudomonas can cause necrosis of the distal extremity of a finger.

Basic Lesions:

Gangrene

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Proteus infection

page: 131

6.11

Cat-scratch disease
More or less fluctuant nodules with ulceration and central crust, accompanied by lymphadenopathy with considerable swelling.

Basic Lesions:

Nodules; Crusts

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Cat-scratch disease

page: 132

Cat-scratch disease

continued

The young patient was scratched by his cat a few weeks previously.

Basic Lesions:

Nodules; Crusts; Ulcers

Causes: search contents print

Mechanical Factors last screen viewed back next

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Bacterial infections diseases

Cat-scratch disease

page: 133

6.12

Intertrigo
Glazed erythematous patches with the appearance of "pages of a book", centred on the base of a large fold. Maceration and infection with common microorganisms are typical.

Basic Lesions:

Erythematous Macule

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Bacterial infections diseases

Intertrigo

page: 134

6.13

Cutaneous tuberculosis
Lupus vulgaris
Large reddish-yellow lesion affecting the face and the earlobe. False appearance of healing at the centre.

Basic Lesions:

Tubercles; Scars

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alphabetical

Bacterial infections diseases

Cutaneous tuberculosis

page: 135

Lupus vulgaris

continued

Basic Lesions:

Tubercles

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Vitropression reveals characteristic orange-red coloration, which dermatologists at the beginning of the century compared to "barley sugar", a delicacy which has now gone out of fashion.

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alphabetical

Bacterial infections diseases

Cutaneous tuberculosis

page: 136

Scofuloderma
Chronic tuberculous cervical lymphadenopathy with skin ulceration.

Basic Lesions:

Ulcers; Scars

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cause

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alphabetical

Bacterial infections diseases

Cutaneous tuberculosis

page: 137

Basic Lesions:

Nodules

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Chemical Agents last screen viewed back next

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cause

Non-specific abscess formation after BCG vaccination. This complication of BCG vaccination is generally the result of an injection made too deeply.

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Complication of BCG vaccination

alphabetical

Bacterial infections diseases

Cutaneous tuberculosis

page: 138

6.14

Atypical mycobacterial infections
Infection with mycobacterium marinum
This condition is found mainly in fish fanciers (fish-tank disease) and classically appears in the form of a chain of nodules spaced like rosary beads, extending along the line of lymphatic drainage. These are more or less keratotic papulonodular lesions and/or ulcers. There is generally little pain. Deep biopsy with culture in a suitable medium very easily reveals the mycobacterium.

Basic Lesions:

Nodules; Ulcers

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Atypical mycobacterial infections

page: 139

continued

Basic Lesions:

Nodules; Ulcers

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The papulonodules can be single or multiple. The latter form of the mycobacterial infection is sometimes known as sporotrichoid.

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Infection with mycobacterium marinum

alphabetical

Bacterial infections diseases

Atypical mycobacterial infections

page: 140

Abscess and violet nodules occurring a few weeks after repeated injections as part of mesotherapy (in the treatment of "cellulitis").

Basic Lesions:

Nodules; Ulcers

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cause

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Infection with mycobacterium fortuitum or chelonae

alphabetical

Bacterial infections diseases

Atypical mycobacterial infections

page: 141

6.15

Corynebacterium infections
Erythrasma
Broad and distinctly demarcated brownish or buff macule, with rounded margins, usually symmetrical and affecting either the groins or the axillae. These lesions are homogeneous and finely squamous. The pathogen is Corynebacterium minutissimum . Examination in Wood's light reveals coral-red fluorescence.

Basic Lesions:

Pigmented Macules; Scales

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Corynebacterium infections

page: 142

Trichomycosis axillaris
This is a bacterial infection caused by corynebacteria. The axillary hairs are surrounded by small yellowish nodules corresponding to colonies of bacteria. There is little in the way of subjective symptoms. The sweat sometimes becomes yellowish.

Basic Lesions:

None specific

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Corynebacterium infections

page: 143

Pitted keratolysis
Small serpiginous erosions of the horny layer with a punched-out appearance, mainly found on weight-bearing areas of the soles and causing an interruption in footprints. An associated plantar hyperhidrosis is often present. The erosions correspond to areas of desquamation in a block of the horny layer invaded by corynebacteria.

Basic Lesions:

Excoriations (or Ulcerations)

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Bacterial infections diseases

Corynebacterium infections

page: 144

Chapter 7:

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Treponematoses and other sexually transmitted diseases

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page: 145

7.1

Syphilis
Syphilitic chancre (primary sore)
Ulceration with erosion situated on the glans penis or sheath. Distinctly palpable induration. Considerable swelling of inguinal lymph nodes, usually unilateral.

Basic Lesions:

Excoriations (or Ulcerations)

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Syphilis

page: 146

continued

Basic Lesions:

Excoriations (or Ulcerations)

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The characteristics of female chancre are identical with those in the male. In women the chancre is often accompanied by considerable oedema of the labia majora.

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Syphilitic chancre (primary sore)

alphabetical

Treponematoses and other sexually transmitted diseases

Syphilis

page: 147

Occurring about six weeks after the start of the chancre, secondary syphilis appears in the form of pink oval macules with little or no scaling and no itching. These macules are located mainly on the trunk.

Basic Lesions:

Erythematous Macule

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Secondary syphilis (macular syphilid)

alphabetical

Treponematoses and other sexually transmitted diseases

Syphilis

page: 148

Late secondary syphilis
Dull red, sometimes brownish, very distinctly indurated papules, which are not itchy, located on the trunk and on the proximal regions of the limbs.

Basic Lesions:

Dermal Papules

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Treponematoses and other sexually transmitted diseases

Syphilis

page: 149

Papular syphilids
Slightly reddish macules with peripheral desquamative collarette (Biett's collarette). These papular syphilids occur four to twelve months after the chancre.

Basic Lesions:

Erythematous Macule; Dermal Papules; Scales Infection last screen viewed back next

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cause

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alphabetical

Treponematoses and other sexually transmitted diseases

Syphilis

page: 150

Genital gonorrhoea
Diffuse redness of the glans, purulent urethral discharge, considerable dysuria, pollakiuria. Presence of two mollusca contagiosa, equally sexually transmitted.

Basic Lesions:

Erythematous Macule; Epidermal Papules Infection last screen viewed back next

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cause

picture

alphabetical

Treponematoses and other sexually transmitted diseases

Syphilis

page: 151

Chapter 8:

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cause

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Mycoses

alphabetical

page: 152

8.1

Dermatophytoses
Tinea corporis
Round or oval lesion, as in the present case, with a distinctly raised margin, sometimes with fine vesicles, sometimes very scaly. There is often a false appearance of healing at the centre. These round lesions are generally slightly scaly. Pruritus is not always present as a subjective symptom. The lesions can be single.

Basic Lesions:

Erythematous Macule; Scales

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Mycoses

Dermatophytoses

page: 153

Tinea corporis

continued

The lesions can be multiple. The pathogen is generally Microsporum canis, or Trichophyton rubrum.

Basic Lesions:

Erythematous Macule; Scales

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Mycoses

Dermatophytoses

page: 154

Tinea faciei
The dermatophytosis has the same appearance as on glabrous skin, but can assume an impressive clinical picture owing to it's spread.

Basic Lesions:

Erythematous Macule; Scales

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Mycoses

Dermatophytoses

page: 155

Tinea faciei

continued

Basic Lesions:

Erythematous Macule; Scales

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The dermatophytosis can also assume a more or less atypical clinical picture owing to late diagnosis or unsuitable topical therapy with corticosteroids.

picture

alphabetical

Mycoses

Dermatophytoses

page: 156

Tinea cruris
Dermatophytosis of the inguinal fold (also called dhobi itch and Hebra's eczema marginatum). This dermatophytosis affects men more frequently than women. A very distinct vesicular border circumscribes a central red, sometimes brownish, central region, which is always scaly. The lesion typically spreads towards the inner thigh.

Basic Lesions:

Erythematous Macule; Vesicles; Scales Infection last screen viewed back next

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Mycoses

Dermatophytoses

page: 157

Tinea manuum
This condition affects the palms, most frequently on one hand. There is no substantial hyperkeratosis. An active margin may be noticeable at the wrist. Association with athlete's foot or eczema marginatum is typical, and it is a good idea to persevere in looking for this. Scraping with a curette generally yields plenty of horny, brittle, powdery material.

Basic Lesions:

Erythematous Macule; Scales

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Mycoses

Dermatophytoses

page: 158

Tinea manuum

continued

It is characterized by diffuse redness and dryness with floury accentuation of flexural creases of the palms.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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Mycoses

Dermatophytoses

page: 159

Tinea pedum (athlete's foot)
Fissured and scaly intertrigo of the space between the fourth and the fifth toes. There is often a small painful crack running along the base of the fold.

Basic Lesions:

Erythematous Macule; Scales; Fissures Infection last screen viewed back next

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Dermatophytoses

page: 160

Tinea pedum (athlete's foot)
continued

Sometimes the whole area is eroded, which is a sign of microbial infection.

Basic Lesions:

Erythematous Macule; Scales; Fissures Infection last screen viewed back next

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Mycoses

Dermatophytoses

page: 161

Tinea pedum (athlete's foot)
continued

The dermatophytosis can extend to the sole, which it affects more or less extensively. In some cases in which tinea manuum is associated with tinea pedis, three of the four limbs are affected (e.g. one hand and two feet).

Basic Lesions:

Scales

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Mycoses

Dermatophytoses

page: 162

Tinea capitis or ringworm
The scalp is attacked by a dermatophyte. Children are affected most often. Large plaque of alopecia, presence of numerous short broken hairs, on a greyish and scaly base. The pathogen is most frequently Microsporum canis. Ringworm is characteristic of the prepubescent period: it is distinguished from alopecia or pseudo-alopecia by its floury appearance.

Basic Lesions:

Scales

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Dermatophytoses

page: 163

Kerion
Crusty and well demarcated suppurative patch sometimes tumour-like. Most typical site is the scalp in the child.

Basic Lesions:

Nodules

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page: 164

Kerion

continued

Another most typical site is the beard in the adult.

Basic Lesions:

Nodules

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Dermatophytoses

page: 165

Kerion

continued

The lesion evolves into a definitive scar. The pathogen is Trichophyton mentagrophytes or Trichophyton verrucosum.

Basic Lesions:

Scars

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Dermatophytoses

page: 166

Basic Lesions:

None specific

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Thickened and opaque nail, distal onycholysis. The nail becomes brittle. There is no associated paronychia.

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Onychomycosis due to dermatophytes

alphabetical

Mycoses

Dermatophytoses

page: 167

continued

More rarely, dermatophytic onychomycosis involves the superficial layer of the nail plate and appears in the form of small opaque whitish patches which are well demarcated (appearance of leuconychia). The surface becomes more brittle as a result.

Basic Lesions:

None specific

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Onychomycosis due to dermatophytes

alphabetical

Mycoses

Dermatophytoses

page: 168

8.2

Candidiasis
Thrush
Thrush is the classical form of intraoral candidiasis, characterized by a whitish coating of creamy consistency covering bright red areas of erosion. Scraping with the curette removes the coating and exposes the erosion patches. The inner cheek surface and the tongue are affected. The surrounding mucosa is inflamed and there is a considerable burning sensation. The pathogen is Candida albicans.

Basic Lesions:

Achromic macules; Excoriations (or Ulcerations) Infection last screen viewed back next

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cause

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Mycoses

Candidiasis

page: 169

Angular cheilitis
Fissures, which are most frequently symmetrical, localized at the corners of the lips and surrounded by small impetigo-like crusts. Edentulous patients or patients with badly fitting dentures are most frequently affected. A superimposed bacterial infection is very common.

Basic Lesions:

Fissures

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Mycoses

Candidiasis

page: 170

Candidal intertrigo
More or less symmetrical exudative erythematous axillary patches with small satellite lesions. A peripheral desquamative collarette is often present.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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Mycoses

Candidiasis

page: 171

Candidal intertrigo

continued

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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alphabetical

Mycoses

Candidiasis

page: 172

Candidal vulvovaginitis
Symmetrical involvement of the external genitals with peripheral desquamative collarette and small punctiform erythematous satellite lesions which are sometimes somewhat pustular. Itching is generally severe. There is frequently an associated whitish leucorrhoea.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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Mycoses

Candidiasis

page: 173

Candidal balanitis
Glazed erythema surrounded by a fine whitish border, affecting the glans and the neck of the penis. Relatively intense burning. Recurrences are common.

Basic Lesions:

Erythematous Macule

Causes: search contents print

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alphabetical

Mycoses

Candidiasis

page: 174

Basic Lesions:

Pustules

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Thickened, brittle, and yellowish nail, accompanied by an inflamed nail fold which discharges a purulent exudate on pressure. Pain is typical. Some cases of candidal paronychia are preceded by irritant dermatitis, most frequently to vegetable or animal proteins (protein contact dermatitis).

cause

picture

Candidal paronychia and subungual infection

alphabetical

Mycoses

Candidiasis

page: 175

Napkin candidiasis (infant)
Wide glazed erythematous patch over the whole area of genitals and buttocks with satellite lesions. The condition classically starts at the base of the folds (inguinal folds, cleft of the buttocks or anal region).

Basic Lesions:

Erythematous Macule

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cause

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alphabetical

Mycoses

Candidiasis

page: 176

8.3

Pityriasis versicolor
Small, well-demarcated buff or brownish patches located mainly on the trunk or the neck. Pruritus is moderate or absent.

Basic Lesions:

Erythematous Macule; Scales

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alphabetical

Mycoses

Pityriasis versicolor

page: 177

Pityriasis versicolor

continued

Scraping with a curette reveals a scale becoming detached from a mass of scales: chip sign. The depigmented form can either be scaly from the beginning and thus contagious, or residual after exposure of pigmented pityriasis versicolor to the sun.

Basic Lesions:

Erythematous Macule; Scales

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Mycoses

Pityriasis versicolor

page: 178

Pityriasis versicolor

continued

Basic Lesions:

Achromic macules

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In this case it is not contagious and represents only the aftermath of an old pityriasis versicolor after treatment. In cases of doubt, mycological examination reveals the presence of short mycelial filaments accompanied by colonies of small round spores (Malassezia furfur). Wood's light examination reveals the presence of a yellowish fluorescence.

cause

picture

alphabetical

Mycoses

Pityriasis versicolor

page: 179

8.4

Deep fungal infections
Sporotrichosis
Multiple violet papulonodular lesions developing along the lines of lymphatic drainage, associated with infection with Sporothrix schenkii. The limbs are most frequently affected.

Basic Lesions:

Dermal Papules; Nodules

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Mycoses

Deep fungal infections

page: 180

Mycetoma (Madura foot)
Severe inflammatory swelling located most frequently on the foot, exuding a purulent material containing grains through fine breaks. The pathogens can be either eumycetes or actinomycetes.

Basic Lesions:

Nodules

Causes: search contents print

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alphabetical

Mycoses

Deep fungal infections

page: 181

Chapter 9:

Parasitic diseases – arthropods

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page: 182

9.1

Human scabies
Parasitic disease caused by Sarcoptes scabiei. Blackish burrows from 5 to 15 mm in length, ending in a vesicle at one end ("mite hill"). The sides of the fingers and the anterior surfaces of the wrist are sites of predilection. Numerous marks of excoriation, sometimes accompanied by fine more or less translucent vesicles spread all over the skin.

Basic Lesions:

None specific

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Human scabies

page: 183

Human scabies

continued

These excoriations are mainly the sign of very severe itching in the evening and at night.

Basic Lesions:

Excoriations (or Ulcerations)

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Human scabies

page: 184

Human scabies

continued

Basic Lesions:

Nodules

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Scabies nodules: very distinctly infiltrated, extremely itchy reddish nodules in the axillae, on the scrotum, and on the penis, persisting even after successful treatment.

picture

alphabetical

Parasitic diseases – arthropods

Human scabies

page: 185

Human scabies

continued

In children the lesions usually affect the feet: numerous extremely itchy excoriated papules.

