Rook's Textbook of Dermatology (eBook)
John Wiley & Sons (Verlag)
978-1-118-44117-6 (ISBN)
The world's number 1 dermatology information resource
Universally respected, Rook's Textbook of Dermatology is the most comprehensive, definitive and best-illustrated reference work for dermatologists of all levels worldwide and has been at the forefront of international dermatology publishing since first appearing in 1968.
The Ninth Edition has been radically re-engineered to match the modern day challenges faced by dermatologists. Once again it has been published as a combined digital and print resource, but with a new online platform enabling easier and faster navigation.
A common structure to describe and discuss each disorder has been adopted throughout, whilst maintaining the depth of information for which Rook is renowned. A high priority has been placed on the ease of extracting key information quickly: diagnostic algorithms and management ladders help the reader choose appropriate treatment strategies. More images than ever - over 5000 in total - aid diagnosis by displaying variations in disease manifestations according to body location, skin type and severity. The section on aesthetic dermatology has been greatly expanded with more coverage of procedures in this rapidly developing field.
Rook's Textbook of Dermatology, Ninth Edition provides you with:
- The very best content from the number one brand in dermatology - an essential consultation tool for all dermatologists
- An outstanding combined digital/print resource, exhaustively covering every dermatological disorder
- A complete overhaul of its content - each disorder now follows a consistent templated approach
- A fresh approach to the classification of disorders and organization of chapters, of which there are now 160 instead of 80, all organised into 14 logical sections
- A newly designed sophisticated online platform with a fast and powerful digital search functionality - search by keyword, disorder or chapter or consult the online image database and get expert clinical advice more quickly than ever
- Lavishly illustrated chapters with over 5000 colour images showing variation in disease patterns by body location, skin type and severity
- Comprehensive coverage of medical, surgical and aesthetic dermatology, as well as the basic science underpinning the field
- An experienced British editorial team working with distinguished international authors and associate editor
- Greater emphasis than before on clinical studies/trials, society guidelines and the latest ICD codes
- While key references remain in the printed version, thousands more are cited in the book and can be accessed online, where each is hyperlinked to the relevant text
Rook's Textbook of Dermatology, Ninth Edition is the complete dermatology reference work. More comprehensive than ever, with more images, more disorders covered and faster, more dynamic and wider digital search functionality. It is an essential resource for the modern day dermatologist, whether experienced or at the beginning of a career in dermatology.
EDITED BY
Christopher Griffiths University of Manchester, Manchester, UK
Jonathan Barker St John's Institute of Dermatology, King's College London, UK
Tanya Bleiker Derby Teaching Hospitals, Derby, UK
Robert Chalmers University of Manchester, Manchester, UK
Daniel Creamer King's College Hospital, London, UK
2017 PROSE Award Winner - Multivolume Reference/Science The world's number 1 dermatology information resource Universally respected, Rook's Textbook of Dermatology is the most comprehensive, definitive and best-illustrated reference work for dermatologists of all levels worldwide and has been at the forefront of international dermatology publishing since first appearing in 1968. The Ninth Edition has been radically re-engineered to match the modern day challenges faced by dermatologists. Once again it has been published as a combined digital and print resource, but with a new online platform enabling easier and faster navigation. A common structure to describe and discuss each disorder has been adopted throughout, whilst maintaining the depth of information for which Rook is renowned. A high priority has been placed on the ease of extracting key information quickly: diagnostic algorithms and management ladders help the reader choose appropriate treatment strategies. More images than ever over 5000 in total aid diagnosis by displaying variations in disease manifestations according to body location, skin type and severity. The section on aesthetic dermatology has been greatly expanded with more coverage of procedures in this rapidly developing field. Rook's Textbook of Dermatology, Ninth Edition provides you with: The very best content from the number one brand in dermatology an essential consultation tool for all dermatologists An outstanding combined digital/print resource, exhaustively covering every dermatological disorder A complete overhaul of its content each disorder now follows a consistent templated approach A fresh approach to the classification of disorders and organization of chapters, of which there are now 160 instead of 80, all organised into 14 logical sections A newly designed sophisticated online platform with a fast and powerful digital search functionality search by keyword, disorder or chapter or consult the online image database and get expert clinical advice more quickly than ever Lavishly illustrated chapters with over 5000 colour images showing variation in disease patterns by body location, skin type and severity Comprehensive coverage of medical, surgical and aesthetic dermatology, as well as the basic science underpinning the field An experienced British editorial team working with distinguished international authors and associate editor Greater emphasis than before on clinical studies/trials, society guidelines and the latest ICD codes While key references remain in the printed version, thousands more are cited in the book and can be accessed online, where each is hyperlinked to the relevant text Rook s Textbook of Dermatology, Ninth Edition is the complete dermatology reference work. More comprehensive than ever, with more images, more disorders covered and faster, more dynamic and wider digital search functionality. It is an essential resource for the modern day dermatologist, whether experienced or at the beginning of a career in dermatology.
EDITED BY Christopher Griffiths University of Manchester, Manchester, UK Jonathan Barker St John's Institute of Dermatology, King's College London, UK Tanya Bleiker Derby Teaching Hospitals, Derby, UK Robert Chalmers University of Manchester, Manchester, UK Daniel Creamer King's College Hospital, London, UK
Rook’s Textbook of Dermatology 5
Contents 7
Associate Editors 12
Contributors 13
Preface to the Ninth Edition 23
Preface to the First Edition 24
PART 1 Foundations of Dermatology 25
CHAPTER 1 History of Dermatology 27
Introduction: when did dermatology history begin? 27
Ancient dermatology writings 27
The first medical texts 27
Ancient Egypt 27
Mesopotamia 28
Ancient Greece 28
Ancient India 28
Growth of rational medicine 28
The Silk Road: the pathway of rational medicine 28
China 28
South Indian early Buddhism 28
The Holy Bible 28
Greeks: the rational age 28
The Roman Empire 29
Dermatology after the fall of Rome 29
Early Islamic medicine and dermatology 29
Italy during the European Renaissance 29
European Enlightenment 29
Growth of scientific dermatology 30
Willan and Bateman: definition of skin diseases 30
L’Hôpital St Louis, Paris: the first skin hospital 30
Natural Sciences and the German?speaking Europeans 32
Britain in the late 19th century 32
United States in the 19th century 32
Development of dermatology as a world specialty in the 20th century 33
Skin infections 33
Inflammatory disease and immunomodulatory treatments 34
Dermatology surgery 34
Contact dermatitis and allergy 34
Phototherapy 34
Genital dermatology 34
Psychodermatology and social medicine 34
Paediatric dermatology and genetics 34
Key references 34
CHAPTER 2 Structure and Function of the Skin 37
Components of normal human skin 37
Skin development 39
Epidermal and adnexal structures 41
Keratinocytes 43
Eccrine and apocrine glands 44
Pilosebaceous unit 45
Nails 45
Merkel cells 47
Innate immunity 48
Skin microbiome 49
Langerhans cells 49
Immune surveillance 51
Mast cells 52
Melanocytes 53
Desmosomes 54
Adherens junctions 55
Gap junctions 55
Tight junctions 55
Dermal–epidermal basement membrane 56
Basement membrane collagen 58
Laminins 59
Hemidesmosomes 61
Anchoring fibrils 62
Extracellular matrix 63
Collagens 64
Collagen biosynthesis 66
Collagen biology 67
Collagen cross?linking 67
Collagen degradation 68
Elastic fibres 69
Elastin 70
Elastin?associated microfibrils 72
Proteoglycan/glycosaminoglycans 73
Fibroblasts 76
Blood vessels and lymphatics 77
Subcutaneous fat 79
Physiological functions of skin 79
Skin homeostasis 80
Skin ageing 82
Key references 84
CHAPTER 3 Histopathology of the Skin: General Principles 85
Introduction 85
Biopsy of the skin 86
Techniques of skin biopsy (Table 3.2) 87
Information to be provided with the specimen 88
Care of the specimen 88
Laboratory methods 89
Specimen preparation 89
Routine tissue processing 91
Routine staining techniques, including histochemistry 91
Immunopathology 94
Immunofluorescence methods 94
Immunoenzyme methods 98
Other diagnostic methods 109
Cytodiagnosis and Tzanck smears 109
Electron microscopy 110
Viral disease techniques 111
Immunogenotyping 111
Artefacts 111
Approach to microscopic examination of tissue sections 113
Preparing for microscopy 113
Microscopic interpretation 113
How to produce a histopathology skin report 117
Commonly used descriptive terms in dermatopathology, and their diagnostic significance 117
Histological sections that reveal little or no abnormality 123
Conclusions 124
Key references 124
CHAPTER 4 Diagnosis of Skin Disease 127
Fundamentals of diagnosis 127
Disease definition 127
The history 128
The presenting complaint 128
Quality of life in dermatology patients 131
Examination of the skin 131
Description of skin lesions 131
Sites involved and their distribution 131
Individual lesions – nomenclature 136
Distribution of lesions 142
Palpation of the skin 143
Additional simple clinical examination 144
Additional clinical investigations 145
Clinical microscopy, dermoscopy and other imaging systems 146
Dermoscopy 146
Other imaging systems for localized lesions 147
Other simple microscopy procedures 148
Fine?needle aspiration of lymph nodes 148
Radiological and imaging examinations 148
Skin testing (prick and scratch, intradermal and patch testing) [1] 149
Techniques for skin testing 149
Immediate?weal tests 150
Delayed (4–8 h) tests 150
Intradermal tests for the detection of delayed sensitivity to bacterial, fungal and viral antigens 150
Teledermatology 151
Mobile smartphone applications 152
Key references 152
CHAPTER 5 Epidemiology of Skin Disease 153
What is epidemiology and why is it relevant to dermatology? 153
Thinking in terms of populations rather than individuals 154
Community diagnosis 154
Skin diseases as ‘entities’ in the population 154
Making comparisons and drawing inferences 154
The prevention paradox 155
More than one disease? 156
How much of a public health problem is skin disease? 156
The need for a clear disease definition in epidemiological studies 156
Impairment, disability and handicap caused by skin disease 157
Global Burden of Disease 2010 study 157
What determines the frequency of skin disease in populations? 160
Risk factors, association and causation 160
Genetics 161
Early environment 161
Later environment 161
Describing the natural history and associations of specific skin diseases 162
Health services research in dermatology 162
Needs assessments in dermatology 163
Services available for people with skin diseases 163
Relationship between need, supply and demand for dermatological care 164
Conclusions 164
Glossary of epidemiological terms 165
Measures of disease frequency 165
Measures of disease associations 165
Interpreting results 165
Validity and repeatability 165
Types of epidemiological study 166
Checklist for reading ‘epidemiological studies’ in dermatology 166
Recommended further reading and useful dermatoepidemiology resources 166
Key references 167
CHAPTER 6 Health Economics and Skin Disease 169
Background 169
Introduction to methods and approachesin health economics 169
Perspectives of health economic evaluations 170
Types of health economic evaluation 170
Implementation of health economic findings in decision making 173
Economic burden of disease in dermatology 173
Skin cancer 173
Psoriasis (see Chapter 35) 175
Critical reflection of studies on disease burden 177
Impact for decision making in dermatology practice 177
Key references 177
CHAPTER 7 Genetics and the Skin 179
Advances in genetics 179
Nosology and principles of medical genetics 180
Mutations and disease 183
Mosaicism, Lyonization and the lines of Blaschko 185
Genome sequence and analysis of inherited disorders 186
Prenatal diagnosis 187
Key references 189
CHAPTER 8 Inflammation, Immunology and Allergy 191
Clinical characteristics of inflammation 191
Phases of inflammation 192
Cellular components of cutaneous inflammation 192
Epidermis 192
Dermis 196
Epidermal and dermal cell–cell communication during inflammation 197
Cell–cell adhesion in the epidermis and dermis during inflammation 199
Innate immune defence mechanisms 203
Antimicrobial peptides 203
Role of antimicrobial peptides in immunity and inflammation 204
Toll?like receptors 204
Nucleotide binding site and leucine?rich repeat proteins 205
Scavenger receptors 205
Mannose receptor and other C?type lectins 205
Cells regulating innate immunity 205
Natural killer cells 205
Polymorphonuclear granulocytes 207
Mast cells 209
Monocytes and macrophages 211
Platelets 213
Innate lymphoid cells 216
Adaptive immune system 216
Major histocompatibility complex and skin inflammation 216
Antigen presentation 218
T cells 220
Natural killer T cells 221
B cells 221
Mediators of inflammation 221
Acute?phase proteins 221
Cytokines 222
Interleukins 222
Interferons 222
Tumour necrosis factor 225
Cytokine suppressors and inhibitors 225
Chemokines 226
Chemokine receptors 229
Proteases 230
Matrix metalloproteinases 232
Lysosomal mediators 233
Radical oxygen species 234
Nitric oxide 235
Histamine 236
Platelet?activating factor 237
Prostaglandins and thromboxanes 238
Leukotrienes 239
Neuromediators 239
Cell apoptosis and inflammation 243
Allergy 244
Immunity, T cells and dendritic cells 244
Overview of the phases in an allergic reaction 245
Key references 250
CHAPTER 9 Photobiology 257
Basic principles 257
UVR and its production and sources 257
Measurement of UVR 258
Terrestrial UVR 258
Artificial sources of UVR 259
Interaction of UVR with the skin (physicochemical aspects) 259
Action spectroscopy 260
Normal effects of UVR on skin 261
Molecular and cellular effects 261
Clinical effects of UVR 263
Photoprotection 267
Sunscreens 267
Clothing and shade 268
Population exposure to UVR 268
The sun 268
UV index 268
Non?solar sources 269
Sunbeds 269
Risks versus benefits of population UVR exposure 269
Key references 269
CHAPTER 10 Cutaneous Response to Injury and Wound Healing 271
Introduction 271
Inflammation and the immune response 272
Neutrophils and platelets 272
Macrophages 273
Lymphocytes 273
Re?epithelialization 274
Angiogenesis 276
Fibroblast recruitment, matrix synthesis and scarring 277
Abnormal wound healing and scarring 278
Chronic wounds 278
Diabetes (see Chapter 149) 279
Hypertrophic and keloid scarring (see Chapter 96) 279
Age?related changes in wound healing 279
Physiological basis of treatment of wounds 280
Novel therapies for wound healing 281
Growth factors to augment wound healing 281
Stem cell therapy 281
Skin grafting and biomaterials 282
Key references 283
CHAPTER 11 Psychological and Social Impact of Long-term Dermatological Conditions 285
Psychological and social challenges of dermatological conditions 285
Role of appearance in society 285
Psychological impact of dermatological conditions with emphasis on psoriasis 286
Central role of beliefs in driving distress 286
Emotional reactions to living with skin conditions 287
Distress 287
Depression and anxiety 287
Coping and self?management 288
Non?adherence 288
Social impact of dermatology conditions 289
Scholastic and employment underachievement 289
Social stigma and avoidance 289
Impacts over the lifespan 289
Skin conditions and associated co?morbidities 290
Other medical conditions 290
Lifestyle behaviours 290
Treatment challenges 290
Support for treatment adherence 291
Implications of psychological and social impact of dermatological conditions for integrated clinical management 291
Integrated assessment 291
Integrated management 292
Key references 292
CHAPTER 12 Adverse Immunological Reactions to Drugs 293
Introduction 293
IgE?mediated drug hypersensitivity 293
T?cell?mediated drug hypersensitivity 294
Stevens–Johnson syndrome and toxic epidermal necrolysis 294
Drug reaction with eosinophilia and systemic symptoms 295
Other types of drug hypersensitivity 295
Drugs as haptens 296
Drugs as pro?haptens 296
Drugs as non?haptens 296
Understanding the clinical phenotype 297
Key references 298
CHAPTER 13 Topical Drug Delivery 299
Introduction: skin barrier function 299
Penetration pathways: mechanisms of percutaneous absorption 300
Factors determining drug permeation into the skin 301
Topical drug formulations used to treat dermatological disease 302
Assessment of topical drug bioavailability and bioequivalence between formulations 303
Optimization of dermatological medicines 305
Conclusions 308
Key references 308
CHAPTER 14 Clinical Pharmacology 309
Introduction 309
Types of drugs and terminology 309
Pharmacokinetics 309
Absorption 310
Distribution 311
Metabolism [ 6 ] 311
Excretion 311
Pharmacodynamics 311
Molecular mechanisms underlying drug action 312
Drug toxicity and adverse effects 313
Factors that affect therapeutic outcome 314
Drug choice and medical decision making 314
Clinical factors that affect drug pharmacokinetics and pharmacodynamics 315
Drug interactions 316
Patient adherence to treatment 316
Medication errors 316
Pharmacogenetics and personalized medicine 318
Drug development and licensing procedures 319
Pre?clinical drug identification 319
Drug development 319
Ethics and trial reporting 320
Resources 320
Key references 320
PART 2 Management 321
CHAPTER 15 Principles of Holistic Management of Skin Disease 323
What is holistic management andis it important? 323
Are we doctors or disease management technicians? 324
Is dermatology different? 324
How important is it to empower patients? 325
Patient education 325
Patient self?help groups 325
Conclusions 326
Key references 326
CHAPTER 16 Principles of Measurement and Assessment in Dermatology 327
Measurement of skin disease severity 327
Why measure skin disease severity? 327
What should be measured? 327
Who should do the measuring? 328
What can be measured? 328
Validation of measurement methods 328
Assessment tools 328
Inflammatory disease 328
Psoriasis 328
Atopic eczema 329
Acne 329
Symptoms 329
Therapy benefit 329
Objective methods for measuring skin properties 329
Measurement of the impact of skin disease 330
Quality of life assessment in patients with skin disease 330
Quality of life measures used in dermatology 330
General health measures 330
Dermatology?specific measures 330
Disease?specific quality of life measures 331
Patient?specific and utility measures 332
Measuring the impact of skin disease in children and adolescents 332
Measuring the impact of skin disease on partners and the family 333
Assessing life course impairment resulting from skin disease 333
Practical clinical use of quality of life measures: a vital sign? 334
Key references 334
CHAPTER 17 Principles of Evidence?based Dermatology 335
Evidence?based medicine 335
What is evidence?based medicine? 335
The need for evidence?based medicine 335
Practising evidence?based medicine 336
Limitations of evidence?based medicine 336
Threats to evidence?based medicine 337
Formulating questions and finding evidence 337
Formulating well?built clinical questions 337
What is ‘the best evidence’? 338
Finding the best evidence 340
Critically appraising evidence and applying it to individual patients 341
Critically appraising the evidence 341
Critically appraising systematic reviews 342
Critically appraising individual clinical trials [1,2,25,26] 346
Critically appraising a study about a diagnostic test [1,2,3] 349
Critically appraising a study about adverse events (case–control and cohort studies) [1,2,41] 350
Conclusions 352
Evaluating the data in clinical research papers and a shortcut method for reading clinical research papers 352
Evaluating the data in clinical research papers [1] 352
Statistical methods 354
Shortcut method for appraising clinical research papers 357
Key references 358
CHAPTER 18 Principles of Topical Therapy 361
Introduction 361
Prescribing topical treatment 361
Drug concentration 361
Choice of vehicle 362
Frequency of application 363
Quantity to be applied 363
Advice to patients 364
Hazards associated with topical treatment 365
Formulation of topical medicaments 365
Lipids 365
Polyethylene glycols 367
Emulsifiers 367
Humectants 367
Penetration enhancers 367
Powders 368
Preservatives 368
Topical treatments used in the management of skin disease 368
Emollients 368
Astringents 369
Anti?infective agents 369
Antifungal agents 371
Antiviral agents 372
Antiparasitic agents 373
Topical glucocorticoids 373
Calcineurin inhibitors 379
Retinoids 381
Vitamin D analogues (deltanoids, secosteroids) 383
Cytotoxic and antineoplastic agents 386
Depigmenting agents 388
Depilatories 389
Sensitizing agents 390
Sunscreens 390
Tars 392
Antihistamines 393
Antiperspirants 393
Traditional remedies 393
Miscellaneous agents 394
Key references 397
CHAPTER 19 Principles of Systemic Therapy 401
Introduction 401
General aspects 401
Risk reduction 401
