Clinical Dermatology (eBook)

Richard B. Weller, Hamish J. A. Hunter, Margaret W. Mann (Autoren)

eBook Download: EPUB

2014 | 5. Auflage
John Wiley & Sons (Verlag)
978-1-118-85102-9 (ISBN)

Infos

The best-selling text has been completely revised and revitalised in this fifth edition, with the authors once again encouraging general practitioners, medical students, general physicians and early stage dermatology specialist trainees and interns to relish the unique challenge of diagnosing and treating skin conditions.

Clinical Dermatology, 5th edition contains over 400 high quality pictures and diagrams combined with colourful phrases to illustrate and entertain as it teaches. The book has established a reputation as a 'way of learning' and as an accessible guide to the subject for the aspiring specialist. Readers are guided through the maze that too often lies between the presenting skin complaint and its final diagnosis and treatment. The authors have skilfully crafted an easily read text with enough detail to clarify the subject, but not enough to obscure it.

This fifth edition contains new chapters on non-invasive physical treatment and dermoscopy, and new material on cosmetic dermatology, surgical dermatology, the skin and the psyche, and dermatoses of non-Caucasian skin. The text throughout the book has been updated in line with developments in the science and practice of dermatology.

'... brilliantly succeeds in enticing you to look further. The writing is clear, and the joint British-American authorship avoids any parochial views.' From a review of a previous edition in BMJ

'...a very well-presented book...an excellent aid for teaching. I recommend this book highly to individuals and departments.' From a review of a previous edition in J Derm Treatment

'... provides a good overview of the structure and function of the skin as well as a good foundation for learning dermatology...well organized and includes a chapter dedicated to skin signs of systemic disease which is not covered in the other dermatology primers.' From a review of a previous edition in JAMA

Richard Weller, Senior Lecturer, Department of Dermatology, University of Edinburgh, UK.

Hamish Hunter, Clinical Research Fellow, University of Manchester, UK.

Margaret Mann, Assistant Professor, Director of Aesthetic Dermatology, Case Western School of Medicine, OH, USA

Inhalt

Preface to the Fifth Edition vii

Acknowledgements viii

Introduction ix

1 Skin Disease in Perspective 1

2 The Function and Structure of the Skin 7

3 Diagnosis of Skin Disorders 30

4 Disorders of Keratinization 45

5 Psoriasis 52

6 Other Papulosquamous Disorders 68

7 Eczema and Dermatitis 76

8 Reactive Erythemas and Vasculitis 99

9 Bullous Diseases 113

10 Connective Tissue Disorders 126

11 Disorders of Blood Vessels and Lymphatics 140

12 Sebaceous and Sweat Gland Disorders 156

13 Regional Dermatology 171

14 Racial Skin Differences 197

15 The Skin at Different Ages 208

16 Infections 214

17 Infestations 249

18 Skin Reactions to Light 258

19 Disorders of Pigmentation 267

20 Skin Tumours 278

21 The Skin in Systemic Disease 311

22 Cosmetic Dermatology 323

23 The Skin and the Psyche 334

24 Other Genetic Disorders 342

25 Drug Eruptions 351

26 Medical Treatment 359

27 Physical Forms of Treatment 366

28 Dermoscopy 385

Formulary 1: Topical Treatments 397

Formulary 2: Systemic Medication 410

Index 427A

Textauszug

1
Skin Disease in Perspective

This chapter presents an overview of the causes, prevalence and impact of skin disease.

The many roles of the skin

The skin is the largest organ in the body. It is the boundary between ourselves and the world around us, and its primary role is that of a barrier, preventing the entry of noxious chemicals and infectious organisms, and the exit of water and other chemicals. It is a sort of ‘space suit’, nicely evolved to house all the other organs and chemicals in our body.

Skin has other roles too. It is an important sense organ, and controls heat and water loss. It reflects internal changes (see Chapter 21) and reacts to external ones. It can sweat, grow hair, erect its hairs, change colour, smell, grow nails, secrete sebum, synthesize vitamin D and release nitric oxide. When confronted with insults from outside, it usually adapts easily and returns to a normal state, but sometimes it fails to do so and a skin disorder appears. Some of the internal and external factors that are important causes of skin disease are shown in Figure 1.1. Often several will be operating at the same time. Just as often, however, no obvious cause for a skin abnormality can be found, and here lies much of the difficulty of dermatology. When a cause is obvious, for example when the washing of dishes leads to an irritant hand dermatitis, or when episodes of severe sunburn are followed by the development of a melanoma, education and prevention are just as important as treatment.

Figure 1.1 Internal and external factors causing skin diseases.

The prevalence and cost of skin disorders

Skin diseases are very common. Probably everyone has experienced a skin disorder, such as sunburn, irritation, dry skin, acne, warts or pigment changes. The most common skin disorders in the United Kingdom are given in Table 1.1. People in other countries and in other environments may also develop skin diseases peculiar to their surroundings, or common skin diseases at different rates. For example, people living in tropical areas develop infectious diseases, such as leishmaniasis, not seen in more temperate climates. Different age groups experience different skin conditions. In the United States, for example, diseases of the sebaceous glands (mainly acne) peak at the age of about 18 years and then decline, while the prevalence of skin tumours steadily mounts with age (Figure 1.2).

Table 1.1 The most common categories of skin disorder in the United Kingdom.

Skin cancer Acne Atopic eczema Psoriasis Viral warts Other infective skin disorders Benign tumours and vascular lesions Leg ulcers Contact dermatitis and other eczemas

Figure 1.2 The age-dependent prevalence of some skin conditions.