Basic Lesions:

Epidermal Papules; Pustules

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Human scabies

page: 186

9.2

Animal scabies
Numerous small itchy papules spread all over the skin, which regress spontaneously. There are no burrows. The patient's pet (cat or dog) is typically found to be infested.

Basic Lesions:

Dermal Papules

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Animal scabies

page: 187

9.3

Pediculosis (head lice)
Wide impetigo-like patch at the nape of the neck caused by scratching, associated with very severe undiagnosed infestation.

Basic Lesions:

Crusts

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alphabetical

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Pediculosis (head lice)

page: 188

Pediculosis (head lice)

continued

Area of attachment of a nit to a hair.

Basic Lesions:

None specific

Causes: search contents print

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cause

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alphabetical

Parasitic diseases – arthropods

Pediculosis (head lice)

page: 189

9.4

Crab lice (pubic lice)
Excoriations and presence of louse eggs firmly attached to the pubic hairs. There are also crab lice (Phthirius pubis) grasping the public hairs. On the body, relatively discrete bluish grey macules (maculae caerulae) can sometimes be found.

Basic Lesions:

None specific

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Crab lice (pubic lice)

page: 190

Crab lice (pubic lice)

continued

These blue-grey macules correspond to the release of toxins by the crab louse in the course of successive bites.

Basic Lesions:

Blueish-grey Macules

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Crab lice (pubic lice)

page: 191

9.5

Insect bites
Trombiculiasis
Immunological reactions to bites by harvest mites (larvae of Trombiculidae which feed on blood). Small itchy lesions, sometimes in a line, located anywhere on the skin, with predilection for constricted areas. The lesions sometimes rise to a point in the centre.

Basic Lesions:

Dermal Papules

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Insect bites

page: 192

Trombiculiasis

continued

Basic Lesions:

Dermal Papules

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alphabetical

Parasitic diseases – arthropods

Insect bites

page: 193

Basic Lesions:

Dermal Papules; Vesicles

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Occurring mainly in children, this type of papular urticaria occurs in the form of numerous small erythematous papules, sometimes with fine vesicles. The lesions are found mainly on the legs, are extremely itchy, and very likely to be excoriated. Sometimes a linear disposition is seen, which makes the diagnosis much more obvious. Infantile papular urticaria is caused by an ectoparasite with a cat or dog host.

cause

picture

Infantile papular urticaria (strophulus)

alphabetical

Parasitic diseases – arthropods

Insect bites

page: 194

Flea bites
Large inflammatory papules in a linear disposition. There is a distinct central acumination. Infestation is usually via a pet (cat or dog), which acts as the carrier.

Basic Lesions:

Dermal Papules

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Insect bites

page: 195

Flea bites

continued

In some cases the lesions become frankly bullous and even haemorrhagic.

Basic Lesions:

Bullae

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Insect bites

page: 196

9.6

Leishmaniasis
Large encrusted papular lesion surrounded by an inflammatory rim. There is no associated pain or lymphadenopathy. The course is chronic and the lesion is resistant to conventional antiseptic treatments.

Basic Lesions:

Dermal Papules; Vesicles

Causes: search contents print

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Leishmaniasis

page: 197

Leishmaniasis

continued

Basic Lesions:

Dermal Papules; Vesicles

Causes: search contents print

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cause

It is a protozoan infection caused by a species of Leishmania. The carrier is a Phlebotomus fly, which explains why in most cases the lesions of leishmaniasis are found on uncovered areas (especially the face).

picture

alphabetical

Parasitic diseases – arthropods

Leishmaniasis

page: 198

Leishmaniasis

continued

After a few months the lesion subsides, leaving a scar of variable visibility.

Basic Lesions:

Scars

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Leishmaniasis

page: 199

9.7

Larva migrans (creeping eruption)
Inflammatory serpiginous line ending in a small, extremely itchy papule. Larva migrans is caused by a larva of an Ancylostoma species (hookworm) which migrates about 1 cm per day, thus extending the line of inflammation. In humans contact usually occurs on the beach (soil polluted with animal excreta). Cutaneous larva migrans is found mainly on the feet and the buttocks.

Basic Lesions:

Dermal Papules

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Parasitic diseases – arthropods

Larva migrans (creeping eruption)

page: 200

continued

Basic Lesions:

Dermal Papules

Causes: search contents print

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Larva migrans (creeping eruption)

alphabetical

Parasitic diseases – arthropods

Larva migrans (creeping eruption)

page: 201

9.8

Tungiasis (chigger)
Itchy inflammatory nodule with a small blackish opening at the centre, found in the periungual region of a toe. Secondary superinfection (abscess formation) may be present. Tungiasis is caused by a flea which lives on blood: Tunga penetrans.

Basic Lesions:

Nodules

Causes: search contents print

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Parasitic diseases – arthropods

Tungiasis (chigger)

page: 202

Tungiasis (chigger)

continued

Infestation typically occurs on the feet (walking barefoot in areas where it is endemic, especially Africa and Central America).

Basic Lesions:

Nodules

Causes: search contents print

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Parasitic diseases – arthropods

Tungiasis (chigger)

page: 203

Chapter 10:

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Psoriasis

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page: 204

10.1

Clinical aspects
Psoriasis vulgaris
Very extensive psoriasis. Large confluent patches, mainly erythematous, covered in fine scales.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

None specific last screen viewed back next

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Erythematous form

alphabetical

Psoriasis

Clinical aspects

page: 205

Psoriasis vulgaris
Scaly erythematous form

continued

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

Psoriasis on the knees. Well demarcated scaly erythematous patches. Thick white scales with a shiny micaceous appearance.

picture

alphabetical

Psoriasis

Clinical aspects

page: 206

Psoriasis vulgaris
Plaster-like psoriasis

continued

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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Extended psoriatic lesions on the trunk and the arms. In the present case the scales, which are thick and adherent, mask the erythema which appears here and there like a thin border at the edge of the lesions. The appearance of the scales is such that they are often referred to as cretaceous psoriasis or, more picturesquely "plaster-like scales".

cause

picture

alphabetical

Psoriasis

Clinical aspects

page: 207

Psoriasis vulgaris

continued

Patches resemble candle wax.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

None specific last screen viewed back next

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cause

picture

Characteristic clinical symptoms

alphabetical

Psoriasis

Clinical aspects

page: 208

Psoriasis vulgaris

continued

Patches are bleeding after curettage.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

None specific last screen viewed back next

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cause

picture

Characteristic clinical symptoms

alphabetical

Psoriasis

Clinical aspects

page: 209

Psoriasis vulgaris
Guttate psoriasis

continued

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

Guttate psoriasis consists of innumerable small scaly erythematous patches, a few millimetres across, which in the present case are distributed all over the skin.

picture

alphabetical

Psoriasis

Clinical aspects

page: 210

Psoriasis vulgaris
Guttate psoriasis

continued

In many cases it is an eruptive psoriasis of childhood or adolescence.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Clinical aspects

page: 211

Psoriasis vulgaris
Koebner's phenomenon (isomorphic reaction)

continued

Psoriatic lesions appear around a surgical scar.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

Mechanical Factors last screen viewed back next

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cause

picture

alphabetical

Psoriasis

Clinical aspects

page: 212

Psoriasis vulgaris
Pustular psoriasis of the flexor surface of the forearm. Large erythematous patch with distinct margins, strewn with a scatter of flattened yellowish-white pustules arranged in confluent clusters.

Basic Lesions:

Erythematous Macule; Pustules

Causes: search contents print

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cause

picture

Body

alphabetical

Psoriasis

Clinical aspects

page: 213

Pustular psoriasis
Feet

continued

Basic Lesions:

Erythematous Macule; Pustules; Scales None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

Plantar pustular psoriasis. Isolated pustules appear on a scaly erythematous base with distinct borders.

picture

alphabetical

Psoriasis

Clinical aspects

page: 214

Pustular psoriasis
Feet

continued

Basic Lesions:

Erythematous Macule; Pustules; Scales None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

The most recent yellowish-white pustules are slightly raised, whereas the older pustules are brown and embedded in the horny layer of the epidermis.

picture

alphabetical

Psoriasis

Clinical aspects

page: 215

Psoriatic erythroderma
The erythrodermic psoriasis has spread all over the body.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Clinical aspects

page: 216

Psoriatic erythroderma continued
The erythrodermic psoriasis has spread all over the body without intervals of healthy skin.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Clinical aspects

page: 217

10.2

Particular local forms
Palmoplantar psoriasis
Palmar psoriasis. Scaly erythematous patches with distinctly rounded contours. The covering scales are thick and nacreous.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Particular local forms

page: 218

Flexural psoriasis
Inverse psoriasis of an axilla. The psoriatic eruption consists of a continuous plaque which is bright red, shiny, smooth, and not very scaly, with a well-circumscribed margin.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Particular local forms

page: 219

Psoriasis of the nails
The picture, which is very complete, includes distal onycholysis with yellow coloration, cup-shaped depressions in the central area, and advanced disintegration of the nail plate in the proximal area. In addition, classical psoriatic lesions have invaded the whole of the nail fold.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Particular local forms

page: 220

Psoriasis of the scalp
The round, scaly erythematous patches spread beyond the hairline to invade the cervical region.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Psoriasis

Particular local forms

page: 221

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

Psoriasis of the face is rare and is usually found predominantly in the seborrhoeic regions: wings of the nose, area between the eyebrows, hairline. It is often called "seborrhoeic psoriasis".

picture

Psoriasis of the face (seborrhoeic psoriasis)

alphabetical

Psoriasis

Particular local forms

page: 222

Mucosal psoriasis
Erythematous and slightly glazed plaques with distinct margins, scattered over the upper surface of the tongue. The picture is quite similar to that described by the term geographical tongue (or benign migratory glossitis or lingual erythema migrans).

Basic Lesions:

Erythematous Macule

Causes: search contents print

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cause

picture

1. Psoriasis of the tongue

alphabetical

Psoriasis

Particular local forms

page: 223

Mucosal psoriasis

continued

Large red and well-circumscribed plaques, neither infiltrated nor scaly, with a chronic course. They present problems of differential diagnosis, as they have to be distinguished from balanitis of other origins.

Basic Lesions:

Erythematous Macule

Causes: search contents print

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cause

picture

2. Psoriasis of the glans penis

alphabetical

Psoriasis

Particular local forms

page: 224

Chapter 11:

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cause

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Other skin diseases

alphabetical

page: 225

11.1

Pityriasis rosea
The eruption consists of pink oval patches measuring 1 to 3 cm in diameter, with fine scaling in a peripheral collarette. The initial lesion, looking like an oval medallion, can usually be recognized by its larger size (diameter 5 to 6 cm) and its accentuated margin.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

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alphabetical

Other skin diseases

Pityriasis rosea

page: 226

Pityriasis rosea

continued

Its oblique orientation on the trunk is characteristic.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Pityriasis rosea

page: 227

11.2

Parapsoriasis
Pityriasis lichenoides ("guttate parapsoriasis")
The polymorphic eruption is spread over the trunk and the limbs. It consists of red or brownish and more or less scaly maculopapular lesions. The characteristic feature is a brownish macule covered with an adherent scale, which detaches in one piece.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Parapsoriasis

page: 228

Varioloid parapsoriasis
The eruption affects the trunk and the limbs, it is polymorphic: papulopustular lesions, necrotic, often haemorrhagic lesions, crusts, varioloid scars.

Basic Lesions:

Dermal Papules; Pustules; Crusts; Scars None specific last screen viewed back next

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Parapsoriasis

page: 229

Varioloid parapsoriasis

continued

Basic Lesions:

Dermal Papules; Pustules; Crusts; Scars None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Parapsoriasis

page: 230

The lesions are oval, 2 to 5 cm in diameter, well-circumscribed, flat and yellowish pink with fine scaling. These patches are disposed in lines, the position of which is fairly stereotyped: slanting along the ribs on the trunk, longitudinal on the limbs.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

Chronic superficial scaly dermatitis (digitate dermatosis)

alphabetical

Other skin diseases

Parapsoriasis

page: 231

The lesions consist of wide plaques (10 to 20 cm in diameter) located on the trunk and the base of the limbs. Their appearance is polymorphic: sepia-coloured scaly erythematous plaques, atrophic or even poikilodermal lesions.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

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cause

picture

Premycotic or prereticulotic eruption with large plaques

alphabetical

Other skin diseases

Parapsoriasis

page: 232

11.3

Lichen planus
Simple cutaneous lichen planus
The basic lesion is a firm reddishviolet polygon. The surface, which has a sheen in oblique illumination, is covered with fine greyish striations known as Wickham's striae.

Basic Lesions:

Dermo-epidermal Papules

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Lichen planus

page: 233

One of the preferred sites is the flexor surface of the forearm.

Basic Lesions:

Dermo-epidermal Papules

Causes: search contents print

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Simple cutaneous lichen planus continued

alphabetical

Other skin diseases

Lichen planus

page: 234

Papules may appear along the excoriations caused by scratching (Koebner's phenomenon).

Basic Lesions:

Dermo-epidermal Papules

Causes: search contents print

Mechanical Factors last screen viewed back next

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cause

picture

Simple cutaneous lichen planus continued

alphabetical

Other skin diseases

Lichen planus

page: 235

Oral lichen planus
The lesions are white and reticulated. Their preferred site is the tongue and the lower posterior part of the cheeks ("fern-leaf" appearance).

Basic Lesions:

Achromic macules

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Lichen planus

page: 236

Oral lichen planus

continued

Basic Lesions:

Achromic macules; Ulcers

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cause

A rare form is erosive lichen planus: painful red ulcerations with no tendency towards spontaneous healing. The ulcers are surrounded by a lichen-like whitish border.

picture

alphabetical

Other skin diseases

Lichen planus

page: 237

Hypertrophic lichen planus
The lesions are oval or coalescent, infiltrated, and pink or violet in colour. Their surface is hyperkeratotic. The skin disease classically affects the front of the legs.

Basic Lesions:

Warts

Causes: search contents print

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Lichen planus

page: 238

Hypertrophic lichen planus
continued

Basic Lesions:

Warts

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Lichen planus

page: 239

Lichen planus of the nails
Dorsal pterygium and flaps of nail at the sites.

Basic Lesions:

None specific

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Lichen planus

page: 240

11.4

Graft versus host disease (GVHD)
In the subacute stage the graft's reaction against the host can appear as a lichenoid eruption. The lesions are spread all over the skin.

Basic Lesions:

Dermo-epidermal Papules

Causes: search contents print

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cause

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alphabetical

Other skin diseases

Graft versus host disease (GVHD)

page: 241

The lesions are spread all over the skin and can involve the mucosa.

Basic Lesions:

Achromic macules; Dermoepidermal Papules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

Graft versus host disease (GVHD) continued

alphabetical

Other skin diseases

Graft versus host disease (GVHD)

page: 242

11.5

Lichenification
Well-demarcated thick itchy hyperkeratotic patch on the ankle, forming a grid of scratch lines. The term neurodermatitis is sometimes used to describe this phenomenon.

Basic Lesions:

Keratoses; Excoriations (or Ulcerations) Mechanical Factors last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Lichenification

page: 243

11.6

Subacute prurigo
The excoriated papules are disposed symmetrically on the extensor surfaces of the limbs, the upper back, and sometimes on the face and the scalp.

Basic Lesions:

Dermo-epidermal Papules; Excoriations (or Ulcerations) None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Subacute prurigo

page: 244

Subacute prurigo

continued

Basic Lesions:

Dermo-epidermal Papules; Excoriations (or Ulcerations) None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Subacute prurigo

page: 245

11.7

Lupus erythematosus
Discoid lupus erythematosus
The eruption consists of erythematous patches covered with an adherent hyperkeratotic layer, predominantly at the hair follicles. It resolves into cicatricial atrophy.