Basic pharmacology of systemic therapy 403
Immunomodulatory drugs 403
Antihistamines 403
Antimalarial agents 405
Azathioprine 407
Ciclosporin 410
Colchicine 412
Dapsone 413
Fumaric acid esters 415
Systemic glucocorticoids 417
Hydroxycarbamide 421
Methotrexate 422
Mycophenolate mofetil 425
Potassium iodide 427
Biological therapies (protein therapeutics) 428
Intravenous immunoglobulin therapy 435
Systemic retinoids 437
Thalidomide 440
Antimicrobial drugs 441
Systemic antibiotics 441
Anti?inflammatory effects of antibiotics 443
Antifungal drugs 443
Antiviral drugs 444
Key references 444
CHAPTER 20 Principles of Skin Surgery 447
Introduction 448
Critical anatomical considerations 448
Skin tension lines and scar orientation 448
Undermining levels 448
Head and neck 448
Limbs 451
Equipment and sterilization 451
Safety aspects 454
Complications 454
Bleeding 454
Infection 457
Unsatisfactory outcome 457
Local anaesthetics 457
Principles and types 457
Toxic reactions 457
Methods 458
Biopsy techniques 458
Incisional and excisional elliptical biopsy 458
Punch biopsy 460
Shave biopsy 460
Preoperative preparation 460
Surgeon preparation 460
Patient preparation and consent 460
Preoperative planning and preparation 460
Simple excision, suture technique and wound closure 461
Elliptical excision – general technique [1,2] 461
Surgical needles and suture materials 462
Surgical knots 462
Tying knots with the needle?holder 462
Suture technique [1,2,3] 463
Dressings and postoperative care 468
Basic dressing 469
Pressure dressings 469
Secondary intention healing 469
Postoperative care of granulating wounds 469
Removal of sutures 469
Flaps 471
Advancement flaps 472
Rotation flaps 473
Transposition flaps 476
Pedicle flaps 476
Complications 476
Skin grafts 477
Full?thickness skin grafts 477
Composite grafts 477
Split?thickness skin graft 477
Other techniques for facilitating closure 479
M?plasty [1,2] 479
Z?plasty [3] 479
Wedge excision – lip, eyelid and ear 479
Vermilionectomy 480
‘Dog?ear’ repair (synonyms: tricone repair, standing cutaneous deformity repair) [10] 480
Relaxing incisions 481
Mohs micrographic surgery 481
Definition 481
History 481
Treatment of skin cancer 481
Procedure 483
Results 484
Practical aspects and indications 484
Electrocautery and electrosurgery [1,2,3] 486
Electrocautery 486
Electrosurgery 486
Electrosurgical effects 487
Hazards and risks of electrosurgery 487
Cryosurgery 489
Clinical methods 489
Clinical uses 489
Side effects [1] 489
Caustics 489
Aluminium chloride hexahydrate 489
Silver nitrate [3] 489
Intralesional corticosteroid therapy [1] 490
Indications 490
Intralesional therapies for skin malignancies 490
Miscellaneous surgical procedures and techniques 490
Curettage 490
Haemostasis for open wounds 491
Snip excision 491
Management of specific conditions 491
Epidermoid cysts (see Chapter 134) 491
Lipomas (see Chapter 137) 492
Hidradenitis suppurativa 492
Chondrodermatitis nodularis 492
Digital myxoid cysts 492
Axillary and palmar hyperhidrosis 492
Hypertrophic scars and keloids 492
Lesions on the shoulder, upper back and sternum 492
Benign naevi (see Chapter 132) 492
Non?melanoma skin cancer: basal cell and squamous cell carcinomas 492
Lesions of the mucous membranes (see Chapters 110, 111 and 112) 492
Keratoacanthoma 492
Pigmented lesions (see Chapters 132 and 143) 492
Minor skin lesions: mollusca, milia and comedones 493
Key references 493
CHAPTER 21 Principles of Phototherapy 495
Introduction 495
History and background 496
Ultraviolet radiation 496
What is ultraviolet radiation? 496
Artificial sources 496
Equipment for the delivery of phototherapy 497
Ultraviolet calibration and dosimetry 497
Indications for phototherapy 498
UVB phototherapy and PUVA 498
Choice of phototherapy modality: UVB versus PUVA 499
UVA?1 phototherapy 499
Extracorporeal photochemotherapy 500
How different therapies are administered 501
UVB phototherapy 501
PUVA 502
Combination therapy 503
UVA?1 phototherapy 504
Extracorporeal photochemotherapy 504
Adverse effects 505
UVB phototherapy 505
PUVA 506
UVA?1 phototherapy 508
Extracorporeal photochemotherapy 508
Patient selection, assessment and education 508
Patient selection and assessment 508
Patient education 509
Patient and staff safety 509
Patient follow?up: skin cancer surveillance 509
Clinical governance 510
Documentation 510
Risk management 510
Audit 510
How to set up a phototherapy unit 510
What’s new: developments 511
Key references 511
CHAPTER 22 Principles of Photodynamic Therapy 513
What is photodynamic therapy? 513
History and background 513
Photosensitizers used for photodynamic therapy in dermatology 514
Light sources 515
Indications 516
Actinic keratosis 516
Bowen disease 517
Basal cell carcinoma 517
Other indications 519
Contraindications 519
Methodology and regimens 519
Diagnosis and patient selection 519
Lesion preparation 521
Pro?drug application 521
Irradiation 522
Ambulatory photodynamic therapy 522
Daylight photodynamic therapy 523
Treatment schedules, aftercare and follow?up 524
Adverse effects 524
Acute effects 524
Dermatitis and allergy 525
Pain 525
Clinical governance 526
How to set up a PDT service 526
What’s new? 526
Key references 527
CHAPTER 23 Principles of Cutaneous Laser Therapy 529
Introduction 529
Light and laser light characteristics 529
Lasers and laser beams 530
Tissue optics 531
Light–tissue interaction 532
Selective photothermolysis 532
Tissue cooling 533
Clinical applications of lasers and flashlamps 533
General considerations 533
Vascular lesions and vascular lasers 534
Other applications of vascular lasers (Box 23.1) 538
Tattoos and pigmentary disorders 539
Hair reduction 543
Photothermal ablation in the treatment of skin disorders 544
Non?ablative and fractional modalities 547
Low?power lasers 548
Laser?assisted lipolysis 548
Key references 548
CHAPTER 24 Principles of Radiotherapy 549
Introduction 549
Ionizing radiation in the treatment of skin cancer 549
X?ray photon beams: megavoltage and kilovoltage X?ray therapy 549
Electron beams 549
Moulds, applicators and implants 550
Superficial radiotherapy treatment technique 550
Megavoltage X?ray therapy technique 551
Radiosensitivity 551
Indications for radiotherapy 551
Benign disease 551
Keloids (see Chapter 96) 555
Malignant skin disease 555
Acute radiation reaction (acute radiodermatitis) (Figures 24.18a–c and 24.19a–c) 564
Management 565
Late radiation reaction (chronic radiodermatitis) (Figures 24.20 and 24.21) 566
Tumour recurrence after radiotherapy 567
Radiation?induced tumours 567
Management 567
Rare tumours associated with previous irradiation 567
Atypical fibroxanthoma (see Chapter 137) (syn. pseudosarcoma of the skin) 567
Radiation?induced sarcoma (see Chapter 137) 567
Key references 568
PART 3 Infections and Infestations 569
CHAPTER 25 Viral Infections 571
Introduction 572
General pathology of viral infections 572
POXVIRUS INFECTIONS 575
General description of disease domain 576
Basic biology 576
Smallpox 576
Resources 576
Vaccinia 577
Resources 577
Monkeypox 577
Resources 578
Cowpox 578
Buffalopox 579
Orf 579
Resources 581
Milker’s nodule 581
Resources 582
Molluscum contagiosum 582
Resources 584
Tanapox 585
HERPESVIRUS INFECTIONS 585
General description of disease domain 585
Basic biology 585
Herpes simplex virus infections 586
General description of disease domain 586
Primary infection 586
Recurrent infection 586
Subclinical viral shedding 586
Basic biology [12–16] 586
Primary herpetic gingivostomatitis 586
Recurrent oro?facial and cutaneous herpes 588
Resources 590
Primary herpes genitalis [104] 590
Recurrent genital herpes 591
Resources 592
Neonatal herpes (see Chapter 116) [139] 592
Inoculation herpes simplex 593
Varicella?zoster virus infections 593
General description of disease domain 594
Basic biology 594
Varicella 594
Resources 597
Zoster 597
Resources 601
Epstein–Barr virus infections 601
Introduction 601
General description of disease domain 601
Basic biology 601
Infectious mononucleosis 601
Oral hairy leukoplakia (see Chapter 110) 603
Chronic active Epstein–Barrvirus infection 603
Epstein–Barr virus associated lymphomas and carcinomas 604
Human herpesvirus 6 and 7 virus infections [324] 604
Definition 604
Classification 604
General description of disease domain [329] 604
Basic biology 604
Roseola infantum [338,339] 604
Herpesvirus 7 infections 605
Reactivation of herpesvirus 6 and 7 605
OTHER HERPESVIRUS INFECTIONS 606
Cytomegalovirus infection 606
Human herpesvirus 8 infection 607
Herpes B virus infection [419] 608
Resources 608
Eczema herpeticum 608
POLYOMAVIRUS INFECTIONS 611
Definition 611
General description of disease domain 611
Merkel cell polyomavirus infection 611
Resources 612
Trichodysplasia spinulosa 612
Human polyomavirus 6 and 7 infection 613
HUMAN PAPILLOMAVIRUS INFECTIONS 613
Definition 613
General description of disease domain 613
Basic biology 613
Subclinical and latent human papillomavirus infection 613
Immunity to human papillomavirus [14,15,16] 616
Cutaneous warts 616
Ano?genital warts 625
Human papillomavirus associated intraepithelial and invasive neoplasias of genitalia and mucosae 628
Cervical intraepithelial neoplasia and invasive carcinoma [288] 628
Cutaneous squamous cell carcinoma without immunosuppression 629
Epidermodysplasia verruciformis 629
Human papillomavirus in immune compromise 631
HEPATITIS INFECTIONS 633
Hepatitis B 633
Resources 635
Hepatitis C 635
PARVOVIRUS INFECTIONS 636
General description of disease domain 636
Erythema infectiosum 636
Resources 637
Other parvoviruses 637
HUMAN RETROVIRUS INFECTION 637
General description of disease domain 637
Basic biology 637
Infective dermatitis associated with HTLV?1 638
VIRAL INSECT?BORNE AND HAEMORRHAGIC FEVERS 639
General description of disease domain 639
Basic biology 639
Arenavirus infections 639
General description of disease domain 640
Lassa fever 640
Resources 640
Lujo virus haemorrhagic fever 640
Resources 641
Argentinian, Bolivian, Brazilian and Venezuelan haemorrhagic fevers 641
Resources 642
Bunyavirus infections 642
General description of disease domain 642
Resources 642
Filovirus infections 642
General description of disease domain 642
Marburg and Ebola haemorrhagic fevers 642
Resources 643
Flavivirus infections 643
General description of disease domain 643
Yellow fever 643
Resources 643
Dengue 643
Resources 644
Togavirus infections 644
General description of disease domain 644
Basic biology 645
Sindbis virus infection 645
Chikungunya fever 645
Resources 646
O’Nyong–Nyong fever 646
Ross River virus 646
Resources 647
Barmah Forest virus 647
Resources 647
Mayaro virus infection 647
Resources 648
Rubella 648
Picornavirus infections (enteroviruses) 649
General description of disease domain 649
Basic biology 649
Foot and mouth disease 649
Enterovirus infection 650
Hand, foot and mouth disease 651
Herpangina 652
Parechovirus infection 653
Hepatitis A infection 653
Resources 654
RHABDOVIRUS infections 654
Vesicular stomatitis virus infection 654
Myxovirus infections and related RNA viruses 654
General description of disease domain 654
Measles [1] 654
Resources 656
Respiratory syncytial virus 656
Other cutaneous problems associated with viral infections 656
General description of disease domain 656
Papular?pruritic gloves and socks syndrome 657
TORCH syndrome 657
Gianotti–Crosti syndrome 657
Resources 659
Asymmetric periflexural exanthem of childhood 659
Pityriasis rosea 659
Key references 662
CHAPTER 26 Bacterial Infections 667
Introduction: normal skin bacteria and bacterial microbiome 668
Normal microbial ecology 668
Flora of specialized areas [34] 670
Adherence 671
Skin and defence 671
Gram?positive bacteria 672
Staphylococcus aureus 672
Definition 672
Introduction and general description 672
Epidemiology 672
Incidence and prevalence 672
Age 672
Sex 673
Ethnicity 673
Associated diseases 673
Pathophysiology 673
Predisposing factors 673
Pathology 674
Causative organisms 674
Genetics 674
Environmental factors 675
Coagulase?negative staphylococci 675
Definition 675
Introduction and general description 675
Epidemiology 675
Associated diseases 675
Pathophysiology 675
Predisposing factors 675
Causative organisms 675
Genetics 675
Environmental factors 675
Streptococci 675
Definition 675
Introduction and general description 675
Epidemiology 676
Incidence and prevalence 676
Age 676
Sex 676
Ethnicity 676
Associated diseases 676
Pathophysiology 677
Predisposing factors 677
Pathology 677
Causative organisms 677
Genetics 678
Environmental factors 678
Investigations 678
Staphylococcal and streptococcal infections 678
Clinical history 678
Impetigo 679
Ecthyma 682
Cellulitis and erysipelas 683
Folliculitis 687
Furuncle (boil, abscess) 689
Carbuncle 691
Sycosis 692
Staphylococcal scalded skin syndrome 693
Toxic shock syndrome 695
Recurrent toxin?mediated perineal erythema 698
Streptococcal vulvovaginitis (see Chapter 112) 699
Perianal streptococcal cellulitis 699
Blistering distal dactylitis 700
Toxin?mediated streptococcal disease 700
Scarlet fever 700
Streptococcal toxic shock?like syndrome 702
Coryneform bacteria 703
Definition 703
Introduction and general description 703
Diphtheria 704
Erythrasma 705
Trichomycosis axillaris 707
Pitted keratolysis 708
Arcanobacterium haemolyticum infection 709
Trueperella pyogenes infection 709
Propionibacteria 709
Bacillus 709
Anthrax [1,2] 709
Listeria monocytogenes 711
Listeriosis 711
Erysipelothrix rusiopathiae 712
Erysipeloid [1–3] 712
Clostridium 713
Gas gangrene (clostridial myonecrosis) 713
Gram?negative bacteria 714
Neisseria meningitides [1,2] 714
Meningococcal infection 715
Gonococcal infection 716
Acinetobacter [1–3] 716
Moraxella 716
Pseudomonas aeruginosa [1,2,3] 716
Pseudomonas infection 716
Burkholderia 718
Melioidosis 718
Glanders 719
Stenotrophomonas maltophilia [1] 720
Klebsiella pneumoniae rhinoscleromatis 720
Rhinoscleroma 720
Francisella tularensis 722
Tularaemia 722
Pasteurella 723
Pasteurella multocida and related infections 723
Yersinia 723
Plague and Yersinia infections 723
Yersinia enterocolitica 724
Brucella 724
Brucellosis 724
Bartonella 725
Definition 725
Introduction and general description 725
Trench fever 726
Cat scratch disease 726
Bacillary angiomatosis 727
Oroya fever and verruga peruana 728
Ehrlichia 729
Ehrlichiosis 729
Other Gram?negative bacilli 729
Vibrio vulnificus infections 730
Anaerobic bacteria 730
Definition 730
Clinical features 730
Management 731
Tropical ulcer 731
Granuloma inguinale 732
Spirochaetes and spiral bacteria 732
Definition 732
Treponemes 732
Non?venereal (endemic) treponematoses [1–7] 732
Endemic syphilis or bejel 732
Yaws 733
Pinta 734
Borrelia 734
Relapsing fever 734
Borrelia burgdorferi and Lyme disease 735
Leptospira 737
Leptospirosis (including Weil disease and canicola fever) 737
Rat?bite fevers 737
Spirillum minor rat?bite fever or sodoku 737
Streptobacillary rat?bite fever and Haverhill fever 738
Legionellosis 738
Definition 738
Epidemiology 738
Clinical features 738
Miscellaneous 738
Botryomycosis 738
Necrotizing subcutaneous infections 739
Mycoplasma infections 741
Clinical features 741
Investigations 741
Management 741
Chlamydiae [1,2] 741
Psittacosis 742
Rickettsial infections 742
Epidemic typhus [1] 742
Brill–Zinsser disease [1] 743
Murine typhus [1] 743
Spotted fever group 743
Rocky Mountain spotted fever [1,4–6] 743
Tick typhus [1] 744
Rickettsialpox [1,9] 745
Scrub typhus [1,10] 745
Actinomycete infections 745
Actinomycosis 745
Nocardiosis 747
Dermatoses possibly attributable to bacteria 748
Chancriform pyoderma 748
Pyoderma vegetans 749
Dermatitis gangrenosa infantum 749
Kawasaki disease 750
Key references 751
CHAPTER 27 Mycobacterial Infections 755
Introduction 755
Mycobacterial infection 756
Classification 756
Epidemiology 756
Mycobacterium tuberculosis infection 756
HIV and Mycobacterium tuberculosis co?infection 757
Non?tuberculous mycobacterial infections 757
Basic biology 757
Immunology of tuberculosis 757
Protective immunity to M. tuberculosis 757
Immunopathology 758
Diagnostic tests for tuberculosis 758
Tuberculin skin test 758
Interferon?? release assays for the diagnosis of latent tuberculosis 758
Diagnosis of mycobacterial infections 759
Tuberculosis of the skin 759
Classification 759
Clinical spectrum of cutaneous tuberculosis 759
Classification difficulties 760
General description 760
Basic biology 760
Pathogenesis 760
Development of the granuloma [5] 761
Histopathology [9] 761
Disease?specific changes 761
Differential diagnosis 761
Diagnostic tests for cutaneous tuberculosis 762
Nucleic acid amplification tests [7,8] 762
Treatment 763
General measures 763
Drug therapy 763
Current treatment regimens 763
Prognosis 764
BCG vaccination [1] 765
Complications 765
Therapeutic use 765
Tuberculosis and anti?TNF?? treatment (see Chapter 35) 766
Primary inoculation tuberculosis 766
Scrofuloderma 767
Orificial tuberculosis 770
Acute cutaneous miliary tuberculosis 771
Metastatic tuberculous abscess 772
Warty tuberculosis 773
Lupus vulgaris 775
Tuberculids 779
Classification 779
General description 779
Basic biology 779
Lichen scrofulosorum 779
Papulonecrotic tuberculid 782
Erythema induratum of Bazin 783
Other nodular tuberculids 785
Erythema nodosum 785
Nodular vasculitis 785
Lupus miliaris disseminatus faciei 785
Tuberculous mastitis 786
Non?tuberculous (atypical) mycobacteria 786
Classification 786
General description 786
Basic biology 787
Mycobacterium marinum infection 787
Mycobacterium kansasii infection 789
Mycobacterium ulcerans infection 790
Mycobacterium avium complex (M. avium and M. intracellulare) infection 793
Mycobacterium haemophilum infection 794
Mycobacterium scrofulaceum infection 795
Mycobacterium szulgai infection 796
Infection with fast?growing mycobacteria 796
Key references 799
CHAPTER 28 Leprosy 803
Definition and nomenclature 803
Introduction and general description 803
Epidemiology 803
Incidence and prevalence 803
Age 804
Sex 804
Pathophysiology 804
Predisposing factors 804
Pathology 804
Causative organisms 808
Clinical features 809
History 809
Presentation [73] 809
Clinical variants 809
Differential diagnosis 813
Classification of severity 814
Complications and co?morbidities 814
Investigations [99] 816
Slit?skin smears [101] 816
Skin biopsy [102] 816
Nerve biopsy 816
Serology 816
Pregnancy 816
Management 816
Expectations of treatment 816
First line 816
Second line 818
Complications of treatment 818
Additional aspects of management 818
Prevention and control 819
Resources 819
Key references 820
INTRODUCTION TO CHAPTERS 29 AND 30: Global Overview of Sexually Transmitted Infections 821
References 821
CHAPTER 29 Syphilis and Congenital Syphilis 823
Syphilis 823
Resources 847
Congenital syphilis 847
Resources 855
Key references 855
CHAPTER 30 Other Sexually Transmitted Bacterial Diseases 857
Gonorrhoea 857
Resources 864
Genital Chlamydia infection 864
Resources 871
Lymphogranuloma venereum 871
Resources 876
Chancroid 876
Resources 879
Granuloma inguinale 879
Resources 881
Key references 882
CHAPTER 31 HIV and the Skin 885
HIV INFECTION AND AIDS 885
Definition 885
Introduction and general description 885
Epidemiology 886
Incidence and prevalence 886
Sex 886
Ethnicity 886
Pathophysiology 886
Virology 886
Immunology 887
Clinical features 889
AIDS case definition 889
Presentation 890
Dermatological manifestations of acute primary HIV infection 891
Clinical variants 891
Complications and co?morbidities 891
Disease course and prognosis 892
Investigations 892
Management 893
HIV prevention 893
Antiretroviral treatment 893
DERMATOLOGICAL MANIFESTATIONS OF HIV INFECTION 895
Introduction 895
Pruritus, xerosis and ichthyosis 896
Pigmentary disorders 896
Coagulopathies 897
Inflammatory dermatoses 897
Erythroderma 898
Seborrhoeic dermatitis 898
Atopic eczema 898
Psoriasis 899
Eosinophilic folliculitis 900
Pruritic papular eruption 900
Granuloma annulare (see Chapter 97) 901
Porphyria cutanea tarda (see Chapter 60) 901
Drug reactions 901
Infections 904
Bacterial infections (see Chapter 26) 904
Other bacterial infections 906
Viral infections (see Chapter 25) 906
Herpes simplex 906
Varicella?zoster virus 907
Cytomegalovirus 907
Human papillomavirus 908
Mollusca 909
Other viral infections 909
Fungal infections (see Chapter 32) 910
Candidosis 910
Dermatophytosis 910
Histoplasmosis 910
Cryptococcosis 911
Other fungal infections 911
Protozoal infections (see Chapter 33) 912
Scabies (see Chapter 34) 912
Miscellaneous infections 912
Neoplasms 913
Kaposi sarcoma 913
Melanoma and non?melanoma skin cancer 914
Lymphoma 915
Other neoplasms 916
Special situations 916
Hair and nails 916
Oro?pharynx 917
Women 918
Children 918
Haemophilia 919
Intravenous drug use 919
IRIS/IRD/IRAD 919
Key references 921
CHAPTER 32 Fungal Infections 923
Introduction 924
Basic biology 924
Reproduction 924
Taxonomy and classification 925
Nomenclature 927
SUPERFICIAL MYCOSES 928
Classification 928
General description 928
Identification 928
Wood’s light examination 928
Collection of material 929
Direct examination 930
Culture (Table 32.4 ) 930
Molecular diagnostics 931
Identification of isolates 932
SKIN DISEASE CAUSED BY MALASSEZIA SPECIES 932
Pityriasis versicolor 932
Malassezia folliculitis 935
Other cutaneous disorders associated with Malassezia yeasts 936
SUPERFICIAL MYCOSES CAUSED BY OTHER SPECIES 936
Tinea nigra 936
Black piedra 937
White piedra 938
Otomycosis 939
Miscellaneous superficial mycoses caused by saprophytic moulds 940
DERMATOPHYTOSIS 940
Classification 940
General description 940
Basic biology 942
Invasion of the epidermis 943
Adherence 943
Penetration 943
Immunity 943
Pathophysiology 944
Other factors affecting infection 944
Identification 945
Genus Microsporum 945
Genus Trichophyton 949
Genus Epidermophyton 954
Management 954
General principles of management 954
Therapeutic agents 955
Treatment regimen 956
Treatment failures 956
Superficial mycoses caused by dermatophyte infection 957
Tinea corporis 957
Tinea capitis 960
Tinea barbae 963
Tinea faciei 963
Tinea pedis 964
Tinea manuum 967
Tinea cruris 968
Onychomycosis caused by dermatophytes 969
Steroid?modified tinea 972
