A COLOR GUIDE TO DIAGNOSIS AND THERAPY

CLINICAL
DERMATOLOGY

THOMAS P. HABIF
FOURTH EDITION

Mosby
 Disorders Index
Abscesses, 284 Cat-scratch disease, 528
Acanthosis nigricans, 900 Cavernous hemangiomas, 818
Acne keloidalis, 283, 861 Cellulitis, 273
Acne rosacea, 198 Cement dermatitis and burns, 95

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Acne, 162
lentiginous melanoma, 796
Acrochordon, 706
Actinic cheilitis, 738
Actinic comedones, 664
Actinic keratosis, 736
Adenoma sebaceum, 909
Allergic contact dermatitis, 84
Alopecia areata, 855
Androgenetic alopecia female 844
Androgenetic alopecia men, 842
147
Chancroid, 327
Chapped fissured feet, 62
Cherry angioma, 824
389
Cholinergic urticaria, 145
Chondrodermatitis nodularis chronica hellicis, 716
Churg-Strauss syndrome, 640, 649
Cicatricial pemphigoid, 548
Cold urticaria, 146
Compound nevi, 774
Condyloma acuminata, 358
Congenital nevi, 777

Angiokeratoma, 824 Congenital syphilis, 320
Angular cheilitis, 450 Contact dermatitis, 81
Animal bites, 529 Contact urticaria syndrome, 152
Ants, 538 Coral poisoning, 543
I pruritus, 147 Corns 374
Aquagenic urticaria, 142 Cowden's disease, 912
Arsenical keratoses, 753 Crab lice, 506
Arterial leg ulcers, 74 Cradle cap, 242
n
Arthritis-dermatitis syndrome, 333
Hjn Creeping eruptions, 537
Asteatotic eczema (xerosis), 60 CREST syndrome, 617, 832
Atopic dermatitis, 105 Cutaneous horn, 706
Atypical mole syndrome, 782 Cutaneous larva migrans, 537
Baboon syndrome, 94 Cutaneous lymphoma, 754
Bacillary angiomatosis, 827 Cystic acne, 174
RH
Basal cell carcinoma, 724 Delusions of parasitosis, 70
Bathing trunk nevus, 778 Dermal nevi, 775
Beau's lines, 463, 865, 884 Dermatitis herpetiformis, 548, 554
Becker's nevus, 780 Dermatofibroma, 708
Bee stings, 531 607
Benign familial chronic pemphigus, 575 Dermatophytid reaction, 414
Benign juvenile melanoma, 781 Dermographism, 142
Berlock dermatitis, 682 Digital mucous cyst, 888
Bite wounds, 530 Discoid lupus erythematosus, 596,
Black heel, 374 Dissecting cellulitis, 861
Black widow spider bites, 512 Distal nail splitting, 883
Blepharitis, 242 Dog bites, 529
Blistering distal dactylitis, 287 Drug eruptions, 490
Blue nevus, 782 Dyshidrosis (pompholyx), 58
Bowenoid papulosis, 343 Dysplastic nevi, 782
Bowen's disease, 748 Dystrophic epidermolysis bullosa, 576
Brown recluse spider bites, 514 Ecthyma gangrenosum, 298
Bullous impetigo, 268 Ecthyma, 272
Bullous pemphigoid, 567-570, 568, 569 Eczema craquele, 60
Buschke-Lowenstein, giant condylomata of, 752 Eczema 388
spots, 694, 905 dermatitis, 107
Candidiasis, 440 En coup de sabre, 622
Capillary hemangioma, lobular, 826 Eosinophilic folliculitis 358
Carbuncles, 284 Ephelides, 691
Cat bites, 529 Epidermal cyst, 717
Caterpillar dermatitis, 510 Epidermal nevus, 713
 Disorders Index
Epidermolysis bullosa acquisita, 574 Labial melanocytic macule, 782
Epidermolysis bullosa simplex, 576 Lentigo (liver spots), 691
Erysipelas, 273 Lentigo maligna, 794
Erysipeloid, 287 Leukocytoclastic vasculitis, 642

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Erythema ab
Erythema elevatum
Erythema
Erythema multiforme,
Erythema nodosum, 635

419
694

Erythema toxicum neonatorum, 582

psoriasis, 213
Erythroplasia of Queyrat, 749
Erythropoietic protoporphyria 680
subitum, 471
Exercise-induced anaphylaxis, 145
653
Leukonychia, 882
Leukoplakia, 751
Lichen planopilaris, 861
Lichen planus, 250
Lichen sclerosis et atrophicus, 257
Lichen simplex chronicus, 54, 63, 66
Linear