Basic Lesions:

Erythematous Macule; Keratoses

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

1. Face

alphabetical

Other skin diseases

Lupus erythematosus

page: 246

Discoid lupus erythematosus
continued

1. Face The erythema is associated with severe oedema, producing one or more swollen patches with distinct margins, a smooth surface, and an oedematous consistency. A rare form is lupus erythematosus tumidus.

Basic Lesions:

Erythematous Macule; Keratoses

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

cause

picture

alphabetical

Other skin diseases

Lupus erythematosus

page: 247

Discoid lupus erythematosus
continued

2. Scalp This consists of erythematous and somewhat atrophic alopecic plaques which heal with scarring.

Basic Lesions:

Erythematous Macule; Atrophy; Scars Sunlight, Ultraviolet Radiation last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Lupus erythematosus

page: 248

Subacute lupus erythematosus
The eruption corresponds to a profuse form consisting of erythematous and somewhat scaly polycyclic annular plaques which resolve to leave depigmentation and telangiectasia.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

alphabetical

Other skin diseases

Lupus erythematosus

page: 249

Systemic lupus erythematosus
The eruption is in the form of slightly oedematous erythematous sheets, without atrophy or follicular hyperkeratosis. The lesions are often symmetrical and located on areas exposed to the sun ("butterfly" appearance).

Basic Lesions:

Erythematous Macule

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

1. Face

alphabetical

Other skin diseases

Lupus erythematosus

page: 250

Systemic lupus erythematosus
continued

2. Fingers The site of the lesions on the fingers is usually around the nails. The lesions are usually erythematous and telangiectatic, sometimes violet (chilblain-like in appearance).

Basic Lesions:

Erythematous Macule

Causes: search contents print

Cold last screen viewed back next

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cause

picture

alphabetical

Other skin diseases

Lupus erythematosus

page: 251

11.8

Jessner and Kanof disease
The eruption consists of more or less tumid smooth erythematous papules with a flat surface and no scaling. These lesions tend to be located on the face, neck, and the upper trunk.

Basic Lesions:

Dermal Papules

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cause

picture

alphabetical

Other skin diseases

Jessner and Kanof disease

page: 252

11.9

Dermatomyositis
1. Face Diffuse oedematous and telangiectatic erythema of the face. The lesions are usually found predominantly on the eyelids.

Basic Lesions:

Erythematous Macule

Causes: search contents print

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picture

alphabetical

Other skin diseases

Dermatomyositis

page: 253

Dermatomyositis
2. Hands and fingers

continued

Basic Lesions:

Erythematous Macule

Causes: search contents print

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cause

Lesions or purplish erythema predominantly on the dorsal surface of the hand and finger joints, mainly in the supraarticular regions.

picture

alphabetical

Other skin diseases

Dermatomyositis

page: 254

11.10 Scleroderma
Localized morphoea
The condition consists of one or more indurated nacreous white plaques which have a sheen in oblique light. They are bordered by a mauve band (lilac ring) which disappears as the lesions develop.

Basic Lesions:

Erythematous Macule; Achromic macules; Sclerosis None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

1. Plaque lesions

alphabetical

Other skin diseases

Scleroderma

page: 255

Localized morphoea
2. Bands

continued

Basic Lesions:

Atrophy; Scars; Sclerosis

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cause

This variant of morphoea is characterized by a paramedian band of sclerosis and atrophy. In some cases actual facial hemiatrophy develops.

picture

alphabetical

Other skin diseases

Scleroderma

page: 256

Systemic sclerosis
Systemic sclerosis is found mainly on the face and on the extremities. The facial expression seems fixed. The tapering of the nose and narrowing of the mouth, surrounded by radial furrows, aggravate the lack of expression.

Basic Lesions:

Sclerosis

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cause

picture

alphabetical

Other skin diseases

Scleroderma

page: 257

Systemic sclerosis

continued

The sclerodactyly is characterized by tapering of the fingers, which become fixed in flexion. There are painful ulcerations on the pulps.

Basic Lesions:

Sclerosis

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Scleroderma

page: 258

11.11 Lichen sclerosus
Skin (glabrous skin) Well-circumscribed shiny white papules resembling mother-ofpearl, with a slight depression at the centre, sometimes clustered in plaques with fragmented margins.

Basic Lesions:

Dermo-epidermal Papules; Sclerosis

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Lichen sclerosus

page: 259

Lichen sclerosus
Vulva

continued

Basic Lesions:

Purpuric Macule; Achromic macules; Sclerosis None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

The vulval mucosa assumes a nacreous white shiny appearance. There are sometimes areas of bruising.

picture

alphabetical

Other skin diseases

Lichen sclerosus

page: 260

Lichen sclerosus
Glans penis

continued

Porcelain-white patches which are either disseminated or, more often, located around the meatus.

Basic Lesions:

Achromic macules; Sclerosis

Causes: search contents print

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cause

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alphabetical

Other skin diseases

Lichen sclerosus

page: 261

11.12 Sarcoidosis
Papular form Small, round, well-circumscribed elevations, either isolated or multiple, measuring 1 to 3 mm in diameter. Their colour is red, violet, or sepia. They appear yellowish on vitropression.

Basic Lesions:

Nodules; Tubercles

Causes: search contents print

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cause

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alphabetical

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Sarcoidosis

page: 262

Sarcoidosis
Nodular form

continued

Basic Lesions:

Nodules

Causes: search contents print

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cause

Larger lesions (diameter 5 to 10 mm). These are smooth, firm, violet or brownish red, and have the same appearance of yellowish lupoid infiltration on vitropression.

picture

alphabetical

Other skin diseases

Sarcoidosis

page: 263

Sarcoidosis
Angiolupoid form

continued

Basic Lesions:

Nodules

Causes: search contents print

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cause

This very rare clinical variant consists of a tumid, round or oval, reddish violet infiltration appearing on the nose.

picture

alphabetical

Other skin diseases

Sarcoidosis

page: 264

Sarcoidosis
Scar sarcoidosis

continued

Development of sarcoid nodules around foreign matter contained in a scar. These nodules sometimes appear in the context of active systemic sarcoidosis. Sometimes, however, they represent a simple local granulomatous reaction.

Basic Lesions:

Blueish-grey Macules; Nodules; Tubercles Mechanical Factors last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Sarcoidosis

page: 265

11.13 Granuloma annulare
Small, firm, well-circumscribed nodules with a smooth surface, which are normal or pink in colour and show little inflammation. They are clustered in rings which spread outwards from the centre. The ring does not generally exceed a diameter of 1 to 2 cm. Giant annular granulomas (several centimetres in diameter) are much more rare.

Basic Lesions:

Nodules

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Granuloma annulare

page: 266

11.14 Necrobiosis lipoidica
Large sclerotic and atrophic pretibial plaque with distinct margins, red and telangiectatic. Its surface is shiny, which explains the "hot spot" on the photograph.

Basic Lesions:

Erythematous Macule; Atrophy; Scars; Sclerosis None specific last screen viewed back next

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Necrobiosis lipoidica

page: 267

Necrobiosis lipoidica

continued

The centre of the plaque is smooth, with a cicatricial appearance which is often yellowish owing to an excess of fat.

Basic Lesions:

Erythematous Macule; Atrophy; Scars; Sclerosis None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Other skin diseases

Necrobiosis lipoidica

page: 268

11.15 Vasculitis
The term vasculitis is used collectively for diseases associated with inflammation of the walls of blood vessels in the skin and other organs. The classification of vasculitis is usually based on two features: the calibre of the affected vessels and the type of inflammatory reaction. Urticarial vasculitis is included in the section on urticaria.

Basic Lesions:

Dermal Papules

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Vasculitis

page: 269

Histologically, cutaneous vasculitis is characterized by infiltration of polymorphonuclear neutrophils, which are often pyknotic, into and around the vessel walls, hence the often-used term leucocytoclastic vasculitis. It occurs in two main welldefined forms: purpuric and necrotic.

Basic Lesions:

Dermal Papules

Causes: search contents print

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picture

Cutaneous vasculitis (allergic vasculitis)

alphabetical

Other skin diseases

Vasculitis

page: 270

continued

Purpuric form In this form the lesions essentially correspond to infiltrated purpuric papules, which affect mainly the legs and which can extend over other skin areas.

Basic Lesions:

Purpuric Macule; Dermal Papules

Causes: search contents print

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cause

picture

Cutaneous vasculitis (allergic vasculitis)

alphabetical

Other skin diseases

Vasculitis

page: 271

continued

Necrotic form Purpuric papules coexist with vesiculobullous, pustular, or necrotic lesions, hence the old name used in the French literature: "Gougerot's triad".

Basic Lesions:

Purpuric Macule; Dermal Papules; Gangrene None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

Cutaneous vasculitis (allergic vasculitis)

alphabetical

Other skin diseases

Vasculitis

page: 272

Basic Lesions:

Purpuric Macule; Gangrene

Causes: search contents print

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cause

Picture of chronic vasculitis of the ankle regions, characterized by purpura which necroses rapidly, leaving very small painful ulcerations bordered by a violet ring.

picture

Atrophie blanche (livedo vasculitis)

alphabetical

Other skin diseases

Vasculitis

page: 273

continued

Basic Lesions:

Purpuric Macule; Gangrene

Causes: search contents print

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cause

picture

Atrophie blanche (livedo vasculitis)

alphabetical

Other skin diseases

Vasculitis

page: 274

Polyarteritis nodosa
The clinical appearance is generally polymorphic, combining cutaneous nodules, livedo, infiltrated purpura, and necrotic ulcerations. These cutaneous signs are part of general systemic illness (weight loss, fever, aching all over the body).

Basic Lesions:

Purpuric Macule; Nodules

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Vasculitis

page: 275

Erythema elevatum diutinum
Very rare vasculitis characterized by the appearance of red or violet papules, plaques, and nodules distributed symmetrically over the extensor surfaces of the limbs. The course is chronic and successive episodes are accompanied by fever.

Basic Lesions:

Dermal Papules; Nodules

Causes: search contents print

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cause

picture

alphabetical

Other skin diseases

Vasculitis

page: 276

11.16 Erythema nodosum
The eruption Painful red nodules found mainly on the extensor surfaces of the legs, usually accompanied by fever and pains in the joints.

Basic Lesions:

Nodules

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cause

picture

alphabetical

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Erythema nodosum

page: 277

Erythema nodosum
Regression

continued

The nodules resolve in about ten days and turn blue and yellow, like bruises.

Basic Lesions:

Nodules

Causes: search contents print

None specific last screen viewed back next

basic lesion

cause

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Erythema nodosum

page: 278

11.17 Nodular vasculitis (panniculitis)
Firm cyanotic nodules with little inflammation, located on the lower third of the legs. They occur in women, usually overweight women suffering from chronic venous insufficiency.

Basic Lesions:

Nodules

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Nodular vasculitis (panniculitis)

page: 279

11.18 Pyoderma gangrenosum
Superficial ulceration with circular margins, bordered by a firm inflammatory swelling, which is undermined by deep-seated purulent lesions. The condition can be idiopathic or associated with various internal diseases, in particular, diseases of the digestive tract such as Crohn's disease or ulcerative colitis. The illustrations correspond to two stages of development of the same lesion in a leg.

Basic Lesions:

Pustules; Ulcers

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Pyoderma gangrenosum

page: 280

Pyoderma gangrenosum

continued

Basic Lesions:

Pustules; Ulcers

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cause

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Pyoderma gangrenosum

page: 281

11.19 Erythema multiforme
Erythema multiforme is a syndrome of the skin and mucosa associated with various aetiological circumstances, among which herpes infections occupy an important place. Non-bullous "target" form Dull red, round, symmetrical maculopapules on the backs of the hands. The characteristic configuration is like a target or butterfly.

Basic Lesions:

Erythematous Macule; Dermoepidermal Papules None specific last screen viewed back next

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Erythema multiforme

page: 282

Erythema multiforme
Non-bullous "target" form

continued

Basic Lesions:

Erythematous Macule; Dermoepidermal Papules None specific last screen viewed back next

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Erythema multiforme

page: 283

Erythema multiforme
Bullous form

continued

Basic Lesions:

Erythematous Macule; Dermoepidermal Papules; Bullae None specific last screen viewed back next

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basic lesion

cause

The maculopapules in a butterfly configuration are bullous in the centre and can follow a necrotic course. The mucous membranes are sometimes affected.

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Erythema multiforme

page: 284

Erythema multiforme
Stevens-Johnson syndrome

continued

This is the most severe form of erythema multiforme. In addition to the cutaneous symptoms there are severe erosive mucosal lesions affecting the lips, buccal cavity, and sometimes the genital organs. The clinical picture is severe, with fever and alterations of the general condition.

Basic Lesions:

Ulcers

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Erythema multiforme

page: 285

11.20 Sweet's syndrome (acute febrile neutrophilic dermatosis)
Well-circumscribed infiltrated erythematous plaques, depressed at the centre, appearing on the limbs. Raised temperature, aching joints, abdominal pain, and neutrophilia accompany the skin symptoms.

Basic Lesions:

Nodules

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Sweet's syndrome (acute febrile neutrophilic dermatosis)

page: 286

11.21 Bullous pemphigoid
Early stage Large urticaria-like polycyclic patches, bordered by a few firm bullae of varying size and containing a clear liquid.

Basic Lesions:

Dermal Papules; Bullae

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Bullous pemphigoid

page: 287

Bullous pemphigoid
Further development

continued

Basic Lesions:

Bullae

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cause

Presence of very numerous firm bullae of varying size, some of which are haemorrhagic. Some bullae rupture, leaving extensive skin erosions.

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Bullous pemphigoid

page: 288

11.22 Autoimmune forms of pemphigus
Two forms of autoimmune pemphigus are distinguished, according to the preferred site of separation of epidermal cells from each other: "deep" pemphigus (pemphigus vulgaris and pemphigus vegetans) on the one hand and "superficial" pemphigus (pemphigus erythematosus) on the other.

Pemphigus vulgaris
Skin Presence of superficial flaccid bullae, which rupture easily to expose extensive erosions.
Basic Lesions: Bullae; Ulcers

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Autoimmune forms of pemphigus

page: 289

Pemphigus vulgaris
Oral

continued

Dragging painful erosions of the buccal mucosa of the inside of the cheeks, the palate, and the dental cuffs, exposing a bright red surface without a fibrinous coating. Similar erosions can occur in other bullous diseases, but in pemphigus they are more constant and more characteristic.

Basic Lesions:

Ulcers

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Autoimmune forms of pemphigus

page: 290

Pemphigus erythematosus
Crusty, scaly, erythematous plaques of the seborrhoeic regions on the face and the trunk, which are sometimes itchy. These lesions represent the development of superficial bullae.

Basic Lesions:

Erythematous Macule; Bullae; Scales; Crusts Chemical Agents last screen viewed back next

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Autoimmune forms of pemphigus

page: 291

Pemphigus erythematosus
continued

This variant is also characteristic of drug-induced pemphigus (d-penicillamine).

Basic Lesions:

Erythematous Macule; Bullae; Scales; Crusts Chemical Agents last screen viewed back next

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cause

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Autoimmune forms of pemphigus

page: 292

11.23 Benign familial chronic pemphigus (Hailey-Hailey disease)
Erosive vesiculobullous lesions which become covered with small yellowish crusts. The lesions are clustered in well-defined plaques traversed by very characteristic parallel fissures. The preferred sites of these lesions are the sides of the neck, the axillae, and the inguinogenital region.

Basic Lesions:

Vesicles; Bullae; Fissures

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Benign familial chronic pemphigus (Hailey-Hailey disease)

page: 293

11.24 Dermatitis herpetiformis
Urticaria -like erythematous or papular lesions surmounted by vesicles and bullae, clustered in a herpetiform ring. The symmetry of the lesions, the constant pruritus, and the association with a glutensensitive enteric disease are the other peculiarities of this rare skin disease.