Dermatophytide reactions 972
SUPERFICIAL MYCOSES DUE TO OTHER HYPHAL FUNGI 973
Superfi cial mycoses caused by Neoscytalidium species 973
ONYCHOMYCOSIS CAUSED BY OTHER NON?DERMATOPHYTE MOULDS 975
General description 975
Identification 975
Onychomycoses caused by Scopulariopsis infections 976
Superficial onychomycosis caused by non?dermatophytes 977
Onychomycosis caused by Onychocola canadensis 977
Onychomycosis caused by miscellaneous moulds 977
CANDIDOSIS 978
Definition and nomenclature 978
Classification 978
General description 978
Basic biology 978
Candida ecology 978
Pathophysiology 979
Organisms 979
Host factors 980
Endocrine factors [7,20] 980
Immunological factors 980
Candidosis and HIV/AIDS 981
Identification 981
Histology [1,2] 982
Management 983
General principles of management [1] 983
Therapeutic agents 983
First line 983
Candidosis of the oral mucous membranes 983
Acute pseudomembranous candidosis 984
Acute erythematous candidosis 984
Chronic pseudomembranous candidosis 984
Chronic erythematous candidosis 984
Chronic plaque?like candidosis 985
Chronic nodular candidosis 985
Angular cheilitis 985
Median rhomboid glossitis 985
Candidosis of the skin and genital mucous membranes 985
Candida intertrigo 985
Vulvo?vaginal candidosis 986
Candida balanitis 987
Perianal and scrotal candidosis 987
Perineal candidosis of infancy 987
Nodular or granulomatous candidosis of thenapkin area 988
Candidosis of the nail and paronychium 988
Candida paronychia 988
Candida onychomycosis 989
Other Candida diseases 989
Congenital candidosis 989
Candida allergy [ 25 ] 989
Chronic mucocutaneous candidosis 990
SUBCUTANEOUS MYCOSES 992
Classification 992
General description 992
Identification 992
Collection of samples 992
Direct examination and histopathology 992
Culture and identification of isolates 992
Sporotrichosis 993
Mycetoma 995
Chromoblastomycosis 998
Phaeohyphomycosis 1000
Lobomycosis 1001
Rhinosporidiosis 1001
Subcutaneous mycosis due to Basidiobolus and Conidiobolus 1002
SYSTEMIC MYCOSES 1003
Pathophysiology 1003
Identification 1003
Serological tests 1003
Direct examination and histopathology 1004
Culture and identification of isolates 1004
Histoplasmosis 1004
Blastomycosis 1007
Coccidioidomycosis 1009
Paracoccidioidomycosis 1011
Infections caused by Talaromyces marneffei 1012
Cryptococcosis 1014
Systemic candidosis 1016
Mucormycosis 1016
Unusual causes of skin lesions among opportunistic systemic mycoses 1016
Cutaneous infection caused by Pneumocystis jiroveci 1017
Infections caused by Pythium insidiosum 1017
Protothecosis 1017
Glossary of terms 1017
Key references 1018
CHAPTER 33 Parasitic Diseases 1019
Infection with human nematodes 1019
Onchocerciasis 1019
Streptocerciasis 1024
Lymphatic filariasis 1025
Loiasis 1028
Dracunculiasis 1029
Enterobiasis 1031
Ancylostomiasis 1033
Strongyloidiasis 1033
Infection with nematodes of other animals 1035
Cutaneous larva migrans 1036
Visceral larva migrans 1037
Gnathostomiasis 1038
Dirofilariasis 1040
Trichinosis 1040
Infection with trematodes 1042
Schistosomiasis 1043
Cercarial dermatitis 1045
Paragonimiasis 1046
Infection with cestodes 1047
Echinococcosis 1047
Cysticercosis 1048
Sparganosis 1049
Infection with protozoa 1051
Malaria 1051
Amoebiasis 1052
Trichomoniasis 1053
Trypansomiasis 1054
Leishmaniasis 1058
Cutaneous leishmaniasis 1058
Visceral leishmaniasis 1066
Toxoplasmosis 1069
Key references 1070
CHAPTER 34 Arthropods 1073
SKIN DISEASE DUE TO ARTHROPODS 1073
Definition 1073
Pathophysiology 1073
Mechanical trauma 1073
Injection of irritant, cytotoxic or pharmacologically active substances 1074
Injection of potential allergens 1074
Secondary infection 1074
Invasion of the host’s tissues 1074
Contact reactions 1074
Reactions to retained mouthparts 1074
Transmission of disease 1074
Environmental factors 1074
Pathology [23–25] 1075
Clinical features 1075
Investigations 1076
Management 1077
Prevention: insect repellents [35,36,37,38] 1077
General management 1077
CLASS INSECTA 1078
Mosquitoes, gnats, midges and flies (Diptera) 1078
Myiasis 1080
Fleas (Siphonaptera) 1084
Tungiasis 1085
Bees, wasps and ants (Hymenoptera) 1086
Lice (Phthiraptera) 1088
Head lice (Pediculus capitis) 1090
Resources 1093
Clothing/body lice (Pediculus corporis) 1093
Resources 1094
Crab lice (Phthiriasis pubis) 1094
Resources 1095
Bugs (Hemiptera) 1095
Family Cimicidae, including bedbugs 1096
Resources 1099
Family Reduviidae (kissing bugs, assassin bugs andcone?nosed bugs) 1099
Family Anthocoridae, commonly called minute piratebugs or flower bugs 1100
Family Pentatomidae, commonly called stink bugs 1100
Family Belostomatidae (giant water bugs) 1100
Thrips (Thysanoptera) 1100
Beetles (Coleoptera) 1100
Cockroaches (Dictyoptera) 1102
Locusts (Orthoptera) 1102
Butterflies and moths (Lepidoptera) 1102
CLASS ARACHNIDA 1104
Spiders (Araneae) 1104
Family Theridiidae 1104
Family Hexathelidae 1105
Family Sicariidae (formerly Loxoscelidae) 1105
Family Lycosidae (wolf spiders) 1106
Other venomous species [7,8,11,44–47] 1106
Scorpions (Scorpiones) 1106
Ticks (Acari) 1107
Mites (Acari) 1111
Family Sarcoptidae: human classical scabies 1111
Family Sarcoptidae: human crusted scabies 1117
Family Sarcoptidae: animal scabies 1119
Family Knemidokoptidae 1119
Family Psoroptidae 1119
Family Listrophoridae 1119
Mites of stored products [1,2] 1120
House?dust mites 1120
Pyemotes mites 1121
Family Tydeidae 1121
Plant mites 1122
Cheyletiella mites 1122
Harvest mites (Trombiculidae) 1123
Bird, rodent and reptile mites (Gamasida) 1124
Follicle mites (Demodicidae) 1124
CLASS CHILOPODA (CENTIPEDES) AND DIPLOPODA (MILLIPEDES) 1126
Centipedes 1126
Millipedes 1126
Key references 1127
PART 4 Inflammatory Dermatoses 1131
CHAPTER 35 Psoriasis and Related Disorders 1133
Definition 1133
PLAQUE PSORIASIS 1133
Epidemiology 1133
Incidence and prevalence 1133
Ethnicity 1134
Age at onset 1134
Gender 1134
Pathophysiology 1134
Genetics 1134
Environmental factors 1136
Pathogenic mechanisms 1138
Histopathology 1138
Clinical features 1139
History 1139
Presentation 1140
Psoriasis affecting specific sites 1142
Clinical variants (based on morphology or natural history) 1147
Other specified forms of psoriasis (based on age, precipitants) 1149
Differential diagnosis 1150
Classification of severity 1151
Complications and co-morbidities 1152
Disease course and prognosis 1153
Investigations 1154
Management 1154
General 1154
Topical treatment 1154
Phototherapy 1157
Systemic therapy 1158
Biological therapy 1161
PUSTULAR PSORIASIS 1164
Introduction and general description 1164
Generalized pustular psoriasis 1164
Palmoplantar pustulosis 1169
Acrodermatitis continua of Hallopeau 1172
PSORIATIC ARTHRITIS 1174
Definition and nomenclature 1174
Epidemiology 1175
Incidence and prevalence 1175
Age at onset 1175
Associated diseases 1175
Genetics and pathophysiology 1175
Causes 1176
Pathophysiology 1176
Clinical features 1176
Differential diagnosis 1176
Classification of severity 1176
Investigations 1176
Treatment 1176
Systemic therapy 1177
Biological treatment 1177
Key references 1178
CHAPTER 36 Pityriasis Rubra Pilaris 1181
Definition and nomenclature 1181
Introduction and general description 1181
Epidemiology 1181
Incidence and prevalence 1181
Age 1181
Sex 1181
Ethnicity 1181
Associated diseases 1181
Pathophysiology 1182
Pathology 1182
Genetics 1182
Clinical features 1182
History 1182
Presentation 1182
Clinical variants 1182
Differential diagnosis 1184
Complications and co-morbidities 1184
Disease course and prognosis 1184
Investigations 1185
Management 1185
Key references 1187
CHAPTER 37 Lichen planus and Lichenoid Disorders 1189
Definition 1189
Lichen planus 1189
Introduction and general description 1189
Epidemiology 1190
Pathophysiology 1190
Immunopathology 1190
Causative organisms 1190
Genetics 1190
Environmental factors 1191
Clinical features 1191
History and clinical presentation 1191
Clinical variants 1193
Lichen planus principally involving mucous membranes 1193
Lichen planopilaris 1194
Hypertrophic lichen planus 1195
Lichen planus of the palms and soles 1195
Actinic lichen planus 1195
Lichen planus pigmentosus 1196
Annular lichen planus 1196
Guttate lichen planus 1197
Acute and subacute lichen planus with a confluence of lesions 1197
‘Mixed’ lichen planus/discoid lupus erythematosus disease patterns 1197
Bullous lichen planus and lichen planus pemphigoides 1197
Lichen nitidus 1198
Nékam disease 1199
Complications 1199
Hair 1199
Nails 1200
Mucous membranes 1200
Associated conditions 1201
Disease course and prognosis 1201
Investigations 1201
Management 1203
Cutaneous lichen planus 1204
Oral lichen planus 1204
Ano-genital lichen planus 1205
Lichen planopilaris 1205
Frontal fibrosing alopecia 1205
Nail lichen planus 1205
Severe erosive lichen planus 1206
Lichen nitidus 1206
Nékam disease/keratosis lichenoides chronica 1206
‘Mixed’ lichen planus/discoid lupus erythematosus disease patterns 1206
Actinic lichen planus 1206
Bullous lichen planus and lichen planus pemphigoides 1206
Lichen striatus 1206
Definition and nomenclature 1206
Epidemiology 1206
Incidence and prevalence 1206
Age 1206
Sex 1206
Associated diseases 1206
Pathophysiology 1206
Pathology 1206
Genetics 1207
Environmental factors 1207
Clinical features 1207
History 1207
Presentation 1207
Clinical variants 1207
Differential diagnosis 1208
Disease course and prognosis 1208
Investigations 1208
Management 1208
General principles of management 1208
Key references 1208
CHAPTER 38 Graft?versus?host Disease 1209
Definition and nomenclature 1209
Introduction and general description 1209
Epidemiology 1209
Incidence and prevalence 1209
Pathophysiology 1210
Predisposing factors 1210
Pathology 1210
Acute graft-versus-host disease 1211
Chronic graft-versus-host disease 1214
Key references 1219
CHAPTER 39 Eczematous Disorders 1221
ASSESSMENT, INVESTIGATION AND MANAGEMENT OF ECZEMATOUS DISORDERS 1221
Eczema 1221
Nummular dermatitis 1227
Asteatotic eczema 1230
Dermatitis and eczema of the hands 1231
Dermatitis and eczema of the lower legs 1238
Dermatitis and eczema of the eyelids 1241
Juvenile plantar dermatosis 1241
MISCELLANEOUS SPECIFIED ECZEMATOUS DERMATOSES 1242
Infective dermatitis 1242
Infective dermatitis of children associated with human T-cell leukaemia virus 1221
infection 1244
Post-traumatic eczema 1244
Pityriasis alba 1245
Chronic superficial scaly dermatitis 1246
Dermatophytide 1247
Halo dermatitis 1247
Murray Williams’ warts 1248
OTHER RELATED DERMATOSES 1248
Lichen simplex and lichenification 1248
Erythroderma 1250
Key references 1255
CHAPTER 40 Seborrhoeic Dermatitis 1257
Introduction and general description 1257
Epidemiology 1257
Pathophysiology 1257
Genetics 1258
Environmental factors 1258
Clinical features 1258
History 1258
Presentation 1258
Clinical variants 1258
Differential diagnosis 1260
Classification of severity 1260
Complications and co-morbidities 1260
Quality of life 1260
Disease course and prognosis 1261
Investigations 1261
Management 1261
Key references 1262
CHAPTER 41 Atopic Eczema 1263
Definition and nomenclature 1263
Introduction and general description 1263
Atopic and non-atopic eczema 1263
Diagnostic criteria 1264
Epidemiology 1265
Incidence and prevalence 1265
Disease severity 1265
Age and sex 1266
Morbidity and cost 1266
What we can learn from prevalence surveys 1266
Pathophysiology 1266
Genetics 1267
Environmental factors 1268
The hygiene hypothesis 1270
Immune dysregulation 1271
Food allergy 1274
Allergic contact dermatitis 1275
Infection 1275
Autoimmunity 1276
Pharmacological and vascular abnormalities 1276
Pruritus 1276
Sweating 1277
Endocrine and psychological factors 1277
Clinical features 1277
History 1277
Presentation and clinical variants 1278
Diagnosis and differential diagnosis 1283
Classification of severity 1283
Complications and co-morbidities 1283
Other patterns of eczema 1285
Disease course and prognosis 1286
Disease prevention and occupational advice 1287
Investigations 1287
Management 1288
First assessment 1288
Treatment 1288
First line 1288
Second line 1293
Third line 1294
Conclusion 1296
References 1296
CHAPTER 42 Urticaria 1297
Definition and nomenclature 1297
Terminology 1297
Classification 1297
Introduction and general description 1299
Epidemiology 1299
Incidence and prevalence 1299
Age 1299
Sex 1299
Ethnicity 1299
Associated diseases 1299
Pathophysiology 1300
Predisposing factors 1300
Aetiology 1300
Pathology 1302
Genetics 1303
Environmental factors 1303
Clinical features 1303
Spontaneous urticaria 1303
Inducible urticarias 1304
Urticaria due to mechanical forces 1304
Temperature-dependent urticaria 1306
Other types of inducible urticaria 1308
Presentation 1310
Differential diagnosis 1310
Classification of severity 1310
Complications and co-morbidities 1310
Disease course and prognosis 1310
Investigations 1310
Acute urticaria 1310
Chronic urticaria 1310
Management 1312
First line therapies (antihistamines) 1312
Second line therapies (targeted therapy) 1313
Third line therapies (immunomodulatory) 1314
Fourth line treatment 1314
Key references 1314
CHAPTER 43 Recurrent Angio?oedema without Weals 1315
Definition and nomenclature 1315
Introduction and general description 1316
Mast cell mediator-induced angio-oedema 1316
Hereditary angio-oedema 1316
ACE inhibitor-induced angio-oedema 1316
Epidemiology 1316
Incidence and prevalence 1316
Age 1316
Sex 1316
Ethnicity 1316
Associated diseases 1316
Pathophysiology 1317
Mast cell mediator-induced angio-oedema 1317
ACE inhibitor-induced angio-oedema 1317
Hereditary angio-oedema 1317
Angio-oedema due to acquired C1INH deficiency 1317
Infections 1317
Genetics 1317
Environmental factors 1318
Clinical features 1318
Mast cell mediator-induced angio-oedema 1318
ACE inhibitor-induced angio-oedema 1318
Hereditary angio-oedema 1318
Clinical variants 1318
Differential diagnosis 1318
Assessment of disease activity and impact on patients 1318
Disease course and prognosis 1318
Investigations 1319
Management 1319
Emergency treatment of hereditary angiooedema 1319
Short-term prophylaxis of hereditary angiooedema 1319
Long-term prophylaxis of hereditary angiooedema 1320
Treatment of acquired C1-esterase inhibitor deficiency 1320
Key references 1320
CHAPTER 44 Urticarial Vasculitis 1321
Definition and nomenclature 1321
Introduction and general description 1321
Epidemiology 1321
Incidence and prevalence 1321
Age 1321
Sex 1321
Ethnicity 1321
Associated diseases 1322
Pathophysiology 1322
Predisposing factors 1322
Pathology 1322
Genetics 1323
Environmental factors 1323
Clinical features 1323
History 1323
Presentation 1323
Clinical variants 1323
Differential diagnosis 1323
Classifi cation of severity 1324
Complications and co-morbidities 1324
Disease course and prognosis 1324
Investigations 1324
Management 1324
Key references 1325
CHAPTER 45 Autoinflammatory Diseases Presenting in the Skin 1327
Introduction 1327
MONOGENIC AUTOINFLAMMATORY SYNDROMES 1327
Definition 1327
Introduction and general description 1328
Epidemiology 1328
Pathophysiology 1330
Hereditary periodic fevers 1330
Cryopyrin-associated periodic syndrome 1330
Tumour necrosis factor associated periodic syndrome 1331
Familial Mediterranean fever 1331
Mevalonate kinase deficiency with recurrent fever and hyper-IgD syndrome 1332
Autoinfl ammatory granulomatosis of childhood (Blau syndrome) 1333
Autoinfl ammatory syndromes with pustulosis 1333
Deficiency of interleukin 1 receptor antagonist 1333
Deficiency of interleukin 36 receptor antagonist 1334
Pyogenic sterile arthritis, pyoderma gangrenosum and acne syndrome 1334
Miscellaneous monogenic autoinflammatory syndromes 1334
Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature 1334
Majeed syndrome 1334
COMPLEX AND POLYGENIC AUTOINFLAMMATORY DISEASES PRESENTING WITH URTICARIAL OR MACULOPAPULAR RASH 1335
Schnitzler syndrome 1335
Adult-onset Still disease 1336
Systemic-onset juvenile idiopathic arthritis 1337
Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome 1337
OTHER DISEASES IN WHICH AUTOINFLAMMATORY MECHANISMS MAY PLAY AN IMPORTANT ROLE 1337
Management 1338
Key references 1338
CHAPTER 46 Mastocytosis 1339
Definition and nomenclature 1339
Classification 1339
Introduction and general description 1340
Aetiopathogenesis 1340
Epidemiology 1340
Incidence and prevalence 1340
Age 1340
Sex 1340
Ethnicity 1341
Genetics 1341
Associated diseases 1341
Pathophysiology 1341
Pathology 1341
Clinical features 1341
Cutaneous mastocytosis 1341
Systemic mastocytosis 1344
Monoclonal mast cell activation syndrome 1345
Mast cell activation syndrome 1345
Investigations 1345
Management 1346
First line 1347
Second line 1347
Third line 1348
Disease course and prognosis 1348
Key references 1348
CHAPTER 47 Reactive Inflammatory Erythemas 1349
Introduction 1349
Erythema multiforme 1349
Annular erythema of infancy 1354
Erythema annulare centrifugum 1356
Erythema gyratum repens 1358
Erythema marginatum 1359
Necrolytic migratory erythema 1361
Key references 1365
CHAPTER 48 Adamantiades–Behçet Disease 1367
Definition and nomenclature 1367
Epidemiology 1367
Incidence and prevalence 1367
Age 1367
Sex 1367
Ethnicity 1368
Associated diseases 1368
Pathophysiology 1368
Pathology 1368
Causative organisms 1368
Genetics 1368
Immunogenetic factors 1369
Clinical features 1369
History 1369
Presentation 1369
Clinical variants 1370
Differential diagnosis 1372
Classification of severity 1372
Complications and co-morbidities 1372
Disease course and prognosis 1372
Investigations 1373
Pathergy test 1373
Radiological findings 1373
Management 1373
Prevention 1376
Key references 1376
CHAPTER 49 Neutrophilic Dermatoses 1377
Pyoderma gangrenosum 1377
Sweet syndrome 1382
Bowel-associated dermatitis–arthritis syndrome 1388
Subcorneal pustular dermatosis 1390
Other neutrophilic dermatoses and variants 1392
Pyodermatitis–pyostomatitis vegetans 1392
Amicrobial pustulosis of the skin folds 1392
Aseptic abscess syndrome 1393
Key references 1393
CHAPTER 50 Immunobullous Diseases 1395
Introduction 1395
INTRAEPIDERMAL IMMUNOBULLOUS DISEASES 1395
Pemphigus 1395
Subepidermal immunobullous diseases 1403
Introduction 1403
Bullous pemphigoid 1404
Mucous membrane pemphigoid 1417
Linear IgA disease 1427
Anti-p200 pemphigoid 1432
Epidermolysis bullosa acquisita 1435
Bullous systemic lupus erythematosus 1440
Very rare pemphigoid disorders 1443
Lichen planus pemphigoides 1443
Cicatricial pemphigoid 1443
Anti-type IV collagen pemphigoid 1445
Anti-105 kDa antigen pemphigoid 1446
Dermatitis herpetiformis 1446
Key references 1449
CHAPTER 51 Lupus Erythematosus 1453
Introduction 1453
Discoid lupus erythematosus 1454
Subacute cutaneous lupus erythematosus 1463
Systemic lupus erythematosus 1466
Neonatal lupus erythematosus 1489
Key references 1491
CHAPTER 52 Antiphospholipid Syndrome 1493
Definition and nomenclature 1493
Introduction and general description 1493
Epidemiology 1493
Incidence and prevalence 1493
Age 1493
Sex 1493
Ethnicity 1493
Associated diseases 1494
Pathophysiology 1494
Genetics 1494
Clinical features 1494
History 1494
Presentation in the skin 1494
Differential diagnosis 1494
Complications and co?morbidities 1494
Disease course and prognosis 1494
Investigations 1494
Management 1494
Key references 1495
CHAPTER 53 Dermatomyositis 1497
Definition 1497
Introduction and general description 1497
Epidemiology 1498
Incidence/prevalence 1498
Age 1498
Sex 1498
Ethnicity 1498
Associated diseases 1498
Pathophysiology 1498
Histopathology 1499
Clinical features 1499
History 1499
Presentation 1499
Clinical variants 1505
Differential diagnosis 1506
Classification of severity 1506
Complications and co?morbidities 1506
Disease course and prognosis 1506
Investigations 1506
Management 1507
Key references 1508
CHAPTER 54 Mixed Connective Tissue Disease 1511
Definition and nomenclature 1511
Introduction and general description 1511
Epidemiology 1511
Incidence and prevalence 1511
Age 1511
Sex 1511
Pathophysiology 1512
Predisposing factors 1512
Pathology 1512
Genetics 1512
Environmental factors 1512
Clinical features 1512
History 1512
Presentation 1512
Clinical variants 1512
Differential diagnosis 1512
Classification of severity 1512
Complications and co?morbidities 1512
Investigations 1512
Management 1513
First line 1513
Second line 1513
Key references 1513
CHAPTER 55 Dermatological Manifestations of Rheumatoid Disease 1515
Introduction 1515
Rheumatoid arthritis 1515
DERMATOLOGICAL MANIFESTATIONS OF RHEUMATOID ARTHRITIS 1516
Rheumatoid nodules 1516
Histopathology 1516
Differential diagnosis 1516
Linear subcutaneous bands and interstitial granulomatous dermatitis 1516
Rheumatoid neutrophilic dermatosis 1517
Vascular lesions 1517
Leg ulcers 1517
Livedo reticularis 1518
Other dermatological associations 1518
Fibroblastic rheumatism 1518
OTHER RHEUMATOID DISEASES 1518
Still disease 1518
Adult Still disease 1518
Sjögren syndrome 1519
Rheumatic fever 1522
Key references 1522
CHAPTER 56 Systemic Sclerosis 1523
Definition and nomenclature 1523
Synonyms and inclusions 1523
Classification 1523
Introduction and general description 1526
Epidemiology 1528
Incidence and prevalence 1528
Age 1529
Sex 1529
Ethnicity 1529
Associated diseases 1529
Pathophysiology 1531
Predisposing factors 1531
Pathology 1531
Causative organisms 1533
Genetics 1533
Environmental factors 1534
Clinical features 1535
History 1535
Presentation 1535
Clinical variants 1537
Differential diagnosis 1538
Classification of severity 1539
Complications and co-morbidities 1539
Disease course and prognosis 1540
Investigations 1540
Diagnosis 1540
Assessment of organ-based disease and systematic follow-up investigations 1540
Management 1541
Key references 1545
CHAPTER 57 Morphoea and Allied Scarring and Sclerosing Inflammatory Dermatoses 1547
Definition and nomenclature 1547
Terminology 1547
Classification 1548
Introduction and general description 1550
Epidemiology 1550
Incidence and prevalence 1550
Age 1550
Sex 1550
Ethnicity 1550
Associated diseases 1551
Pathophysiology 1552
Predisposing factors 1552
Pathology 1552
Causative organisms 1555
Genetics 1555
Environmental factors 1556
Clinical features 1557
History 1557