Lyme disease,
bullous dermatosis, 556
Lupus erythematosus, 592

Lymphangioma circumscriptum, 825

Male-pattern baldness, 842
Malignant melanoma, 786

Exfoliative erythroderma, 491 Mastocytosis, 156
External otitis, 294 Measles, 460
Extramammary Paget's disease, 764 299
Fifth disease, 468 Methotrexate 229
I
Fire ant stings, 538 194
Folliculitis decalvans, 860 Miliaria rubra, 205
Folliculitis, 279 Morphea, 620
Furuncles (boils), 284 disease, 261
n
Gardner's syndrome, 913
Hjn Muir-Torre syndrome, 914
Genital warts, 336 Mycosis fungoides, 754
German measles, 467 Myiasis, 534
Gonorrhea, 330 Necrobiosis lipoidica, 897
Granuloma annulare, 898 Neurotic excoriations, 68
Granuloma inguinale, 329 Nevoid basal cell carcinoma syndrome, 731
RH
Guttate psoriasis, 212 Nevus flammeus (port-wine stains), 819
Hairy leukoplakia, 363 Nevus sebaceous, 715
Halo nevi, Nummular eczema, 54
Hand eczema, 50 Onycholysis, 880
Hand, foot, and mouth disease, 462 Onychomycosis 875
Henoch-Schonlein purpura, 645 Otitis externa, 294
Herpes simplex, 381 Paronychia, 867
Herpes zoster, 394 Parvovirus B-19 infection, 468
Herpetic whitlow, 873 Pearly penile papules, 339
Hidradenitis suppurativa, 202 Pediculosis, 506
Hirsutism, 846 Pemphigoid, 567
Hypersensitivity vasculitis, 642 Pemphigus, 559
Ichthyosis vulgaris, 115 Perioral dermatitis, 30, 195
Idiopathic guttate hypomelanosis, 689 Perleche, 450
Intertrigo, 418 Pilar cyst, 719
Irritant contact dermatitis, 82 Pilar cysts, 719
Isotretinoin, 186 Pitted keratolysis, 416
Junction nevus, 774 Pityriasis alba, 689
Kaposi's sarcoma, 827 Pityriasis lichenoides chronica, 261
Kawasaki syndrome, 474 Pityriasis rosea, 246
Keloids, 709 Pityriasis rubra pilaris, 240
Keratoacanthoma, Plantar warts, 374
Keratoderma blennorhagicum, 216 PLEVA 261
Keratolysis exfoliativa, 55 Poikiloderma vasculare atrophicans, 756
Keratolysis, pitted, 416 Poikiloderma, 609
Keratosis pilaris, Poison ivy, 85

Continued
 Disorders Index
Polyarteritis nodosa, 640 Sweet's syndrome, 650
Polymorphous light eruptions, 671 Swimmer's itch, 539
Pompholyx 58 Sycosis barbae, 282
Porphyria cutanea tarda, 675 Syphilis, 315

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Port-wine stains, 819
Postherpetic neuralgia, 400
Pressure urticaria, 144
Prurigo nodularis, 68,

Pseudofolliculitis barbae, 280

folliculitis, 290
Pseudopelade, 860
Pseudoporphyria, 679
Pseudoxanthoma elasticum, 916
Psoriasis, 209
Pustular psoriasis
Syringoma, 721
Systemic lupus erythematosus, 600
lyphoma, cutaneous, 754
Telangiectasia macularis eruptiva perstans, 157
Telangiectasia, 830
Telogen effluvium, 841
Tendinous xanthoma, 904
Terry's nails, 885
Tick bite paralysis, 526
Tinea
Tinea barbae, 434
Tinea capitis, 427
243

Pyoderma gangrenosum, 653 Tinea corporis, 420
Pyogenic granuloma, 826, 889 Tinea cruris, 417
Rocky Mountain spotted fever, 524 Tinea gladiatorum, 422
Rosacea, 198 Tinea incognito, 38, 417, 426
I
Roseola infantum, 471 Tinea pedis, 413
Rubella, 467 Tinea unguium, 874
Scabies, 497 Tinea versicolor, 451
Scarlet fever, 464 Toxic epidermal necrolysis, 491, 627
n
Hjn disease, 656 Toxic shock syndrome, 479
Scleroderma, 613 Transient neonatal pustular melanosis, 582
Seabather's eruption, 540 Trichomonas vaginalis, 440
Sebaceous hyperplasia, 720 Trichomycosis axillaris, 862
Seborrheic dermatitis, 242 Trichotillomania, 858
Seborrheic keratosis, 698 Tuberous sclerosis, 909
RH
Senile comedones, 194 Tuberous xanthoma, 904
Serum sickness, Tufted folliculitis, 860
Sezary syndrome, 760 Unilateral nevoid telangiectasia syndrome, 832
Shingles, 394 Urethritis, 309
Skin tags, 706 Urticaria pigmentosa, 156
Small-vessel vasculitis, Urticaria, 129
Speckled lentiginous nevus, 778 Urticarial vasculitis,
Spider angioma, 830 Vaginal lichen planus, erosive, 255
Spider bites, Vaginosis, bacterial, 313t
Spitz nevus, 781 Varicella, 389
Squamous cell carcinoma, 744 Venous lake, 825
Staphylococcal scalded skin syndrome, 288 Venous ulcers, 73
Stasis dermatitis, 72 Verrucous carcinoma, 752
Stasis ulcers, 14 Verrucous epidermal nevus, 714
Steroid acne, 33, 191 Viral exanthems, 473
Steroid atrophy, 34 Virilization, 846
Steroid rosacea, 30 Vitiligo, 684
Stevens-Johnson syndrome, 630 Von Recklinghausen's neurofibromatosis, 905
Stinging insects, 531 Warts, 368
Strawberry hemangiomas, Wegener's granulomatosis, 640, 648
Striae, 15 White superficial onychomycosis, 876
Stucco keratosis, 705 Xanthelasma, 903
Sturge-Weber syndrome, 822 Xanthoma, 902
Sunburn, 233 Xerosis, 60
Superficial basal cell carcinoma, 726 Yellow nails syndrome, 884
Superficial spreading melanoma, 788 Zoster sine herpete, 402
A brand new edition
...in a brand new way!
Accessing unparalleled clinical guidance on
the identification, diagnosis, and treatment
A COLOR GUIDE TO DIAGNOS of virtually every common skin disorder is
now easier than ever!
CLINICAL
DERMATOLOGY A variety of formats delivers unprecedented
reference power!
Clinical Dermatology: A Color Guide
to Diagnosis and Therapy (Edition
This multimedia package includes the 4th Edition
THOMAS P. HABlF
of the textbook and access to the state-of-the-art
website!
The textbook delivers over 900 pages and
1,000 illustrations for today's most effective
guidance in the field.
Clinical Dermatology: A Color At www.clinderm.com, you can search the
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By Thomas R Habif, MD a PowerPoint slide image library, with 2,000 additional color images
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Complete, authoritative, frequent content updates, as well as a Case of the Month and more!
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Clinical Dermatology
A COLOR GUIDE TO DIAGNOSIS AND THERAPY
 Clinical Dermatology