Basic Lesions:

Dermal Papules; Vesicles; Bullae

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Dermatitis herpetiformis

page: 294

Dermatitis herpetiformis
continued

Basic Lesions:

Dermal Papules; Vesicles; Bullae

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Dermatitis herpetiformis

page: 295

11.25 Linear IgA bullous disease
Large firm bullae containing a clear liquid, occurring on normal or erythematous skin. The usual sites are the lower part of the trunk, buttocks, perineum, and the thighs. This chronic bullous skin disease of children and adults is characterized by linear deposits of IgA in direct immunofluorescence.

Basic Lesions:

Bullae; Ulcers

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Linear IgA bullous disease

page: 296

11.26 Epidermolysis bullosa
Simple epidermolysis bullosa (non-dystrophic)
Clear bullae of various sizes, triggered by trauma and by persistent friction, which heal without leaving a trace. The usual sites are the hands, feet, elbows, and knees in the adult and the bottom in the infant.

Basic Lesions:

Bullae

Causes: search contents print

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Epidermolysis bullosa

page: 297

Basic Lesions:

Bullae

Causes: search contents print

Mechanical Factors last screen viewed back next

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cause

There is no abnormality of the teeth or the nails. The condition is transmitted in the autosomal dominant mode.

picture

Simple epidermolysis bullosa (non-dystrophic) continued

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Epidermolysis bullosa

page: 298

Basic Lesions:

Bullae; Crusts; Ulcers

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Mechanical Factors last screen viewed back next

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cause

In dystrophic forms of epidermolysis bullosa, of which there are a number of variants, the traumatic bullae leave atrophic scars and milia when they heal. Some joints can be fixed in flexion.

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Dystrophic forms of epidermolysis bullosa

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Epidermolysis bullosa

page: 299

continued

Basic Lesions:

Bullae

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cause

Certain abnormalities of the teeth or the nails are sometimes associated. The mode of transmission varies according to the form of the disease.

picture

Dystrophic forms of epidermolysis bullosa

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Epidermolysis bullosa

page: 300

11.27 Diabetic bullae
Translucent bullae of various sizes, haemorrhagic in rare cases, without inflammatory areola, which are usually multiple, found especially on the extremities, particularly on the feet. The condition tends to occur in complicated cases of diabetes of all types.

Basic Lesions:

Bullae

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Diabetic bullae

page: 301

11.28 Porphyria cutanea tarda
The preferred sites of porphyria cutanea tarda lesions are areas exposed to light, such as the backs of the hands and the face. On the backs of the hands the condition is characterized by several symptoms associated with increased skin fragility: serous or haemorrhagic bullae, erosions after various traumas, milia.

Basic Lesions:

Bullae; Ulcers

Causes: search contents print

Mechanical Factors; Sunlight, Ultraviolet Radiation last screen viewed back next

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Porphyria cutanea tarda

page: 302

Porphyria cutanea tarda
continued

Basic Lesions:

Scars

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Mechanical Factors; Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

On the face the condition is characterized mainly by hypertrichosis of the malar regions and a diffuse brownish pigmentation.

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Porphyria cutanea tarda

page: 303

Basic Lesions:

Vesicles; Bullae

Causes: search contents print

Sunlight, Ultraviolet Radiation; Chemical Agents last screen viewed back next

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cause

Erythematous vesicular or bullous eruption reproducing the pattern of a grass or leaf. Sun, humidity, and contact with the plant are the three prerequisites for the appearance of the skin condition.

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Bullous phytophotodermatitis (Meadow dermatitis)

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Porphyria cutanea tarda

page: 304

11.29 Acne and rosacea
Acne vulgaris
Acne vulgaris (adolescent acne) essentially includes three types of lesion: comedones, papules and pustules. To these can be added nodules and cysts.

Basic Lesions:

Dermal Papules; Nodules; Keratoses; Pustules None specific last screen viewed back next

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Acne and rosacea

page: 305

Acne vulgaris
Papulopustular acne

continued

Basic Lesions:

Dermal Papules; Pustules

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cause

Papulopustular acne essentially comprises isolated or confluent papules and very inflamed papulopustules. It is often associated with seborrhoea. Comedones are never absent.

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Acne and rosacea

page: 306

Acne vulgaris
Comedo acne

continued

Comedo acne is characterized by a distinct preponderance of comedones over the lesions of adolescent acne. The comedones are either open (blackheads) or closed (whiteheads). Blackheads are the prominent lesions in this illustration. Cosmetic acne often takes the form of this variant.

Basic Lesions:

Keratoses

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Acne and rosacea

page: 307

Acne vulgaris
Nodular and cystic acne

continued

Basic Lesions:

Nodules; Scars

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In addition to the basic lesions just mentioned (comedones, papules and pustules), this form of acne presents epidermal cysts of follicular origin and inflamed nodules resulting from the rupture of these cysts. The nodules can develop into abscesses, which leave indurated, pitted, or retractile scars when they dry out.

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Acne and rosacea

page: 308

Acne conglobata
The lesions are polymorphic and numerous: multiple comedones, follicular cysts, pustules, nodules, and abscesses developing to form fistulae, haemorrhagic ulcers, then pitted scars and adhesions bridging the scars.

Basic Lesions:

Nodules; Pustules; Ulcers; Scars

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Acne and rosacea

page: 309

Acne conglobata

continued

This form of acne classically affects the face and trunk, but it can also spread to the arms and the buttocks.

Basic Lesions:

Nodules; Pustules; Ulcers; Scars

Causes: search contents print

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Acne and rosacea

page: 310

Basic Lesions:

Dermal Papules; Keratoses; Pustules

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This variant of acne, of indeterminate origin, appears in infants aged between 3 and 6 months. It is usually severe, but in most cases fades in 1 to 2 years. It is characterized by the presence of comedones, papules, and pustules, found mainly on the cheeks. It should be distinguished from a much more rare variety of acne: neonatal acne (acne neonatorum).

cause

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Infantile acne (acne infantum)

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Acne and rosacea

page: 311

Rosacea
The blotchy form comprises erythema and telangiectasia affecting the nose, cheeks and sometimes the forehead and chin. Flushes appear in various circumstances: in the presence of stress or a change in ambient temperature, after the consumption of alcohol, hot drinks, or hot food.

Basic Lesions:

Erythematous Macule

Causes: search contents print

Heat last screen viewed back next

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Blotchy form

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Acne and rosacea

page: 312

Rosacea
Papulopustular form

continued

Basic Lesions:

Erythematous Macule; Dermal Papules; Pustules Heat last screen viewed back next

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cause

Inflamed papules and aseptic pustules appear on a background of telangiectatic erythema, but never comedones (which necessarily leads to rejection of the term "acne rosacea").

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Acne and rosacea

page: 313

Perioral dermatitis
This is characterized by the appearance of micropapules and micropustules on a base of erythema and oedema, mainly around the mouth, separated from the lips by a border of healthy skin. The lesions can sometimes spread to the nasolabial folds.

Basic Lesions:

Erythematous Macule; Dermal Papules; Pustules None specific last screen viewed back next

Causes: search contents print

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cause

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alphabetical

Other skin diseases

Acne and rosacea

page: 314

11.30 Drug-induced eruptions
Fixed pigmented erythema
Well-circumscribed pigmented erythematous patch occurring 48 h after the ingestion of a drug, in this case phenacetin. The lesion resolves into a residual pigmentation which disappears gradually. Reintroduction of the drug causes a recurrence, invariably at the same site. In some cases the centre of the lesion can be bullous (fixed bullous toxic dermatitis).

Basic Lesions:

Erythematous Macule; Pigmented Macules; Bullae Chemical Agents last screen viewed back next

Causes: search contents print

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Drug-induced eruptions

page: 315

Eruption characterized by dull red congestive patches on the skin. These vary in size and run together into sheets. Two prominent characteristics are the usual symmetry of the lesions and their itchiness. The present case is an ampicillin rash.

Basic Lesions:

Erythematous Macule

Causes: search contents print

Chemical Agents last screen viewed back next

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cause

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Maculopapular exanthema (morbilliform eruption)

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Drug-induced eruptions

page: 316

Basic Lesions:

Bullae; Ulcers

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Chemical Agents last screen viewed back next

basic lesion

Detachment of large pieces of epidermis, leaving extensive areas of erosion. The eruption usually spreads all over the skin. All mucous membranes are involved in the necrolytic process. The situation is similar to that of major burns. The drug responsible in this particular case was sulfonamide.

cause

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Lyell's syndrome (toxic epidermal necrolysis)

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Drug-induced eruptions

page: 317

Lichenoid eruptions
Drug-induced lichenoid eruption caused by methyldopa. The clinical picture is quite similar to that of lichen planus, but the lesions are often more red and scaly.

Basic Lesions:

Dermo-epidermal Papules; Scales

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Drug-induced eruptions

page: 318

Lichenoid eruptions

continued

The distribution of the lesions is symmetrical and more diffuse than in most forms of lichen planus.

Basic Lesions:

Dermo-epidermal Papules; Scales

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Drug-induced eruptions

page: 319

Drug-induced phototoxic eruption associated with the ingestion of a tetracycline. Erythematous oedematous lesions whose pattern corresponds strictly to the skin areas exposed to sunlight. The borders of the lesions are as if "cut with a knife".

Basic Lesions:

Erythematous Macule

Causes: search contents print

Sunlight, Ultraviolet Radiation; Chemical Agents last screen viewed back next

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cause

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Drug-induced phototoxic eruption

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Drug-induced eruptions

page: 320

Basic Lesions:

Erythematous Macule; Dermal Papules; Vesicles Sunlight, Ultraviolet Radiation; Chemical Agents last screen viewed back next

Causes: search contents print

basic lesion

Drug-induced photoallergic reaction associated with the ingestion of a phenothiazine. The symptoms comprise erythema, confluent papules, and plaques of weeping vesicular eczema. The lesions, which are accompanied by severe itching, spread beyond the areas exposed to the sun, in contrast to the phototoxic reactions.

cause

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Drug-induced photoallergic eruption

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Drug-induced eruptions

page: 321

Acneiform facial eruption
This drug-induced eruption is associated in the present case with intramuscular injections of vitamin B12. It is clinically monomorphic, i.e. it is characterized by the presence of papules and pustules and by the absence of comedones.

Basic Lesions:

Dermal Papules; Pustules

Causes: search contents print

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Drug-induced eruptions

page: 322

Psoriatiform eruption
Psoriatiform eruption associated with the ingestion of a ß-blocker. In certain cases this is an aggravation of existing psoriasis. The lesions are not usually very scaly. They can be itchy. There is an increasingly large number of suspected groups of drugs.

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

Chemical Agents last screen viewed back next

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Drug-induced eruptions

page: 323

Drug-induced lupus
Induced lupus usually assumes the appearance of subacute or systemic lupus. It is reversible when the treatment is stopped and recurs if the treatment is reintroduced. In this case the suspected drug is an anticonvulsant.

Basic Lesions:

Erythematous Macule

Causes: search contents print

Chemical Agents last screen viewed back next

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Drug-induced eruptions

page: 324

Cortisone atrophy
Prolonged systemic use of corticosteroids leads to a reduction in collagen tissue, culminating in atrophy of the skin. This occurs particularly on the extensor surfaces of the forearms. The atrophy is accompanied by purpura, ecchymoses, and also by these three unusual star-shaped false scars resulting from an internal tear in the dermal tissue (without a wound).

Basic Lesions:

Purpuric Macule; Atrophy; Scars

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Drug-induced eruptions

page: 325

Basic Lesions:

Nodules; Pustules; Crusts

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Chemical Agents last screen viewed back next

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Very rare reactions to the use of drugs containing bromide or iodine. Bromide and iodide eruptions appear as plaques and lumps with infiltration and vegetation, which are sometimes covered in pustules and crusts. The illustration is of a bromide eruption caused by bromazepam.

cause

picture

Bromide and iodide eruptions (Halide eruptions)

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Drug-induced eruptions

page: 326

Gingival hyperplasia
Gingival hyperplasias are often provoked by a drug. The drugs most frequently blamed are anticonvulsants (phenytoin, sodium valproate) and cyclosporin, as in the present case.

Basic Lesions:

Vegetations

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Drug-induced eruptions

page: 327

Melasma (chloasma)
A specifically female skin disease, melasma is hyperpigmentation appearing on the upper part of the face (temples and forehead), but sparing the hairline. It is generally bilateral, but never perfectly symmetrical. Its colour varies from light to dark brown. Melasma occurs in pregnancy or during treatment with hormonal contraceptives. It becomes more pronounced in summer and the aggravating influence of exposure to solar ultraviolet is evident.
Basic Lesions: Pigmented Macules

Causes: search contents print

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Drug-induced eruptions

page: 328

11.31 Skin disorders caused by physical agents
Benign summer photodermatitis
Small acuminate erythematous papules, a few millimetres in diameter, and papulovesicles clustered on the extensor surface of the arms (as in the present case), legs, and exposed areas of the neck and the chest. The eruption usually spares the face. It occurs a few hours after sunbathing.

Basic Lesions:

Dermal Papules

Causes: search contents print

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Skin disorders caused by physical agents

page: 329

Polymorphic light eruption
Small erythematous papules or oedematous plaques appearing on exposed parts of the body, especially the face (forehead, nose, cheekbones), behind the ears, the exposed area of neck and chest, and the extensor surfaces of the limbs. In more than 70% of the cases the eruption appears in spring. The patient does not have to be unaccustomed to the sun. The condition appears in the course of everyday life, whether the sky is clear or cloudy.
Basic Lesions: Erythematous Macule; Dermal Papules Sunlight, Ultraviolet Radiation last screen viewed back next

Causes: search contents print

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cause

picture

alphabetical

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Skin disorders caused by physical agents

page: 330

Chilblains
Erythematous and cyanotic infiltrations of the toes which may become covered with clear or haemorrhagic bullae, ulcerations, or small crusts. Chilblains are purple and painful in the cold, but become red and itchy when the sufferer enters a heated room. Chilblains are most common in young women, but they are seen at all ages in both sexes. Other sites include the heels, ankles, knees, ears, etc.

Basic Lesions:

Erythematous Macule

Causes: search contents print

Heat; Cold last screen viewed back next

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Skin disorders caused by physical agents

page: 331

Chapter 12:

Topographical dermatology

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page: 332

12.1

Alopecia
Alopecia areata
Alopecia areata of the scalp is characterized by the appearance of round or oval, smooth, shiny patches of alopecia which gradually increase in size. The patches are usually homogeneously glabrous and are bordered by a peripheral scatter of short brokenoff hairs known as exclamationmark hairs.

Basic Lesions:

None specific

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Topographical dermatology

Alopecia

page: 333

Alopecia areata

continued

Alopecia areata of the occipital region, known as ophiasis, is more resistant to regrowth. Other hair regions can also be affected: eyebrows, eyelashes, beard, and the axillary and pubic regions. In some cases the alopecia can be generalized: this is known as alopecia totalis (scalp) and alopecia universalis (whole body).

Basic Lesions:

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Topographical dermatology

Alopecia

page: 334

Pseudopelade
Pseudopelade consists of circumscribed alopecia which varies in shape and in size, with more or less distinct limits. The skin is atrophic and adheres to the underlying tissue layers. This unusual cicatricial clinical appearance can be symptomatic of various other conditions: lupus erythematosus, lichen planus, folliculitis decalvans. Some cases are idiopathic and these are known as pseudopelade.

Basic Lesions:

Atrophy; Scars

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Topographical dermatology

Alopecia

page: 335

Trichotillomania
Plucking of the hair on a large scale. In trichotillomania the alopecia has irregular, "geographic" margins which may be distinct or indefinite. The area of alopecia can be entirely glabrous or dotted with clumps of broken hairs of very different lengths, and either smooth or covered irregularly with small excoriations or crusts caused by scratching. Similar lesions can appear on the nails (onychotillomania).

Basic Lesions:

None specific

Causes: search contents print

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Topographical dermatology

Alopecia

page: 336

Androgenetic alopecia
This alopecia, known generally as baldness, occurs in adulthood both in men, where it affects the temporal regions (photo) and/or the crown, and in women, where it is confined to the central area of the scalp, in a longitudinal band which extends from the forehead to the crown. In females alopecia always leaves a large number of healthy hairs which are scattered irregularly over the alopecic area.