Presentation 1557
Limited type 1557
Generalized type 1560
Linear type 1563
Mixed type 1566
Differential diagnosis 1566
Classification of severity 1566
Complications and co-morbidities 1568
Disease course and prognosis 1569
Investigations 1570
Management 1572
Key references 1575
PART 5 Metabolic and Nutritional Disorders Affecting the Skin 1577
CHAPTER 58 Cutaneous Amyloidoses 1579
Introduction 1579
Ultrastructure and amyloidogenesis 1579
Functional and disease-causing amyloids 1580
Basic classification 1580
Clinical presentation 1580
Investigations 1580
Histology 1581
Immunohistochemistry 1581
Electron microscopy 1582
Localized cutaneous amyloidoses 1582
Cutaneous amyloidoses due to systemic disease 1586
Management of cutaneous amyloidoses 1590
Key references 1591
CHAPTER 59 Cutaneous Mucinoses 1593
Introduction and general description 1593
PRIMARY MUCINOSES 1594
DERMAL MUCINOSES 1594
Lichen myxoedematosus (papular mucinosis) 1594
Scleromyxoedema 1594
Localized lichen myxoedematosus 1598
Reticular erythematous mucinosis 1600
Scleredema 1601
Myxoedema in thyroid diseases 1603
Localized (pretibial) myxoedema 1603
Papular and nodular mucinosis in connective tissue diseases 1605
Self-healing cutaneous mucinosis 1606
Cutaneous focal mucinosis 1606
Digital myxoid (mucous) cyst 1607
FOLLICULAR MUCINOSES 1607
Pinkus follicular mucinosis 1607
Urticaria-like follicular mucinosis 1608
SECONDARY MUCINOSES 1610
Key references 1610
CHAPTER 60 Cutaneous Porphyrias 1611
Introduction 1611
GENERAL CONSIDERATIONS 1611
Theoretical basis for understanding the porphyrias 1611
Phototoxicity of porphyrins 1611
Chemistry of porphyrins and haem 1611
Photochemistry of the porphyrins 1612
Enzyme deficiencies and the porphyrias 1612
Biosynthesis of haem 1612
Clinical features of the porphyrias: general considerations 1612
Classification of the porphyrias 1612
Porphyria and the skin 1614
Acute attacks of porphyria 1616
Clinician’s guide to laboratory testing in porphyria 1617
What samples to send 1617
Handling of samples 1617
Laboratory analysis of porphyrins 1617
Interpretation of results 1618
Biochemical diagnosis of an acute attack of porphyria 1619
Screening of relatives 1619
INDIVIDUAL PORPHYRIAS 1619
PORPHYRIAS THAT CAUSE CUTANEOUS DISEASE BUT DO NOT CAUSE ACUTE ATTACKS 1619
Congenital erythropoietic porphyria 1619
Porphyria cutanea tarda 1621
Erythropoietic protoporphyria 1624
PORPHYRIAS THAT CAUSE CUTANEOUS DISEASE AND ACUTE ATTACKS 1627
Hereditary coproporphyria 1627
Variegate porphyria 1627
MISCELLANEOUS 1628
Pseudoporphyria 1628
Key references 1629
CHAPTER 61 Calcification of the Skin and Subcutaneous Tissue 1631
Dystrophic calcification secondary to inflammatory disease and infections 1631
Dystrophic calcification secondary to trauma or injection/infusion of calcium-containing materials 1633
Dystrophic calcification secondary to tumours and genetic disease 1633
Idiopathic calcification of the skin and subcutaneous tissues 1634
Metastatic calcification 1635
Calciphylaxis 1636
Key references 1640
CHAPTER 62 Xanthomas and Abnormalities of Lipid Metabolism and Storage 1641
Introduction 1641
Classification of dyslipidaemias 1641
XANTHOMAS 1642
Introduction 1642
Classification 1642
Tendon xanthoma 1642
Tuberous xanthoma 1643
Eruptive xanthoma 1643
Dyslipidaemic plane (planar) xanthoma 1644
Xanthelasma 1644
Plane xanthoma 1645
Palmar xanthoma 1645
PRIMARY DYSLIPIDAEMIAS: HYPERCHOLESTEROLAEMIA 1646
Familial hypercholesterolaemia 1646
PRIMARY DYSLIPIDAEMIAS: COMBINED DYSLIPIDAEMIA 1647
Type III hyperlipoproteinaemia 1647
PRIMARY DYSLIPIDAEMIAS: HYPERTRIGLYCERIDAEMIAS 1648
Type I hyperlipoproteinaemia 1648
Type V hyperlipoproteinaemia 1649
Type IV hyperlipoproteinaemia 1650
OTHER PRIMARY DYSLIPIDAEMIAS 1650
Cerebrotendinous xanthomatosis 1650
Sitosterolaemia 1650
SECONDARY DYSLIPIDAEMIAS 1650
Secondary dyslipidaemia and diabetes 1651
Secondary dyslipidaemia and insulin resistance 1651
Secondary dyslipidaemia due to chronic cholestasis 1651
Secondary dyslipidaemia and the nephrotic syndrome 1651
Secondary dyslipidaemia due to drugs 1651
Key references 1652
CHAPTER 63 Nutritional Disorders Affecting the Skin 1653
Nutrition 1653
Malnutrition 1653
Vitamins 1659
Vitamin A 1659
Deficiency 1659
Excess 1660
Vitamin D 1661
Deficiency 1661
Vitamin E 1663
Deficiency 1663
Excess 1664
Vitamin K 1664
Deficiency 1664
Vitamin B1 1665
Deficiency 1665
Vitamin B2 1666
Deficiency 1666
Vitamin B3 1667
Deficiency 1667
Vitamin B6 1669
Deficiency 1669
Vitamin B9 1670
Deficiency 1670
Vitamin B12 1671
Deficiency 1671
Vitamin C 1672
Deficiency 1672
Biotin 1674
Deficiency 1674
Minerals 1675
Iron 1675
Deficiency 1675
Zinc 1677
Deficiency 1677
Copper 1679
Deficiency 1679
Selenium 1680
Deficiency 1681
Excess 1682
Manganese 1682
Deficiency and excess 1682
Key references 1683
CHAPTER 64 Skin Disorders in Diabetes Mellitus 1685
Introduction 1685
Vascular damage 1685
Leg ulceration 1685
Wet gangrene of the foot 1685
Erysipelas-like erythema 1686
Diabetic dermopathy 1686
Rubeosis 1686
Neurological damage 1686
Diabetic foot 1686
Diabetic foot ulcer 1686
Infections 1687
Obesity and hyperlipidaemia-related skin disease 1687
Acanthosis nigricans 1687
Skin tags 1687
Eruptive xanthomas of the skin 1687
Treatment-related skin manifestations 1688
Insulin lipodystrophy 1688
Allergic reactions to insulin 1688
Allergic reactions to oral hypoglycaemic drugs 1688
Disease associations and genetic syndromes 1688
Reactive perforating collagenosis (folliculitis) 1688
Autoimmune disease 1688
Genetic and other systemic diseases 1688
Miscellaneous 1689
Granulomatous disorders 1689
Stiff skin and joints 1690
Pruritus 1691
Diabetic bullae 1691
Other 1691
Key references 1691
PART 6 Genetic Disorders Involving the Skin 1693
CHAPTER 65 Inherited Disorders of Cornification 1695
Introduction 1696
Ichthyoses 1696
Definition 1696
Common ichthyoses 1696
Ichthyosis vulgaris 1696
Recessive X-linked ichthyosis 1698
Non-syndromic congenital ichthyoses 1700
Autosomal recessive congenital ichthyosis 1700
Harlequin ichthyosis 1701
Collodion baby and self-improving congenital ichthyosis 1701
Bathing suit ichthyosis 1701
Lamellar ichthyosis and congenital ichthyosiform erythroderma 1703
Keratinopathic ichthyoses 1707
Epidermolytic ichthyosis 1707
Superficial epidermolytic ichthyosis 1709
Annular epidermolytic ichthyosis 1709
Congenital reticular ichthyosiform erythroderma 1709
Ichthyosis Curth–Macklin 1711
Erythrokeratoderma 1711
Erythrokeratoderma variabilis 1711
Progressive symmetrical erythrokeratoderma 1712
Symmetrical acrokeratoderma 1713
Other non-syndromic forms of ichthyosis 1713
Keratosis linearis–ichthyosis congenita–sclerosing keratoderma (KLICK) 1713
Exfoliative ichthyosis 1714
Syndromic ichthyoses 1714
X-linked syndromes concerning distal cholesterol biosynthesis 1714
Conradi–Hünermann–Happle syndrome 1714
Congenital hemidysplasia–ichthyosiform naevus–limb defect syndrome 1716
Ichthyosis follicularis–atrichia–photophobia syndrome 1717
Exfoliative disorders of cornification 1718
Comèl–Netherton syndrome 1718
Severe dermatitis–multiple allergies–metabolic wasting syndrome 1719
Peeling skin syndromes 1720
Peeling skin syndrome type A 1720
Inflammatory peeling skin disease 1720
Acral peeling skin syndrome 1721
Neuro-ichthyotic syndromes 1721
CEDNIK, MEDNIK, ARC, Gaucher disease type II, ELOVL4 deficiency and Stormorken syndrome 1721
Refsum disease 1721
Multiple sulphatase deficiency 1723
Sjögren–Larsson syndrome 1723
Keratitis–ichthyosis–deafness 1724
Neutral lipid storage disease with ichthyosis 1726
Trichothiodystrophy/Tay syndrome 1727
Neu–Laxova syndrome 1728
Coloboma–heart defect–ichthyosiform dermatosis–mental retardation–ear anomalies syndrome 1728
Miscellaneous syndromic ichthyoses 1728
Ichthyosis prematurity syndrome 1728
Ichthyosis with hypotrichosis 1730
Neonatal ichthyosis–sclerosing cholangitis 1730
Management of congenital ichthyoses 1730
Management of collodion baby 1731
The issue of bathing 1732
Practical treatment options for daily care 1732
Systemic treatment options 1732
Special aspects of treatment 1733
Patient organizations and other resources 1733
Acquired ichthyoses 1734
Pathophysiology 1734
Clinical features 1734
Pityriasis rotunda 1735
Palmoplantar keratoderma 1736
Definition and diagnostic approach 1736
Non-syndromic palmoplantar keratoderma 1737
Epidermolytic palmoplantar keratoderma 1737
Pachyonychia congenita 1738
Painful hereditary callosities 1740
Non-epidermolytic palmoplantar keratoderma 1740
Mal de Meleda 1741
Loricrin keratoderma 1743
Striate (and focal) palmoplantar keratoderma 1743
Punctate palmoplantar keratoderma 1745
Spiny keratoderma 1746
Marginal papular keratoderma 1747
Cole disease 1748
Transient aquagenic keratoderma 1748
Syndromic keratoderma 1749
Palmoplantar keratoderma and cardiomyopathy 1749
Naxos syndrome 1749
Carvajal-Huerta syndrome 1750
Palmoplantar keratoderma and hearing impairment 1750
Vohwinkel syndrome and Bart–Pumphrey syndrome 1750
Bart–Pumphrey syndrome 1751
Mitochondrial palmoplantar keratoderma with hearing impairment 1751
Palmoplantar keratoderma and cancer 1752
Huriez syndrome 1753
Tylosis oesophageal cancer/Howel-Evans syndrome 1753
Palmoplantar keratoderma, sex reversal and cancer 1753
Palmoplantar keratoderma in ectodermal dysplasia and related diseases 1755
Clouston syndrome (hidrotic ectodermal dysplasia type 2) 1755
Odonto-onychodermal dysplasia 1755
Papillon–Léfèvre and Haim–Munk syndrome 1755
Olmsted syndrome 1755
Palmoplantar keratoderma and ophthalmic manifestations 1757
Oculocutaneous tyrosinaemia (tyrosinaemia type II) 1757
Palmoplantar keratoderma and neurological manifestations 1758
Acquired keratodermas 1758
Clinical features and pathology 1758
Miscellaneous disorders of keratinization 1760
Keratolytic winter erythema 1760
Porokeratoses 1761
Perforating keratotic disorders 1762
Multiple minute digitate hyperkeratoses 1763
Flegel disease 1764
Circumscribed palmoplantar hypokeratosis 1764
Waxy keratoses of childhood 1765
Hyperkeratosis of the nipple 1765
Key references 1765
CHAPTER 66 Inherited Acantholytic Disorders 1771
Darier disease 1771
Hailey–Hailey disease 1780
Key references 1784
CHAPTER 67 Ectodermal Dysplasias 1785
Ectodermal dysplasias 1785
X-linked hypohidrotic ectodermal dysplasia with immunodeficiency 1794
Hypohidrotic ectodermal dysplasia 1795
Ankyloblepharon–ectodermal defect–cleft lip/palate syndrome 1799
Ectrodactyly–ectodermal dysplasia–cleft lip/palate syndrome 1801
Tricho-dento-osseous syndrome 1803
Tricho-rhino-phalangeal syndrome 1804
Hidrotic ectodermal dysplasia 1805
Focal dermal hypoplasia 1807
MIDAS syndrome 1808
Focal facial dermal dysplasia 1809
Key references 1810
CHAPTER 68 Inherited Hair Disorders 1813
Definition 1813
Introduction and general description 1813
HYPERTRICHOSES 1813
GENERALIZED HYPERTRICHOSES 1813
Hypertrichosis universalis congenita, Ambras type 1823
Generalized hypertrichosis terminalis 1823
Cantu syndrome 1823
LOCALIZED HYPERTRICHOSES 1823
DIFFERENTIAL DIAGNOSIS 1824
TREATMENT 1824
ATRICHIAS 1824
Atrichia with papular lesions 1824
Ichthyosis follicularis with atrichia and photophobia 1827
HYPOTRICHOSES 1827
NON-SYNDROMIC AUTOSOMAL DOMINANT HYPOTRICHOSES 1827
NON-SYNDROMIC AUTOSOMAL RECESSIVE HYPOTRICHOSES 1828
SYNDROMIC AUTOSOMAL DOMINANT HYPOTRICHOSES 1828
Tricho-rhino-phalangeal syndrome 1828
Connexin disorders 1828
SYNDROMIC AUTOSOMAL RECESSIVE HYPOTRICHOSES 1829
Hypotrichosis with juvenile macular dystrophy 1829
Autosomal recessive ichthyosis with hypotrichosis 1829
HAIR SHAFT STRUCTURAL ABNORMALITIES 1830
Monilethrix 1831
Woolly hair 1831
Pili torti 1832
Trichorrhexis nodosa 1833
Trichorrhexis invaginata 1833
Trichothiodystrophy 1833
Pili triangulati et canaliculi 1834
Other inherited hair shaft defects 1835
Pili annulati and pseudoannulati 1835
Loose anagen syndrome 1835
Kinky hair 1835
Spiky hair 1835
OVERALL APPROACH TO THE DIAGNOSIS OF GENOTRICHOSES 1835
Key references 1836
CHAPTER 69 Genetic Defects of Nails and Nail Growth 1837
Pachyonychia congenita 1837
Dyskeratosis congenita 1848
Nail–patella syndrome 1851
Hereditary anonychia 1852
Key references 1853
CHAPTER 70 Genetic Disorders of Pigmentation 1855
Introduction and general description 1855
HYPOPIGMENTATION DISORDERS 1857
Piebaldism 1857
Waardenburg syndrome 1858
Oculocutaneous albinism 1860
Hermansky–Pudlak syndrome 1862
Chédiak–Higashi syndrome 1862
Griscelli–Pruniéras syndrome types I and II 1863
Oculocerebral syndrome with hypopigmentation (Cross syndrome/Kramer syndrome) 1863
Albinism–deafness syndrome (Ziprkowski–Margolis syndrome/Woolf syndrome) 1863
Hypomelanosis of Ito 1864
HYPERPIGMENTATION DISORDERS 1865
Familial progressive hyperpigmentation/progressive hyperpigmentation and generalized lentiginosis without associated systemic symptoms/familial progressive hyper- and hypopigmentation 1865
Incontinentia pigmenti 1865
Linear and whorled naevoid hypermelanosis 1865
Dyskeratosis congenita 1866
Naegeli–Franceschetti–Jadassohn syndrome and dermatopathia pigmentosa reticularis 1867
Dowling–Degos disease 1868
Reticulate acropigmentation of Kitamura 1868
Peutz–Jeghers–Touraine syndrome 1868
DYSCHROMATOSES 1869
Dyschromatosis symmetrica hereditaria 1869
Dyschromatosis universalis hereditaria 1870
Key references 1871
CHAPTER 71 Genetic Blistering Diseases 1873
Introduction 1873
Definition and classification 1873
Prevalence and incidence 1874
Skin proteins and genes implicated in epidermolysis bullosa 1875
Keratins 5 and 14: KRT5, KRT14 1875
Plakophilin-1: PKP1 1875
Desmoplakin: DSP 1875
Plakoglobin: JUP 1875
Exophilin-5: EXPH5 1875
Transglutaminase 5: TGM5 1876
Plectin: PLEC 1876
Dystonin epidermal isoform (BP230): DST-e 1876
a6ß4 integrin: ITGA6, ITGB4 1876
a3 integrin subunit: ITGA3 1876
Kindlin-1: KIND1/FERMT1 1876
Type XVII collagen: COL17A1 1876
Laminin-332: LAMA3, LAMB3, LAMC2 1877
Type VII collagen: COL7A1 1877
Other proteins and genes linked to skin fragility 1877
Desmocollin 3: DSC3 1877
Desmoglein-1: DSG1 1877
Corneodesmosin: CDSN 1877
CD151 antigen/tetraspanin: CD151 1877
Keratins 1 and 10: KRT1, KRT10 1878
Clinical subtypes 1878
EB simplex 1878
Molecular pathology of EB simplex 1882
Junctional EB 1883
Molecular pathology of junctional EB 1886
Dystrophic EB 1886
Molecular pathology of dystrophic EB 1890
Kindler syndrome 1890
Molecular pathology of Kindler syndrome 1891
Diagnosis 1891
Skin biopsy 1891
Sanger sequencing 1894
Next generation sequencing 1895
Differential diagnosis 1895
Other blistering genodermatoses 1895
Peeling skin syndromes 1895
Keratodermas 1896
Calcium pump disorders 1896
Desmosomal disorders 1896
Metabolic and signalling disorders 1896
Treatment 1896
Management of neonates and infants 1896
Management of EB simplex 1897
Management of generalized severe junctional EB 1897
Management of generalized severe recessive dystrophic EB 1897
Systemic treatments for recessive dystrophic EB 1899
Cancer and recessive dystrophic EB 1899
Pain management 1899
Skin grafting 1899
Innovative therapies 1899
Gene therapy for dominant EB 1899
Gene therapy for recessive EB 1900
Genomic editing 1900
Recombinant protein therapy 1900
Cell therapy with intradermal allogeneic fibroblasts 1900
Cell therapy with intradermal mesenchymal stromal cells 1900
Bone marrow stem cell therapy 1901
Natural gene therapy: revertant mosaicism 1901
Inducible pluripotent stem cells 1901
Nonsense read-through drugs and small molecule therapies 1902
Key references 1902
CHAPTER 72 Genetic Disorders of Collagen, Elastin and Dermal Matrix 1905
Inherited disorders of collagen 1905
Ehlers–Danlos syndrome 1905
Prolidase deficiency 1912
Osteogenesis imperfecta 1913
Inherited disorders of elastic fibres 1915
Elastinopathies 1915
Inherited generalized cutis laxa 1915
Williams–Beuren syndrome 1918
Michelin tyre baby 1919
Fibrillinopathy 1919
Marfan syndrome 1919
Infantile stiff skin syndromes 1921
Hyaline fibromatosis syndrome 1921
Stiff skin syndrome 1922
Winchester syndrome 1923
Restrictive dermopathy 1924
Premature ageing syndromes 1924
Progeria 1924
Werner syndrome 1926
Acrogeria 1927
Familial mandibuloacral dysplasia 1928
Mulvihill–Smith syndrome 1929
Neonatal progeroid syndrome 1930
Disorders of ectopic calcification and abnormal mineralization 1930
Pseudoxanthoma elasticum 1930
Fibrodysplasia ossificans progressiva 1935
Primary hypertrophic osteoarthropathy 1935
Miscellaneous dermal disorders 1936
Adermatoglyphia 1936
Lipoid proteinosis 1936
Pterygium syndromes 1937
Key references 1937
CHAPTER 73 Disorders Affecting Cutaneous Vasculature 1939
Introduction 1939
CAPILLARY DISORDERS 1939
Capillary malformation 1939
Sturge–Weber syndrome 1940
Capillary malformation–arteriovenous malformation 1941
Angioma serpiginosum 1942
Cerebral cavernous malformation 1942
Capillary malformation in localized overgrowth syndromes 1943
Microcephaly–capillary malformation syndrome 1944
ARTERIOVENOUS DISORDERS 1945
Arteriovenous malformation 1945
Hereditary haemorrhagic telangiectasia 1946
PTEN hamartoma tumour syndrome 1947
VENOUS DISORDERS 1947
Venous malformation 1947
Mucocutaneous venous malformation 1949
Blue rubber bleb naevus syndrome 1950
Glomuvenous malformation 1951
Maffucci syndrome 1952
LYMPHATIC DISORDERS 1953
Lymphatic malformation 1953
Schimmelpenning–Feuerstein–Mims syndrome 1955
Hereditary lymphoedema type IA 1955
Lymphoedema–distichiasis syndrome 1956
Hypotrichosis–lymphoedema–telangiectasia syndrome 1957
Hennekam lymphangiectasia–lymphoedema syndrome 1957
Microcephaly with or without chorioretinopathy, lymphoedema or mental retardation 1957
Choanal atresia and lymphoedema 1958
Primary lymphoedema with myelodysplasia 1958
Other syndromes with lymphoedema 1958
Conclusions 1958
Key references 1959
CHAPTER 74 Genetic Disorders of Adipose Tissue 1961
Introduction 1961
Congenital (familial) lipodystrophies 1961
Congenital generalized lipodystrophies 1961
Familial partial lipodystrophies 1961
Hereditary obesity 1963
Monogenic obesity without cutaneous features 1963
Monogenic obesity with cutaneous features 1964
Genetic associations with lipoma 1966
CLOVES syndrome 1966
Hereditary panniculitis 1969
Familial lipoedema 1970
Key references 1970
CHAPTER 75 Congenital Naevi and Other Developmental Abnormalities Affecting the Skin 1971
CONGENITAL NAEVI 1971
Introduction 1971
Principles underlying the observable phenotypes of congenital naevi 1971
Classification of congenital naevi 1972
Congenital epidermal naevi 1973
Congenital pigment cell naevi 1979
Congenital melanocytic naevi 1979
Congenital Spitz naevus, congenital blue naevus and congenital naevus spilus 1985
Congenital connective tissue naevi and fat naevi 1987
‘Naevoid’ entities and currently unclassifiable naevi 1989
OTHER DEVELOPMENTAL ABNORMALITIES AFFECTING THE SKIN 1989
Aplasia cutis congenita 1989
Congenital muscle hamartoma 1990
Heterotrimeric G-protein mosaic disorders 1990
McCune–Albright syndrome 1991
Sturge–Weber syndrome 1991
Phakomatosis pigmentovascularis 1992
Appendix 1994
Key references 1994
CHAPTER 76 Chromosomal Disorders 1997
Introduction 1997
Autosomal chromosome defects 1997
Down syndrome (trisomy 21) 1997
Trisomy 18 (Edwards syndrome) 1998
Trisomy 13 1998
Other autosomal abnormality syndromes 1998
Sex chromosome defects 1999
Turner syndrome 1999
Klinefelter syndrome 2000
Other abnormalities of the sex chromosomes 2000
Chromosomal mosaicism 2001
Key references 2001
CHAPTER 77 Poikiloderma Syndromes 2003
Introduction 2003
Dyskeratosis congenita 2003
Rothmund–Thomson syndrome 2007
Poikiloderma with neutropenia, Clericuzio type 2009
Hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis 2009
Acrokeratotic poikiloderma of Weary 2009
Key references 2009
CHAPTER 78 DNA Repair Disorders with Cutaneous Features 2011
Introduction 2011
Xeroderma pigmentosum 2011
Cockayne syndrome 2017
Trichothiodystrophy 2019
Other disorders 2021
Ataxia telangiectasia (Louis-Bar syndrome) 2021
Fanconi anaemia 2021
Muir–Torre syndrome 2022
Key references 2022
CHAPTER 79 Syndromes with Premature Ageing 2023
Introduction 2023
Werner syndrome 2023
Bloom syndrome 2025
Progeroid laminopathies and related conditions 2026
Hutchinson–Gilford progeria syndrome 2026
Mandibulo-acral dysplasia with type A and type B lipodystrophy 2027
Cutis laxa: autosomal dominant and autosomal recessive 2027
Key references 2029
CHAPTER 80 Hamartoneoplastic Syndromes 2031
Introduction 2031
Neurofibromatosis 2031
Neurofibromatosis type 1 2031
Association of neurofibromatosis type 1, juvenile xanthogranuloma and juvenile chronic myeloid leukaemia 2035
Segmental neurofibromatosis 2035
Café-au-lait spots and pulmonary stenosis 2035
Neurofibromatosis–Noonan syndrome 2037
Legius syndrome 2038
RASopathies 2038
Tuberous sclerosis complex 2039
Gardner syndrome 2043
Cowden syndrome 2043
Key references 2045
CHAPTER 81 Inherited Metabolic Diseases 2047
Introduction 2047
LYSOSOMAL STORAGE DISORDERS 2047
Mucopolysaccharidoses 2047
Glycoprotein degradation disorders 2050
Individual glycoprotein degradation disorders 2051
Mucolipidoses types II and III 2051
Sphingolipidoses 2052
Fabry disease 2053
MITOCHONDRIAL RESPIRATORY CHAIN DISORDERS 2055
Dermatological features of mitochondrial disorders 2055
Multiple symmetrical lipomatosis 2055
Acrocyanosis 2056
Palmoplantar keratoderma 2056
Other dermatological features 2056
CONGENITAL DISORDERS OF GLYCOSYLATION 2056
Phosphomannomutase 2 deficiency 2056
DISORDERS OF AMINO ACID METABOLISM 2056
TRANSPORT 2057
Phenylketonuria 2058
Tyrosinaemia type 2 2058
Alkaptonuria 2059
Prolidase deficiency 2060
Argininosuccinic aciduria 2061
Hartnup disease 2061
DISORDERS OF CHOLESTEROL SYNTHESIS 2062
Smith-Lemli-Opitz syndrome 2062
Mevalonate kinase deficiency 2062
OTHER METABOLIC DISORDERS 2062
Lesch–Nyhan syndrome 2062
Disorders of biotin metabolism 2063
Acrodermatitis enteropathica 2063
Menkes disease and occipital horn syndrome 2064
Wilson disease 2065
Familial tumoral calcinosis 2065
Key references 2066
CHAPTER 82 Inherited Immunodeficiency 2067
Introduction 2067
Definition 2067
Epidemiology 2067
Diagnosis 2067
Clinical features suggesting primary immunodeficiency 2067