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A COLOR GUIDE TO DIAGNOSIS AND THERAPY

Thomas Habif MD
Adjunct Professor of Medicine (Dermatology)
Dartmouth Medical School
Hanover, NH, USA

Commissioning Editor: Sue Hodgson
I Project Development Editor: Louise Cook
Publishing Services Manager: Melissa Lastarria
Layout Design: Jeanne Genz
Design Coordinator: Jayne Jones
n
Illustration Coordinator: Michael Ruddy
Hjn Project Organization: Laura A. McCann
Medical Photography: Alan N. Binnick, MD, and
Thomas P. Habif, MD

Photographs: Barry M. Austin, MD, Richard D. Baughman,

RH
MD, Daniel W. Collison, MD, Warren M. Pringle, MD,
Cameron L. Smith, MD, and Steven K. Spencer, MD

Technical Advice: David V. Habif, Jr, MD

Moral Support: Dorothy, Tommy, and David

Mosby Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2004
 Mosby
An Affiliate of Elsevier

The Curtis Center

Independence Square West

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Philadelphia, Pennsylvania 19106

I
CLINICAL DERMATOLOGY: A COLOR GUIDE TO
DIAGNOSIS AND THERAPY
n
Hjn Mosby, All rights reserved.

No part of this publication may be reproduced or transmitted

or by any means, electronic or mechanical, including photocopying,
form
RH
recording, or any information storage and retrieval system, without
permission in writing from the publisher. Permissions may be sought
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(11) 215 238 7869, fax: (11) 238 2239, e-mail:
You may also complete your request on-line via the Elsevier
homepage by selecting 'Customer Support' and
then Permissions'.

ronicor
Dermatology is an ever-changing field. Standard safety precautions must be
followed, but as new research and clinical experience broaden our knowl-
edge, changes in treatment and therapy may become necessary or ap-
Readers are advised to check the most current product informa-
tion provided by the manufacturer of each to be administered to verify
the recommended dose, the method and duration of administration, and
contraindications. It is the responsibility of the licensed prescriber, relying
on experience and knowledge of the patient, to determine dosages and the
best treatment each individual patient. Neither the publisher nor the au-
thor assumes any liability for any injury damage to persons or prop-
erty arising from this publication.

Previous editions copyrighted

International Standard Book Number 0-323-01319-8

Printed in Chile

Last digit i s t h e print n u m b e r :

