ABC of Dermatology-6판

Front Matter
Contents
List of Contributors
Preface
Acknowledgements

CHAPTER 1 Introduction
OVERVIEW
Introduction
Figure 1.1 Atopic dermatitis.
Figure 1.2 Erythema nodosum in pregnancy.
Box 1.1 Dermatology history-taking
The significance of skin disease
Figure 1.3 Superficial spreading melanoma.
Descriptive terms
Figure 1.4 Section through skin.
Figure 1.5 Erythema due to a drug reaction.
Figure 1.6 Section through skin with a papule.
Figure 1.7 Papules in lichen planus.
Figure 1.8 Nodules in hypertrophic lichen planus.
Figure 1.9 Section through skin with plaque.
Figure 1.10 Psoriasis plaques on the knees.
Figure 1.11 Bullae in bullous pemphigoid.
Figure 1.12 Section through skin showing sites of vesicle and bulla.
Figure 1.13 Lichenification in chronic eczema.
Figure 1.14 Discoid lesions in discoid eczema.
Figure 1.15 Inflammatory sterile pustules in contact dermatitis.
Figure 1.16 Epidermal atrophy in extra-genital lichen sclerosus.
Figure 1.17 Ulceration in pyoderma ganrenosum.
Figure 1.18 Erosions in paraneoplastic bullous pemphigoid.
Figure 1.19 Excoriation of epidermis in atopic dermatitis.
Figure 1.20 Hyperkeratosis with fissures in rubber allergy.
Figure 1.21 Desquamation following a severe drug reaction.
Figure 1.22 Annular (ring-shaped) lesions of granuloma annulare.
Figure 1.23 Reticulate pattern in vasculitis.
Rashes
Approach to diagnosis
Symmetry
Figure 1.24 Symmetrical chronic plaque psoriasis.
Figure 1.25 Irritant eczema on dominant hand of chef.
Figure 1.26 Bilateral contact dermatitis to cement.
Diagnosis
Figure 1.27 Polymorphous light eruption.
Distribution
Morphology
Figure 1.28 Eczema: intraepidermal vesicle (arrow).
Figure 1.29 Vesicles and bullae in erythema multiforme.
Figure 1.30 Vesicles in herpes simplex.
Figure 1.31 Vesicles and bullae in bullous pemphigoid.
Figure 1.32 Bullae in cellulitis on lower leg.
Figure 1.33 Bullae from insect bite reactions.
Assessment of the patient
Figure 1.34 Possible precipitating factors in psoriasis.
Box 1.2 Examination of skin lesions – key points
Further Reading

CHAPTER 2 Psoriasis
OVERVIEW
Figure 2.1 Pathophysiological mechanisms involved in the development of psoriasis.
Figure 2.2 (diagram/histology composite) Increased epidermal proliferation.
Figure 2.3 Pitting and onycholysis of the nails.
Clinical appearance
Figure 2.4 Multiple small plaques.
Figure 2.5 Large chronic plaques.
The typical patient
Clinical presentation
Figure 2.6 Common patterns of distribution of psoriasis.
Figure 2.7 Generalised plaques.
Figure 2.8 Psoriatic plaques on the trunk.
Figure 2.9 Annular plaques.
Figure 2.10 Koebner’s phenomenon: psoriasis in surgical scar.
Figure 2.11 Hyperkeratotic palmar psoriasis.
Figure 2.12 Scalp psoriasis.
Figure 2.13 Onycholysis in nail psoriasis.
Figure 2.14 Guttate psoriasis.
Figure 2.15 Palmar pustular psoriasis.
Figure 2.16 Acute unstable pustular psoriasis.
Figure 2.17 Flexural psoriasis.
Figure 2.18 Napkin psoriasis.
Figure 2.19 Erythrodermic psoriasis.
Psoriatic arthritis – pathophysiology
Psoriatic arthritis – clinical presentation
Figure 2.20 Chronic psoriatic arthropathy.
Figure 2.21 Acute arthropathy X-ray signs.
Further reading

CHAPTER 3 Management of Psoriasis
OVERVIEW
Dermatology Day Treatment Units
Topical treatment
Figure 3.1 Psoriasis suitable for topical dithranol treatment.
Scalp psoriasis
Figure 3.2 Scalp psoriasis.
Ultraviolet treatment – phototherapy and photochemotherapy
Figure 3.3 Thin plaques of psoriasis suitable for TL01.
Figure 3.4 Psoralen with ultraviolet A (PUVA) cabinet.
Figure 3.5 Psoriasis before phototherapy.
Figure 3.6 Skin after phototherapy.
Ultraviolet B (UVB)
Ultraviolet A (UVA)
Figure 3.7 (a, b) Hand and foot PUVA.
Systemic treatment
Figure 3.8 Severe psoriasis suitable for systemic therapy.
Methotrexate
Acitretin
Ciclosporin A
Mycophenolate mofetil (MMF)
Biological therapy
Etanercept
Infliximab
Adalimumab
Ustekinumab
Further reading