Infectious disease related manifestations of primary immunodeficiencies 2068
Non-infectious non-specific manifestations of immunodeficiency 2068
Diagnostic laboratory tests 2069
Management 2069
Primary immunodeficiencies with skin manifestations 2069
Combined immunodeficiencies 2073
Combined immunodeficiencies with associated or syndromic features 2077
Antibody deficiencies 2078
Diseases with immune dysregulation 2079
Congenital defects of phagocyte function, differentiation and adhesion 2081
Defects in innate immunity 2082
Complement diseases 2083
Key references 2084
PART 7 Psychological, Sensory and Neurological Disorders and the Skin 2085
CHAPTER 83 Pruritus, Prurigo and Lichen Simplex 2087
Pruritus 2087
Prurigo nodularis 2099
Lichen simplex chronicus 2104
Key references 2104
CHAPTER 84 Mucocutaneous Pain Syndromes 2107
Introduction 2107
Burning mouth syndrome 2107
Post-herpetic neuralgia 2109
Trigeminal neuropathic pain syndrome 2111
Trigeminal trophic syndrome 2112
Atypical trigeminal trophic syndrome 2113
Vulovodynia, scrotodynia and penodynia 2114
Chronic scalp pain 2115
Erythromelalgia 2116
Key references 2116
CHAPTER 85 Neurological Conditions Affecting the Skin 2119
Introduction 2119
Skin innervation 2119
Sensory innervation 2119
Autonomic nervous system 2121
Neurophysiological testing for skin innervation 2122
Neuropathic ulcer 2122
Syringomyelia 2125
Spinal dysraphism 2126
Dermatoses associated with spinal cord injury 2128
Hereditary sensory and autonomic neuropathies 2128
Sympathetic nerve injury 2130
Complex regional pain syndrome 2130
Horner syndrome 2132
Gustatory hyperhidrosis 2133
Restless legs syndrome/burning feet syndrome 2134
Key references 2135
CHAPTER 86 Psychodermatology and Psychocutaneous Disease 2137
Introduction 2137
What is psychodermatology? 2137
Psychodermatology multidisciplinary teams 2138
Models of provision of psychodermatology services 2138
Classification 2138
Psychological co-morbidities of chronic skin disease and the ’golden rules of psychodermatology’ 2138
Stigmatization, visible differences and coping strategies 2139
Disability, quality of life and assessment in psychodermatology 2140
Delusional beliefs 2140
Introduction and general description 2140
Delusional infestation 2140
Olfactory delusions 2144
Morgellons syndrome 2145
Obsessive and compulsive behaviour 2146
General principles of treatment 2146
Body dysmorphic disorder 2146
Lichen simplex chronicus and nodular prurigo 2149
Skin picking disorder 2150
Acné excoriée 2151
Trichotillomania/trichotillosis 2153
Onychotillomania and onychophagia 2155
Health anxieties 2156
Eating disorders 2156
Introduction and general description 2156
Anorexia nervosa and bulimia 2156
Psychogenic itch 2157
Psychogenic pruritus 2157
Factitious skin disease 2158
Introduction and general description 2158
Dermatitis artefacta 2159
Dermatitis simulata 2164
Dermatological pathomimicry 2164
Dermatitis passivata 2165
Malingering 2165
Pseudologia fantastica and Münchausen syndrome 2165
Fabricated and induced illness 2166
Medicolegal issues in suspected factitious skin diseases 2166
Deliberate self-harm 2166
Definition and nomenclature 2166
Deliberate self-harm with suicidal ideation 2167
Deliberate self-harm without suicidal intent 2167
Other psychodermatology and psychocutaneous diseases 2168
Cutaneous disease and alcohol misuse 2168
Depression in dermatological patients 2168
Assessment of mood disorders 2169
Suicide in dermatological patients 2169
Assessment of risk 2170
Isotretinoin and mood changes 2170
Psychiatric therapies in dermatology 2171
Drug therapies (medications) 2171
Antidepressants 2171
Antipsychotic medication 2173
Anxiolytics 2174
Mood stabilizers 2174
Psychological therapies 2174
The therapeutic relationship 2175
Cognitive behavioural therapy 2175
Interpersonal psychotherapy and interpersonal counselling 2175
Dynamic psychotherapies and psychoanalysis 2175
Alternative therapies 2176
Key references 2176
PART 8 Skin Disorders Associated with Specific Cutaneous Structure 2177
CHAPTER 87 Acquired Disorders of Epidermal Keratinization 2179
CHAPTER 88 Acquired Pigmentary Disorders 2209
Skin pigmentation and the melanocyte 2209
The colour of the skin 2209
The melanocyte 2210
Epidermal melanin unit 2210
Distribution of melanocytes 2211
Melanoblast migration and differentiation 2211
Melanosome transport 2212
Melanosome transfer to keratinocytes 2212
Melanocyte culture 2212
Biochemistry of melanogenesis 2213
Eumelanin formation 2213
Phaeomelanin formation 2213
Trichochromes 2213
Regulation of human pigmentation by UV light and by endocrine, paracrine and autocrine factors 2213
Melanocyte response to UV radiation 2213
Biological significance of melanin 2216
Classification of disorders of melanin pigmentation 2216
Constitutive pigmentation, human pigmentation and the response to sun exposure 2216
Acquired hypermelanosis 2217
Physiological hypermelanosis (tanning in response to UV radiation) 2217
Facial melanoses 2217
Melasma 2218
Photocontact facial melanosis 2220
Poikiloderma of Civatte 2221
Erythromelanosis follicularis of the face and neck 2222
Peribuccal pigmentation of Brocq 2223
Ephelides 2223
Lentiginosis 2224
Generalized lentiginosis 2224
Unilateral lentiginosis (zosteriform lentiginosis) 2224
Inherited patterned lentiginosis in black people 2224
Eruptive lentiginosis 2224
PUVA lentigines 2225
Hypermelanosis due to endocrine disorders 2225
Addison disease 2225
Acromegaly 2226
Cushing syndrome 2226
ACTH administration 2226
Hyperthyroidism 2227
Hypermelanosis in other systemic disorders 2227
Neoplastic diseases 2227
Hyperpigmentation in rheumatic diseases 2228
Systemic sclerosis and morphoea 2228
Dermatomyositis and lupus erythematosus 2229
Neurological disorders 2229
Multiple organ failure, renal failure and primary biliary cirrhosis 2229
Haemochromatosis 2230
Cutaneous amyloidosis 2230
Nutritional deficiencies 2231
POEMS syndrome 2233
Hypermelanosis of drug origin 2233
Drug-induced hyperpigmentation 2233
Fixed drug eruption 2236
Pigmentation resulting from acute photodynamic and phototoxic reactions 2237
Post-inflammatory hypermelanosis 2239
Ashy dermatosis and erythema dyschromicum perstans 2240
Treatment of hypermelanosis 2241
Acquired hypomelanosis 2242
Vitiligo 2242
Halo naevus 2248
Acquired syndromic hypomelanosis 2251
Vogt-Koyanagi–Harada syndrome 2251
Alezzandrini syndrome 2251
Post-inflammatory hypomelanosis 2251
Progressive macular hypomelanosis 2253
Chemical depigmentation 2253
Idiopathic guttate hypomelanosis 2254
Punctate leukoderma 2255
Non-melanin pigmentation 2255
Endogenous non-melanin pigmentation 2255
Cutaneous haemosiderosis 2256
Jaundice and bronze baby syndrome 2257
Carotenoderma 2258
Ochronosis 2259
Exogenous pigmentation 2260
Metals 2260
Medication 2261
Tattoos 2261
Key references 2263
CHAPTER 89 Acquired Disorders of Hair 2265
CHAPTER 90 Acne 2343
Acne vulgaris 2343
Synovitis acne pustulosis hyperostosis osteitis syndrome (SAPHO) 2348
HAIR-AN syndrome 2350
SAHA (seborrhoea, acne, hirsutism and androgenetic alopecia) 2351
PAPA syndrome (pyogenic sterile arthritis, pyoderma gangrenosum and acne) 2351
Apert syndrome 2351
Drug-induced acne 2352
Acne cosmetica 2359
Acne fulminans 2392
Acne conglobata 2396
Occupational acne 2398
Prepubertal acne 2401
Key references 2406
CHAPTER 91 Rosacea 2409
Definition and nomenclature 2409
Classification and grading of severity 2409
Introduction and general description 2409
Epidemiology 2411
Incidence and prevalence 2411
Age 2411
Sex 2411
Ethnicity 2411
Associated diseases 2412
Pathophysiology 2412
Predisposing factors 2412
Pathology 2413
Causative organisms 2413
Genetics 2413
Environmental factors 2414
Clinical features 2414
History and presentation 2414
Erythematotelangiectatic rosacea 2414
Papulopustular rosacea 2414
Phymatous rosacea 2415
Ocular rosacea 2416
Clinical variants 2416
Granulomatous rosacea 2416
Differential diagnosis 2417
Erythematotelangiectatic rosacea 2417
Papulopustular rosacea 2418
Phymatous rosacea 2419
Ocular rosacea 2419
Complications and co-morbidities 2419
Disease course and prognosis 2420
Investigations 2420
Management 2420
First line management 2421
Second line management 2421
Third line management 2422
Facial dermatoses with an uncertain nosological relationship to rosacea 2423
Idiopathic facial aseptic granuloma 2423
Rosacea conglobata and rosacea fulminans 2423
Solid facial lymphoedema 2424
Corticosteroid-induced rosacea-like facial dermatosis 2424
Periorificial facial dermatitis 2425
Childhood granulomatous periorificial dermatitis 2426
Key references 2427
CHAPTER 92 Hidradenitis Suppurativa 2429
Definition and nomenclature 2429
Introduction and general description 2429
Epidemiology 2429
Incidence and prevalence 2429
Age 2430
Sex 2430
Ethnicity 2430
Associated diseases 2430
Pathophysiology 2430
Predisposing factors 2430
Pathology 2431
Causative organisms 2432
Genetics 2432
Environmental factors 2432
Clinical features 2432
History 2432
Presentation 2432
Clinical variants 2435
Differential diagnosis 2435
Classification of severity 2435
Complications and co-morbidities 2437
Disease course and prognosis 2437
Investigations 2437
Management 2437
Key references 2439
CHAPTER 93 Other Acquired Disorders of the Pilosebaceous Unit 2441
Pseudofolliculitis 2441
Folliculitis keloidalis 2443
Necrotizing lymphocytic folliculitis of the scalp margin 2444
Scalp folliculitis 2445
Actinic folliculitis 2446
Disseminate and recurrent infundibulofolliculitis 2446
Eosinophilic pustular folliculitis 2447
Infantile eosinophilic pustular folliculitis 2449
Heterotopic sebaceous glands (Fordyce spots) 2450
Sebaceous gland hyperplasia 2452
Key references 2453
CHAPTER 94 Disorders of the Sweat Glands 2455
Introduction 2455
Eccrine glands 2455
Anatomy and physiology of eccrine glands 2455
Control of eccrine sweating 2457
disorders of eccrine sweat glands 2458
Hyperhidrosis 2458
Generalized hyperhidrosis 2458
Focal hyperhidrosis 2459
Localized circumscribed and asymmetrical hyperhidrosis 2460
Cold-induced sweating syndrome 2461
Gustatory hyperhidrosis 2461
Management of hyperhidrosis 2462
Topical drug treatment 2462
Systemic drug treatment 2463
Surgical treatment 2463
Granulosis rubra nasi 2464
Anhidrosis and hypohidrosis 2464
Ross syndrome 2465
Acquired idiopathic generalized anhidrosis 2466
Miliaria 2466
Neutrophilic eccrine hidradenitis 2467
Eccrine syringosquamous metaplasia 2468
Drugs and eccrine glands 2468
Disorders with sweat gland cellular inclusions 2468
Apocrine glands 2469
Anatomy and physiology of apocrine glands 2469
Disorders of apocrine sweat glands 2469
Abnormal sweat odour (bromhidrosis) 2469
Trimethylaminuria 2470
Chromhidrosis 2471
Apocrine miliaria 2471
Differential diagnosis 2472
Key references 2472
CHAPTER 95 Acquired Disorders of the Nails and Nail Unit 2475
Anatomy and biology of the nail unit 2476
Structure 2476
Gross anatomy 2476
Microscopic anatomy 2477
Blood supply 2478
Nail growth and morphology 2478
Cell kinetics 2478
Nail morphology 2479
Linear nail growth 2479
Nail signs and their significance 2479
Abnormalities of shape 2480
Clubbing 2480
Koilonychia 2481
Pincer nail 2481
Anonychia 2482
Abnormalities of nail attachment 2482
Nail shedding 2482
Onycholysis 2483
Pterygium 2484
Changes in nail surface 2484
Longitudinal grooves 2484
Transverse grooves and Beau’s lines 2485
Nail pitting 2485
Trachyonychia 2485
Onychoschizia (lamellar dystrophy) 2486
Beading and ridging 2486
Changes in nail colour 2486
Nail plate pigmentation 2486
Loss of nail plate lucency 2487
Subungual disturbances 2487
Nail bed changes 2487
Leukonychia 2487
Colour changes due to drugs and chemicals 2488
Yellow nail syndrome 2488
Red lunulae 2489
Longitudinal erythronychia 2489
Splinter haemorrhages 2490
Traumatic nail disorders 2490
Acute trauma 2490
Subungual haematoma 2490
Nail bed laceration 2491
Delayed trauma 2491
Chronic repetitive trauma 2491
Nail biting 2491
Damage from nail manicure instruments 2492
Trauma from footwear 2492
Tumours under or adjacent to the nail 2495
Benign tumours 2495
Lobular capillary haemangioma (pyogenic granuloma) of nail apparatus 2495
Glomus tumour 2496
Subungual exostosis 2497
Digital myxoid pseudocyst 2498
Acquired ungual fibrokeratoma 2500
Subungual keratoacanthoma 2501
Onychomatricoma 2502
Superficial acral fibromyxoma 2504
Onychopapilloma 2505
Malignant tumours 2505
Squamous cell carcinoma 2505
Basal cell carcinoma 2507
Melanoma 2507
Perionychial disorders 2509
Nail fold infections 2509
Acute paronychia 2509
Herpetic paronychia 2509
Orf paronychia 2510
Erythema multiforme secondary to viral infections 2510
Paronychia of the great toe of infants 2510
Chronic paronychia 2510
Primary syphilis on the finger 2511
Periungual toe infections in neutropenic patients 2511
Subungual abscess 2511
Other disorders of the perionychium 2512
Drug-induced paronychia 2512
Periungual tissues subject to trauma – onychotillomania 2512
Painful dorsolateral fissure of the fingertip 2512
Hypertrophy of the lateral nail fold 2512
Dermatoses affecting the nails 2512
Nail psoriasis 2512
Darier disease of the nails 2517
Eczema involving the nails 2517
Lichen planus of the nails and related conditions 2518
Twenty-nail dystrophy 2519
Idiopathic atrophy of the nails 2519
Nails in childhood and old age 2520
Childhood 2520
Old age 2520
Imaging of the nail 2520
X-ray examination 2520
Acquired acro-osteolysis, acronecrosis and distal phalangeal erosive lesions 2521
Occupational acro-osteolysis 2521
Connective tissue diseases 2521
Thermal/biomechemical/neuropathic injuries 2521
Hyperparathyroidism 2522
Soft-tissue lesions 2522
Osseous neoplasms 2522
Ultrasound imaging 2522
Optical coherence tomography 2522
Confocal microscopy 2523
Magnetic resonance imaging 2524
Proximal nail fold capillaroscopy 2524
Acrosyndromes 2525
Systemic autoimmune diseases 2526
Nail surgery 2527
Introduction and general description 2527
Anaesthesia 2527
Premedication 2527
Instrumentation 2528
Diagnostic surgery 2528
Proximal nail fold biopsy 2528
Nail bed biopsy 2528
Nail matrix biopsy 2528
Biopsy of whole structures of nail apparatus 2528
Excisional surgery 2531
Nail avulsion 2531
Acute paronychia 2532
Chronic paronychia 2532
Fibrokeratoma resection 2532
Chemical cautery for ingrowing toenails 2532
Longitudinal melanonychia removal 2534
Postoperative care 2534
The nail and cosmetics 2534
Coatings that harden upon evaporation 2534
Nail varnish 2534
Coatings that polymerize 2536
Sculptured nails 2536
Allergic reactions 2536
Irritant reactions 2536
Light-cured gels 2536
Gel polish 2537
Preformed plastic nails 2537
Nail-mending kits 2537
Removal of nail coatings that polymerize 2537
Cuticle removers 2537
Nail hardeners 2537
Silicone rubber nail prosthesis 2537
Nail cream 2538
Nail buffing 2538
Nail whitener 2538
Infection risks 2538
Conclusion 2538
Key references 2538
CHAPTER 96 Acquired Disorders of Dermal Connective Tissue 2541
Changes in dermal connective tissue due to ageing and photodamage 2541
Introduction and general description 2541
Wrinkles 2542
Actinic elastosis 2542
Actinic comedonal plaque 2543
Elastotic nodules of the ear 2543
Collagenous and elastotic marginal plaques of the hands 2544
Adult colloid milium and colloid degeneration of the skin 2545
Other causes of cutaneous atrophy 2546
Introduction and general description 2546
Atrophy due to corticosteroids 2547
Striae 2549
Acquired poikiloderma 2550
Atrophic scars 2551
Congenital erosive and vesicular dermatosis with reticulate scarring 2552
Spontaneous atrophic scarring of the cheeks 2552
Acrodermatitis chronica atrophicans 2553
Atrophodermas 2554
Follicular atrophoderma 2554
Linear atrophoderma 2555
Atrophoderma of Pasini and Pierini 2555
Paroxysmal haematoma of the finger 2556
Panatrophy 2557
Facial hemiatrophy 2557
Disorders of elastic fibre degradation 2558
Introduction and general description 2558
Tensile strength 2559
Lax skin 2559
Acquired cutis laxa 2559
Anetoderma 2560
Mid-dermal elastolysis 2563
Upper dermal elastolysis 2564
Blepharochalasis 2564
Actinic granuloma and annular elastolytic giant cell granuloma 2565
Granuloma multiforme 2567
Other elastolytic conditions 2567
Acquired pseudoxanthoma elasticum-like syndromes 2568
Perforating pseudoxanthoma elasticum 2568
Acquired pseudoxanthoma elasticum 2568
Saltpetre disease 2568
Acrokeratoelastoidosis 2568
Acquired disorders of elastic tissue deposition 2569
Linear focal elastosis 2569
Late-onset focal dermal elastosis 2570
Elastofibroma dorsi 2570
Elastoderma 2570
Papular elastorrhexis 2570
Fibromatoses and other causes of diffuse fibrosis 2570
Introduction and general description 2570
Fibromatoses 2571
Palmar fascial fibromatosis 2571
Plantar fascial fibromatosis 2573
Penile fibromatosis 2573
Knuckle pads 2574
Pachydermodactyly 2576
White fibrous papulosis of the neck 2576
Camptodactyly 2577
Juvenile fibromatoses 2578
Infantile myofibromatosis 2578
Juvenile hyaline fibromatosis 2579
Other benign fibrous cutaneous nodules 2580
Nodular fasciitis 2580
Collagenoma 2580
Collagen naevi 2580
Albopapuloid form of epidermolysis bullosa 2580
Buschke–Ollendorff syndrome 2580
Fibrous digital nodules 2580
Nephrogenic systemic fibrosis 2580
Diabetic thick skin 2582
Environmental and drug-induced scleroderma 2582
Constricting bands of the extremities 2583
ABNORMAL FIBROTIC RESPONSES TO SKIN INJURY 2585
Keloids and hypertrophic scars 2585
Perforating dermatoses 2589
Definition 2589
Introduction and general description 2589
Acquired perforating dermatosis 2589
Elastosis perforans serpiginosa 2591
Key references 2593
CHAPTER 97 Granulomatous Disorders of the Skin 2597
Granuloma annulare 2597
Necrobiosis lipoidica 2604
Cutaneous Crohn disease 2607
Key references 2609
CHAPTER 98 Sarcoidosis 2611
Definition 2611
Introduction and general description 2611
Epidemiology 2611
Incidence and prevalence 2611
Age 2611
Sex 2612
Ethnicity 2612
Associated diseases 2612
Pathophysiology 2612
Pathology 2612
Immunopathogenesis 2612
Causative organisms 2614
Genetics 2614
Environmental factors 2614
Clinical features 2615
Systemic manifestations of sarcoidosis 2615
Cutaneous manifestations of sarcoidosis 2616
Specific forms of cutaneous sarcoidosis 2616
Maculopapular sarcoidosis 2616
Nodular and plaque sarcoidosis 2618
Lupus pernio 2618
Scar sarcoidosis 2619
Subcutaneous sarcoidosis 2620
Less common forms of cutaneous sarcoidosis 2622
Angiolupoid sarcoidosis 2622
Hypopigmented sarcoidosis 2623
Lichenoid sarcoidosis 2623
Ulcerative sarcoidosis 2623
Psoriasiform sarcoidosis 2623
Verrucous sarcoidosis 2623
Necrobiosis-lipoidica-like lesions 2623
Ichthyosiform sarcoidosis 2623
Erythrodermic sarcoidosis 2623
Morphoea-like lesions 2623
Livedo 2623
Other 2623
Special locations of specific cutaneous lesions 2624
Alopecia 2624
Nails 2624
Oral 2624
Genital 2624
Non-specific lesions 2624
Investigations 2624
Diagnostic criteria 2625
Management 2625
First line 2625
Second line 2626
Third line 2626
Other reported treatments 2627
Cutaneous sarcoid reaction 2627
Key references 2627
CHAPTER 99 Panniculitis 2629
Anatomy and physiology of subcutaneous fat 2629
Introduction 2629
Cellular composition of subcutaneous tissue 2631
Anatomy of subcutaneous tissue 2631
Physiology of adipose tissue 2632
Energy homeostasis 2632
Role of leptin 2633
Adipogenesis 2633
Insulin sensitivity 2633
Adiponectin 2633
Other adipokines 2634
Panniculitis 2634
Introduction and general description 2634
Types of necrosis of the adipocytes 2636
Superficial migratory thrombophlebitis 2636
Cutaneous polyarteritis nodosa 2638
Necrobiosis lipoidica 2639
Deep morphoea 2640
Subcutaneous granuloma annulare 2641
Rheumatoid nodule 2643
Necrobiotic xanthogranuloma 2645
Erythema nodosum 2646
Erythema nodosum leprosum 2652
Erythema induratum of Bazin 2654
Sclerosing panniculitis 2656
Calcific uraemic arteriolopathy (calciphylaxis) 2659
Cold panniculitis 2661
Lupus panniculitis 2663
Dermatomyositis-associated panniculitis 2666
Pancreatic panniculitis 2666
Alpha-1 antitrypsin deficiency panniculitis 2669
Infective panniculitis 2671
Factitious panniculitis 2673
Neutrophilic lobular panniculitis 2676
Subcutaneous sarcoidosis 2678
Traumatic panniculitis 2679
Lipoatrophic panniculitis of the ankles in childhood 2680
Subcutaneous fat necrosis of the newborn 2681
Poststeroid panniculitis 2683
Sclerema neonatorum 2684
Gouty panniculitis 2685
Fungal panniculitis due to zygomycosis mucormycosis and aspergillosis 2686
Cytophagic histiocytic panniculitis and subcutaneous panniculitis-like T-cell lymphoma 2686
Sclerosing postirradiation panniculitis 2687
Key references 2689
CHAPTER 100 Other Acquired Disorders of Subcutaneous Fat 2691
Introduction 2691
Acquired lipodystrophy 2691
Acquired generalized lipodystrophy 2691
Acquired partial lipodystrophy 2694
HIV-associated lipodystrophy 2696
Localized lipoatrophy and/or lipodystrophy 2698
Semicircular lipoatrophy 2698
Localized lipoatrophy due to injected drugs 2699
Insulin-induced localized lipoatrophy 2699
Localized lipoatrophy due to injected corticosteroid 2700
Localized lipodystrophy secondary to panniculitis 2701
Centrifugal lipodystrophy 2701
Fat hypertrophy 2702
Insulin-induced localized fat hypertrophy 2702
Subcutaneous lipomatosis 2703
Benign symmetrical lipomatosis 2703
Dercum disease 2705
Infiltrating lipomatosis of the face 2707
Encephalocraniocutaneous lipomatosis 2708
Lipoedema 2709
Lipoedema of the lower limbs 2709
Lipo-lymphoedema 2711
Lipoedema of the scalp and lipoedematous alopecia 2712
Miscellaneous disorders of subcutaneous fat 2713
Cellulite 2713
Obesity and the skin 2715
Key references 2716
PART 9 Vascular Disorders Involving the Skin 2719
CHAPTER 101 Purpura 2721
Introduction 2721
Classifi cation of purpura 2722
PURPURA DUE TO THROMBOCYTOPENIA OR PLATELET DEFECTS 2723
Thrombocytopenia 2723
Abnormalities of platelet function 2723
Thrombocytosis 2723
NON-THROMBOCYTOPENIC VASCULAR CAUSES OF PURPURA AND SYNDROMES OF PRIMARY ECCHYMOTIC HAEMORRHAGE 2724
RAISED INTRAVASCULAR PRESSURE 2724
ABNORMAL OR DECREASED SUPPORT OF BLOOD VESSELS 2725
Physical and artefactual bleeding 2726
Dysproteinaemic and Waldenström hypergammaglobulinaemic purpura 2727