Basic Lesions:

None specific

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Topographical dermatology

Alopecia

page: 337

12.2

Mucosal diseases
Aphtae, aphthosis, Behçet's disease
Small "punched-out" ulcerations of the buccal mucosa, characterized by a yellowish base resembling the colour of fresh butter and by an erythematous inflammatory halo. Often very painful, aphthae are accompanied by lymphadenopathy.

Basic Lesions:

Ulcers

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Topographical dermatology

Mucosal diseases

page: 338

Aphthae can occur on the genital mucosa (bipolar aphthosis).

Basic Lesions:

Ulcers

Causes: search contents print

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Aphtae, aphthosis, Behçet's disease continued

alphabetical

Topographical dermatology

Mucosal diseases

page: 339

Basic Lesions:

Pustules

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Behçet's disease is a severe condition with the additional characteristics of aphthae on the skin and an isomorphic reaction to injections.

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Aphtae, aphthosis, Behçet's disease continued

alphabetical

Topographical dermatology

Mucosal diseases

page: 340

Black hairy tongue
Black hairy tongue comprises hypertrophy of the villi on the upper surface of the tongue. These are loaded with oxidized keratin, which explains the brown or black colour of the lesion. It can occur after the use of certain drugs, such as antibiotics or metronidazole, for example.

Basic Lesions:

Vegetations

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Topographical dermatology

Mucosal diseases

page: 341

Scrotal / fissured tongue
The upper surface of the tongue is criss-crossed by deep grooves running in various directions. The lingual papillae are often hypertrophic and inflamed. On discovery of this anatomical peculiarity the subjects often complain of a painful sensation (glossodynia).

Basic Lesions:

None specific

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Topographical dermatology

Mucosal diseases

page: 342

Basic Lesions:

Ulcers

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Well-defined patches denuded of papillae, surrounded by an unobtrusive whitish border. The spread of these areas is eccentric and their appearance changes from one day to the next. This could be a variant of lingual psoriasis. Association with scrotal tongue is common.

cause

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Geographic tongue (benign migratory glossitis)

alphabetical

Topographical dermatology

Mucosal diseases

page: 343

12.3

Cheilitis
Allergic contact cheilitis
Allergic contact dermatitis connected with the application of a lipstick containing balsam of Peru. The eczematous condition extends far beyond the limits of the vermilion zone of the lips, to spread out over the surrounding skin.

Basic Lesions:

Erythematous Macule; Scales

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Topographical dermatology

Cheilitis

page: 344

Cheilitis caused by ingestion of isotretinoin. This is a fissured, scaly, erythematous cheilitis which is dependent on the isotretinoin dose administered. There are sometimes associated episodes of epistaxis.

Basic Lesions:

Erythematous Macule; Scales; Fissures Chemical Agents last screen viewed back next

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Cheilitis caused by systemic use of isotretinoin

alphabetical

Topographical dermatology

Cheilitis

page: 345

12.4

Miscellaneous
Darier's disease
Hereditary skin disease with a characteristic topography (sides of the face, trunk). Multiple small greyish-brown papules are observed, keratotic, dry, and very adherent. These papules can run together to form extensive brownish plaques. The lesions have a very distinct tendency to increase during the months of sunshine.

Basic Lesions:

Epidermal Papules; Keratoses

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Topographical dermatology

Miscellaneous

page: 346

Darier's disease

continued

Basic Lesions:

None specific

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Topographical dermatology

Miscellaneous

page: 347

Ichthyosis vulgaris
Condition transmitted by a dominant gene, sometimes associated with atopic dermatitis. The whole of the skin is affected, sprinkled with small dry scales, which vary in number. Improvement during the months of sunshine is typical. Acquired ichthyosis must always make one think of a paraneoplastic syndrome (e.g. underlying Hodgkin's disease).

Basic Lesions:

Scales

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Topographical dermatology

Miscellaneous

page: 348

Basic Lesions:

Scales

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Also called ichthyosis nigricans, this variant of ichthyosis is found only in boys, does not spare the major skin folds, and presents in the form of wide, adherent, blackish scales.

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Sex-linked (recessive) ichthyosis

alphabetical

Topographical dermatology

Miscellaneous

page: 349

continued

Basic Lesions:

Scales

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Sex-linked (recessive) ichthyosis

alphabetical

Topographical dermatology

Miscellaneous

page: 350

Basic Lesions:

Keratoses

Appearing very early in life (between the 4th and 8th week), this palmoplantar keratoderma represents the model of a disease with autosomal dominant transmission. There are extensive yellowish keratotic plaques, accompanied by large cracks in flexural creases of the palms. This keratoderma is distinctly demarcated and does not extend to the wrist. The keratotic lesions are accentuated by an inflammatory border. There is sometimes associated hyperhidrosis.

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Hereditary palmoplantar keratoderma (Thost-Unna syndrome)

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Topographical dermatology

Miscellaneous

page: 351

Pityriasis rubra pilaris
Association of diffuse orangeyellow palmoplantar keratoderma with a scoring of small fissures and horny follicular papules producing a grid on the skin. On palpation it feels abrasive (like emery paper). The pinkish papules are pointed at the top and surmounted by a small horny follicular plug. The course is usually chronic. Episodes of erythroderma may be seen as time goes on.

Basic Lesions:

Keratoses

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page: 352

Pityriasis rubra pilaris

continued

Basic Lesions:

Keratoses

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Topographical dermatology

Miscellaneous

page: 353

Keratosis pilaris
Extremely common skin disease surrounded by a fine erythematous border, characterized by slight hyperkeratosis of the hair follicle orifices. This "condition" is transmitted by an autosomal dominant gene and is usually seen on the cheeks and the temples.

Basic Lesions:

Keratoses

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page: 354

Keratosis pilaris

continued

Basic Lesions:

Keratoses

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In adults the exterior surfaces of the arms and anterior surfaces of the thigh are most frequently affected. The affected areas feel abrasive on palpation. Exposure to sunlight attenuates the condition.

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alphabetical

Topographical dermatology

Miscellaneous

page: 355

Basic Lesions:

Erythematous Macule

Extensive annular lesions of the arms with the appearance of healing at the centre. The distinctly infiltrated erythematous margins spread slowly outwards. Having appeared suddenly, this condition has become chronic, each ring developing over several weeks at a rate of 2 to 3 mm per week. It should be noted that when two rings join together they never overlap. There is no pruritus. It is always important to check for a possible underlying cause, though in a number of cases erythema annulare centrifugum remains idiopathic.

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Erythema annulare centrifugum (Darier's)

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Topographical dermatology

Miscellaneous

page: 356

continued

Basic Lesions:

Erythematous Macule

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Among the potential causes the following should be remembered: remote infectious foci, viral diseases, Hodgkin's disease, visceral cancer, autoimmune thyroiditis, lupus erythematosus, liver disease, etc. In the present case it was viral hepatitis B which, after an acute episode, subsequently developed into chronic active hepatitis.

cause

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Erythema annulare centrifugum (Darier's)

alphabetical

Topographical dermatology

Miscellaneous

page: 357

12.5

Leg ulcers
Venous leg ulcer
Extensive ulceration with pliant borders and outlines which vary from one case to the next. The base of the ulcer is granular in some places and sanious and necrotic in others. Surrounding trophic disorders are evident: gravitational purpura, atrophie blanche.

Basic Lesions:

Ulcers; Atrophy

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Leg ulcers

page: 358

Venous leg ulcer

continued

This type of ulcer can be the result of a varicose disorder or a postphlebitic syndrome. It represents more than 80% of leg ulcer cases. It affects women most frequently and there is an evident hereditary factor. The pains vary individually in intensity and are improved by lying down.

Basic Lesions:

Ulcers

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Leg ulcers

page: 359

Ischaemic (arterial) leg ulcer
Punched-out ulceration which is most often unilateral. Its site is near the ankle. There is no associated trophic disorder. The pulse in the foot can be felt only with difficulty. Ischaemic ulcers develop rapidly and cause intense pain which is often aggravated by lying down. They are much less common than venous ulcers and can be found in diabetes, arteriosclerosis, or Buerger's disease.

Basic Lesions:

Crusts; Ulcers

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Leg ulcers

page: 360

Ulcer caused by capillaritis
Slow and relatively superficial ulceration with jagged and irregular margins. There is surrounding pigmentary and purpuric angiodermatitis, sometimes associated with small patches of atrophie blanche. The pains are often intense and persistent, and are not influenced by lying down. Diabetes and arteriosclerosis promote this condition.

Basic Lesions:

Purpuric Macule; Crusts; Ulcers; Atrophy None specific last screen viewed back next

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Topographical dermatology

Leg ulcers

page: 361

Basic Lesions:

Ulcers

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Deep circular, punched-out ulcer found at the bearing surface of the metatarsal joint. The base is necrotic. There is no tendency towards spontaneous cicatrization. There is virtually no pain. In the present case it is caused by diabetes with a major neuropathological component. Other neurological conditions can be responsible (e.g. syringomyelia).

cause

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Neurotrophic leg ulcer (perforating ulcer)

alphabetical

Topographical dermatology

Leg ulcers

page: 362

continued

Basic Lesions:

Ulcers

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Neurotrophic leg ulcer (perforating ulcer)

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Topographical dermatology

Leg ulcers

page: 363

12.6

Pathomimicry
Skin self-mutilation simulated disease
Extensive escharotic ulceration of the back of the hand, caused intentionally with caustic soda. The margins are distinct, the angular edges and the configuration "surprising". The appearance of the lesion was very rapid and recurrences at the same site are typical.

Basic Lesions:

Crusts; Ulcers; Scars

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Pathomimicry

page: 364

continued

The course is usually capricious, spontaneous healing retarded, and persistence indefinite. In the present case the patient acted voluntarily with intent to deceive, for her own advantage (extension of sick leave from work).

Basic Lesions:

Crusts; Ulcers; Scars

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Skin self-mutilation simulated disease

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Topographical dermatology

Pathomimicry

page: 365

Basic Lesions:

Crusts; Ulcers

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Ulceration of exogenous origin on the face, with distinct margins and "aberrant" configuration. This particular topography is rarely found in cases of disease simulation. True pathomimicry is caused by the patient who is "unconscious" of it or shows "dual consciousness".

cause

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Self-mutilation, pathomimicry

alphabetical

Topographical dermatology

Pathomimicry

page: 366

continued

Basic Lesions:

Crusts; Ulcers

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Major psychological disturbances are present. There is no evident intention to take financial advantage of the condition.

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Self-mutilation, pathomimicry

alphabetical

Topographical dermatology

Pathomimicry

page: 367

Chapter 13:

Benign skin tumours

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page: 368

13.1

Epidermal tumours
Seborrhoeic keratosis / wart
Excrescences of varying size, covered with a greasy, scaly keratotic layer which is not very adherent. They can have various colours: yellow, sepia, grey, dark brown, or pure black. Each lesion seems to be "placed" on the skin surface, is well-circumscribed, has no underlying infiltration.

Basic Lesions:

Warts; Keratoses

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Benign skin tumours

Epidermal tumours

page: 369

Seborrhoeic keratosis / wart
continued

Basic Lesions:

Warts; Keratoses

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alphabetical

Benign skin tumours

Epidermal tumours

page: 370

Verrucous epidermal naevus
The epidermal naevus appears in the form of raised papuloverrucous lesions, rough to the touch and sometimes fragmented. It is usually disposed in continuous linear bands following the Blaschko's classical lines, to be interrupted over the midline.

Basic Lesions:

Warts; Keratoses

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Benign skin tumours

Epidermal tumours

page: 371

Verrucous epidermal naevus
continued

The colour is that of normal skin, sometimes greyish or brownish.

Basic Lesions:

Warts; Keratoses

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Benign skin tumours

Epidermal tumours

page: 372

ILVEN appears in the form of psoriatiform scaly erythematous patches, which are sometimes lichenoid or verrucous, disposed in linear bands following Blaschko's lines (like the lesions of verrucous epidermal naevus).

Basic Lesions:

Erythematous Macule; Warts; Pustules; Scales; Gangrene None specific last screen viewed back next

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Inflammatory linear verrucous epidermal naevus (ILVEN)

alphabetical

Benign skin tumours

Epidermal tumours

page: 373

continued

Inflammatory episodes can occur, causing exacerbation of pruritus, more or less severe excoriations, secondary eczematization, and even areas of necrosis.

Basic Lesions:

Erythematous Macule; Warts; Pustules; Scales; Gangrene None specific last screen viewed back next

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Inflammatory linear verrucous epidermal naevus (ILVEN)

alphabetical

Benign skin tumours

Epidermal tumours

page: 374

Basic Lesions:

Pigmented Macules

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Hyperpigmented unilateral plaque, the preferred site of which is the chest or the shoulder, sometimes covered in hairs. It appears most often in young adults after exposure to the sun. It corresponds to a late epithelial (epidermal and follicular) naevus with secondary epidermal melanin hyperpigmentation.

cause

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Becker's naevus (pigmented and hairy epidermal naevus)

alphabetical

Benign skin tumours

Epidermal tumours

page: 375

Clear cell acanthoma
Small, round and domed firm tumour, which is generally isolated, pink in colour, usually with a moist surface. The diagnosis of this lesion is essentially histopathological.

Basic Lesions:

Nodules

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Benign skin tumours

Epidermal tumours

page: 376

Kerato-acanthoma
Very well defined nodule surmounted by a central horny plug. Its growth is rapid, the maximum size of the lesion being reached in a few weeks. The lesion usually regresses spontaneously in a few months.

Basic Lesions:

Nodules

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Benign skin tumours

Epidermal tumours

page: 377

Basic Lesions:

Nodules; Fissures

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Well-circumscribed, slightly pink retro-auricular papulonodule, 1-2 cm in diameter, surrounded by an inflammatory halo. The lesion is divided in two by a groove (fold).

picture

Spectacle frame acanthoma (fissured acanthoma)

alphabetical

Benign skin tumours

Epidermal tumours

page: 378

Acanthoma occurs in the weeks or months after the patient starts wearing a new spectacle frame.

Basic Lesions:

Nodules; Fissures

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Spectacle frame acanthoma (fissured acanthoma) continued

alphabetical

Benign skin tumours

Epidermal tumours

page: 379

13.2

Follicular and sebaceous tumours
Epidermoid cyst
Inflammatory subcutaneous nodule, often with a punctiform opening at its centre, through which malodorous whitish or yellowish material can be expressed. It is a single or multiple lesion which occurs especially in seborrhoeic areas, within the context of acne vulgaris or nodulocystic acne. Epidermoid cysts are sometimes wrongly called "sebaceous cysts".

Basic Lesions:

Nodules

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Benign skin tumours

Follicular and sebaceous tumours

page: 380

Trichilemmal cyst (pilar cyst)
Generally located on the scalp, it appears in the form of a subcutaneous nodule covered with non-adherent pink and glabrous skin. The cysts are sometimes multiple. They range from pea-size to egg-size and are colloquially known as wens.

Basic Lesions:

Nodules

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Benign skin tumours

Follicular and sebaceous tumours

page: 381

Milia
Milia are very superficial small white elevations which occur in various circumstances. In newborn babies they appear as innumerable small white dots on the face, as illustrated in the photograph, caused by transient retention of sebum. They disappear spontaneously in a few weeks. In adolescents and adults they are commonly seen on the cheeks, the eyelids, and the nose, and are due to clogging of follicles.
Basic Lesions: Dermal Papules

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Benign skin tumours

Follicular and sebaceous tumours

page: 382

Trichoepithelioma
Translucent, flattened or globular papular formations, 2 to 5 mm in diameter, pink or white in colour and sometimes surmounted by fine telangiectasias. Their preferred site is the face (nose, nasolabial folds, cheeks, forehead, chin). These are generally multiple and hereditary lesions, appearing from childhood or in adolescence.