 Preface
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Clinical Dermatology is intended to be a practical resource for
the busy clinician. Over 1000 illustrations are combined with
disease descriptions and current and comprehensive thera-
peutic information. Bold headings are used to facilitate rapid
access to information. Diseases can be accessed in many ways.
The classic method of organizing skin diseases is used.
Common diseases are covered in depth. Illustrations of clas-
sic examples of these disorders and photographs of variations
I
seen at different stages are included. Basic dermatologic sur-
gical techniques are covered in detail. Specialized techniques
such as Mohs' surgery are described so that the
physician can be better prepared to suggest referral.
n
Theoretical information, disease mechanisms, and rare dis-
Hjn
ease are found in comprehensive textbooks.
Rapid Access to the Text
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1. List of disorders with page front cover.
2. List of common topical disorders pages.
3. List of diseases by region with page
back cover.
4. List of diseases by lesion type with page 3.
5. Formulary is located on pages 945 to 973.
How to Use This Book
Students in the classroom
Students should learn the primary and secondary lesions and
the distribution of diseases in Chapter 1 and study the differ-
ential diagnosis of each lesion. Select a few familiar diseases
from each list and read about them. Study the close-up pic-
tures carefully. Obtain an overview of the text. Turn the
pages, look at the pictures, and read the captions.
Students in the clinic
You see skin abnormalities every day in the clinic. Try to
identify these diseases, or ask for assistance. Study all
eases, especially tumors, with a magnifying glass or ocular
lens. Read about what you see and you will rapidly gain a
broad fund of knowledge.
Study Chapters 20 (Benign Skin Tumors), 21 (Premalignant
and Malignant Nonmelanoma Skin Tumors), and 22 (Nevi
and Malignant Melanoma). Skin growths are common, and it
is important to recognize their features.
House officers are responsible for patient management.
Read Chapter 2 and study all aspects of the use of
topical steroids. These valuable agents are used to treat a
great variety of inflammatory skin conditions. It is tempting
to use these agents as a therapeutic trial and ask for a consul-
tation only if therapy fails. Topical steroids mask some dis-
eases, make some diseases worse, and create other diseases.
Do not develop bad habits; if you do not know what a disease
is, do not treat it.
The diagnosis of skin disease is deceptively easy. Do not
make hasty diagnoses. Take a history, study primary lesions
and the distribution, and be deliberate and methodical. Ask
for help. With time and experience you will feel comfortable
managing many common skin diseases.
The practicing clinician
Most skin diseases are treated by practitioners other than
dermatologists. This includes primary care physicians, nurse
practitioners and physician assistants. Clinicians involved in
direct patient care should read the above guidelines for using
this book. Learn a few topical steroids in each potency group.
There are a great number of agents in the Formulary. Many
in each table contain similar ingredients and have the same
therapeutic effect. Develop an armamentarium of agents and
gain experience in their use.
Inflammatory conditions are often confusing, and some-
times biopsies are of limited value in their diagnosis. Eczema
is common, read Chapters 2 and 3. Acne is seen everyday,
read Chapter 7. Managing acne effectively will provide a great
service to many young patients who are very uncomfortable
with their appearance. The clinical diagnosis of pigmented le-
sions is complicated. A dermatologist can often make a spe-
cific diagnosis without the need for a biopsy.
The dermatologist
Many dermatologists use the pictures as an aid to reassure
patients. Examine the patient, make a diagnosis, and then
 viii Clinical Dermatology
show them an illustration of their disease. Many patients see
the similarity and are reassured.
This book is designed to be a practical resource. All of the
most current descriptive and therapeutic information that is
practical and relevant has been included. All topics are re-
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searched on Medline. Details about basic science and com-
plex mechanisms of disease can be found elsewhere. Rare dis-
eases are found in larger textbooks.
Photography
The photographs were taken with medium format cameras,
35-mm macro cameras, and digital macro cameras. The dig-
ital images for this edition were taken by me with a Nikon
digital camera fitted with a 60 mm macro lens and a
Canfield TwinFlash. The macro camera takes pictures that
simulate the view through a hand lens. Therefore the distri-
bution of the disease and the primary lesion can be accu-
rately illustrated. Over 4000 new digital images were ac-
quired in preparation for this edition. Alan N.
I Adjunct Assistant Professor of Medicine (Dermatology),
Dartmouth Medical School, provided all of the new images
taken with transparency film. He has 25 years of experience
as a clinician, teacher, and expert photographer. His entire
n
Hjn collection was available for this edition.
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Production
The author writes the manuscript. The publishing company
makes the book. Manufacturing a book is a complicated
process. The key people involved in this effort are listed on
the title page. As my first editor said 20 years ago, "if people
ever realized what was involved in making a book, they
would not believe that it could ever get done."
The layout and design of each page in this book is done the
"old fashion way," by cutting and pasting images and strips
of text by the layout artist. Page layout design is a science and
an art. Jeanne Genz has designed all four editions of this
book. This older, slower, noncomputerized technique cre-
ated by an expert produces pages that are balanced and of
maximum clarity. Computer layout programs are not capa-
ble of this art. The final "pasted" book is then converted to a
digital file and printed on high-grade glossy paper on a
sheetfed press. Glossy paper retains ink at the surface to en-
hance definition. Sheetfed presses print slowly and allow ink
to be laid down precisely so that exceptional sharpness and
color balance are achieved.
Thomas P. Habif
2003
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1 Principles of Diagnosis and Anatomy 1
Skin anatomy 1
Epidermis 1
Dermis 1
Dermal nerves and vasculature 1
Diagnosis of skin disease 2
A methodical approach 2
I
Examination technique 2
Approach to treatment 2
Primary lesions 2
Secondary lesions 2
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Special skin lesions 16
Hjn
Regional differential diagnoses 18
2 Topical Therapy and Topical Corticosteroids 23
Topical therapy 23
Emollient creams and lotions 23
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Severe dry skin (xerosis) 23
Wet dressings 24
Topical corticosteroids 25
Strength 25
Vehicle 26
Steroid-antibiotic mixtures 27
Amount of cream to dispense 27
Application 28
Adverse reactions 30
3 Eczema and Hand Dermatitis
Stages of eczematous inflammation 43
Acute eczematous inflammation 43
Subacute eczematous inflammation 44
Chronic eczematous inflammation 48
Hand eczema 50
Irritant contact dermatitis 51
Atopic hand dermatitis 53
Allergic contact dermatitis 54
Nummular eczema 54
Lichen simplex chronicus 54
Recurrent focal palmar peeling 55
Hyperkeratotic eczema 55
Fingertip eczema 57
Pompholyx 59
Id reaction 59
Eczema: various presentations 60
Asteatotic eczema 60
Nummular eczema 61
Chapped fissured feet 62
Self-inflicted dermatoses 63
Lichen simplex chronicus 63
Prurigo nodularis 68
Neurotic excoriations 68
Psychogenic parasitosis 70
Stasis dermatitis and venous ulceration: postphlebitic
syndromes 72
Stasis dermatitis 72
Types of eczematous inflammation 72
Venous leg ulcers 74
4 Contact Dermatitis and Patch Testing 81
Irritant contact dermatitis 82
Allergic contact dermatitis 84
Systemically induced allergic contact dermatitis 84
Clinical presentation 84
Rhus dermatitis 88
Natural rubber latex allergy 90
Shoe allergy 92
Metal dermatitis 93
Cement dermatitis and burns 95
Further examples of allergic contact dermatitis 95
Patients with leg ulcers 97
41
Cosmetic and fragrance allergy 97
Diagnosis of contact dermatitis 98
Patch testing 98
5 Atopic Dermatitis 105
Pathogenesis and immunology 106
Clinical aspects 107
Infant phase (birth to 2 years) 108
Childhood phase (2 to 12 years) 111
Adult phase (12 years to adult) 114
Associated features 115
Dry skin and xerosis 115
Ichthyosis vulgaris 115
Keratosis pilaris 116
Hyperlinear palmar creases 118
Pityriasis alba 118
 Atopic pleats 118 Overview of diagnosis and treatment 163
Cataracts and keratoconus 118 Etiology and pathogenesis 169
Triggering factors 120 Approach to acne therapy 170
Temperature change and sweating 120 Acne treatment 171
Decreased humidity 120 Therapeutic agents for treatment of acne 178