PIGMENTED PURPURIC DERMATOSES 2728
Pigmented purpurpic dermatosis 2728
DISORDERS OF CUTANEOUS MICROVASCULAR OCCLUSION 2730
Platelet plugging: heparin necrosis 2730
Platelet plugging: thrombocytosis 2731
Cryogelling/cryoagglutination disorders 2732
ORGANISMS IN VESSELS 2735
EMBOLI 2735
Cholesterol embolus 2735
Oxalate embolus, cardiac embolus and other emboli 2736
Systemic coagulopathies: protein C/protein S-related disease 2737
Systemic coagulopathies: antiphospholipid antibody/lupus anticoagulant syndrome 2739
VASCULAR COAGULOPATHIES 2741
Sneddon syndrome 2741
Livedoid vasculopathy/atrophie blanche 2742
Malignant atrophic papulosis 2743
Calcific uraemic arteriolopathy 2744
Key references 2745
CHAPTER 102 Cutaneous Vasculitis 2749
Overview 2749
Definition 2749
Introduction and general description 2749
Epidemiology 2749
Pathophysiology 2749
Clinical features 2749
Investigations 2752
Management 2752
SINGLE-ORGAN SMALL-VESSEL VASCULITIS 2753
Cutaneous small-vessel vasculitis 2753
Erythema elevatum diutinum 2756
Recurrent cutaneous necrotizing eosinophilic vasculitis 2758
Granuloma faciale 2759
SMALL-VESSEL IMMUNE COMPLEX-ASSOCIATED VASCULITIS 2761
IgA vasculitis 2761
Cryoglobulinaemic vasculitis 2764
Hypocomplementaemic urticarial vasculitis 2766
Antiglomerular basement membrane vasculitis disease 2767
SMALL-VESSEL ANCA-ASSOCIATED VASCULITIS 2768
Microscopic polyangiitis 2768
Granulomatosis with polyangiitis 2771
Eosinophilic granulomatosis with polyangiitis 2775
MEDIUM-VESSEL VASCULITIS 2777
Polyarteritis nodosa and cutaneous polyarteritis nodosa 2777
Kawasaki disease 2780
LARGE-VESSEL VASCULITIS 2781
Giant cell arteritis 2781
Takayasu arteritis 2783
Key references 2784
CHAPTER 103 Dermatoses Resulting from Disorders of the Veins and Arteries 2787
ARTERIAL AND ARTERIOLAR DISORDERS 2787
Vasculogenesis, angiogenesis and arteriogenesis 2787
Arterial disease and peripheral ischaemic disorders 2788
Thromboangiitis obliterans 2790
NEUROVASCULAR DISORDERS 2792
Erythromelalgia 2792
TELANGIECTASES 2794
Definition and nomenclature 2794
Introduction and general description 2794
Pathophysiology 2795
Spider telangiectases 2796
Cherry angiomas 2798
Angiokeratomas 2799
Angiokeratoma circumscriptum 2799
Venous lakes 2800
Primary telangiectasia 2801
Angioma serpiginosum 2801
Generalized essential telangiectasia 2802
Hereditary benign telangiectasia 2804
Unilateral naevoid telangiectasia syndrome 2804
MALFORMATIONS 2805
Arteriovenous malformations 2805
Venous malformations 2807
Solitary venous malformations 2807
Verrucous haemangioma 2809
Disorders associated with venous malformations 2810
Klippel–Trenaunay syndrome 2810
Parkes Weber syndrome 2811
VENOUS DISORDERS 2813
Anatomy 2813
Physiology: the venous macrocirculation 2813
Venous thrombosis 2814
Deep-vein thrombosis 2814
Superficial venous thrombosis 2816
Thrombophlebitis migrans 2817
Mondor disease 2819
Varicose veins 2820
Chronic venous insufficiency 2822
Venous insufficiency 2822
Key references 2827
CHAPTER 104 Ulceration Resulting from Disorders of the Veins and Arteries 2831
Introduction 2831
Venous leg ulcer 2831
Mixed leg ulcer 2835
Arterial leg ulcer 2838
Hypertensive ischaemic leg ulcer 2840
Key references 2844
CHAPTER 105 Disorders of the Lymphatic Vessels 2845
Introduction 2845
Clinical presentations of lymphatic dysfunction 2845
Chronic, venous and drug-induced oedema 2845
Chronically swollen leg 2849
Phleboedema and mixed lymphovenous disease 2850
Lipodermatosclerosis (chronic cellulitis) 2853
Recurrent cellulitis (erysipelas) 2854
Swollen arm 2856
Swollen face, head and neck 2858
Swollen genitalia and mons pubis 2861
Obesity-related lymphoedema 2863
Abdominal wall lymphoedema 2864
Cancer-related lymphoedema 2866
Swollen breast and breast lymphoedema 2867
Massive localized lymphoedema 2868
Primary lymphoedema 2869
Lipoedema 2874
Yellow-nail syndrome 2877
Lymphatic malformation and lymphangioma circumscriptum 2878
Lymphoedema as a result of amniotic band constriction 2881
Lymphangiomatosis, lymphangioleiomyomatosis and non-malignant lymphatic tumours 2883
Lymphangiectasia 2884
Lymphocele, seroma and lymph fistula 2886
Lymphatic filariasis 2886
Podoconiosis 2889
Pretibial myxoedema 2891
Trauma-induced lymphoedema 2893
Lymphoedema due to immobility 2894
Lymphangitis 2895
Complications of lymphoedema 2895
Swelling 2895
Skin changes 2896
Infection 2896
Psychosocial issues 2896
Malignancy 2897
Miscellaneous conditions 2897
Imaging of the lymphatic system 2897
Lymphography and lymphoscintigraphy 2898
Fluorescence microlymphangiography 2898
Near infrared lymphangiography 2898
Magnetic resonance lymphangiography 2898
Histopathological investigation of the lymphatic system 2899
Lymphoedema management 2899
Medical assessment 2899
Physical therapies 2899
Care of the skin and prevention of infection 2900
Exercise 2900
External compression 2900
Massage (manual lymphatic drainage therapy) 2900
Breathing, postural exercise, elevation and rest 2901
Intensive and maintenance treatment 2901
Pharmacological therapies 2901
Surgical options 2902
Excisional methods 2902
Lymphatico-venous anastomosis surgery 2902
Lymphatico-lymphatic anastomosis surgery 2902
Lymph node transfer surgery 2902
Liposuction 2902
Key references 2903
CHAPTER 106 Flushing and Blushing 2909
Introduction 2909
Epidemiology 2909
Physiology 2909
Pathophysiology of flushing 2910
Psychosocial aspects of blushing 2911
Clinical presentation 2911
Investigations 2916
Management 2916
Complications 2917
Prognosis 2917
Key references 2918
PART 10 Skin Disorders Associated with Specific Sites, Sex and Age 2919
CHAPTER 107 Dermatoses of the Scalp 2921
SCALING DISORDERS OF THE SCALP 2921
Seborrhoeic dermatitis 2921
Psoriasis 2922
Pityriasis amiantacea 2923
Contact dermatitis 2924
Lichen simplex chronicus 2924
Radiodermatitis 2924
SECONDARY CICATRICIAL ALOPECIA 2925
Scleroderma and morphoea 2926
Necrobiotic disorders 2926
Sarcoidosis 2926
Follicular mucinosis 2927
Cicatricial pemphigoid 2927
Dissecting cellulitis of the scalp 2928
THICKENED SCALP DISORDERS 2929
Cutis verticis gyrata 2929
Lipoedematous alopecia 2929
TUMOURS OF THE SCALP 2929
Sebaceous naevus 2930
Syringocystadenoma papilliferum 2930
Tumours of the pilosebaceous unit 2930
Scalp metastases 2930
INFECTIONS OF THE SCALP 2930
Syphilis 2930
Human immunodeficiency virus 2930
PUSTULAR CONDITIONS OF THE SCALP 2931
Erosive pustular dermatosis of the scalp 2931
Iatrogenic scalp pustulation 2932
OTHER SCALP DISORDERS 2932
Scalp pruritus 2932
Scalp dysaesthesia 2934
Key references 2934
CHAPTER 108 Dermatoses of the External Ear 2937
Introduction 2937
Anatomy and physiology 2937
Microbiology 2938
Cerumen (wax) 2938
Examination 2939
Developmental defects 2939
Microtia (small ears) 2940
Macrotia (large ears) 2940
Low-set ears 2941
Peri-auricular anomalies 2941
Variations in the shape of the pinna 2941
Developmental anomalies of ear hair 2942
Management 2942
Ageing changes 2942
Ear length 2942
Earlobe creases 2942
Traumatic conditions 2942
Contusion and haematoma 2942
Ear piercing 2943
Chondrodermatitis nodularis 2944
Pseudocyst of the ear 2946
Manifestation of skin disease and systemic disease in the ear 2947
Infection 2947
Otitis externa 2951
Necrotizing otitis externa 2955
Otomycosis 2957
Tumours of the auricle and external auditory canal 2958
Squamous cell carcinoma of the auricle (pinna) 2960
Squamous carcinoma of the external auditory canal 2962
Miscellaneous conditions 2963
Key references 2964
CHAPTER 109 Dermatoses of the Eye, Eyelids and Eyebrows 2967
Introduction 2967
Anatomy and physiology of the eye 2967
Eyebrows 2967
Eyelids 2967
Lacrimal glands 2968
Precorneal tear film 2969
Glossary of ophthalmological terms 2969
Disorders affecting the eyebrows and eyelashes 2969
Disorders of the eyebrows 2969
Disorders of the eyelashes 2970
Abnormalities of the eyelids 2971
Ptosis 2971
Skin diseases affecting the eyelids 2971
SKIN DISEASES AFFECTING THE EYE AND EYELIDS 2972
Blepharitis, meibomian gland dysfunction, rosacea and seborrhoeic dermatitis 2972
Atopy and atopic eye disease 2981
Cicatrizing conjunctivitis associated with immunobullous disorders 2991
Mucous membrane pemphigoid 2991
Other subepithelial disorders and conjunctivitis 3000
Systemic diseases with skin and eye involvement 3002
Infections 3002
Viral infections 3002
Warts 3002
Molluscum contagiosum 3002
Herpes simplex virus 3002
Herpes zoster 3004
Bacterial infections 3007
Staphylococcal infections 3007
Impetigo 3007
Hordeolum 3007
Streptococcal infections 3007
Erysipelas 3007
Necrotizing fasciitis 3008
Mycobacterial infections 3007
Tuberculosis 3007
Leprosy 3008
Treponemal infections 3008
Syphilis 3008
Lyme disease 3008
Parasitic infections 3008
Phthiriasis (lice) 3008
Filariasis (onchocerciasis) 3008
Other infections 3009
Protozoal infections 3009
Other disorders 3009
Inherited disorders 3009
Ocular complications of dermatological therapy 3009
Tumours 3012
Benign tumours of the eyelid 3012
Malignant tumours of the eyelid 3015
Key references 3017
CHAPTER 110 Dermatoses of the Oral Cavity and Lips 3019
Introduction 3020
BIOLOGY OF THE MOUTH 3021
Oral epithelium 3021
Lips 3021
Oral mucosa 3021
Teeth 3021
Junction of the mucosa with the teeth 3022
Immunity in the oral cavity 3022
EXAMINATION OF THE MOUTH AND PERIORAL REGION 3022
Lymph nodes 3022
Temporomandibular joints and muscles of mastication 3023
Inspection 3023
Palpation 3023
Jaws 3023
Salivary glands 3024
Intraoral examination 3024
Anatomical variants 3025
DISORDERS AFFECTING THE ORAL MUCOSA OR LIPS 3025
Blisters, erosions and ulcers 3025
Lumps and swellings 3025
Pigmentation 3026
Redness 3026
White patches 3027
GENETIC DISORDERS AFFECTING THE ORAL MUCOSA OR LIPS 3027
LUMPS AND SWELLINGS 3027
Angio-oedema (hereditary) 3027
Focal dermal hypoplasia 3028
Acanthosis nigricans 3028
Lymphangioma 3028
Dermoid cyst 3028
Lingual tonsil 3028
Lingual thyroid 3029
Multiple mucosal neuroma syndrome 3029
PIGMENTED LESIONS 3029
Lentiginoses 3029
Centrofacial lentiginosis syndrome 3030
Complex of myxomas, spotty pigmentation and endocrine overactivity 3030
Inherited patterned lentiginosis in black people 3030
Laugier–Hunziker syndrome 3030
Melanotic macule 3030
Naevi 3031
Peutz–Jeghers syndrome 3031
Pseudoxanthoma elasticum 3031
RED LESIONS 3031
Benign migratory glossitis (geographic tongue) 3031
Hereditary haemorrhagic telangiectasia 3032
Haemangioma 3033
Sturge–Weber–Krabbe syndrome 3033
Klippel–Trenaunay–Weber syndrome 3033
Blue rubber–bleb naevus syndrome 3033
Glomovenous malformations 3033
Maffucci syndrome 3033
Mucoepithelial dysplasia 3033
Venous mucocutaneous malformation 3034
Wiskott–Aldrich syndrome 3034
VESICULOEROSIVE DISORDERS 3034
Acrodermatitis enteropathica 3034
Epidermolysis bullosa 3034
Felty syndrome 3034
Immune defects 3035
WHITE OR WHITISH LESIONS 3035
Chronic mucocutaneous candidosis 3035
Clouston syndrome 3035
Darier disease 3035
Dyskeratosis congenita 3035
Focal palmoplantar and oral hyperkeratosis syndrome 3036
Fordyce spots 3036
Hereditary benign intraepithelial dyskeratosis 3036
Keratitis, ichthyosis and deafness syndrome 3037
Leukoedema 3037
Naevus sebaceous of Jadassohn 3037
Olmsted syndrome 3037
Pachyonychia congenita 3037
Sebaceous adenoma 3037
Tylosis 3037
Warty dyskeratoma 3037
White sponge naevus 3037
OTHER CONGENITAL ANOMALIES 3038
Ankyloglossia 3038
Fissured tongue 3038
Oral hair 3039
VARIOUS OROCUTANEOUS SYNDROMES 3039
Cleft lip/palate 3039
Syndromic cleft palate 3041
Cowden syndrome 3042
De Lange syndrome 3042
Double lip 3042
Down syndrome 3042
Erythropoietic protoporphyria 3042
Focal mucinosis 3042
Gardner syndrome 3042
Gorlin syndrome 3043
Jacob disease 3043
Kindler syndrome 3043
Lip pits and sinuses 3043
Noonan syndrome 3043
Tuberous sclerosis 3044
Van der Woude syndrome 3044
Von Recklinghausen neurofibromatosis 3044
Xeroderma pigmentosum 3044
ACQUIRED DISORDERS OF THE ORAL MUCOSA OR LIPS 3044
Blisters, erosions and ulcers 3044
Mouth ulcers of local aetiology 3045
Eosinophilic ulcer of the oral mucosa 3045
Recurrent mouth ulcers 3045
Recurrent aphthous stomatitis 3045
Behçet syndrome 3048
Sweet syndrome 3050
Malignant neoplasms 3050
Oral squamous cell carcinoma 3050
Verrucous carcinoma 3056
Florid oral papillomatosis 3056
Other oral malignant primary neoplasms 3056
Ulcers in association with systemic disease 3057
Haematological diseases 3057
Gastrointestinal diseases 3059
Dermatological diseases 3060
Collagen–vascular diseases 3066
Infective diseases 3066
Bacterial infections 3070
Fungal infections 3071
Protozoal infestations 3072
Immune defects 3072
Vasculitides 3072
Iatrogenic conditions 3073
Drugs 3073
Miscellaneous causes 3074
LOSS OF ELASTICITY OF ORAL TISSUES 3074
Oral submucous fibrosis 3074
Systemic sclerosis 3075
LUMPS AND SWELLINGS 3076
Abscesses 3076
Amyloidosis 3076
Angio-oedema 3077
Buccal fat-pad herniation 3077
Denture-induced hyperplasia 3077
Focal epithelial hyperplasia (multifocal epithelial hyperplasia) 3078
Foliate papillitis 3078
Franklin disease 3078
Leiomyoma 3078
Lipoma 3078
Macroglossia 3078
Mucocoele (mucous cyst) 3078
Myeloma and paraproteinaemias 3079
Myxoma 3079
Nodular fasciitis 3079
Oral allergy syndrome 3079
Osteoma mucosae 3079
Papillary hyperplasia 3079
Papilloma 3079
Pulse granuloma 3079
Rhabdomyoma 3080
Rhabdomyosarcoma 3080
Sarcoidosis 3080
Thrombotic thrombocytopenic purpura 3080
Verruciform xanthoma 3080
Waldenström macroglobulinaemia 3080
Warts 3080
ORAL SORENESS WITHOUT ULCERATION 3081
Burning mouth syndrome 3081
Deficiency glossitis 3082
Geographic tongue 3082
Lichen planus 3082
PIGMENTED LESIONS 3082
Amalgam tattoos 3083
Body art 3083
Coated, furred, brown or black hairy tongue 3083
Drug, food, habits and heavy metal induced hyperpigmentation 3084
HIV infection 3085
Kaposi sarcoma 3085
Melanoma 3085
Melanocanthoma 3085
Melanotic macule 3085
Pigmentary incontinence 3086
Purpura 3086
RED LESIONS 3086
Angina bullosa haemorrhagica 3086
Candidosis 3086
Acute candidosis 3087
Denture-related stomatitis 3087
HIV-associated candidosis 3088
Median rhomboid glossitis 3089
Desquamative gingivitis 3089
Erythroplasia 3089
Glossitis 3090
Larva migrans 3090
Strawberry tongue 3090
Telangiectasia 3090
Varicosities 3090
Vascular proliferative lesions 3090
Venous lake 3090
WHITE LESIONS 3091
Burns 3091
Candidosis 3091
Thrush 3091
Chronic candidosis 3091
Cheek biting 3092
Cheilitis (actinic) 3092
Hairy leukoplakia 3092
Keratoses 3093
Koplik spots 3093
Leukoplakia 3093
Lichen planus 3096
Psoriasis 3096
ACQUIRED LIP LESIONS 3096
Actinic cheilitis (solar cheilosis) 3096
Actinic prurigo 3097
Angular cheilitis 3097
Blisters on the lips 3098
Cancer of the lip 3099
Carcinoma of the lip 3099
Basal cell carcinoma of the lip 3099
Keratoacanthoma of the lip 3100
‘Chapping’ of the lips 3100
Cheilitis 3100
Contact cheilitis 3100
Drug-induced cheilitis 3101
Eczematous cheilitis 3102
Exfoliative cheilitis 3102
Foreign body cheilitis 3103
Glandular cheilitis 3103
Granulomatous cheilitis 3103
Infective cheilitis 3105
Plasma cell cheilitis 3105
Other lesions of the lip 3106
Calibre-persistent artery 3106
Lip fissure 3106
Lupus erythematosus 3106
Reactive perforating collagenosis 3106
Sarcoidosis 3106
ORAL MANIFESTATIONS OF SYSTEMIC DISEASES 3107
Key references 3110
CHAPTER 111 Dermatoses of the Male Genitalia 3113
Introduction 3114
History and examination 3114
Investigations 3116
Structure and function of the male genitalia 3116
Normal variants 3117
The foreskin 3118
Circumcision 3118
Congenital and developmental abnormalities 3119
Trauma and artefact 3119
Definition 3119
Introduction and general description 3119
Penile haematoma and rupture 3119
Sclerosing lymphangitis 3120
Strangulation of the penis 3120
Foreign body 3120
Lipogranuloma 3120
Dermatitis artefacta and mutilation 3120
Child abuse 3120
Other traumatic and artefactual conditions 3121
Inflammatory dermatoses 3121
Psoriasis 3121
Eczema 3122
Zoon balanitis 3124
Lichen sclerosus 3125
Lichen planus 3128
Miscellaneous inflammatory dermatoses 3128
Non-specific balanoposthitis 3128
Ulcerative disease and penile necrosis 3129
Pilonidal sinus 3131
Penile acne 3131
Peyronie disease 3131
Drug reactions 3131
Other inflammatory dermatoses 3131
Non-sexually transmitted infections 3133
Staphylococcal cellulitis 3133
Streptococcal dermatitis/perianal cellulitis 3133
Chronic penile oedema 3133
Ecthyma gangrenosum 3134
Fournier gangrene 3134
Trichomycosis pubis 3134
Tuberculosis 3135
Non-syphilitic spirochaetal ulcerative balanoposthitis 3135
Yaws 3135
Candidosis 3135
Tinea 3135
Deep fungal infections 3136
Other non-sexually transmitted infections 3136
Dermatological aspects of sexually transmitted disease 3136
MRSA 3136
Syphilis 3136
Viral warts 3137
Molluscum contagiosum 3137
HIV infection 3137
Phthiriasis 3137
Scabies 3137
Other infections 3138
Benign tumours 3138
Median raphe cysts 3138
Mucoid cysts 3138
Scrotal calcinosis 3138
Verruciform xanthoma 3138
Other benign tumours 3138
Pre-cancerous dermatoses and carcinoma in situ 3139
Erythroplasia of Queyrat, Bowen disease of the penis and bowenoid papulosis 3139
Miscellaneous pre-cancerous conditions 3140
Squamous hyperplasia and squamous intraepithelial lesion(s) 3140
Penile horn 3141
Porokeratosis 3141
Pseudoepitheliomatous micaceous and keratotic balanitis 3141
Squamous carcinoma and other malignant neoplasms 3141
Carcinoma of the penis 3141
Carcinoma of the scrotum 3143
Verrucous carcinoma/giant condyloma/Buschke–Löwenstein tumour 3144
Extramammary Paget disease 3144
Malignant melanoma 3145
Kaposi sarcoma 3145
Other malignant neoplasms 3145
Miscellaneous cutaneous male genital conditions 3146
Penile melanosis 3146
Hypopigmentation 3146
Pain and swelling 3147
Iatrogenic swelling and lymphoedema 3147
Idiopathic lipogranuloma 3147
Priapism 3147
Dermatological non-disease, dysaesthesia and chronic pain syndromes 3148
Key references 3148
CHAPTER 112 Dermatoses of the Female Genitalia 3155
Introduction 3155
History and examination 3156
Investigations 3156
Structure and function of the female genitalia 3156
Labial and clitoral variations 3157
Normal flora 3157
Normal variants 3157
CONGENITAL ABNORMALITIES 3158
Disorders of sexual development 3158
GENODERMATOSES 3158
Epidermolysis bullosa 3158
Hailey–Hailey disease 3159
Darier disease 3159
INFLAMMATORY DERMATOSES OF THE VULVA 3160
Lichen sclerosus 3160
Lichen planus 3163
Zoon’s vulvitis 3166
Seborrhoeic eczema 3167
Irritant eczema 3167
Allergic contact dermatitis 3168
Allergic contact urticaria 3169
Lichen simplex 3169
Psoriasis 3170
Reactive arthritis 3171
ULCERATIVE AND BULLOUS DISORDERS 3172
Aphthous ulcers 3172
Lipschutz ulceration 3172
Behçet disease 3173
Immunobullous disease 3173
PIGMENTARY DISORDERS 3174
Vitiligo 3174
Vulval melanosis 3174
Acanthosis nigricans 3175
Dowling–Degos disease 3175
VULVAL OEDEMA 3176
Crohn disease 3176
NON-SEXUALLY TRANSMITTED INFECTIONS 3177
DIAGNOSIS OF VAGINAL DISCHARGE 3177
BACTERIAL INFECTIONS 3177
Staphylococcal infections 3177
Streptococcal infections 3178
Mycobacterial infections 3178
Malakoplakia 3178
Other bacterial infections 3179
FUNGAL INFECTIONS 3179
Candidal vulvo-vaginitis 3179
Tinea cruris 3180
VIRAL INFECTIONS 3181
Poxvirus infections 3181
Herpes simplex 3182
Human papillomavirus infection 3182
BENIGN TUMOURS 3183
Mucinous cysts 3183
Bartholin’s cyst 3185
Papillary hidradenoma 3185
Cutaneous endometriosis 3185
Atypical genital naevi 3186
PRE-MALIGNANT CONDITIONS 3186
Vulval intraepithelial neoplasia 3186
MALIGNANT NEOPLASMS 3188
Squamous cell carcinoma 3188
Verrucous carcinoma 3189
Extramammary Paget disease 3190
Basal cell carcinoma 3191
Vulval melanoma 3192
Langerhans cell histiocytosis 3192
Other malignant vulval neoplasms 3193
PAIN DISORDERS 3193
Vulval pain 3193
TRAUMATIC LESIONS 3194
Nympho-hymenal tears 3194
Female genital mutilation 3195
MISCELLANEOUS 3196
Graft-versus-host disease 3196
Vulvo-vaginal adenosis 3196
Necrolytic migratory erythema 3196
Genital papular acantholytic dyskeratosis 3197
Key references 3197
CHAPTER 113 Dermatoses of Perineal and Perianal Skin 3201
Introduction 3201
History and examination 3201
Investigations in perineal and perianal dermatology 3201
Structure and function of the ano-genital region 3201
Embryogenesis of the ano-genital region 3203
Congenital and developmental abnormalities 3204
PERIANAL ITCHING 3204
Pruritus ani 3204
INFLAMMATORY DERMATOSES 3206
DRUG REACTIONS 3208
INFECTIONS 3209
BACTERIAL INFECTIONS 3209
Folliculitis and furunculosis 3209
OTHER BACTERIAL INFECTIONS 3210
FUNGAL INFECTIONS 3211
VIRAL INFECTIONS 3211
HELMINTH INFECTIONS 3211
MISCELLANEOUS INFECTIONS 3212
OTHER DISEASES AND INFECTIONS 3212
Sexually transmitted diseases 3212
Human immunodeficiency virus infection 3213
Human papillomavirus infection 3213
Anal intraepithelial neoplasia 3215
Anal and perianal malignancy 3217
Miscellaneous malignancies 3220
Hidradentitis suppurativa 3221
Pilonidal sinus 3223
Crohn disease 3224
Anal abscess 3225
Anal fistula 3226
Anal fissure 3228
Haemorrhoids 3229
Trauma and artefact 3231
Perineal and perianal pain 3232
Key references 3233
CHAPTER 114 Cutaneous Complications of Stomas and Fistulae 3235
Introduction 3235
Types of stomas and appliances 3235
Assessment of the patient 3235
General aspects of treatment for stomas 3235
Allergic contact dermatitis 3235
Infections 3237
Other skin conditions presenting near stomas 3238
Dermatoses associated with underlying bowel disease 3241
Irritant skin reactions 3244
Key references 3247
CHAPTER 115 Dermatoses of Pregnancy 3249
PHYSIOLOGICAL SKIN CHANGES IN PREGNANCY 3249
Pigmentation 3249
Hair and nail changes 3249
Eccrine, apocrine and sebaceous gland activity 3250
Vascular changes 3250
Striae distensae 3251
Immune system changes 3251
SKIN INFECTIONS 3251
Human papillomavirus infection 3251
Herpes simplex virus infection 3251
Varicella zoster virus infection 3251
HIV infection 3252
Scabies 3252
Leprosy 3253
AUTOIMMUNE SKIN DISEASES 3253
Systemic lupus erythematosus 3253
Pemphigus vulgaris and foliaceus 3253
Other connective tissue disorders 3254
SKIN TUMOURS 3255
Benign melanocytic naevi 3255