Basic Lesions:

Dermal Papules

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Benign skin tumours

Follicular and sebaceous tumours

page: 383

Senile sebaceous adenoma
These adenomas correspond to senile adenomatous hyperplasia of the sebaceous glands.

Basic Lesions:

Dermal Papules

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Benign skin tumours

Follicular and sebaceous tumours

page: 384

continued

Senile sebaceous adenoma
continued

Basic Lesions:

Dermal Papules

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Small yellowish umbilicate formations, 3 to 6 mm in diameter, occurring on seborrhoeic areas of the face (forehead, temples, cheeks) in both sexes after the age of fifty.

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alphabetical

Benign skin tumours

Follicular and sebaceous tumours

page: 385

Jadassohn's sebaceous naevus
This is a tumour on the scalp or the face, which is often congenital. Its appearance changes with age. During childhood there is an oval or pink and slightly raised alopecic plaque. Starting from puberty the surface becomes mamillated and warty, and assumes the characteristic orange-yellow colour. In adulthood it can, in exceptional cases, give rise to a basal-cell carcinoma.

Basic Lesions:

Nodules

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Benign skin tumours

Follicular and sebaceous tumours

page: 386

13.3

Sweat gland tumours
Syringoma
Small, always multiple lesions measuring 1 to 3 mm in diameter and forming smooth, fleshcoloured papules generally occurring on the face (especially the eyelids), chest, neck, and axillae.

Basic Lesions:

Dermal Papules

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Benign skin tumours

Sweat gland tumours

page: 387

Eccrine poroma
Solitary benign congestive tumour bleeding in pinpoint haemorrhages, the wide base of which is encircled by a keratin collar. Its preferred site is the area of the sole around the heel.

Basic Lesions:

Nodules

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page: 388

Eccrine poroma

continued

In differential diagnostics it must be distinguished from pyogenic granuloma and achromic malignant melanoma.

Basic Lesions:

Nodules

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Benign skin tumours

Sweat gland tumours

page: 389

Cylindroma
Multiple benign tumours, often familiar, appearing on the scalp, which becomes mamillated and embossed (turban-like tumours). The surface of these tumours is smooth, glabrous, normal or pink in colour, with telangiectasias. There is no adherence to deep layers.

Basic Lesions:

Nodules

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Benign skin tumours

Sweat gland tumours

page: 390

13.4

Connective tissue tumours
Dermatofibroma
Nodular intradermal tumour 5 to 6 mm in diameter, firm to the touch, generally located on the legs. Its surface is pigmented to varying degree and often slightly keratotic. A dermatofibroma can sometimes be caused by an insect bite.

Basic Lesions:

Nodules

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page: 391

Dermatofibroma

continued

Basic Lesions:

Nodules

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An unusual variant is the pastillelike fibroma, a pink shiny nodule with a smooth surface surrounded by a very fine scaly collarette separated from the tumour by a groove.

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Benign skin tumours

Connective tissue tumours

page: 392

Acquired digital fibrokeratoma
Small tumour situated on the fingers or toes, more rarely on the palms and soles. Like the pastille fibroma, it is a solitary domed lesion, sometimes elongated and pedunculate, surrounded by a fine demarcating border. The surface is slightly warty. It is perhaps caused by a trauma.

Basic Lesions:

Warts

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Connective tissue tumours

page: 393

Keloid
Red and taut fibrous tumour with a smooth surface, slightly dented and sometimes surrounded by pseudopodia-like extensions called crab legs. They are very often itchy, painful, or tender. Post-traumatic keloids secondary to wounds, burns, vaccinations, or inflammatory skin lesions (such as adolescent acne) are distinguished from spontaneous keloids, which are more common in black people.

Basic Lesions:

Scars

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page: 394

Small and very soft fleshy mass, on average 3 to 5 mm in diameter, implanted in the skin by a thin stalk. These lesions are often multiple and their preferred sites are the axillae or inguinal flexures, the neck, the eyelids, and the orbital area.

Basic Lesions:

None specific

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Skin tag (acrochordon, molluscum pendulum)

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Benign skin tumours

Connective tissue tumours

page: 395

Juvenile xanthogranuloma
Single or multiple papulonodular yellow, orange or brown lesion of soft consistency, usually appearing on the face, scalp, trunk, and the base of the limbs. It occurs most frequently in neonates and infants, but can also be seen in children and even in adults.

Basic Lesions:

Nodules

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page: 396

Tuberous xanthoma
Small hemispherical papules, from a few millimetres to a centimetre in diameter, pink or orange in colour, sometimes very yellow on vitropression. The preferred sites are the elbows, knees, and buttocks.

Basic Lesions:

Dermal Papules; Nodules

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page: 397

Tuberous xanthoma

continued

A rare variant (eruptive xanthoma) is found in cases of severe hypertriglyceridaemia.

Basic Lesions:

Dermal Papules; Nodules

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page: 398

Xanthelasma palpebrarum
Flattened and clearly delimited yellowish or orange plaques around the eyes. This is one of the variants of xanthoma planum.

Basic Lesions:

Dermal Papules

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page: 399

Lipoma
Single or multiple benign tumours the colour of normal skin, which develop from subcutaneous fat. They are soft in consistency and they can attain a large size.

Basic Lesions:

Nodules

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page: 400

Leiomyoma
Benign tumours originating from the smooth muscles connected with hair follicles, genitals, nipples, or blood vessels. Leiomyomas are single or multiple, contractile, nodular tumours, which are red, pink, or brownish in colour.

Basic Lesions:

Nodules

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page: 401

Cutaneous mastocytosis
The term mastocytosis covers all lesions caused by the proliferation of mast cells in skin. Urticaria pigmentosa This is the most common form, encountered in all age groups. It produces a fairly monomorphic eruption of smooth violet or brown itchy macules or maculopapules. The reactivity of the lesions to certain stimuli, such as rubbing, is very characteristic (Darier's sign).
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Connective tissue tumours

page: 402

Cutaneous mastocytosis
continued

Mastocytoma Single firm tumour, orange in colour, occurring only in children.

Basic Lesions:

Erythematous Macule; Pigmented Macules; Dermal Papules None specific last screen viewed back next

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Connective tissue tumours

page: 403

Neural crest diseases
Nodules which are of normal skin colour or pink. Their firmness can vary. Their essential characteristic is that they are readily depressible.

Basic Lesions:

Nodules

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Neurofibroma

alphabetical

Benign skin tumours

Connective tissue tumours

page: 404

Neural crest diseases
Von Recklinghausen neurofibromatosis

continued

This is the most common form of systemic neural crest disease. It is essentially characterized by the combination of café au lait spots, “freckling", and cutaneous neurofibromas.

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 405

Neural crest diseases
Von Recklinghausen neurofibromatosis

continued

The "principal tumour" is a neurofibroma which is very large in relation to all those surrounding it. This hereditary condition is transmitted by an autosomal dominant gene with high penetrance and variable expression.

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 406

Neural crest diseases

continued

a. Angiofibroma Small, firm, pink or red tumid nodules covered in fine telangiectases and distributed symmetrically over the face: nasolabial folds, cheeks, perioral region.

Basic Lesions:

Nodules

Causes: search contents print

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cause

Tuberous sclerosis is a condition with autosomal dominant transmission, characterized by various isolated or associated clinical signs and symptoms.

picture

Bourneville's tuberous sclerosis (epiloia)

alphabetical

Benign skin tumours

Connective tissue tumours

page: 407

Neural crest diseases
b. Periungual fibromas (Koënen's tumours)

continued

Very rare horny angiofibromas of the toes.

Basic Lesions:

Warts

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 408

Neural crest diseases
c. Shagreen patch

continued

d. Achromic patches Fairly regular macules 1 to 10 cm in diameter, oval, rounded, or more characteristically in the shape of an ash leaf. They are white and do not have a hyperaemic or pigmented halo.
Basic Lesions: None specific

Causes: search contents print

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cause

Raised patch with an irregular outline and surface, covered with pale "orange-skin". Its preferred site is the lumbosacral region.

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 409

Angioma
Vascular star, composed of a red central point, sometimes raised and pulsatile, and arborizations radiating outwards. The arborizations disappear on vitropression.

Basic Lesions:

Vascular Macule

Causes: search contents print

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cause

picture

Spider telangiectasis

alphabetical

Benign skin tumours

Connective tissue tumours

page: 410

Angioma

continued

Basic Lesions:

Vascular Macule

Causes: search contents print

None specific last screen viewed back next

basic lesion

Autosomal dominant disease, characterized by telangiectases of the skin and mucous membranes, often not appearing until after puberty. The telangiectatic macules are poorly defined and the arborizations, in contrast to spider telangiectasis, are not symmetrical. They occur predominantly on the face, hands, buccal mucosa, the lips, and the tongue.

cause

picture

Hereditary haemorrhagic telangiectasia (Osler-Rendu-Weber disease)

alphabetical

Benign skin tumours

Connective tissue tumours

page: 411

Angioma
Angioma planum

continued

Congenital erythematous macule of varying intensity, extent, and shape. The colour varies from pale pink to dark red. Its preferred site is the face and the limbs, but it can spread to the mucosa. From the fourth decade of life the angioma thickens and superficial violet nodules can appear.

Basic Lesions:

Vascular Macule

Causes: search contents print

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Benign skin tumours

Connective tissue tumours

page: 412

Angioma
Tuberous angioma

continued

Bright red, distinctly demarcated, raised angioma in infants, projecting above the surrounding normal skin. Its growth is rapid, and it can bleed and ulcerate. Most of these angiomas disappear spontaneously in childhood, leaving no trace.

Basic Lesions:

Vascular Macule; Nodules

Causes: search contents print

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 413

Angioma
Subcutaneous angioma

continued

Basic Lesions:

Vascular Macule; Nodules

Causes: search contents print

None specific last screen viewed back next

basic lesion

cause

Tumour protruding under skin which is either normal, bluish, or telangiectatic. This lesion does not undergo spontaneous involution.

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 414

Angioma
Angiokeratoma

continued

Papular telangiectasia with a hyperkeratotic surface. Angiokeratomas of the scrotum and vulva are the most common. They are usually benign. Nevertheless, if they have disseminated over the buttocks, one must investigate for Fabry's disease.

Basic Lesions:

Dermal Papules; Keratoses

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 415

Angioma
Glomus tumour

continued

Small, bluish intradermal tumour, remarkable for its painfulness. Its site is most likely to be peripheral, on the hands and feet, more rarely on the forearms and buttocks. A common and characteristic site is the subungual region.

Basic Lesions:

Nodules

Causes: search contents print

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picture

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Benign skin tumours

Connective tissue tumours

page: 416

Angioma
Glomus tumour

continued

Basic Lesions:

Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 417

Angioma
Pyogenic granuloma

continued

Fleshy vascular pimple secondary to minimal or unnoticed trauma. Its eroded surface bleeds easily. Pyogenic granuloma may be "nipped" at its base by a characteristic groove which separates it from neighbouring skin.

Basic Lesions:

Nodules

Causes: search contents print

Mechanical Factors last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Connective tissue tumours

page: 418

Angioma

continued

B

A
basic lesion
Basic Lesions: Vascular Macule; Warts; Keratoses None specific last screen viewed back next Causes: search contents print

cause

Small bright red patches, flat or slightly tumid. Extremely common in old people, usually multiple and found on the trunk (A). In many cases they coexist with seborrhoeic warts (keratoses) (B).

picture

Senile angioma (cherry angioma)

alphabetical

Benign skin tumours

Connective tissue tumours

page: 419

Lymphangioma
Pseudovesicular elevations 1 to 5 mm in diameter, arranged in clusters or irregular plaques, translucent and taut but readily depressible. The lesions can occur anywhere on the body, but are more commonly found on the trunk and the base of the limbs. Lymphangioma (A) is very often found concomitantly with hemangionma (B).

A
B

Basic Lesions:

Vesicles

Causes: search contents print

None specific last screen viewed back next

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cause

picture

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Benign skin tumours

Connective tissue tumours

page: 420

(painful nodule in the ear) Inflammatory nodule of the helix, which is painful or tender. Its centre is keratotic or crater-like. It is nowadays regarded as a chondrodermatitis, but its aetiology has not been clarified.

Basic Lesions:

Nodules; Keratoses

Causes: search contents print

Mechanical Factors last screen viewed back next

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cause

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Chondrodermatitis nodularis helicis

alphabetical

Benign skin tumours

Connective tissue tumours

page: 421

Mucoid pseudocyst
Small, firm, flesh-coloured translucent nodule, occurring on the backs of the fingers near the distal interphalangeal joints and often causing a characteristic nail deformation with longitudinal grooves. It is the result of the accumulation of a mucoid substance in the dermis.

Basic Lesions:

Nodules

Causes: search contents print

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cause

picture

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Benign skin tumours

Connective tissue tumours

page: 422

13.5

Melanocytic naevi
Lentigo
Small (1 to 3 mm) brown or black hyperpigmented macules which can be distributed all over the skin and/or mucous membranes. Lentigines are often isolated. Sometimes they are generalized (lentiginosis) and form part of complex syndromes involving several internal organs. They represent epidermal hypermelanocytosis.

Basic Lesions:

Pigmented Macules

Causes: search contents print

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Benign skin tumours

Melanocytic naevi

page: 423

Mongolian spot
Bluish grey macules varying in size from a few millimetres to tens of centimetres and occurring most frequently on the loins and buttocks. They are especially common in Orientals. These spots represent dermal hypermelanocytosis.

Basic Lesions:

Pigmented Macules

Causes: search contents print

None specific last screen viewed back next

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alphabetical

Benign skin tumours

Melanocytic naevi

page: 424

Basic Lesions:

Pigmented Macules; Dermoepidermal Papules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

Melanocytic naevi are wellcircumscribed lesions which show a wide variety of colour, shape, thickness, consistency, and size, their diameter ranging from a few millimetres to a few centimetres.

picture

Melanocytic naevi (naevocytic naevi)

alphabetical

Benign skin tumours

Melanocytic naevi

page: 425

continued

Basic Lesions:

Pigmented Macules; Dermoepidermal Papules; Nodules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

They can be flat or raised, lenticular or discoid, and vary in colour from pale yellow to black-brown. The domed forms may be without pigmentation.

picture

Melanocytic naevi (naevocytic naevi)

alphabetical

Benign skin tumours

Melanocytic naevi

page: 426

Hairy melanocytic naevus
Some melanocytic naevi become covered in hairs at puberty.

Basic Lesions:

Pigmented Macules; Dermoepidermal Papules; Nodules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 427

Congenital pigmented naevus
Congenital pigmented naevi vary in size. Some are called giant because of their wide spread. They have an inhomogeneous surface (flat, papular, nodular, verrucous) and are most often variegated in colour, which ranges from light brown to black. They are often covered with thick hairs.

Basic Lesions:

Pigmented Macules; Dermoepidermal Papules; Nodules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 428

Spitz naevus (juvenile)
Isolated pinkish papulonodular tumour, frequently located on the face or the limbs. The histopathological appearance of this melanocytic naevus is very characteristic. In fairly exceptional cases there may be multiple Spitz naevi.

Basic Lesions:

Nodules

Causes: search contents print

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cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 429

Blue naevus
Small nodule, often less than a centimetre in diameter, blue-grey to black-blue in colour and situated especially frequently on the back of the hands and the feet, sometimes on the face. Its colour is caused by the deep dermal site of the melanocytic clusters.

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 430

Halo naevus (Sutton's naevus)
Sutton's naevus is a melanocytic naevus surrounded by a depigmented corona. In the course of its natural development the naevus component gradually disappears and the white halo undergoes gradual repigmentation. This feature of its course is probably autoimmune.

Basic Lesions:

Pigmented Macules; Achromic macules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 431

Halo naevus (Sutton's naevus)
continued

Basic Lesions:

Pigmented Macules; Achromic macules None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 432

Naevus of the nails
Presence of a more or less dark brown longitudinal band in the nail plate (melanonychia), clinical evidence of the existence of a melanocytic naevus in the matrix region.