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Excessive washing 120 Acne surgery 190
Contact with irritating substances 120 Other types of acne 190
Contact allergy 120 Perioral dermatitis 195
Aeroallergens 120 Treatment 197
Microbic agents 120 Rosacea (acne rosacea) 198
Food 120 Skin manifestations 198
Aeroal lergens 120 Ocular rosacea 200
Treatment 120 Treatment 200
Dry skin 122 Hidradenitis suppurativa 202
Inflammation and infection 122 Clinical presentation 202
Infants 123 Pathogenesis 202
Children and adults 123 Management 203

Tar 124 Miliaria 205
Hospitalization for severely resistant cases 125 Miliaria crystalline 205
Lubrication 125 Miliaria rubra 205
Sedation and antihistamines 125 Miliaria profunda 205
I
Phototherapy 126
Diet restriction and breast-feeding 126
8 Psoriasis and Other Papulosquamous
Diseases 209
6 Urticaria and Angioedema 129 Psoriasis 209
Clinical aspects 130 Clinical manifestations 210
n
HjnPathophysiology 133 Histology 211
Initial evaluation of all patients with urticaria 134 Clinical presentations 211
Acute urticaria 134 Chronic plaque psoriasis 212
Chronic urticaria 136 Guttate psoriasis 212
Treatment of urticaria 139 Generalized pustular psoriasis 213
Antihistamines 140 Erythrodermic psoriasis 213
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Epinephrine 141 Light-sensitive psoriasis 214
Oral corticosteroids 141 Psoriasis of the scalp 214
Immunotherapy 141 Psoriasis of the palms and soles 214
Physical urticarias 142 Pustular psoriasis of the palms and soles 214
Dermographism 142 Keratoderma blennorrhagicum (Reiter's syndrome) 216
Pressure urticaria 144 Psoriasis of the penis and Reiter's syndrome 216
Cholinergic urticaria 145 Pustular psoriasis of the digits 216
Exercise-induced anaphylaxis 145 Psoriasis inversus (psoriasis of the flexural or intertriginous
Cold urticaria 146 areas) 217
Solar urticaria 147 Human immunodeficiency virus (HlV)-induced psoriasis 217
Heat, water, and vibration urticarias 147 Psoriasis of the nails 218
Aquagenic pruritus 147 Psoriatic arthritis 220
Angioedema 147 Treatment of psoriasis 222
Acquired forms of angioedema 148 Topical therapy 224
Hereditary angioedema 151 Systemic therapy 228
Contact urticaria syndrome 152 Biologic therapy for psoriasis 238
Pruritic urticarial papules and plaques Pityriasis rubra pilaris 240
of pregnancy 152 Seborrheic dermatitis 242
Urticarial vasculitis 154 Infants (cradle cap) 242
Serum sickness 155 Young children (tinea amiantacea and blepharitis) 242
Mastocytosis 156 Adolescents and adults (classic seborrheic dermatitis) 245
Acquired immunodeficiency syndrome 245
7 Acne, Rosacea, and Related Disorders 162
Pityriasis rosea 246
Acne 162
Lichen planus 250
Classification 163
Localized papules 250
 Hypertrophic lichen planus 252 Clinical manifestations 299
Generalized lichen planus and lichenoid drug eruptions 252 Diagnosis 301
Lichen planus of the palms and soles 252 Differential diagnosis 301
Follicular lichen planus 252 Management 301
Oral mucous membrane lichen planus 254 Nontuberculous mycobacteria 304

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9
Follic ular lichen planus 252
Nails 255
Diagnosis 255
Treatment 256
Lichen sclerosus et atrophicus 257
Lichen sclerosus et atrophicus of the penis 258
Pityriasis lichenoides 261

Bacterial Infections
Skin infections 267
Impetigo 267
Ecthyma 272
267
. ulcerans, . fortuitum, . chelonei, and M. avium
intracellulare 304

10 Sexually Transmitted Bacterial Infections 307

Sexually transmitted disease presentations 307
Genital ulcers 307
Syphilis 315
Incidence 315
Stages 315
Risk of transmission 317
T. pallidum 317
Primary syphilis 317