Malignant melanoma 3255
INFLAMMATORY SKIN DISEASES 3256
Psoriasis and generalized pustular psoriasis 3256
Acne vulgaris and rosacea 3256
Pityriasis rosea 3257
Urticaria 3257
Erythema nodosum 3257
ITCHING 3258
Pruritus gravidarum 3258
Intrahepatic cholestasis of pregnancy 3258
SPECIFIC DERMATOSES 3259
Polymorphic eruption of pregnancy 3259
Pemphigoid gestationis 3261
Atopic eruption of pregnancy 3263
GENERAL GUIDANCE ON SAFE TREATMENTS IN PREGNANCY 3265
Topical corticosteroids 3265
Systemic treatments 3265
Key references 3265
CHAPTER 116 Dermatoses of the Neonate 3267
INTRODUCTION 3267
Nomenclature 3267
Skin function in the neonate 3267
Barrier function 3267
Eccrine sweating 3268
Sebaceous gland secretion 3268
Appearance of neonatal skin 3269
Full-term neonate 3269
Preterm neonate 3270
Small-for-dates and postmature neonates 3270
SKIN DISORDERS IN THE NEONATE 3270
Toxic erythema of the newborn 3270
Miliaria 3271
Transient pustular melanosis 3273
Infantile acropustulosis 3273
Neonatal pustulosis of transient myeloproliferative disorder 3274
Congenital erosive and vesicular dermatosis healing with reticulated supple scarring 3274
COMPLICATIONS OF PREMATURITY 3275
Anetoderma of prematurity 3275
COMPLICATIONS OF MEDICAL PROCEDURES ON THE FETUS AND NEONATE 3276
Antenatal procedures 3276
Neonatal medical procedures 3276
Phototherapy 3276
ATROPHIC LESIONS OF NEONATES 3276
Medallion-like dermal dendrocyte hamartoma 3276
DISORDERS CAUSED BY TRANSPLACENTAL TRANSFER/MATERNAL MILK 3277
Transplacental transfer of maternal autoantibodies 3277
Neonatal pemphigus vulgaris 3277
Transplacental pemphigoid gestationis 3277
Neonatal lupus erythematosus 3278
Transplacental transfer of maternal malignant disease 3279
Transfer of toxic substances in maternal milk 3280
DISORDERS OF SUBCUTANEOUS FAT 3280
Cold panniculitis 3280
Neonatal cold injury 3280
Subcutaneous fat necrosis of the newborn 3280
Sclerema neonatorum 3282
MISCELLANEOUS DISORDERS 3283
Raised linear bands of infancy 3283
Neonatal adnexal polyp 3284
Collodion baby 3285
‘Blueberry muffin’ baby (dermal erythropoiesis) 3286
Neonatal purpura fulminans 3287
INFECTIONS 3287
Viral infections 3287
Neonatal herpes simplex 3287
Fetal varicella syndrome 3288
Congenital rubella 3288
Human immunodeficiency virus infection 3289
Bacterial infections 3289
Bullous impetigo 3289
Staphylococcal scalded skin syndrome 3290
Periporitis staphylogenes and sweat gland abscesses 3290
Mastitis and breast abscesses 3290
Neonatal staphylococcal cold abscesses of the large folds 3290
Omphalitis 3291
Preorbital and orbital cellulitis 3291
Necrotizing fasciitis 3291
Neonatal listeriosis 3291
Ecthyma gangrenosum 3292
Noma neonatorum (cancrum oris/oro-facial gangrene) 3292
Purpura fulminans 3292
Congenital syphilis 3292
Congenital tuberculosis 3292
Fungal infections 3293
Neonatal candidiasis 3293
Congenital candidiasis 3293
Malassezia pustulosis 3293
Key references 3293
CHAPTER 117 Dermatoses and Haemangiomas of Infancy 3297
Introduction 3297
INFANTILE DERMATOSES 3297
INFLAMMATORY CONDITIONS 3297
Cradle cap 3297
Seborrhoeic dermatitis 3298
Atopic eczema 3298
Napkin dermatitis 3299
Jacquet dermatitis 3300
Infantile gluteal granuloma 3300
Infantile psoriasis 3300
Parakeratosis pustulosa 3300
Infantile acropustulosis 3300
Pityriasis alba 3301
Infantile acne 3301
Urticaria 3301
INFECTIVE CONDITIONS 3302
Viral exanthems 3302
Roseola 3302
Fifth disease 3302
Hand, foot and mouth disease 3302
Varicella 3303
Measles 3303
Impetigo 3303
Other infections and infestations 3303
Staphylococcal scalded skin syndrome 3303
Blistering distal dactylitis 3304
Perianal dermatitis 3304
Cutaneous Candida infection 3304
Tinea corporis 3304
Tinea capitis 3305
Scabies 3305
Molluscum contagiosum 3305
REACTIVE CONDITIONS 3305
Acute haemorrhagic oedema in infancy 3305
Kawasaki disease 3306
Chronic bullous disease of childhood 3306
Gianotti–Crosti syndrome 3307
Papular urticaria 3307
Eosinophilic pustular folliculitis 3307
DEVELOPMENTAL/GENETIC CONDITIONS 3308
Dermoid cysts 3308
Preauricular cysts and sinuses 3308
Pigmentary mosaicism 3308
Linear morphoea 3308
MISCELLANEOUS CONDITIONS 3309
Milia 3309
Koilonychia 3309
Non-accidental injury 3309
Bite injuries 3309
Pedal papules of infancy 3310
Calcified cutaneous nodules of the heels 3310
Hair loss in infancy 3310
Juvenile xanthogranuloma 3310
Langerhans cell histiocytosis 3311
Mastocytosis 3311
INFANTILE AND CONGENITAL HAEMANGIOMAS 3312
Infantile haemangiomas 3312
Congenital haemangiomas 3319
Appendix 117.1 Protocol for the use of propranolol in treating infantile haemangiomas 3320
Key references 3320
PART 11 Skin Disorders Caused by External Agents 3323
CHAPTER 118 Benign Cutaneous Adverse Reactions to Drugs 3325
Drug-induced exanthem 3325
Drug-induced pruritus 3327
Drug-induced eczema 3328
Symmetrical drug-related intertriginous and flexural exanthem 3329
Drug-induced urticaria, angio-oedema and anaphylaxis 3330
Drug-induced serum sickness-like reaction 3332
Lichenoid drug eruptions 3333
Fixed drug eruption 3335
Drug-induced pityriasis rosea 3338
Drug-induced erythema nodosum 3339
Drug-induced acneform eruptions 3340
Key references 3341
CHAPTER 119 Severe Cutaneous Adverse Reactions to Drugs 3343
Acute generalized exanthematous pustulosis 3343
Drug reaction with eosinophilia and systemic symptoms 3346
Drug-induced generalized exfoliative dermatitis 3353
Stevens–Johnson syndrome/toxic epidermal necrolysis 3355
Key references 3364
CHAPTER 120 Cutaneous Side Effects of Chemotherapy and Radiotherapy 3367
Toxic erythema of chemotherapy 3367
Papulopustular eruptions 3369
Chemotherapy mucositis 3371
Chemotherapy-induced hair changes 3371
Chemotherapy-induced alopecia 3371
Chemotherapy-induced hypertrichosis 3372
Chemotherapy-induced nail changes 3372
Dyspigmentation 3374
Chemotherapy-induced hyperpigmentation 3374
Chemotherapy-induced hypopigmentation 3375
Photosensitivity 3376
Recall reaction 3377
Radiotherapy-associated skin side effects 3378
Other skin side effects of radiotherapy 3379
Key references 3380
CHAPTER 121 Dermatoses Induced by Illicit Drugs 3381
Introduction 3381
Cannabis 3381
Cannabis-induced dermatoses 3382
Inhalants 3382
Inhalant-induced dermatoses 3382
Ecstasy 3382
Ecstasy-induced dermatoses 3382
Methamphetamine 3382
Methamphetamine-induced dermatoses 3382
Cocaine 3382
Cocaine-induced dermatoses 3383
Heroin 3383
Heroin-induced dermatoses 3383
Dermatoses caused by injecting drug use 3383
Scarring, ulceration and necrosis 3383
Skin and soft tissue infections 3383
Key references 3384
CHAPTER 122 Dermatological Manifestations of Metal Poisoning 3385
Introduction 3385
Reactions to antimony 3385
Reactions to arsenic 3386
Reactions to gold 3387
Reactions to lead 3388
Reactions to mercury 3389
Reactions to selenium 3390
Reactions to silver 3391
Reactions to thallium 3392
Reactions to other metals 3392
Key references 3393
CHAPTER 123 Mechanical Injury to the Skin 3395
Overview of skin injury 3395
Determinants of the response to injury 3395
Isomorphic (Koebner) response 3396
Nikolsky sign 3396
Utilization of mechanical stimuli 3396
Biomechanical considerations 3397
Mechanical properties of the skin 3398
Determinants of the mechanical properties of the skin 3398
Stratum corneum 3398
Basement-membrane region 3399
Dermis 3399
Physiological variation 3399
Age 3399
Sex 3399
Body site 3399
Light exposure 3399
Pathological variation 3399
Effects of friction 3399
Callosities, corns and calluses 3400
Friction blisters 3402
Black heel and palm 3404
Skin reactions to musical instruments 3405
Hypothenar hammer syndrome 3406
Achenbach syndrome 3407
Other reactions to mechanical injury 3407
Spectacle-frame acanthoma 3407
Semicircular lipoatrophy 3408
Acne mechanica 3409
Traumatic effects of sports 3409
Reactions to foreign bodies 3410
Foreign-body reaction 3410
Specific foreign-body reactions 3414
Paraffinoma 3414
Sclerodermiform reaction to vitamin K and vitamin B12 injections 3414
Pentazocine ulcers 3414
Reactions to intralesional corticosteroids 3414
Reactions to silicone 3414
Fibreglass dermatitis 3415
Complications of tattoos 3415
Hair as a foreign body 3416
Other skin injuries 3417
Hand–arm vibration syndrome 3417
Piezogenic pedal papules 3419
Key references 3420
CHAPTER 124 Pressure Injury and Pressure Ulcers 3423
Definition and nomenclature 3423
Introduction and general description 3423
Epidemiology 3424
Pathophysiology 3424
Intrinsic risk factors 3424
Extrinsic risk factors 3424
Clinical features and classification 3425
Investigations: histopathology 3425
Management 3425
Complications 3425
Prevention 3427
Treatment 3428
Are pressure ulcers avoidable? 3430
Key references 3430
CHAPTER 125 Cutaneous Reactions to Cold and Heat 3431
PHYSIOLOGICAL REACTIONS TO COLD 3431
DISEASES CAUSED OR AGGRAVATED BY COLD 3431
Frostbite 3432
Trench foot 3433
Perniosis 3434
Acrocyanosis 3435
Erythrocyanosis 3436
Livedo reticularis 3436
Raynaud phenomenon 3438
Cryoglobulinaemia 3440
Cold agglutinins 3441
PHYSIOLOGICAL REACTIONS TO HEAT AND INFRARED RADIATION 3441
Experimental effects 3441
Acute effects 3441
Chronic effects 3441
Carcinogenesis 3441
DISEASES CAUSED BY HEAT AND INFRARED RADIATION 3442
Erythema ab igne 3442
Key references 3443
CHAPTER 126 Burns and Heat Injury 3445
Introduction 3445
Initial assessment, pre-hospital care and emergency treatment 3446
Burn shock and resuscitation 3446
Inhalation injury 3448
Background 3448
Diagnosis 3448
Treatment 3449
Evaluation and early management of the burn wound 3449
Evaluation of burn depth 3449
Choice of topical dressings 3451
Escharotomy 3451
Operative management 3451
Infection control 3451
Clinical management of burn wound infection 3452
Central line associated infections 3452
Ventilator-associated pneumonia 3452
Sepsis 3453
Hypermetabolism 3453
Treatment of the hypermetabolic response 3453
Nutrition 3454
Other non-pharmacological strategies 3454
Pharmacological modalities 3454
Summary and conclusions 3455
Key references 3456
CHAPTER 127 Cutaneous Photosensitivity Diseases 3457
Introduction 3457
IDIOPATHIC (IMMUNOLOGICAL) PHOTODERMATOSES 3458
Polymorphic light eruption 3458
Juvenile springtime eruption 3464
Actinic prurigo 3465
Chronic actinic dermatitis 3469
Solar urticaria 3476
Hydroa vacciniforme 3479
DRUG- AND CHEMICAL-INDUCED PHOTOSENSITIVITY 3482
Exogenous drug- and chemical-induced photosensitivity 3482
PHOTOAGGRAVATED DERMATOSES 3487
CLINICAL ASSESSMENT AND MANAGEMENT OF A PATIENT WITH SUSPECTED PHOTOSENSITIVITY 3487
Investigations 3489
Management 3491
Key references 3491
CHAPTER 128 Allergic Contact Dermatitis 3493
History 3493
Definition and nomenclature 3494
Introduction and general description 3494
Epidemiology 3495
Incidence and prevalence 3495
Age 3497
Sex 3498
Ethnicity 3498
Associated diseases 3498
Drugs 3498
Pathophysiology 3498
Sensitization and elicitation 3498
Predisposing factors 3500
Pathology 3502
Causative organisms 3502
Genetics 3502
Environmental factors 3503
Clinical features 3503
History 3503
Presentation 3505
Specific allergens 3511
Clinical variants 3550
Differential diagnosis 3553
Complications and co-morbidities 3554
Disease course and prognosis 3555
Investigations 3556
Patch testing 3556
Concentrations and vehicles for patch testing 3563
Complications of patch and photopatch tests 3563
Multiple patch test reactions 3564
Other tests 3565
Management 3567
General principles 3567
Prevention 3567
Photoallergic contact dermatitis 3569
Allergic contact urticaria 3573
Key references 3577
CHAPTER 129 Irritant Contact Dermatitis 3581
Irritant contact dermatitis 3581
Cosmetic dermatitis 3584
Volatile/airborne irritant contact dermatitis 3585
Cheilitis 3585
Napkin (diaper), peristomal and perianal dermatitis 3585
Non-immune contact urticaria 3588
Phototoxic contact dermatitis 3589
Subjective sensory irritation 3590
Immediate-type stinging 3590
Delayed-type stinging 3590
Chemical burns 3591
Key references 3593
CHAPTER 130 Occupational Dermatology 3595
Occupational irritant contact dermatitis 3595
Occupational allergic contact dermatitis 3599
Acne of chemical origin 3604
Occupational dyspigmentation 3606
Occupationally induced skin tumours 3607
Vibration white finger 3608
Key references 3609
CHAPTER 131 Stings and Bites 3611
Stings 3611
Jellyfish, sea anemones and corals 3611
Sponges 3612
Sea urchins 3613
Sea mats 3613
Mollusca 3613
Venomous fish 3614
BITES 3614
Rodent bites 3614
Snake bites 3615
Dog and cat bites 3615
Human bites 3616
Key references 3616
PART 12 Neoplastic, Proliferative and Infiltrative Disorders Affecting the Skin 3619
CHAPTER 132 Benign Melanocytic Proliferations and Melanocytic Naevi 3621
Freckle or ephelis 3621
lentigines 3623
Definition 3623
Introduction and general description 3623
Simple lentigo 3624
Solar or actinic lentigo 3626
Photochemotherapy (PUVA) lentigo 3627
Ink-spot lentigo 3628
mucosal melanotic lesions 3629
Pigmented melanotic macules 3629
Labial melanotic macules 3631
dermal melanocytic lesions 3632
Introduction and general description 3632
Mongolian spot 3632
Naevus of Ota 3633
Naevus of Ito 3634
congenital melanocytic naevi 3635
Speckled lentiginous naevus 3635
common acquired naevi 3638
Acquired melanocytic naevi 3638
naevi in unusual sites 3642
Definition 3642
Introduction and general description 3643
Melanocytic naevi of the genital area 3643
Acral naevi 3643
Conjunctival naevi 3644
Naevi of the nail matrix or nail bed 3644
naevi with unusual morphology 3645
Introduction and general description 3645
Combined melanocytic naevi 3646
Recurrent melanocytic naevi 3647
Halo naevus 3648
Meyerson naevus 3649
Cockade naevus 3651
Targetoid haemosiderotic naevus 3651
other naevi 3652
Spitz naevus 3652
Blue naevus and variants 3658
Malignant blue naevus 3661
Clinically atypical naevi 3662
Key references 3667
CHAPTER 133 Benign Keratinocytic Acanthomas and Proliferations 3669
BENIGN KERATINOCYTIC ACANTHOMAS 3669
Seborrhoeic keratosis 3669
Stucco keratosis 3672
Inverted follicular keratosis 3672
Dermatosis papulosa nigra 3672
Warty dyskeratoma 3673
Clear cell acanthoma 3673
Lichenoid keratosis 3674
OTHER BENIGN PROLIFERATIONS 3675
Skin tags 3675
Pseudoepitheliomatous hyperplasia 3675
Key references 3676
CHAPTER 134 Cutaneous Cysts 3677
Introduction and general description 3677
Epidermoid cysts 3677
Trichilemmal cysts 3679
Steatocystoma multiplex 3680
Milium 3680
Key references 3681
CHAPTER 135 Lymphocytic Infiltrates 3683
Pseudolymphoma 3683
Pityriasis lichenoides 3685
Parapsoriasis 3688
Small plaque parapsoriasis 3688
Large plaque parapsoriasis 3689
Lymphocytoma cutis 3690
Jessner’s lymphocytic infiltrate 3692
Key references 3693
CHAPTER 136 Cutaneous Histiocytoses 3695
Introduction 3695
Ontogeny of histiocytes 3695
Function of histiocytes 3695
Classification of histiocytoses 3696
DISORDERS OF DENDRITIC CELLS 3696
Langerhans cell histiocytosis 3696
DISORDERS OF NON-DENDRITIC CELLS 3703
Haemophagocytic lymphohistiocytosis 3703
NON-LANGERHANS CELL HISTIOCYTOSES 3705
DENDRITIC CELL ORIGIN 3706
Disorders with mainly skin involvement with/without a systemic component 3706
Juvenile xanthogranuloma 3706
Benign cephalic histiocytosis 3708
Generalized eruptive histiocytosis 3708
Papular xanthoma 3709
Progressive nodular histiocytosis 3710
Xanthoma disseminatum 3710
Diffuse plane xanthomatosis 3712
Disorders in which skin may be involved but the systemic component predominates 3713
Erdheim–Chester disease 3713
NON-DENDRITIC CELL ORIGIN 3714
Disorders with mainly skin involvement with/without a systemic component 3714
Reticulohistiocytoma 3714
Familial sea-blue histiocytosis 3714
Hereditary progressive mucinous histiocytosis 3715
Malakoplakia 3715
Necrobiotic xanthogranuloma 3715
Disorders in which skin may be involved but the systemic component predominates 3716
Multicentric reticulohistiocytosis 3716
Sinus histiocytosis with massive lymphadenopathy 3718
MALIGNANT HISTIOCYTOSES 3720
Malignant histiocytosis 3720
True histiocytic lymphoma 3721
Histiocytic sarcoma 3722
Key references 3723
CHAPTER 137 Soft?tissue Tumours and Tumour?like Conditions 3725
Introduction and general description 3726
FIBROUS AND MYOFIBROBLASTIC TUMOURS 3726
Fibrous papule of the face 3726
Storiform collagenoma 3727
Pleomorphic fibroma 3727
Acquired digital fi brokeratoma 3728
Nodular fasciitis 3728
Ischaemic fasciitis 3730
Fibrous hamartoma of infancy 3730
Calcifying fibrous tumour/pseudotumour 3731
Calcifying aponeurotic fibroma 3731
Dermatomyofibroma 3732
Plaque-like CD34-positive dermal fibroma 3732
Angiomyofibroblastoma 3733
Cellular angiofibroma 3733
Elastofibroma 3734
Inclusion body (digital) fibromatosis 3734
Fibroma of tendon sheath 3735
Desmoplastic fibroblastoma 137 3736
Nuchal-type fibroma 3736
Palmar and plantar fibromatosis (superficial fibromatoses) 3737
Penile fibromatosis 3737
Lipofibromatosis 3738
Dermatofibrosarcoma protuberans 3738
Giant cell fibroblastoma 3740
Myxoinflammatory fibroblastic sarcoma 3740
Malignant fibrous histiocytoma 3741
Myxofi brosarcoma 3741
Low-grade fibromyxoid sarcoma 3742
FIBROHISTIOCYTIC TUMOURS 3743
Giant cell tumour of tendon sheath 3743
Fibrous histiocytoma (dermatofibroma) 3743
Plexiform fibrohistiocytic tumour 3746
Atypical fibroxanthoma 3746
VASCULAR TUMOURS 3747
REACTIVE VASCULAR LESIONS 3747
Intravascular papillary endothelial hyperplasia 3747
Reactive angioendotheliomatosis 3748
Glomeruloid haemangioma 3749
BENIGN VASCULAR TUMOURS 3749
Tufted angioma 3749
Papillary haemangioma 3750
Lobular capillary haemangioma (pyogenic granuloma) 3750
Cirsoid aneurysm 3752
Epithelioid haemangioma 3752
Cutaneous epithelioid angiomatous nodule 3753
Acquired elastotic haemangioma 3754
Hobnail haemangioma 3754
Microvenular haemangioma 3755
Sinusoidal haemangioma 3755
Spindle cell haemangioma 3756
Symplastic haemangioma 3756
VASCULAR TUMOURS OF INTERMEDIATE MALIGNANCY 3757
Kaposiform haemangioendothelioma 3757
Giant cell angioblastoma 3758
Retiform haemangioendothelioma 3758
Papillary intralymphatic angioendothelioma 3758
Composite haemangioendothelioma 3759
Pseudomyogenic haemangioendothelioma 3759
MALIGNANT VASCULAR TUMOURS 3760
Angiosarcoma 3760
Epithelioid haemangioendothelioma 3762
Epithelioid angiosarcoma 3763
LYMPHATIC TUMOURS 3763
Acquired progressive lymphangioma 3763
Atypical vascular proliferation after radiotherapy 3764
Diffuse lymphangiomatosis 3765
TUMOURS OF PERIVASCULAR CELLS 3766
Infantile myofibromatosis and adult myofibroma 3766
Myopericytoma 3766
Glomus tumour 3767
PERIPHERAL NEUROECTODERMAL TUMOURS 3769
Neuromuscular hamartoma 3769
Multiple mucosal neuromas 3769
Amputation stump neuroma 3769
Morton neuroma 3769
Solitary circumscribed neuroma 3770
Schwannoma 3770
Solitary neurofibroma 3772
Plexiform neurofibroma 3772
Diffuse neurofibroma 3773
Perineurioma 3773
Dermal nerve sheath myxoma 3774
Cellular neurothekeoma 3774
Granular cell tumour 3775
Meningothelial heterotopias 3776
Glial heterotopic nodules 3776
Epithelial sheath neuroma 3777
Pigmented neuroectodermal tumour of infancy 3777
Malignant peripheral nerve sheath tumour 3778
Peripheral primitive neuroectodermal tumour 3778
TUMOURS OF MUSCLE 3779
Smooth muscle hamartoma 3779
Leiomyoma 3779
Leiomyosarcoma (dermal and subcutaneous) 3781
SKELETAL MUSCLE TUMOURS 3781
Rhabdomyosarcomatous congenital hamartoma 3781
Rhabdomyoma 3782
Cutaneous rhabdomyosarcoma 3782
TUMOURS OF FAT CELLS 3782
Angiolipoma 3782
Lipoma 3782
Hibernoma 3783
Lipoblastoma and lipoblastomatosis 3783
Spindle cell and pleomorphic lipoma 3784
Atypical lipomatous tumour 3784
Liposarcoma 3785
TUMOURS OF UNCERTAIN HISTOGENESIS 3785
Acral fibromyxoma 3785
Superficial angiomyxoma 3786
Digital mucous cyst 3786
Dermal non-neural granular cell tumour 3786
Haemosiderotic fibrolipomatous tumour 3787
Perivascular epithelioid cell tumour (‘PEComa’) 3787
Deep (‘aggressive’) angiomyxoma 3788
Angiomatoid fibrous histiocytoma 3788
Epithelioid sarcoma 3789
Clear cell sarcoma 3790
Key references 3791
CHAPTER 138 Tumours of Skin Appendages 3797
Introduction 3797
HAIR FOLLICLE TUMOURS 3798
Inverted follicular keratosis 3798
Dilated pore 3799
Tumour of the follicular infundibulum 3799
Pilar sheath acanthoma 3800
Trichoadenoma 3800
Comedo naevus 3800
EXTERNAL ROOT SHEATH TUMOURS 3801
Trichilemmal cyst 3801
Proliferating trichilemmal tumour 3801
Trichilemmoma 3802
Trichilemmal carcinoma 3802
HAMARTOMAS AND HAIR GERM TUMOURS AND CYSTS 3803
Hair follicle naevus 3803
Eruptive vellus hair cyst 3803
Trichofolliculoma 3804
Trichoepithelioma 3805
Desmoplastic trichoepithelioma 3806
Solitary giant trichoepithelioma 3807
Trichoblastoma 3807
Cutaneous lymphadenoma 3808
Basaloid follicular hamartoma 3809
HAIR MATRIX TUMOURS 3809
Pilomatricoma 3809
Pilomatricarcinoma 3810
LESIONS OF HAIR FOLLICLE MESENCHYME 3811
Trichodiscoma 3811
Perifollicular fibroma 3811
Fibrofolliculoma 3812
SEBACEOUS GLAND TUMOURS 3812
Sebaceous adenomas and sebaceomas 3812
Superficial epithelioma with sebaceous differentiation 3814
Sebaceous carcinoma 3814
APOCRINE GLAND TUMOURS 3815
Apocrine hidrocystoma 3815
Syringocystadenoma papilliferum 3816
Hidradenoma papilliferum 3817
Erosive adenomatosis of the nipple 3818
Apocrine tubular adenoma 3818
Apocrine carcinoma 3819
ECCRINE GLAND HAMARTOMAS AND TUMOURS 3819
Eccrine angiomatous naevus 3820
Eccrine hidrocystoma 3820
Hidroacanthoma simplex 3821
Eccrine dermal duct tumour 3821
Eccrine poroma 3821
Eccrine syringofibroadenoma 3822
Syringoma 3823
Tubular papillary adenoma 3824
ECCRINE OR APOCRINE/FOLLICULAR TUMOURS 3825
Hidradenoma 3825
Cylindroma 3826
Spiradenoma 3827
Mixed tumour of the skin 3828
Cutaneous myoepithelioma 3829
SWEAT GLAND CARCINOMAS, INCLUDING DUCTAL APOCRINE/FOLLICULAR CARCINOMAS 3830
Eccrine gland carcinomas 3830
Malignant eccrine poroma 3830
Squamoid eccrine ductal carcinoma 3831
Digital papillary adenocarcinoma 3831
Eccrine or apocrine/follicular carcinomas 3831
Malignant cylindroma 3831
Hidradenocarcinoma 3832
Spiradenocarcinoma 3832
Microcystic adnexal carcinoma 3833
Eccrine epithelioma 3834
Mucinous carcinoma 3834
Endocrine mucin-producing sweat gland carcinoma 3835
Adenoid cystic carcinoma 3835
MISCELLANEOUS TUMOURS 3836
Tumours of ano-genital mammary-like glands 3836