Basic Lesions:

Pigmented Macules

Causes: search contents print

None specific last screen viewed back next

basic lesion

cause

picture

alphabetical

Benign skin tumours

Melanocytic naevi

page: 433

Chapter 14:

Premalignant skin tumours

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cause

picture

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page: 434

Raised red and well-defined plaques with a rough surface covered in scales of varying thickness. The lesions are isolated or multiple and their preferred site is on exposed regions such as the back of the hands or the face.

Basic Lesions:

Keratoses; Scales

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

Solar keratoses (senile keratoses)

alphabetical

Premalignant skin tumours

page: 435

continued

Basic Lesions:

Keratoses; Scales

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

The lesions are isolated or multiple and their preferred site is on exposed regions such as the back of the hands or the face. Here one can observe some characteristics of skin-ageing caused by sunlight: sallow skin, accentuated wrinkles, etc. If left untreated, some cases of solar keratosis develop into squamous cell carcinoma.

cause

picture

Solar keratoses (senile keratoses)

alphabetical

Premalignant skin tumours

page: 436

Actinic cheilitis
Relatively well-demarcated scaly erythematous plaque, sometimes encrusted and occurring essentially on the lower lip. Under the hyperkeratotic layer the epithelium is atrophic and bleeds easily at the slightest trauma. Actinic cheilitis spreads slowly over time and can degenerate into true squamous cell carcinoma.

Basic Lesions:

Erythematous Macule; Scales; Crusts Sunlight, Ultraviolet Radiation last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Premalignant skin tumours

page: 437

Well-demarcated and more or less rounded white or greyish plaques on the lower lip or the buccal mucosa. They occur more frequently in men and are probably promoted by smoking. Their natural evolution is in the direction of squamous cell carcinoma.

Basic Lesions:

Achromic macules; Warts

Causes: search contents print

Chemical Agents last screen viewed back next

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cause

picture

Leucoplakia – smoker's keratosis (stomatitis nicotina)

alphabetical

Premalignant skin tumours

page: 438

Bowen's disease
Slightly raised round or oval discoid lesion with distinct borders, varying in size, red or reddish brown in colour and covered with a crust of scales or with small crusts. The current understanding of Bowen's disease is that it is an intraepidermal carcinoma (in situ).

Basic Lesions:

Erythematous Macule; Scales; Crusts None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Premalignant skin tumours

page: 439

Bowen's disease

continued

Basic Lesions:

Erythematous Macule; Scales; Crusts None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Premalignant skin tumours

page: 440

Eryhtroplasia of Queyrat
Mucosal site of Bowen's disease. Red, well-demarcated, slightly protuberant plaque, with a glazed surface, on the glans penis. Similar lesions are observed on the vulval mucosa.

Basic Lesions:

Erythematous Macule

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Premalignant skin tumours

page: 441

Bowenoid papulosis
Erythematous or brownish papules on the glans and shaft of the penis, the vulva, and sometimes the perianal region. Their histopathology is similar to that of Bowen's disease. Human papillomaviruses (16, 18, 33) are the initial cause of this papulosis.

Basic Lesions:

Epidermal Papules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Premalignant skin tumours

page: 442

Radiodermatitis
Cicatricial atrophy, telangiectases, and pigmentation abnormalities form the classical picture of radiodermatitis. At a further stage ulcerations can appear. Basal cell carcinoma or squamous cell carcinoma are liable to develop after several years.

Basic Lesions:

Ulcers; Atrophy; Scars

Causes: search contents print

X-rays last screen viewed back next

basic lesion

cause

picture

alphabetical

Premalignant skin tumours

page: 443

Xeroderma pigmentosum
A hereditary disease with recessive autosomal transmission. The genetic basis of xeroderma pigmentosum is an enzyme deficiency resulting in disorders of DNA repair after ultraviolet irradiation. The condition is characterized by extreme photosensitivity and chronic actinic lesions including skin atrophy, freckles, and solar keratosis. Some tumours can develop early: keratoacanthoma, basal cell or squamous cell carcinoma, malignant melanoma.
Basic Lesions: Pigmented Macules; Nodules; Keratoses; Atrophy Sunlight, Ultraviolet Radiation last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Premalignant skin tumours

page: 444

Dubreuilh's melanosis picture
next

(Lentigo maligna melanoma, melanosis circumscripta precancerosa of Dubreuilh) Polychromatic pigmented macule, not raised and poorly defined. Its colour varies from pale beige to black. Dubreuilh's melanosis is observed in old people, most frequently on the face, less so on the back of the hands and on the legs. It spreads very slowly, reaching a diameter of several centimetres in about ten years.

Basic Lesions:

Pigmented Macules

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back

basic lesion

cause

alphabetical

Premalignant skin tumours

page: 445

Chapter 15:

Malignant skin tumours

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cause

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alphabetical

page: 446

15.1

Basal cell carcinomas
Nodular basal cell carcinoma
Globular tumour with a waxy or reddish tint, more or less translucent ("pearly" carcinoma), the smooth surface of which is streaked with fine telangiectases. The most common site is the face, but other areas can also be involved: back, limbs, genital region. Nodular basal cell carcinoma increases gradually in size and can ulcerate.

Basic Lesions:

Nodules

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Basal cell carcinomas

page: 447

Rodent ulcer
This variant of ulcerated basal cell carcinoma is characterized by 1. an ulcer as the primary lesion 2. considerable superficial spread 3. considerable spread in depth: the tumour "eats" into the tissue (hence "rodent ulcer") 4. the persistence of a translucent pearly and slightly telangiectatic border is very characteristic of basal cell carcinoma.
Basic Lesions: Nodules; Ulcers

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Basal cell carcinomas

page: 448

Basic Lesions:

Nodules; Atrophy; Sclerosis

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

This variant of carcinoma appears more like a plaque than a nodule. The whole central area of the lesion is white, atrophic, sclerous, and morphoea-like, but unlike morphoea it is streaked with telangiectases. At the edge of the lesion there is usually a pearly, telangiectatic, indurated swelling, sometimes covered with small crusts.

cause

picture

Flat cicatricial basal cell carcinoma ("scleroderma-like" carcinoma)

alphabetical

Malignant skin tumours

Basal cell carcinomas

page: 449

Basic Lesions:

Nodules

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

cause

A very rare variant, pigmented basal cell carcinoma is characterized by a considerable excess of melanin. It is usually nodular and is not ulcerated.

picture

Pigmented basal cell carcinoma

alphabetical

Malignant skin tumours

Basal cell carcinomas

page: 450

Basic Lesions:

Erythematous Macule; Scales

Causes: search contents print

None specific last screen viewed back next

basic lesion

The usual appearance is a pink plaque distinctly circumscribed by rounded outlines. Its limits are usually marked by a fine, pearly, filiform edge, which distinguishes it from Bowen's disease. Growth is very slow. The preferred site of this variant is on the trunk.

cause

picture

Pagetoid basal cellular carcinoma (superficial basal cell carcinoma)

alphabetical

Malignant skin tumours

Basal cell carcinomas

page: 451

15.2

Squamous cell carcinomas
The majority of squamous cell carcinomas are seen on uncovered areas: face (lower lip in particular) and the back of the hands. They develop either in apparently healthy skin, or, most frequently, over a precancerous lesion: solar keratosis, Bowen's disease, etc. They are liable to metastasize, mainly via lymph.

Basic Lesions:

Nodules

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

cause

picture

alphabetical

Malignant skin tumours

Squamous cell carcinomas

page: 452

Basic Lesions:

Nodules

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

cause

Large, ulcerated, which oozes blood and forms crusts. The peripheral swelling is very indurated. The base of the whole lesion is distinctly infiltrated.

picture

Squamous cell carcinoma of the face

alphabetical

Malignant skin tumours

Squamous cell carcinomas

page: 453

Basic Lesions:

Nodules; Scales; Crusts; Ulcers

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

basic lesion

cause

This sanious ulceration is surrounded by an indurated peripheral swelling. In the present case it is developing from actinic cheilitis.

picture

Squamous cell carcinoma of the lower lip

alphabetical

Malignant skin tumours

Squamous cell carcinomas

page: 454

Hard ulcerated vegetating tumour of the glans.

Basic Lesions:

Nodules

Causes: search contents print

None specific last screen viewed back next

basic lesion

cause

picture

Squamous cell carcinoma of the penis

alphabetical

Malignant skin tumours

Squamous cell carcinomas

page: 455

15.3

Paget's disease
Encrusted scaly erythematous and locally erosive plaque on the nipple and the areola. Its perfectly defined border distinguishes it from an eczematous reaction (see page 52). The disappearance of the nipple's elevation must also be noted. This carcinoma is seen in 3 to 5% of breast cancers and develops mainly in postmenopausal women. Extramammary sites are rare and confined to skin areas with apocrine sweat glands (genitals, perineum, perianal region).

Basic Lesions:

Erythematous Macule; Scales; Crusts None specific last screen viewed back next

Causes: search contents print

basic lesion

cause

picture

alphabetical

Malignant skin tumours

Paget's disease

page: 456

15.4

Cutaneous metastases
Cutaneous metastases of deep cancers can assume various clinical appearances: Carcinomatous lymphangitis Classically observed in cancer of the breast, characterized by an extensive inflammatory plaque, sometimes wrongly called "carcinomatous erysipelas".

Basic Lesions:

Erythematous Macule; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Cutaneous metastases

page: 457

Cutaneous metastases

continued

forming skin-embedded spherical colourless or bluish masses.

Basic Lesions:

Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

Nodularcutaneous-subcutaneous metastases

alphabetical

Malignant skin tumours

Cutaneous metastases

page: 458

15.5

Melanoma (malignant)
Melanoma is a tumour which develops either as a primary lesion from epidermal melanocytes or from the cells of congenital junctional and compound naevi, or much more rarely from intradermal and blue naevi. It metastasizes via lymph and/or blood. Several variants of melanoma have been described:

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Melanoma (malignant)

page: 459

Basic Lesions:

Pigmented Macules

Causes: search contents print

None specific last screen viewed back next

basic lesion

Slightly raises melanotic spot, varying in colour from brown to black, with a margin. It undergoes a horizontal growth phase lasting several months and then finally starts its vertical phase, in which it invades the deep tissue. It occurs anywhere on the body, but more readily on the back in men and on the legs in women.

cause

picture

Superficial spreading melanoma (SSM)

alphabetical

Malignant skin tumours

Melanoma (malignant)

page: 460

Nodular melanoma
Infiltrated brown or black nodules, sometimes violet-red and more rarely achromic. The lesion, which is often dome-shaped, finally ulcerates and bleeds.

Basic Lesions:

Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Melanoma (malignant)

page: 461

Infiltrated nodular formations, which may or may not be pigmented, sometimes oozing blood, developing from a Dubreuilh's melanosis.

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

Sunlight, Ultraviolet Radiation last screen viewed back next

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cause

picture

Melanoma developing over Dubreuilh's melanosis precancerosa

alphabetical

Malignant skin tumours

Melanoma (malignant)

page: 462

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

None specific last screen viewed back next

basic lesion

Located on the extremities (palm of the hands, sole of foot, digital extremities), it resembles superficial spreading melanoma or nodular melanoma, representing only a particular site of either of these. The illustration suggests this double categorization particularly well.

cause

picture

Acral lentiginous melanoma (melanoma of the extremities)

alphabetical

Malignant skin tumours

Melanoma (malignant)

page: 463

Melanoma metastases
Numerous black or bluish indurated nodules developing near a previously excised melanoma.

Basic Lesions:

Pigmented Macules; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Melanoma (malignant)

page: 464

15.6

Dermatofibrosarcoma protuberans (Darier-Ferrand fibrosarcoma)
Large multinodular dented tumour which adheres to the skin surface without ulcerating it and infiltrates the dermis and subcutaneous tissue, often beyond the limits of palpation. The tumour develops gradually, without painful symptoms. It affects adults of both sexes with a preference for the trunk and the base of the limbs. This fibrosarcoma has local malignancy, but can metastasize in exceptional cases.

Basic Lesions:

Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Dermatofibrosarcoma protuberans (Darier-Ferrand fibrosarcoma)page:

15.7

Kaposi's angiosarcoma
Violet nodules on the ankles and feet in an elderly patient. In the present case it is not occurring in the context of acquired immune deficiency syndrome.

Basic Lesions:

Vascular Macule; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Kaposi's angiosarcoma

page: 466

15.8

Malignant lymphomas – mycosis fungoides
Among the many malignant cutaneous lymphomas, mycosis fungoides (epidermotropic Tlymphoma) represents an unusual entity. At the eruptive stage, the clinical picture is characterized by dull coppery red infiltrated plaques distributed in arcs.

Basic Lesions:

Erythematous Macule; Nodules

Causes: search contents print

None specific last screen viewed back next

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cause

picture

alphabetical

Malignant skin tumours

Malignant lymphomas – mycosis fungoides

page: 467

Tumours can subsequently develop, and these may ulcerate.

Basic Lesions:

Ulcers

Causes: search contents print

None specific last screen viewed back next

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cause

picture

Malignant lymphomas – mycosis fungoides continued

alphabetical

Malignant skin tumours

Malignant lymphomas – mycosis fungoides

page: 468

15.9

Paraneoplastic syndromes
Malignant neoplasms can be accompanied by skin diseases which themselves are not neoplastic in character, nor directly caused by the presence of the tumour (in contrast to metastases), but which develop alongside the malignant neoplasm, regressing if and when the latter is eliminated and reappearing if it recurs. These so-called paraneoplastic dermatoses can occur when the malignant neoplasm has already distinctly developed, but they can also appear as a sign revealing a small neoplasm (Bazex's sign).
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Malignant skin tumours

Paraneoplastic syndromes

page: 469

Basic Lesions:

Warts; Keratoses

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Paraneoplastic skin diseases are, amongst others, malignant acanthosis nigricans, Gammel's erythema gyratum repens, and Bazex's paraneoplastic keratosis, hypertrichosis lanuginosa. Both last diseases have been selected to illustrate paraneoplastic syndromes.

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Bazex's paraneoplastic acrokeratosis

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Malignant skin tumours

Paraneoplastic syndromes

page: 470

Hypertrichosis lanuginosa
This occurs suddenly (within a few weeks), in the form of a down of long, white, silky, fine, and extremely numerous lanuginous hairs extending all over the glabrous skin and especially on the face. The rate of growth is accelerated and the hair (of the head) becomes more luxuriant. The papillae on the lingual mucosa are hypertropic and glazed. There is a distinct change in the sense of taste.

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Hypertrichosis lanuginosa
continued

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The appearance of such a picture must lead one to suspect the presence of an associated neoplasm. In the present case a neoplasm was detected in the breast. Radical treatment of the cancer leads to the disappearance of the acquired lanuginous hypertrophy. The recurrence of the neoplasm is accompanied by reappearance of the hypertrichosis (paraneoplastic dermatosis in the strict sense).

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Malignant skin tumours

Paraneoplastic syndromes

page: 472

Chapter 16:

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Algorithmic approach to a dermatological diagnosis

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page: 473

16.1

Urticaria
To conclude this pictorial presentation of the most common skin diseases for the general practitioner, we thought it would be interesting to include the modern diagnostic procedure in dermatology applied to an everyday problem: urticaria.

Physical Urticaria? Provoked by direct contact with a substance? Genetic origin? Systemic origin? Medicamentouse or food allergy? Infectious origin?