Cellulitis and erysipelas 273 Secondary syphilis 318
Cellulitis of specific areas 274 Latent syphilis 320
Necrotizing fasciitis 278 Tertiary syphilis 320
Folliculitis 279 Syphilis and human immunodeficiency virus 320
I
Staphylococcal folliculitis 279
Keratosis pilaris 280
Congenital syphilis 320
Syphilis serology 321
Pseudofolliculitis barbae (razor bumps) 280 Treatment of syphilis 323
Sycosis barbae 282 Posttreatment evaluation of syphilis 324
n
HjnAcne keloidalis 283 Rare sexually transmitted diseases 325
Furuncles and carbuncles 284 Lymphogranuloma venereum 325
Location 284 Chancroid 327
Bacteria 284 Granuloma inguinale (donovanosis) 329
Predisposing conditions 284 Diseases characterized by urethritis and cervicitis 330
Clinical manifestations 284 Gonorrhea 330
RH
Differential diagnosis 285 Neisseria gonorrhoeae 330
Treatment of furuncles 285 Nongonococcal urethritis 334
Recurrent furunculosis 286
11 Sexually Transmitted Viral Infections 336
Erysipeloid 287
Genital warts 336
Clinical manifestation 287
Human papillomavirus 336
Diagnosis 287
Incidence 336
Treatment 287
Transmission 336
Blistering distal dactylitis 287
Clinical presentation 337
Staphylococcal scalded skin syndrome 288
Diagnosis 340
Epidermolytic toxin 288
Treatment 340
Incidence 288
Bowenoid papulosis 343
Clinical manifestations 288
Molluscum contagiosum 344
Pathophysiology 289
Clinical manifestations 344
Diagnosis 289
Diagnosis 344
Treatment 289
Treatment 345
Pseudomonas aeruginosa infection 290
Genital herpes simplex 346
Pseudomonas folliculitis 290
Prevalence 346
Pseudomonas hotfoot syndrome 290
Risk factors 346
Pseudomonas cellulitis 292
Rate of transmission 348
External otitis 294
Primary and recurrent infections 348
Malignant external otitis 297
Prevention 350
Toe web infection 298
Laboratory diagnosis 350
Ecthyma gangrenosum 298
Serology 351
Meningococcemia 299
Psychosocial implications 352
Transmission 299
Treatment of genital herpes (Centers for Disease Control
Incidence 299
Guidelines) 352
Pathophysiology 299
 Genital herpes simplex during pregnancy 354 Chronic mucocutaneous candidiasis 450
Genital herpes simplex dur infection 355 Tinea versicolor 451
Acquired immunodeficiency syndrome 356 Pityrosporum folliculitis 454
Human immunodeficiency virus pathogenesis 356
14 Exanthems and Drug Eruptions 457
Diagnosis 356
Exanthems 460

y zTH
Viral burden 356
Measles 460
Assessment of immune status (CD4 + T-cell determinations)
Hand, foot, and mouth disease 462
357
Scarlet fever 464
Revised Centers for Disease Control and Prevention classifica-
Rubella 467
tion and management 357
Erythema infectiosum (parvovirus B19 infection) 468
Dermatologic diseases associated with human immunodefi-
Roseola infantum (human herpes virus 6 and 7 infection) 471
ciency virus infection 358
Enteroviruses: echovirus and coxsackievirus exanthems 473
12 Warts, Herpes Simplex, and Other Viral Kawasaki syndrome 474
Infections 368 Superantigen toxin-mediated illnesses 478
Warts 368 Toxic shock syndrome 479
Common warts 371 Cutaneous drug reactions 482

Filiform and digitate warts 372 Drug eruptions: clinical patterns and most frequently
Flat warts 373 causal drugs 485
Plantar warts 374 Exanthems (maculopapular) 485
Subungual and periungual warts 378 Urticaria 488
Genital warts 378 Pruritus 489
I
Molluscum contagiosum 379 Drug eruptions 490
Herpes simplex 381 Acute generalized exanthemous pustulosis 490
Oral-labial herpes simplex 384 Acneiform (pustular) eruptions 490
n
Cutaneous herpes simplex 386 Eczema 490
Hjn
Eczema herpeticum 388
Varicella 389
Chickenpox in the immunocompromised patient 391
Chickenpox and HIV infection 391
Chickenpox during pregnancy 391
Blistering drug eruptions 491
Erythema multiforme and toxic epidermal necrolysis 491
Exfoliative erythroderma 491
Fixed drug eruptions 492
Lichenoid (lichen planus-like drug eruptions) 493
RH
Congenital and neonatal chickenpox 392 Lupus erythematosus-like drug eruptions 493
Herpes zoster 394 Photosensitivity 493
Herpes zoster after varicella immunization 398 Pigmentation 494
Herpes zoster and HIV infection 398 Vasculitis 494
Herpes zoster during pregnancy 398 Lymphomatoid drug eruptions 494
Syndromes 398 Chemotherapy-induced acral erythema 494
Prevention of postherpetic neuralgia: early combined antiviral Skin eruptions associated with specific drugs 494
drugs and antidepressants 404
15 Infestations and Bites 497
Treatment of postherpetic neuralgia 404
Scabies 497
13 Superficial Fungal Infections 409 Anatomic features, life cycle, and immunology 499
Dermatophyte fungal infections 409 Clinical manifestations 500
Tinea 413 Diagnosis 503
Tinea of the foot 413 Treatment and management 504
Pitted keratolysis 416 Scabies in long-term care facilities 505
Tinea of the groin 417 Pediculosis 506
Tinea of the body and face 420 Biology and life cycle 506
Tinea of the hand 425 Clinical manifestations 507
Tinea incognito 426 Diagnosis 508
Treatment of the scalp 427 Treatment 509
Tinea of the beard 434 Caterpillar dermatitis 510
Treatment of Fungal Infections 434 Clinical manifestations 510
Candidiasis (Moniliasis) 440 Diagnosis 512
Candidiasis of normally moist areas 440 Treatment 512
Candidiasis of large skin folds 446 Spiders 512
Candidiasis of small skin folds 449 Black widow spider 512
 Brown recluse spider 514 Localized pemphigoid 571
Ticks 516 Benign chronic bullous dermatosis of childhood 572
Lyme disease and erythema migrans 517 Herpes gestationis (pemphigoid gestationis) 573
Rocky mountain spotted and spotless fever 524 Pemphigoid-like disease 574
Tick bite paralysis 526 Epidermolysis bullosa acquisita 574

