Contents 1. The History of Dermatology 1 Ancient history 1 The middle ages 2 Modern age 3 Pioneer dermatologists 4 2. Skin: Structure, Function and Development 10 Skin types 10 Structure of the skin 10 Epidermis 11 Desmosomes 15 Physiology of keratinization 16 Characteristics of epidermal differentiation 16 The cell cycle 16 Control of the epidermal proliferation 17 The other cells of the epidermis 18 Basement membrane complex 20 Epidermal appendages 21 Hair 25 Nail 29 Dermis 32 Cellular components of the dermis 36 The cutaneous vasculature 37 Lymphatic circulation 38 Cutaneous nerves 38 Muscles of the dermis 39 Subcutaneous tissue 39 Skin lines 40 Occurrence of skin disease in relation to racial and ethnic characteristics 41 Development of skin 42 Functions of the skin 45 3. Approach Towards a Dermatological Patient 48 History taking 48 Examination 49 Some diagnostic hints 50 Special diagnostic procedures 50 Some clinical signs that help in diagnosis 51 Other laboratory investigations 51 Molecular diagnostics 51 Primary and secondary skin lesions 52 Commonly used descriptive terms in dermatopathology 55
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Contents · Lichen simplex chronicus 247 Pityriasis alba 248 Asteatotic eczema 249 Juvenile plantar dermatosis 250 Eczematous drug eruptions 250 Hand eczema 251 10. Keratinizing and
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Contents
1. The History of Dermatology 1 Ancient history 1 The middle ages 2 Modern age 3 Pioneer dermatologists 4
2. Skin: Structure, Function and Development 10 Skin types 10 Structure of the skin 10 Epidermis 11 Desmosomes 15 Physiology of keratinization 16 Characteristics of epidermal differentiation 16 The cell cycle 16 Control of the epidermal proliferation 17 The other cells of the epidermis 18 Basement membrane complex 20 Epidermal appendages 21 Hair 25 Nail 29 Dermis 32 Cellular components of the dermis 36 The cutaneous vasculature 37 Lymphatic circulation 38 Cutaneous nerves 38 Muscles of the dermis 39 Subcutaneous tissue 39 Skin lines 40 Occurrence of skin disease in relation to racial and ethnic characteristics 41 Development of skin 42 Functions of the skin 45
3. Approach Towards a Dermatological Patient 48 History taking 48 Examination 49 Some diagnostic hints 50 Special diagnostic procedures 50 Some clinical signs that help in diagnosis 51 Other laboratory investigations 51 Molecular diagnostics 51 Primary and secondary skin lesions 52 Commonly used descriptive terms in dermatopathology 55
xiv A Manual of Dermatology
4. Bacterial Infections 57 Infections caused by Staphylococcus aureus and
15. Diseases of Blood Vessels and Lymphatic System 374 Vasculitis 374 Classification 374 According to the size of vessel involved 375 Cutaneous and systemic vasculitis 375 Neutrophilic vasculitis 375 Lymphocytic vasculitis 379
Contents xvii
Granulomatous vasculitis 380 Vasculitis-miscellaneous 382 Erythemas of the skin 384 Other erythemas 388 Hypersensitivity syndromes (Toxic erythemas) 393 Telangiectasia 394 Primary telangiectasia 394 Secondary telangiectasia 394 Disorders of the lymphatic system 397 Lymphedema 397
16. Urticaria 400 Etiology 400 Mechanism of production of urticaria 401 Classification 401 Differential diagnosis 404 Angioedema (Quincke’s edema) 405 Mastocytosis 406 Papular urticaria 408