Paget disease of the nipple 3836
Extramammary Paget disease 3838
Lymphoepithelioma-like carcinoma 3839
Key references 3840
CHAPTER 139 Kaposi Sarcoma 3845
Definition and nomenclature 3845
Introduction and general description 3845
Epidemiology 3845
Pathophysiology 3845
Predisposing factors 3845
Pathology 3845
Causative organisms 3846
Genetics 3847
Environmental factors 3847
Clinical features 3848
Presentation 3848
Clinical variants 3848
Differential diagnosis 3848
Classifi cation of severity 3849
Complications and co-morbidities 3849
Disease course and prognosis 3849
Investigations 3850
Management 3850
Key references 3850
CHAPTER 140 Cutaneous Lymphomas 3851
Introduction 3851
primary cutaneous t-cell lymphomas 3852
Introduction and general description 3852
Mycosis fungoides 3854
Follicular mucinosis 3865
Pagetoid reticulosis 3866
Granulomatous slack skin disease 3867
Sézary syndrome 3868
Molecular features of mycosis fungoides and Sézary syndrome 3870
Management of mycosis fungoides and Sézary syndrome 3872
primary cutaneous cd30+ lymphoproliferative disorders 3877
Introduction and general description 3877
Lymphomatoid papulosis 3878
Primary cutaneous anaplastic (CD30+) large-cell lymphoma 3879
Subcutaneous panniculitis-like T-cell lymphoma 3881
primary cutaneous peripheral t-cell lymphoma (unspecified) 3882
Introduction and general description 3882
Primary cutaneous aggressive epidermtropic CD8+ T-cell lymphoma 3882
Primary cutaneous ?? T-cell lymphoma 3883
Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma 3884
Adult T-cell leukaemia–lymphoma (HTLV-1 associated) 3884
Extranodal NK/T-cell lymphoma (nasal type) 3886
primary cutaneous b-cell lymphomas 3887
Introduction and general description 3887
Marginal zone lymphoma 3888
Follicle centre cell lymphoma 3890
Diffuse large B-cell lymphoma 3891
secondary cutaneous b-cell lymphomas 3893
Intravascular large B-cell lymphoma 3893
Lymphomatoid granulomatosis 3894
secondary cutaneous t-cell lymphomas 3895
Angioimmunoblastic T-cell lymphoma 3895
other disorders 3896
Blastic plasmacytoid dendritic cell neoplasm (CD4+/CD56+ haematodermic neoplasm) 3896
Post-transplant lymphoproliferative disorder 3897
Leukaemia cutis 3898
Cutaneous manifestations of Hodgkin disease 3899
Key references 3900
CHAPTER 141 Basal Cell Carcinoma 3909
BASAL CELL CARCINOMA 3909
Definition and nomenclature 3909
Introduction and general description 3909
Epidemiology 3910
Incidence and prevalence 3910
Pathophysiology 3910
Predisposing factors 3910
Environmental factors 3910
Genetics 3911
Immunosuppression 3911
Other risk factors 3911
Pathology 3912
Clinical features 3916
Clinical variants 3916
Differential diagnosis 3918
Investigations 3919
Management 3920
Medical treatments 3921
Surgical treatments 3924
FIBROEPITHELIAL BASAL CELL CARCINOMA 3925
Definition and nomenclature 3925
Introduction and general description 3925
Epidemiology 3925
Incidence and prevalence 3925
Age 3925
Sex 3925
Ethnicity 3925
Pathophysiology 3925
Predisposing factors 3925
Pathology 3925
Clinical features 3925
Presentation 3925
Differential diagnosis 3925
Investigations 3925
Management 3925
NAEVOID BASAL CELL CARCINOMA SYNDROME 3926
Definition and nomenclature 3926
Epidemiology 3926
Incidence and prevalence 3926
Age 3926
Pathophysiology 3926
Pathology 3926
Genetics 3926
Clinical features 3926
Presentation 3926
Differential diagnosis 3927
Complications and co-morbidities 3927
Investigations 3928
Management 3928
BAZEX–DUPRÉ–CHRISTOL SYNDROME 3929
Definition and nomenclature 3929
Introduction and general description 3929
Epidemiology 3929
Age 3929
Sex 3929
Pathophysiology 3929
Genetics 3929
Clinical features 3929
Presentation 3929
Management 3929
Key references 3929
CHAPTER 142 Squamous Cell Carcinoma and its Precursors 3931
Introduction 3931
LESIONS WITH UNCERTAIN OR UNPREDICTABLE MALIGNANT POTENTIAL 3931
Actinic keratosis 3931
Cutaneous horn 3941
Arsenical keratosis 3942
Post-ionizing radiation keratosis 3944
Disseminated superficial actinic porokeratosis 3944
IN SITU CARCINOMA OF THE SKIN 3946
Bowen disease 3946
Anal, vulval, penile and perianal intraepithelial carcinoma 3955
SQUAMOUS CELL CARCINOMA OF THE SKIN 3955
Definition and nomenclature 3955
Introduction and general description 3955
Epidemiology 3955
Incidence and prevalence 3955
Age 3956
Sex 3956
Ethnicity 3956
Associated diseases 3956
Pathophysiology 3956
Predisposing factors 3957
Pathology 3957
Genetics 3958
Environmental factors 3958
Clinical features 3958
History 3958
Presentation 3958
Clinical variants 3958
Differential diagnosis 3958
Classification of severity 3959
Complications and co-morbidities 3959
Disease course and prognosis 3960
Investigations 3960
Management 3960
First line 3961
Second line 3962
KERATOACANTHOMAS AND ASSOCIATED SYNDROMES 3963
Keratoacanthoma 3963
Multiple self-healing squamous epithelioma 3966
Generalized eruptive keratoacanthoma 3967
Muir–Torre syndrome 3968
Key references 3970
CHAPTER 143 Melanoma 3973
MELANOMA CLINICOPATHOLOGY 3974
Definition 3974
Epidemiology 3974
Descriptive epidemiology 3974
Epidemiological trends in incidence and mortality 3974
Current situation and public health consequences 3974
Pathophysiology 3974
Predisposing factors 3974
Genetics 3975
Environmental factors 3977
Prevention 3978
Pathology 3979
Clinical features 3979
General principles of early clinical diagnosis 3979
Diagnostic tools 3980
Presentation 3981
Strategies for early detection 3988
Investigations 3988
Histopathological diagnosis 3988
Prognostic markers 3991
Management 3992
Staging primary melanoma 3992
Follow-up 3993
Key references 3994
MELANOMA SURGERY: BIOPSIES, WIDE RESECTION AND SENTINEL LYMPH NODE SAMPLING 3995
Biopsy 3995
Wide local excision 3995
Melanoma 3995
Melanoma in situ 3996
Lentigo maligna melanoma and lentigo maligna melanoma in situ 3997
Sentinel lymph node biopsy 3997
Lymph node dissection 3999
Future work 3999
Key references 3999
SYSTEMIC TREATMENT OF MELANOMA 4000
General principles of management 4000
Adjuvant systemic therapy: treatment for localized disease after surgical resection in stage III 4000
Adjuvant systemic therapy: specific treatment approaches in stage III–N2–3 disease 4001
Systemic therapy for metastatic disease (advanced stage IIIB/IIIC and stage IV disease) 4001
Key references 4007
CHAPTER 144 Dermoscopy of Melanoma and Naevi 4009
Introduction 4009
Benign dermoscopic patterns in naevi 4009
Dermoscopy of melanoma 4010
Melanomas in special locations 4013
Other melanoma variants 4018
Key references 4020
CHAPTER 145 Merkel Cell Carcinoma 4021
Definition and nomenclature 4021
Introduction and general description 4021
Epidemiology 4021
Pathophysiology 4022
Predisposing factors, causative organisms and environmental factors 4022
Pathology 4022
Clinical features 4023
History and presentation 4023
Disease course and prognosis 4026
Staging 4026
Investigations 4027
Management 4027
General principles of management 4027
Primary tumour and locoregional metastases 4027
Distant metastases: stage IV 4028
Experimental treatment 4029
Follow-up 4029
Key references 4029
CHAPTER 146 Skin Cancer in the Immunocompromised Patient 4031
Introduction 4031
Epidemiology 4031
Primary immunodeficiency 4031
Acquired immunodeficiency 4032
Pathophysiology 4035
UV radiation and genetic changes 4035
Reduced tumour immune surveillance 4035
Drugs 4036
Oncogenic viruses 4037
Host genetic predisposition 4038
Ionizing radiation 4039
Graft-versus-host disease 4039
Donor-derived cells 4039
Clinicopathological features of specific skin cancers 4039
Clinical risk factors 4039
Squamous cell carcinoma 4039
Actinic keratoses, Bowen disease, field carcinogenesis and porokeratosis 4040
Basal cell carcinoma 4041
Melanoma 4041
Kaposi sarcoma 4041
Merkel cell carcinoma 4041
Primary cutaneous lymphoma 4042
Rare skin cancers 4042
Management 4042
Low-risk primary tumours 4042
High-risk primary tumours 4043
Locally advanced and metastatic disease 4044
Pre-transplant skin cancer 4044
Prevention of skin cancer 4045
Future prospects for prevention 4046
Screening and surveillance 4047
Organizations for patients and health care professionals 4048
Conclusion 4048
Key references 4048
PART 13 Systemic Disease and the Skin 4049
CHAPTER 147 Cutaneous Markers of Internal Malignancy 4051
Introduction 4051
Multisystem and haematopoietic tumours that involve the skin 4052
Tumour spread from adjacent and distant tissues 4052
Direct tumour spread and invasion 4052
Cutaneous metastasis 4053
Paget disease 4056
Paget disease of the breast 4056
Extramammary Paget disease 4056
Genodermatoses associated with internal malignancies 4057
Howel–Evans syndrome 4057
Naevoid basal cell carcinoma syndrome 4057
Familial melanoma syndrome 4057
Melanoma–astrocytoma syndrome 4058
Xeroderma pigmentosum 4058
Von Hippel–Lindau disease 4059
Neurofibromatosis types 1 and 2 4059
Tuberous sclerosis complex 4059
Multiple endocrine neoplasia syndromes 4060
Carney complex 4060
PTEN hamartoma tumour syndrome 4061
Sebaceous tumours, keratoacanthomas and visceral malignancy 4061
Hereditary leiomyomatosis and renal cell carcinoma syndrome 4062
Bloom, Rothmund–Thomson and Werner syndromes 4062
Bloom syndrome 4062
Rothmund–Thomson syndrome 4062
Werner syndrome 4063
Immunodeficiency and neoplasia syndromes 4063
Wiskott–Aldrich syndrome 4063
Chediak–Higashi syndrome 4063
Ataxia-telangiectasia 4063
Dyskeratosis congenita 4063
Fanconi anaemia 4064
Paraneoplastic phenomena involving the skin 4064
ACANTHOTIC AND ICHTHYOTIC EPIDERMAL DISORDERS 4064
Acanthosis nigricans 4064
Acanthosis palmaris 4065
Sign of Leser–Trélat 4066
Florid cutaneous papillomatosis 4066
Acquired ichthyosis 4067
other epidermal disorders 4067
Paraneoplastic pigmentation 4067
Hair, nails and skin appendages 4067
Paraneoplastic hypertrichosis lanuginosa acquisita 4067
Clubbing of nails 4067
Hyperhidrosis 4068
Dermatoses associated with internal malignancies 4068
Acrokeratosis paraneoplastica 4069
Migratory erythemas 4069
Connective tissue and rheumatological disorders 4069
Dermatomyositis 4069
Lupus erythematosus 4070
Systemic sclerosis and other inflammatory fibrosing conditions of the dermis and subcutis 4071
Bullous disorders associated with internal malignancy 4071
Paraneoplastic pemphigus 4071
Bullous pemphigoid 4071
Pemphigus 4072
Other blistering disorders 4072
Deposition disorders 4072
Other dermatological disorders 4073
Vascular disorders associated with internal malignancy 4074
Raynaud phenomenon and digital ischaemia 4074
Erythromelalgia 4074
Palmar erythema 4074
Vasculitis 4074
Chilblain-like lesions 4074
Flushing 4074
Cancer-associated thrombosis 4075
Migratory thrombophlebitis 4075
Deep-vein thrombosis 4076
Mondor disease 4076
Venous or lymphatic obstruction 4076
Paraneoplastic pruritus 4076
Generalized pruritus 4076
Localized pruritus 4076
Key references 4077
CHAPTER 148 The Skin and Disorders of the Haematopoietic and Immune Systems 4079
Introduction 4079
Skin manifestations of haematological malignancies 4079
SKIN DISORDERS CAUSED BY INFILTRATION OF THE SKIN WITH NEOPLASTIC CELLS 4080
Leukaemia cutis 4080
Lymphomatous skin infiltrates 4082
Malignant infiltration of the skin in plasma cell disorders 4082
Extramedullary haematopoiesis 4083
IMMUNOGLOBULIN DEPOSITION DISORDERS OF THE SKIN 4083
Macroglobulinaemia cutis 4083
Primary systemic or amyloid light-chain amyloidosis 4083
Type I cryoglobulinaemia 4084
PARANEOPLASTIC CONDITIONS STRONGLY ASSOCIATED WITH HAEMATOLOGICAL MALIGNANCIES 4084
Sweet syndrome 4084
Pyoderma gangrenosum 4085
Neutrophilic eccrine hidradenitis 4085
Paraneoplastic pemphigus 4086
Insect bite-like reaction or exaggerated insect bite reaction 4086
Scleromyxoedema 4086
Scleredema 4087
Necrobiotic xanthogranuloma and normolipaemic xanthoma 4087
Paraneoplastic pruritus 4088
PARANEOPLASTIC CONDITIONS OCCASIONALLY ASSOCIATED WITH HAEMATOLOGICAL NEOPLASMS 4088
SYNDROMES ASSOCIATED WITH HAEMATOLOGICAL MALIGNANCIES AND INVOLVING THE SKIN 4088
Schnitzler syndrome 4088
POEMS syndrome 4089
AESOP 4089
TEMPI syndrome 4090
Neurofibromatosis type 1, juvenile xanthogranuloma and juvenile chronic myeloid leukaemia 4090
Other rare syndromes involving skin associated with haematological cancers 4090
SKIN INVOLVEMENT IN IDIOPATHIC LYMPHADENOPATHIES 4090
Kikuchi–Fujimoto disease 4090
Kimura disease 4091
Sinus histiocytosis with massive lymphadenopathy 4092
IgG4-related disease 4092
SKIN MANIFESTATION IN PRIMARY IMMUNODEFICIENCIES 4092
Mucocutaneous candidosis 4093
Bacterial infections 4093
Persistent HPV infections 4093
Other skin conditions associated with immunodeficiencies 4093
SKIN MANIFESTATIONS OF ACQUIRED IMMUNODEFICIENCIES 4094
ANAEMIAS AND HAEMOGLOBINOPATHIES 4094
Anaemias 4094
Haemoglobinopathies 4094
TRANSFUSION REACTIONS 4094
Allergic transfusion reactions 4097
Transfusion-associated graft-versus-host disease 4097
Post-transfusion purpura 4097
Key references 4097
CHAPTER 149 The Skin and Endocrine Disorders 4099
Introduction and overview 4099
Biological basis of dermatoendocrinology 4099
Principles of endocrinology 4099
Skin as a (neuro-)endocrine organ 4102
Skin as a hormone target 4105
Neuroendocrine stress response systems in human skin and the brain–skin axis 4106
Human skin and hair research models as discovery tools for general neuroendocrinology 4106
(Neuro-)endocrine contributions to cutaneous pathogenesis 4107
Basics of clinical dermatoendocrinology 4108
How to evaluate a patient for a suspected (neuro-)endocrine disorder 4108
Endocrinological considerations in skin therapy 4113
Systematic review of clinical dermatoendocrinology 4114
Hypopituitarism 4114
Hyperpituitarism 4114
Adrenal hyperfunction 4115
Adrenal insufficiency (Addison disease) 4116
Hyperandrogenism 4116
Hypoandrogenism 4117
Hyperoestrogenism 4117
Hypo-oestrogenism 4117
Phaeochromocytoma 4117
Carcinoid 4117
Glucagon and glucagonoma 4117
Polyendocrine disease 4118
Diabetes 4118
Hyper- and hypothyroidism 4118
Hyperparathyroidism 4119
Hypoparathyroidism 4119
Future perspectives 4120
Key references 4120
CHAPTER 150 The Skin and Disorders of the Heart 4123
Introduction 4123
Skin signs of cardiac disease 4123
HEREDITARY SYNDROMES 4123
Lymphoedema–distichiasis syndrome 4125
Fabry disease 4125
RASopathies 4125
Carney complex 4126
CARDIAC INVOLVEMENT IN DERMATOSES OR SYSTEMIC DISEASES WITH SKIN FEATURES 4126
Inflammatory disorders 4126
Infection 4127
Miscellaneous 4127
Key references 4128
CHAPTER 151 The Skin and Disorders of the Respiratory System 4129
INTRODUCTION 4129
ALLERGIC DISORDERS 4129
AUTOIMMUNE DISORDERS 4130
VASCULITIS 4131
Small-vessel vasculitis 4131
Variable-vessel vasculitis 4132
INFECTIONS 4132
CONGENITAL AND INHERITED DISORDERS/GENETIC SYNDROMES 4132
NEUTROPHILIC DERMATOSES 4133
OTHER SYSTEMIC DISEASES 4133
MISCELLANEOUS DISORDERS 4134
Key references 4135
CHAPTER 152 The Skin and Disorders of the Digestive System 4137
Introduction 4137
OESOPHAGUS, STOMACH AND INTESTINE 4137
Inflammatory bowel disease 4137
Collagenous colitis 4139
Coeliac disease 4139
Bowel-associated dermatosis–arthritis syndrome 4139
Whipple disease 4140
Intestinal polyposis 4140
LIVER AND GALL BLADDER 4140
Hepatitis and acute liver disease 4140
Liver cirrhosis 4141
PANCREATIC DISEASE 4141
Acute pancreatitis 4142
Panniculitis/subcutaneous fat necrosis 4142
Migratory thrombophlebitis 4142
Necrolytic migratory erythema 4142
Other dermatological features of pancreatitis 4142
DERMATOLOGICAL MANIFESTATIONS OF OTHER DISORDERS INVOLVING THE DIGESTIVE SYSTEM 4142
Skin disorders associated with gastrointestinal bleeding 4143
Gastrointestinal malabsorption and the skin 4143
Skin complications of stomas 4143
Liver disease and the skin 4143
Systemic diseases and the liver 4143
Pruritus 4144
Skin pigment changes in liver disease 4144
Vascular changes 4144
Hair and nail changes 4145
Porphyria cutanea tarda 4145
Other cutaneous lesions associated with liver disease 4145
Drugs and the liver 4145
Key references 4145
CHAPTER 153 The Skin and Disorders of the Kidney and Urinary Tract 4147
INTRODUCTION 4147
HEREDITARY SYNDROMES WITH SKIN AND RENAL INVOLVEMENT 4147
SKIN SYMPTOMS AND SIGNS ASSOCIATED WITH RENAL DISORDERS 4148
Metabolic and systemic disorders 4148
Renal failure and dialysis 4149
Renal transplantation 4151
ACQUIRED DISORDERS WITH SKIN AND RENAL INVOLVEMENT 4152
SKIN DISORDERS THAT MAY AFFECT THE KIDNEY AND URINARY TRACT 4152
Key references 4152
CHAPTER 154 The Skin and Disorders of the Musculoskeletal System 4155
Introduction 4155
History and examination 4155
INFECTIVE ARTHROPATHIES 4156
Reactive arthritis 4156
Viral arthropathies 4156
Bacterial arthropathies 4157
Other infective arthropathies 4159
INFLAMMATORY ARTHROPATHIES 4159
Seronegative arthritis and spondylitis 4159
Rheumatoid arthritis 4159
Atrophic skin with rheumatoid arthritis 4160
Rheumatoid nodules 4160
Rheumatoid vasculitis and cutaneous ulceration 4160
Rheumatoid neutrophilic dermatosis 4161
Other 4162
Fibroblastic rheumatism 4162
Sarcoidosis 4162
OSTEOARTHRITIS 4162
Heberden and Bouchard nodes 4162
METABOLIC DISORDERS WITH MUSCULOSKELETAL AND CUTANEOUS INVOLVEMENT 4163
Haemochromatosis 4163
Alkaptonuria 4163
Gout 4163
AUTOINFLAMMATORY DISORDERS 4164
Hereditary autoinflammatory disorders 4164
Acquired autoinflammatory disorders 4164
Acne 4164
Hidradenitis suppurativa 4165
INFLAMMATORY CHONDROPATHIES 4165
Relapsing polychondritis 4165
MAGIC syndrome 4167
MISCELLANEOUS DISORDERS INVOLVING THE SKIN AND MUSCULOSKELETAL SYSTEM 4167
Mastocytosis 4167
Multicentric reticulohistiocytosis 4167
Pachydermoperiostosis 4167
Interstitial granulomatous dermatosis 4168
Intralymphatic histiocytosis 4168
CUTANEOUS ADVERSE REACTIONS TO ANTIRHEUMATIC THERAPIES 4168
Key references 4169
PART 14 Aesthetic Dermatology 4171
CHAPTER 155 Skin Ageing 4173
Introduction 4173
Clinical features 4173
Intrinsic ageing 4173
Extrinsic ageing 4173
Extrinsic ageing variants 4173
Smoking and skin ageing 4174
Skin ageing of the neck 4175
Idiopathic guttate hypomelanosis 4175
Bateman purpura 4175
Extrinsic ageing in skin of colour 4176
Menopausal skin ageing 4176
Genetics of skin ageing 4176
Grading and measurement of skin ageing 4176
Pathophysiology 4177
Ultraviolet irradiation damage/episodic exposure 4178
Collagen fibril fragmentation 4178
Photoageing and natural ageing 4180
Implications of skin ageing 4180
Medical implications 4180
Barrier dysfunction 4180
Dermatoporosis 4181
Cosmetic implications 4181
Social implications 4181
Key references 4181
CHAPTER 156 Cosmeceuticals 4183
Introduction 4183
Antioxidants 4183
Antiageing: lightening 4185
Antiageing: rhytide reduction 4185
Herbals and phytochemicals 4187
Antioxidants 4188
Antiageing: lightening 4190
Antiageing: rhytide reduction 4191
Anti-inflammatory 4191
Conclusions 4192
Key references 4194
CHAPTER 157 Soft Tissue Augmentation (Fillers) 4195
Introduction 4195
Indications 4195
Techniques 4196
Needles versus cannulas 4196
Depot versus fanning techniques 4197
Fillers 4197
Biodegradable fillers 4197
Non-biodegradable fillers 4200
Common injection errors and how to avoid them 4202
Adverse reactions and their treatment 4202
Assessing and reducing the risks 4202
Potential adverse reactions 4202
Fillers and different skin types 4204
Key references 4205
CHAPTER 158 Aesthetic Uses of Botulinum Toxins 4207
Introduction 4207
History and early research 4207
History of clinical applications 4208
Pharmacology and action of neurotoxins 4208
Variation and equivalence 4209
Clinical applications of botulinum toxins in aesthetic dermatology 4209
Upper face 4209
Mid face 4211
Lower face 4212
Neck 4213
Adverse events 4214
Special considerations 4214
Acquired resistance to botulinum toxins 4214
Combination treatment and future trends 4214
Key references 4215
CHAPTER 159 Chemical Peels 4217
Introduction 4217
Basic chemistry 4217
Peels with metabolic action 4217
Peels with caustic action 4218
Peels with toxic action 4219
Depth of peels 4219
Superficial peels 4220
Medium depth peels 4220
Deep peels 4220
Indications and contraindications 4220
Indications 4220
Contraindications 4221
Pre-peel procedure 4222
Counselling 4222
Skin priming 4223
Consent and photo documentation 4223
Peeling procedure 4223
Equipment 4223
Peeling technique 4223
Peeling agents 4224
Post-peel care 4225
Side effects and complications 4225
Erythema 4226
Infection 4226
Chemical burns 4227
Premature peeling 4227
Milia 4228
Acneform eruptions 4228
Allergic contact dermatitis 4228
Systemic toxicity 4228
Post-inflammatory hyperpigmentation 4228
Post-inflammatory hypopigmentation 4228
Scarring 4228
Chemical peels in patients with skin of colour 4229
Key references 4229
CHAPTER 160 Lasers and Energy?based Devices 4231
Introduction 4231
Vascular lesions 4231
Types of lasers used 4231
Types of vascular lesions treated with lasers and light 4232
Pigmented lesions 4234
Types of lasers used 4234
Types of pigmented lesions treated with lasers 4234
Laser hair removal 4236
Skin resurfacing 4236
Types of lasers used 4236
Laser management 4238
Skin tightening 4240
Types of radiofrequency devices used 4240
Fat reduction/body contouring 4241
Types of devices used 4241
Conclusions 4242
Key references 4242
Index 4243
EULA 4339
The British Journal of Dermatology BJD published a series of reviews on Rook's Textbook of Dermatology, 9th edition.
| Erscheint lt. Verlag | 29.2.2016 |
|---|---|
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Dermatologie |
| Studium ► 2. Studienabschnitt (Klinik) ► Anamnese / Körperliche Untersuchung | |
| Schlagworte | acne • Cosmetic / Esthetic Dermatology • Dermatitis • Dermatologic • dermatologic surgery • Dermatologie • Dermatologische Chirurgie • Dermatology • eczema • Kosmetische u. Ästhetische Dermatologie • Kosmetische u. Ãsthetische Dermatologie • Medical Science • Medizin • Psoriasis • ROOK • Skin • skin cancer • Skin Disease • skin disorders • skin melanoma |
| ISBN-10 | 1-118-44117-6 / 1118441176 |
| ISBN-13 | 978-1-118-44117-6 / 9781118441176 |
| Informationen gemäß Produktsicherheitsverordnung (GPSR) | |
| Haben Sie eine Frage zum Produkt? |
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