The idea that ‘common things occur commonly’ is well known to surgeons as an aid to diagnosis. It is equally true of dermatology – an immense subject embracing more than 2000 conditions. In the United Kingdom some 70% of a dermatologist's work is caused by only nine types of skin disorder (Table 1.1). Latest figures suggest that approximately one-quarter of the population of England and Wales, some 13 million people, will have a skin condition for which they will seek medical advice over a 12-month period. In the United States approximately one-third of the population has a skin disorder at any given time.

The most recent estimate of the annual cost of skin disease in the United States was $39.3 billion dollars ($29.1 billion dollars in direct medical costs and $10.2 billion in lost productivity costs). Table 1.2 shows a breakdown of the top five most costly skin conditions seen in the United States.

Table 1.2 Most costly skin conditions in the United States (2004).

Condition

Direct medical cost ($billions)

Skin ulcers/wounds

9.7

Acne

2.5

Herpes simplex/zoster

1.7

Cutaneous fungal infection

1.7

Contact dermatitis

1.6

Adapted from Bickers et al. (2006). Reproduced with permission of Elsevier.

In the United Kingdom, skin disorders are the most common reason for a patient to consult their general practitioner with a new problem; on average each general practitioner conducts over 600 consultations per year related to skin disorders. These figures are likely to be an under-estimation of the problem given the complexities of the classification of skin conditions. However, this is only the tip of an iceberg of skin disease, the sunken part of which consists of problems that never get to doctors, being dealt with or ignored in the community.

How large is this problem? No one quite knows, as those who are not keen to see their doctors seldom star in the medical literature. People tend to be shy about skin diseases, and many of them settle spontaneously, often before patients seek help. The Proprietary Association of Great Britain (PAGB) conducted a survey in 2005 in which 1500 members of the general public were asked questions about their everyday health in the preceding 12 months. Of these, 818 (54%) respondents had experienced a skin condition, of which 69% ‘self cared’ for their condition and only 14% sought professional advice, usually from their general practitioner or practice nurse. Figure 1.3 summarizes what happens to those with skin problems in the United Kingdom.

Figure 1.3 Skin problems in the United Kingdom and how they are dealt with in 1 year. Patients in the United States usually refer themselves to dermatologists. (Adapted from Schofield et al. (2009) Skin conditions in the UK: a healthcare needs assessment. Metro Commercial Printing Ltd, Watford.)

Psoriasis is a common chronic inflammatory condition of the skin which affects aproximately 1.5% of the population. Figure 1.4 demonstrates how the ‘iceberg’ analogy can be applied to UK psoriasis patients. In the course of a single year most of those with psoriasis see no doctor, and only a few will see a dermatologist. Some may have fallen victim to fraudulent practices, such as ‘herbal’ preparations laced with steroids, and baseless advice on ‘allergies’.

Figure 1.4 The ‘iceberg’ of psoriasis in the United Kingdom during a single year.

Several population-based studies have confirmed that this is the case with other skin diseases too. In another UK study, 14% of adults and 19% of children had used a skin medication during the previous 2 weeks; only one-tenth of these were prescribed by doctors. In a study of several tons of unused medicinal preparations, 7% by weight had been manufactured for topical use on the skin.

In 2007, £413.9 million was spent in the United Kingdom on over-the-counter (non-prescribed) treatments for skin disorders, 18% of all over-the-counter sales. Preparations used to treat skin disease can be found in about half of all homes in the United Kingdom; the ratio of non-prescribed to prescribed remedies is about 6 : 1. Skin treatments come second only to painkillers in the list of non-prescription medicines.

No one who has worked in any branch of medicine can doubt the importance of diseases of the skin. A neurologist, for example, will know all about the Sturge–Weber syndrome (p. 302), a gastroenterologist about the Peutz–Jeghers syndrome (p. 275) and a cardiologist about the LEOPARD syndrome (p. 275); yet paradoxically, even in their own wards, they will see far more of other, more common skin conditions, such as drug eruptions, asteatotic eczema and scabies. They should know about these too. In primary care, skin problems are even more important, and the prevalence of some common skin conditions, such as skin cancer and atopic eczema, is undoubtedly rising.

The pattern of skin disease in a community depends on many other factors, both genetic and environmental; some are listed in Table 1.3. In developing countries, for example, overcrowding and poor sanitation play a major part. Skin disorders there are common, particularly in the young, and are dominated by infections and infestations – the so-called ‘dermatoses of poverty’ – amplified by the presence of HIV infection.

Table 1.3 Factors influencing the prevalence of skin diseases in a community.

High level of

High incidence of

Ultraviolet radiation

Skin malignancy in Caucasoids

Heat and humidity

Fungal and bacterial infections

Industrialization

Contact dermatitis

Underdevelopment

Infestations

Bacterial and fungal infections

The impact of skin disorders

Much of this book is taken up with ways in which skin diseases can do harm. Most fit into the...

Produkt-Details

• Erscheint lt. Verlag: 19.11.2014
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Dermatologie
• Schlagworte: Book • Clinical • Clinical Dermatology • concise • Dermatologie • Dermatology • Disease • Edition • Editions • Fifth • First • Function • Guide • immediately • Introduction • ix skin • Mark • Medical • Medical Science • Medizin • Popular • Practice • students • Team • VII • wrote
• ISBN-10: 1-118-85102-1 / 1118851021
• ISBN-13: 978-1-118-85102-9 / 9781118851029