y zTH
Removing ticks 527
Cat-scratch and related diseases 528
Clinical manifestations 528
Neurologic complications 528
Bacillary angiomatosis 528
Diagnosis of cat-scratch disease 529
Treatment 529
Animal and human bites 529
Management 529
Stinging insects 531
Toxic reactions 531
Allergic reactions 531
Benign familial chronic pemphigus 575
Epidermolysis bullosa 576
The newborn with blisters, pustules, erosions, and
ulcerations 577

17 Connective Tissue Diseases 587

Diagnosis 587
Antinuclear antibody testing 587
Lupus erythematosus 592
Clinical classification 592
Subsets of cutaneous lupus erythematosus 593
Chronic cutaneous lupus erythematosus 596

Subacute cutaneous lupus erythematosus 598
Diagnosis 532
Systemic lupus erythematosus 600
Indications for venom skin testing and immunotherapy 532
Other cutaneous signs of lupus erythematosus 602
Treatment 532
Drug-induced lupus erythematosus 603
Biting insects 533
I
Papular urticaria 533
Neonatal lupus erythematosus 604
Diagnosis and management of cutaneous lupus
Fleas 533
erythematosus 605
Myiasis 534
Treatment 605
Mosquitoes 536
n
Dermatomyositis and Polymyositis 607
Creeping eruption 537
Hjn Polymyositis 607
Management 537
Dermatomyositis 607
Ants 538
Scleroderma 613
Fire ants 538
Systemic sclerosis 613
Dermatitis associated with swimming 539
Chemically induced scleroderma 613
Swimmer's itch (fresh water) 539
RH
CREST syndrome 617
Nematocyst stings 539
Localized scleroderma 620
Florida, Caribbean, Bahamas 541
Echinoderms (sea urchins and starfish) 543 18 Hypersensitivity Syndromes and Vasculitis 626
Hypersensitivity syndromes 626
16 Vesicular and Bullous Diseases 547
Erythema multiforme 626
Blisters 547
The Stevens-Johnson syndrome/toxic epidermal
Autoimmune blistering diseases 547
necrolysis spectrum of disease 630
Major blistering diseases 547
Stevens-Johnson syndrome 630
Classification 550
Toxic epidermal necrolysis 632
Diagnosis of bullous disorders 551
Erythema nodosum 635
Dermatitis herpetiformis and linear IgA bullous
Vasculitis 637
dermatosis 554
Vasculitis of small vessels 642
Gluten-sensitive enteropathy 556
Hypersensitivity vasculitis 642
Lymphoma 556
Henoch-Schonlein purpura 645
Diagnosis of dermatitis herpetiformis 556
Antinuclear cytoplasmic antibody-associated
Bullae in diabetic persons 559
small-vessel vasculitis 648
Pemphigus 559
Wegener's granulomatosis 648
Pathophysiology 561
Churg-Strauss syndrome 649
Pemphigus vulgaris 561
Microscopic polyangiitis 649
Pemphigus foliaceus, IgA pemphigus, and pemphigus
Antinuclear cytoplasmic antibody-negative
erythematosus 562
small-vessel vasculitis 649
Diagnosis of pemphigus 564
Neutrophilic dermatoses 650
Treatment 565
Sweet's syndrome (acute febrile neutrophilic dermatosis) 650
Pemphigus in association with other diseases 566
Erythema elevatum diutinum 653
The pemphigoid group of diseases 567
Pyoderma gangrenosum 653
Bullous pemphigoid 567
Schamberg's disease 656
 19 Light-Related Diseases and Disorders of Bowen's disease 748
Pigmentation 661 Erythroplasia of Queyrat 750
Photobiology 661 Leukoplakia 751
Sun-damaged skin 662 Verrucous carcinoma 753
Suntan and sunburn 668 Arsenical keratoses and other arsenic-related skin

y zTHSun protection 668

Polymorphous light eruption 671
Hydroa aestivale and hydroa vacciniforme 674
Porphyrias 675
Porphyria cutanea tarda 675
Pseudoporphyria 679
Erythropoietic protoporphyria 680
Phototoxic reactions 681
Photoallergy 683
Disorders of hypopigmentation 684
Vitiligo 684
Idiopathic guttate hypomelanosis 689
diseases 753
Cutaneous T-cell lymphoma 754
Paget's disease of the breast 763
Extramammary Paget's disease 764
Cutaneous metastasis 765

22 Nevi and Malignant Melanoma 773

Melanocytic nevi 773
Common moles 774
Special forms 776
Atypical nevi 782
Malignant melanoma 786