20. Skin and Ultraviolet Radiation 443 Sites of photosensitive eruption 444 Standard erythema dose 444 Ultraviolet radiation and its interaction with the skin 445 Effects of ultraviolet radiation on the skin at molecular level 445 Effects of solar radiation on the skin 447 Disorders of the skin caused by ultraviolet light 449 Classification 453 Treatment of porphyria 456 Photosensitization due to abnormalities in DNA repair 459 Skin diseases aggravated by ultraviolet radiation 461 Protection and treatment of skin against UVR 461
xviii A Manual of Dermatology
21. Cutaneous Reactions to Cold 463 Skin changes on exposure to cold 464 Dermatoses associated with cold sensitivity 467
22. Pruritus 471 Itch receptors 471 Central itch 471 Types of itch 471 Neural pathways of itching 472 Peripheral and central pharmacologic mediators of itch 472 Patterns of itching 474 Influence of skin temperature on itching 474 Causes of pruritus 474 Classification 476 Diagnosis and evaluation of the itching patient 479
23. Disorders of the Sebaceous, Sweat and Apocrine Glands 483 Acne vulgaris 483 Rosacea 494 Perioral dermatitis 497 Tumors of the sebaceous glands 498 Diseases of the sweat glands 498 Diseases of the eccrine glands 499 Hyperhidrosis 499 Intertrigo 501 Pitted keratolysis 501 Anhidrosis 502 Tumors of the sweat glands 503 Congenital disorders of the sweat glands 505 Diseases of the apocrine glands 507 Hidradenitis suppurativa (Acne inversa) 507 Apocrine bromhidrosis 509 Apocrine chromhidrosis 509 Fox-Fordyce disease 509 Apocrine hidrocystoma 510 Approach to a patient with hair disorders 512
24. Hair Disorders 512 Hypertrichosis 514 Hirsutism 515 Noncicatricial alopecia 522 Alopecia areata 526 Cicatricial alopecia 531 Pseudopelade of Brocq 532 Folliculitis decalvans 532 Dissecting cellulitis of the scalp (Perifolliculitis capitis
abscedens et suffodiens) 533 Structural defects of the hair 534 Miscellaneous conditions of the scalp 538
Contents xix
Tumors of the hair follicle 540 Hair cosmetics 542
25. Nail Disorders 547 Nail changes in systemic disease 547 Nail changes due to cutaneous disorders 549 Discoloration (Chromonychia) 552 Diseases of the nailfold 553 Abnormalities of the nail 555 Tumors adjacent to and under the nail 557 Congental nail disorders 557 Pachydermoperiostosis 558
27. Tumors of the Skin 571 Malignant tumors of the skin 571 Primary cutaneous B cell lymphomas 590 Premalignant dermatoses 593 Benign tumors of the skin 597 Tumors associated with congenital diseases 606
29. Malnutrition and Skin 635 Hypovitaminosis A 635 Hypervitaminosis A 636 Vitamin B complex 636 Vitamin D 639 Vitamin K 639 Vitamin E (a-tocopherol) 640 Vitamin C (Ascorbic acid) 640 Minerals 640 Essential fatty acids 642 Marasmus 643 Kwashiorkor 644 Plummer-Vinson syndrome 644 Obesity 645 Primary cutaneous immunodeficiency 646 Innate immunity 646
30. Primary Cutaneous Immunodeficiency 646 Adaptive immunity 647 Humoral immunity 648 Classification of harmful allergic reaction 650 Cell-mediated immunity 651 Laboratory diagnosis and assessment of immunological disorders 652 When to suspect immunodeficiency 653 Disorders of phagocytosis 654 Disorders of the thymus and t lymphocytes 656 Diseases due to deficiency of antibodies 656 X-linked hypogammaglobulinemia (Bruton’s disease) 656 Combined antibody and T cell deficiency 657 Severe combined immunodeficiency 658
31. Cutaneous Manifestations of Systemic Diseases 660 Diabetes mellitus 660 Liver disease 662 Pancreatic disease 664 Cutaneous manifestations of malabsorption states 665 Miscellaneous disorders of gastrointestinal tract 665 Renal disease 666 Rheumatoid arthritis 668 Hyperthyroidism 669 Hypothyroidism 669 Cushing’s syndrome 669 Addison’s disease 670 Xanthomatosis (Hyperlipidemias) 670 Disorders of lipid metabolism 672 Disorders of amino acid metabolism 674 Mucopolysaccharidosis 676