No No No No No

Yes Yes Yes Yes Yes

If duration is longer than 6 weeks: Chronic idiopathic urticaria

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No

Yes

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Urticaria

page: 474

Physical urticaria

Click

Vibratory angio-oedema
Click

Click

Solar urticaria Cholinergic urticaria Cold urticaria Heat urticaria Delayed pressure urticaria
Click

Click

Click

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Click

No Physical urticaria

Click

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Simple or retarded dermographism

Aquagenic urticaria

Click

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Algorithmic approach to a dermatological diagnosis

Urticaria

page: 475

Physical urticaria
Simple or retarded dermographism
Rub with a blunt tip. other disease

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Urticaria

page: 476

Physical urticaria
Solar urticaria
Photosensitivity test. other disease

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Algorithmic approach to a dermatological diagnosis

Urticaria

page: 477

Physical urticaria
Cholinergic urticaria
Small papules induced by heat, physical effort, stress. other disease

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Urticaria

page: 478

Physical urticaria
Cold urticaria
Test with ice cube sheathed in plastic. other disease

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Urticaria

page: 479

Physical urticaria
Heat urticaria
Test with test-tube of hot water.

Aquagenic urticaria
Immersion test: hand in water at ambient temperature.

Vibratory angio-oedema basic lesion
Professional circumstances ( particularly pneumatic hammer). other disease

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page: 480

Physical urticaria
Delayed pressure urticaria
Test by pressure with a weight strapped on to the body. other disease

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Urticaria

page: 481

Provoked by direct contact with a substance
Contact urticaria
Rapid result patch test, prick test or scratch test. other origin

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Urticaria

page: 482

Genetic origin
Hereditary angioneurotic oedema
Investigate for deficiency of C1 esterase inhibitor. other origin

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Urticaria

page: 483

Systemic origin
Lesions persisting at the same place for more than 24h, not very itchy, accompanied by joint pains and myalgias; histopathological appearance that of vasculitis. Investigate for:
1 2

other origin
3 4

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-

acute lupus erythematosus (1-3) Still’s disease macroglobulinaemia blood disease hyperthhyroidism urticarial vasculitis (4)

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alphabetical

Algorithmic approach to a dermatological diagnosis

Urticaria

page: 484

Medicamentous or food allergy
Painstaking history with regard to drugs and food
- Drugs Especially acetylsalicylic acid (see photos) - Food Especially preservatives and colourings Do provocation tests. other origin

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Urticaria

page: 485

Infectious origin
- Hepatitis A (photo) Exceptional case of figured urticaria revealing hepatitis A in its initial phase. The yellowish colour of the central oedematous (urticated zone) is caused by accumulation of bilirubin in the oedema fluid. Hepatitis B or C Infectious mononucleosis Parasitosis Focus of bacterial infection Focus of mycotic infection other origin

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Algorithmic approach to a dermatological diagnosis

Urticaria

page: 486

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Picture Index

alphabetical

page: 487

Skin from the axillary region

Structure of the epidermis

Structure of the epidermis

Structure of the epidermis

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Skin from the forehead region

Skin from the face of an elderly subject

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alphabetical

Picture Index

page: 488

Erythematous macule

Vascular macule

Purpuric macule

Pigmentary macules

Pigmentary macules

Pigmentary macules

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page: 489

Epidermal papules

Dermal papules

Dermo-epidermal papules

Nodules

Tubercles

Vegetations

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page: 490

Warts

Keratoses

Vesicles

Bullae

Pustules

Scales

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page: 491

Crusts

Excoriations (or ulcerations)

Fissures

Ulcers

Gangrene

Atrophy

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page: 492

Scars

Sclerosis

Chronic occupational contact dermatitis

Vesicular contact dermatitis

Vesicular contact dermatitis

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Acute exudative contact dermatitis

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alphabetical

page: 493

Bullous contact dermatitis

Bullous contact dermatitis

Crusted eczema

Crusted eczema

Scaly dry erythematous contact dermatitis

Acute irritant dermatitis

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page: 494

Cumulative insult dermatitis

Infected retro-auricular dermatitis

Atopic dermatitis of childhood

Atopic dermatitis of the folds in a child

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Chronic palmar irritant dermatitis

Atopic dermatitis of the face in an infant

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alphabetical

page: 495

Eczema of the nipples

Atopic cheilitis

Atopic conjunctivitis

Atopic dermatitis of the hands in the adult

Pityriasis alba

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Atopic dermatitis in the adult

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alphabetical

page: 496

Juvenile plantar dermatosis

Juvenile plantar dermatosis

Nummular dermatitis

Nummular dermatitis

Gravitational eczema

Seborrhoeic dermatitis of the trunk

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page: 497

Bullous pompholyx of the palms

Eczematous pompholyx of the palms

Asteatotic eczema

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Seborrhoeic dermatitis of the hairline

Seborrhoeic dermatitis of the face

Pompholyx of the fingers

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alphabetical

page: 498

Latex contact urticaria

Prick test with latex

Dermographism

Pressure urticaria

Cold urticaria

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Provocative use test with latex gloves

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alphabetical

page: 499

Solar urticaria

Urticated weals

Papular urticaria

Figured urticaria

Hereditary angio-oedema

Urticarial vasculitis

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page: 500

Herpes, type I

Herpes, type II (genital)

Varicella

Varicella

Zoster of the trunk

Ophthalmic nerve zoster

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page: 501

Common warts

Plane warts

Plane warts

Condylomata acuminata

Plantar wart

Mosaic warts

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page: 502

Horny filiform wart

Hairy leucoplakia

Molluscum contagiosum

Multiple mollusca contagiosa

ORF

Erythema infectiosum

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page: 503

Erythema infectiosum

Measles

Hand-foot-and-mouth-disease

Hand-foot-and-mouth-disease

Hand-foot-and-mouth-disease

Rubella

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page: 504

Necrotic herpes zoster

Necrotic herpes zoster

Seborrhoeic dermatitis

Prurigo

Gingivitis

Molluscum contagiosum

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page: 505

Kaposi's sarcoma

Kaposi's sarcoma

Condylomata acuminata

Bullous impetigo

Non-bullous impetigo

Ecthyma

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page: 506

Folliculitis

Furuncle (BOIL)

Carbuncle

Erysipelas

Erysipelas

Orbital cellulitis

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page: 507

Septic emboli

Erythema chronicum migrans

Erythema chronicum migrans

Borrelia pseudolymphoma

Proteus infection

Cat-scratch disease

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page: 508

Cat-scratch disease

Intertrigo

Lupus vulgaris

Lupus vulgaris

Scofuloderma

Complication of BCG vaccination

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picture

alphabetical

page: 509

Erythrasma

Trichomycosis axillaris

Pitted keratolysis

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Infection with mycobacterium marinum

Infection with mycobacterium marinum

Infection with mycobacterium fortuitum or chelonae

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alphabetical

page: 510

Late secondary syphilis

Papular syphilids

Genital gonorrhoea

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cause

Syphilitic chancre (primary sore)

Syphilitic chancre (primary sore)

Secondary syphilis

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alphabetical

page: 511

Tinea corporis

Tinea corporis

Tinea faciei

Tinea faciei

Tinea cruris

Tinea manuum

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cause

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page: 512

Tinea manuum

Tinea pedum (athlete's foot)

Tinea pedum (athlete's foot)

Tinea pedum (athlete's foot)

Tinea capitis or ringworm

Kerion

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page: 513

Kerion

Kerion

Onychomycosis due to dermatophytes

Thrush

Angular cheilitis

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Onychomycosis due to dermatophytes

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alphabetical

page: 514

Candidal intertrigo

Candidal intertrigo

Candidal vulvovaginitis

Candidal balanitis

Candidal paronychia and subungual infection

Napkin candidiasis (infant)

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cause

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alphabetical

page: 515

Pityriasis versicolor

Pityriasis versicolor

Pityriasis versicolor

Sporotrichosis

Mycetoma (Madura foot)

Human scabies

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page: 516

Human scabies

Human scabies

Human scabies

Animal scabies

Pediculosis (head lice)

Pediculosis (head lice)

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cause

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alphabetical

page: 517

Crab lice (pubic lice)

Crab lice (pubic lice)

Trombiculiasis

Trombiculiasis

Infantile papular urticaria (strophulus)

Flea bites

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alphabetical

page: 518

Flea bites

Leishmaniasis

Leishmaniasis

Leishmaniasis

Larva migrans (creeping eruption)

Larva migrans (creeping eruption)

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cause

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page: 519

Tungiasis (chigger)

Tungiasis (chigger)

Psoriasis vulgaris

Psoriasis vulgaris

Psoriasis vulgaris

Psoriasis vulgaris

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page: 520

Psoriasis vulgaris

Psoriasis vulgaris

Psoriasis vulgaris

Psoriasis vulgaris

Pustular psoriasis

Pustular psoriasis

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page: 521

Pustular psoriasis

Psoriatic erythroderma

Psoriatic erythroderma

Palmoplantar psoriasis

Flexural psoriasis

Psoriasis of the nails

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page: 522

Psoriasis of the scalp

Psoriasis of the face

Mucosal psoriasis

Mucosal psoriasis

Pityriasis rosea

Pityriasis rosea

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page: 523

Pityriasis lichenoides

Varioloid parapsoriasis

Varioloid parapsoriasis

Chronic superficial scaly dermatitis

Premycotic

Simple cutaneous lichen planus

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alphabetical

page: 524

Oral lichen planus

Hypertrophic lichen planus

Hypertrophic lichen planus

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Simple cutaneous lichen planus

Simple cutaneous lichen planus

Oral lichen planus

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alphabetical

page: 525

Lichen planus of the nails

Graft versus host disease

Graft versus host disease

Lichenification

Subacute prurigo

Subacute prurigo

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page: 526

Discoid lupus erythematosus

Discoid lupus erythematosus

Discoid lupus erythematosus

Subacute lupus erythematosus

Systemic lupus erythematosus

Systemic lupus erythematosus

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page: 527

Jessner and Kanof disease

Dermatomyositis

Dermatomyositis

Localized morphoea

Localized morphoea

Systemic sclerosis

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page: 528

Systemic sclerosis

Lichen sclerosus

Lichen sclerosus

Lichen sclerosus

Sarcoidosis

Sarcoidosis

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page: 529

Sarcoidosis

Sarcoidosis

Granuloma annulare

Necrobiosis lipoidica

Necrobiosis lipoidica

Vasculitis

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Cutaneous vasculitis

Cutaneous vasculitis

Cutaneous vasculitis

Atrophie blanche

Atrophie blanche

Polyarteritis nodosa

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page: 531

Erythema elevatum diutinum

Erythema nodosum

Erythema nodosum

Nodular vasculitis

Pyoderma gangrenosum

Pyoderma gangrenosum

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page: 532

Erythema multiforme

Erythema multiforme

Erythema multiforme

Erythema multiforme

Sweet's syndrome

Bullous pemphigoid

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Bullous pemphigoid

Pemphigus vulgaris

Pemphigus vulgaris

Pemphigus erythematosus

Pemphigus erythematosus

Benign familial chronic pemphigus

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Dermatitis herpetiformis

Dermatitis herpetiformis

Linear IgA bullous disease

Simple epidermolysis bullosa

Simple epidermolysis bullosa

Dystrophic forms of epidermolysis bullosa

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page: 535

Porphyria cutanea tarda

Bullous phytophotodermatitis

Acne vulgaris

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Dystrophic forms of epidermolysis bullosa

Diabetic bullae

Porphyria cutanea tarda

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alphabetical

page: 536

Acne vulgaris

Acne vulgaris

Acne vulgaris

Acne conglobata

Acne conglobata

Infantile acne

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page: 537

Rosacea

Rosacea

Perioral dermatitis

Fixed pigmented erythema

Maculoppapular exanthema

Lyell's syndrome

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Lichenoid eruptions

Lichenoid eruptions

Drug-induced photoallergic eruption

Acneiform facial eruption

Psoriatiform eruption

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Drug-induced phototoxic eruption

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page: 539

Drug-induced lupus

Cortisone atrophy

Bromide and iodide eruptions

Gingival hyperplasia

Melasma

Benign summer photodermatitis

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page: 540

Polymorphic light eruption

Chilblains

Alopecia areata

Alopecia areata

Pseudopelade

Trichotillomania

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Androgenetic alopecia

Aphtae, aphthosis, Behçet's disease

Black hairy tongue

Scrotal / fissured tongue

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Aphtae, aphthosis, Behçet's disease

Aphtae, aphthosis, Behçet's disease

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alphabetical

page: 542

Geographic tongue

Allergic contact cheilitis

Darier's disease

Darier's disease

Ichthyosis vulgaris

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Cheilitis caused by systemic use off isotretinoin

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page: 543

Pityriasis rubra pilaris

Pityriasis rubra pilaris

Keratosis pilaris

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Sex-linked (recessive) ichthyosis

Sex-linked (recessive) ichthyosis

Hereditary palmoplantar keratoderma

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page: 544

Keratosis pilaris

Venous leg ulcer

Venous leg ulcer

Ischaemic (arterial) leg ulcer

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Erythema annulare centrifugum

Erythema annulare centrifugum

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alphabetical

page: 545

Ulcer caused by capillaritis

Neurotrophic leg ulcer

Neurotrophic leg ulcer

Skin self-mutilation simulated disease

Skin self-mutilation simulated disease

Self-mutilation, pathomimicry

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Verrucous epidermal naevus

Verrucous epidermal naevus

Inflammatory linear verrucous epidermal naevus

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Self-mutilation, pathomimicry

Seborrhoeic keratosis / wart

Seborrhoeic keratosis / wart

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page: 547

Kerato-acanthoma

Spectacle frame acanthoma

Spectacle frame acanthoma

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Inflammatory linear verrucous epidermal naevus

Becker's naevus

Clear cell acanthoma

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alphabetical

page: 548

Epidermoid cyst

Trichilemmal cyst

Milia

Trichoepithelioma

Senile sebaceous adenoma

Senile sebaceous adenoma

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Eccrine poroma

Cylindroma

Dermatofibroma

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Jadassohn's sebaceous naevus

Syringoma

Eccrine poroma

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alphabetical

page: 550

Dermatofibroma

Skin tag

Juvenile xanthogranuloma

Tuberous xanthoma

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Acquired digital fibrokeratoma

Keloid

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page: 551

Tuberous xanthoma

Xanthelasma palpebrarum

Lipoma

Leiomyoma

Cutaneous mastocytosis

Cutaneous mastocytosis

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Neural crest diseases

Neural crest diseases

Neural crest diseases

Neural crest diseases

Neural crest diseases

Neural crest diseases

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Angioma

Angioma

Angioma

Angioma

Angioma

Angioma

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Angioma

Angioma

Angioma

Angioma

Lymphangioma

Chondrodermatitis nodularis helicis

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Mucoid pseudocyst

Lentigo

Mongolian spot

Melanocytic naevi

Melanocytic naevi

Hairy melanocytic naevus

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page: 556

Halo naevus

Halo naevus

Naevus of the nails

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basic lesion

cause

Congenital pigmented naevus

Spitz naevus (juvenile)

Blue naevus

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alphabetical

page: 557

Solar keratoses

Solar keratoses

Actinic cheilitis

Leucoplakia

Bowen's disease

Bowen's disease

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page: 558

Eryhtroplasia of queyrat

Bowenoid papulosis

Radiodermatitis

Xeroderma pigmentosum

Dubreuilh's melanosis

Nodular basal cell carcinoma

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page: 559

Rodent ulcer

Pagetoid basal cellular carcinoma

Squamous cell carcinomas

Squamous cell carcinoma of the face

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Flat cicatricial basal cell carcinoma

Pigmented basal cell carcinoma

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page: 560

Cutaneous metastases

Cutaneous metastases

Melanoma (malignant)

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Squamous cell carcinoma of the lower lip

Squamous cell carcinoma of the penis

Paget's disease

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page: 561

Acral lentiginous melanoma

Melanoma metastases

Dermatofibrosarcoma protuberans

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Superficial spreading melanoma

Nodular melanoma

Melanoma over Dubreuilh's melanosis precancerosa

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page: 562

Kaposi's angiosarcoma

Paraneoplastic syndromes

Bazex's paraneoplastic acrokeratosis

Hypertrichosis lanuginosa

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Malignant lymphomas – mycosis fungoides

Malignant lymphomas – mycosis fungoides

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page: 563

Hypertrichosis lanuginosa

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page: 564