Superficial spreading melanoma 789
Pityriasis alba 689
Nodular melanoma 792
Nevus anemicus 690
Tuberous sclerosis 690 Lentigo maligna melanoma 794
Acral lentiginous melanoma 796
Disorders of hyperpigmentation 691
I
Freckles 691
Benign lesions that resemble melanoma 797
Dermoscopy 798
Lentigo in children 691
Lentigo in adults 691 Classification of atypical melanocytic nevi 799
Pregnancy, oral contraceptives, prognosis, and risk 806
Melasma 692
n
Management 806
Hjn Cafe-au-lait spots 694
Diabetic dermopathy 694 Biopsy 806
Initial diagnostic workup 808
Erythema ab igne 694
Follow-up examinations 808
20 Benign Skin Tumors 698 Staging and prognosis 810
Seborrheic keratoses 698 Melanoma staging system 810
RH
Stucco keratoses 705 Medical treatment 810
Dermatosis papulosa nigra 706 Treatment of lentigo maligna 811
Cutaneous horn 706
Skin tags (acrochordon) and polyps 706
23 Vascular Tumors and Malformations 814
Congenital vascular lesions 814
Dermatofibroma 708
Hypertrophic scars and keloids 709 Hemangiomas of infancy 815
Keratoacanthoma 711 Malformations 819
Acquired vascular lesions 824
Epidermal nevus 713
Cherry angioma 824
Nevus sebaceous 715
Angiokeratomas 824
Chondrodermatitis nodularis chronica helicis 716
Epidermal cyst 717 Venous lake 825
Pilar cyst (wen) 719 Lymphangioma circumscriptum 825
Senile sebaceous hyperplasia 720 Pyogenic granuloma (lobular capillary hemangioma) 826
Syringoma 721 Kaposi's sarcoma 827
Telangiectasias 830
21 Premalignant and Malignant Nonmelanoma Spider angioma 830
Skin Tumors 724 Hereditary hemorrhagic telangiectasia 831
Basal cell carcinoma 724 Unilateral nevoid telangiectasia syndrome 832
Pathophysiology 725 Scleroderma 832
Histologic characteristics 726 Generalized essential telangiectasia 832
Clinical types 726
24 Hair Diseases 834
Management and risk of recurrence 732
Anatomy 834
Actinic keratosis 736
Physiology 836
Squamous cell carcinoma 744
Evaluation of hair loss 838
Squamous cell carcinoma of the extremities
Generalized hair loss 841
(Marjolin's ulcer) 747
 Localized hair loss 842 Pseudoxanthoma elasticum 916
Androgenic alopecia in men (male-pattern baldness) 842 Guide to information for families with inherited skin
Adrenal androgenic female-pattern alopecia 844 disorders 917
Hirsutism 846
Alopecia areata 855 27 Dermatologic Surgical Procedures 921

y zTH
Trichotillomania 858
Traction (cosmetic) alopecia 859
Scarring alopecia 860
Trichomycosis 862

25 Nail Diseases 864

Anatomy and physiology 864
Normal variations 868
Nail disorders associated with skin disease 869
Acquired disorders 871
Bacterial and viral infections 871
Fungal nail infections 874
Local anesthesia 922
Hemostasis 922
Wound healing 923
Postoperative wound care 925
Skin biopsy 926
Punch biopsy 926
Shave biopsy and shave excision 926
Simple scissor excision 928
Electrodesiccation and curettage 929
Techniques 929
Curettage 930
Techniquescurettage 930

Trauma 880 Techniqueselectrodesiccation and curettage of basal cell
The nail and internal disease 884 carcinoma 930
Congenital anomalies 886 Blunt dissection 931
Color and drug-induced changes 886 Technique 931
I
Tumors 888 Cryosurgery 931
26 Cutaneous Manifestations of Internal Technique 932
Extraction of cysts 933
Disease 893
Technique 933
n
Internal cancer and skin disease 893
Hjn Mohs' micrographic surgery 934
Cutaneous paraneoplastic syndromes 893
Technique 934
Cutaneous manifestations of diabetes mellitus 896
Chemical peels 936
Necrobiosis lipoidica 896
Filling materials 936
Granuloma annulare 898
Liposuction 936
Acanthosis nigricans 900
Lasers 937
RH
Xanthomas and dyslipoproteinemia 902
Botulinum toxin 938
Neurofibromatosis 905
Tuberous sclerosis 909 Appendix 940
Cancer-associated genodermatoses 912
Dermatologic Formulary 945
Cowden's disease (multiple hamartoma syndrome) 912
Muir-Torre syndrome 914 Index 975
Gardner's syndrome 915
 SKIN ANATOMY

shaft

y zTH
Hair
follicle
Huxley's layer

layer

External sheath

Glassy membrane

Connective
layer

Melanocyte

Sebaceous gland

muscle

corpuscle
Free nerve endings

Pore of sweat gland

Stratum

-Stratum

Stratum

Stratum spinosum

Stratum basale
n I
Hjn
RH

Sweat gland
Hair matrix
Papilla of
follicle Hair cuticle

Sensory nerve Motor (autonomic)

nerve
Elastic fibers
Vater-Pacini Vein
corpuscle

(Copyright 1967, CIBA Pharmaceutical Company, Division of CIBA-GEIGY Corporation. Reprinted

with permission from Clinical Symposia. Illustrated by Frank H. Netter, All rights reserved.)