Contents xxi
Calcinosis cutis 677 Angiokeratoma with systemic disease 678 Cutaneous manifestations of immunosuppression 679 Cutaneous manifestations of internal malignancy 680
33. Ages of Men and their Dermatoses 687 Transient neonatal dermatoses 688 Neonatal dermatoses 689 Specific neonatal dermatoses 690 Panniculitis in neonates 692 Edema of the newborn 693 Cutaneous changes in pregnancy 693 Specific dermatoses of pregnancy 694 Cutaneous changes at menopause 696 Skin disorders of menopause 697 The ageing skin 698 Skin changes in the aging skin 698 Histological features of the ageing skin 700 Dermatoses of the elderly 700 Premature aging syndromes 701 Osteodysplastic geroderma 703 Diagnosis of aging syndromes 703 Methods of improving the skin in aging 704
34. Skin and Sports 706 Skin diseases that prevent sports 706 Diseases transmitted to other players 707 Cutaneous injuries due to sport 707 Injuries due to mechanical trauma 707 Heat induced injuries 710 Cold induced injuries 710 Injuries due to the sun 711 Contact dermatitis 711 Miscellaneous 711 Skin diseases aggravated by sports 714
35. Skin and Psychiatry 715 Classification of psychocutaneous disorders 715 Psychiatric disorders with dermatologic symptoms 715 Dermatologic disorders that are exacerbated by
psychophysiological mechanisms 719 Approach to patients with psychocutaneous disorders 719
36. Diseases of the Oral Cavity 721 Ulcers of the oral cavity 722 White lesions of the oral mucosa 728
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Black/brown pigmented lesions of the oral mucosa 732 Red lesions of the oral mucosa 734 Tumors of the oral cavity 735 Cheilitis 738
37. Cutaneous Manifestation of Diseases of External Genitalia 742 Specific disorders of female external genitalia 742 Male external genitalia 745 Specific disorders of male external genitalia 745 Poikiloderma 749
38. Miscellaneous Disorders 749 Acanthosis nigricans 750 Pyoderma gangrenosum 752 Malignant atrophic papulosis 753 Sweet’s syndrome (Acute febrile neutrophilic dermatosis) 754 Jessner’s lymphocytic infiltration 756 Pseudolymphomas 756 Lymphomatoid papulosis 757 Gangrene of the skin 757 Treatment of gangrene 760 Histiocytosis 761 Classification of histiocytosis 761 Mucinosis 764 Necrobiotic disorders 766 Perforating disorders 768 Prurigo 775 Atrophy of the skin 777 Anetoderma 777 Progressive idiopathic atrophoderma of Pasini and Pierini 778 Acrodermatitis chronica atrophicans 778 Panatrophy 779 Cutis verticis gyrata 779 Ainhum 780 Pseudoainhum 781 Relapsing polychondritis 781 Cutaneous manifestations of drug abuse 782
Diagnosis of occupational skin disease 790 Treatment and prevention of occupational skin disease 791 Prognosis of occupational skin disease 792
40. Injuries due to Burn 793 Assessment of damage caused by burns 793 Clinical assessment of a burn injury 794 Factors to be considered in assessing burn injury 795 Special types of burn 795 Complication of burns 796 Treatment 796 Referral to a burn unit 798
41. Fundamentals of Topical Therapy and Some Common Dermatological Preparations 799
Principles of topical therapy 799 Amount to be dispensed 799 Percutaneous absorption 800 Frequency of application 801 Ingredients in topical preparations 801 Topical preparations 801 Some common dermatological formulae 803
43. Cutaneous Drug Reactions 844 Classification of drug reactions 844 Approach to diagnosis of drug reactions 845 Skin lesions in drug reaction 845 Severe skin reactions 848 Uncommon reactions 849 Prevention 853