CHAPTER 4 Eczema (Dermatitis)
OVERVIEW
Clinical features
Figure 4.1 Chronic atopic dermatitis.
Pathophysiology
Pathology
Figure 4.2 Histology of eczema.
Types of eczema
Endogenous eczema
Figure 4.3 Facial atopic dermatitis.
Figure 4.4 Chronic lichenified eczema on the legs.
Figure 4.5 Distribution of atopic dermatitis.
Figure 4.6 Factors leading to the development of atopic dermatitis.
Figure 4.7 Plantar dermatitis.
Figure 4.8 Eczema herpeticum.
Figure 4.9 Lichen simplex.
Figure 4.10 Asteatotic eczema.
Figure 4.11 Discoid eczema.
Figure 4.12 Pompholyx eczema.
Figure 4.13 Varicose eczema.
Investigations of eczema
Figure 4.14 Infected eczema.
Figure 4.15 Paget’s disease of the nipple – beware unilateral ‘eczema’.
Exogenous eczema
Contact dermatitis
Box 4.1 Common contact allergens
Clinical features
Figure 4.16 Common sources of contact dermatitis by body site.
Figure 4.17 Severe contact dermatitis to potassium dichromate in leather shoes.
Figure 4.18 Contact dermatitis to iodine.
Figure 4.19 Allergic contact dermatitis to melamine formaldehyde resin.
Figure 4.20 Contact dermatitis to fragrance in facial cream.
Figure 4.21 (a) Contact dermatitis to neomycin cream and (b) after stopping the treatment.
Figure 4.22 Acute PPD allergy in a ‘henna’ tattoo.
Figure 4.23 Contact allergy to stoma dressing.
Allergic contact dermatitis
Immune mechanisms
Figure 4.24 Immunological response leading to the development of contact dermatitis.
Irritant contact dermatitis
Photodermatitis
Figure 4.25 Chronic actinic dermatitis.
Occupational dermatitis
Figure 4.26 Irritant hand eczema in a chef.
Investigations of contact dermatitis
Patch testing
Figure 4.27 Test patches in place.
Figure 4.28 Patches being removed after 48 h.
Figure 4.29 Positive patch test reactions.
General management of eczema
Pruritus
Pruritus with skin changes
Pruritus with normal skin
Management of pruritus
Further Reading

CHAPTER 5 Urticaria and Angio-oedema
OVERVIEW
Introduction
Pathophysiology
Clinical history
Figure 5.1 Urticarial vasculitis with bruising.
Figure 5.2 Ordinary urticaria.
Figure 5.3 Urticaria from contact with brown caterpillar moths.
Figure 5.4 Cold-induced urticaria on the cheeks.
Classification of urticaria
Ordinary urticaria
Figure 5.5 Ordinary urticaria with dermatographism.
Figure 5.6 Annular urticaria.
Box 5.1 Causes of non-physical urticaria
Box 5.2 Causes of physical urticaria
Cholinergic urticaria
Solar urticaria
Pressure urticaria
Angio-oedema
Figure 5.7 Angio-oedema of the hand.
General investigations
Figure 5.8 Dermatographism.
General management
Further reading

CHAPTER 6 Skin and Photosensitivity
OVERVIEW
Ultraviolet radiation
Figure 6.1 Light spectrum.
Fitzpatrick skin type classification
Genetic disorders causing photosensitivity
Oculocutaneous albinism
Figure 6.2 Oculocutaneous albinism.
Xeroderma pigmentosum
Metabolic disorders of photosensitivity
Figure 6.3 Porphyia cutanea tarda hand.
Figure 6.4 Erythropoietic porphyria.
Figure 6.5 Varigate porphyria.
Exogenous substances causing photosensitivity
Medications causing photosensitivity
Figure 6.6 Photosensitive drug eruption (sparing under the chin).
Phytophotodermatitis
Figure 6.7 Phytophotodermatitis to lime juice.
Idiopathic disorders causing photosensitivity
Polymorphous light eruption (PMLE)
Figure 6.8 (a) Polymorphous light eruption (PMLE). (b). PMLE papular and erythematous eruption.
Solar urticaria
Chronic actinic dermatitis (CAD)
Figure 6.9 Chronic actinic dermatitis.
Photoprotective behaviour
Vitamin D levels and systemic disease
Sunscreen
Further reading

CHAPTER 7 Drug Rashes
OVERVIEW
Introduction
History
Examination
Investigations
Classification of drug reactions in the skin
Drugs which alter normal skin function
Photosensitivity
Figure 7.1 (a) Photosensitive eruption. (b) Phototoxic eruption.
Table 7.1 Cutaneous reactions and the most commonly implicated drugs
Table 7.2 Time from drug commencement to drug rash.
Pigmentation
Figure 7.2 Diltiazem pigmentation on the face.
Hair and nails
Nails
Drugs which exacerbate pre-existing dermatoses
Common drug-induced rashes
Drug-induced exanthems
Figure 7.3 Maculopapular exanthem.
Urticaria/angio-oedema
Figure 7.4 Urticaria secondary to penicillin.
Drug-induced lupus
Figure 7.5 Drug-induced lupus.
Drug-induced vasculitis
Figure 7.6 Drug-induced vasculitis.
Lichenoid drug eruptions
Figure 7.7 (a) Lichenoid drug reaction to nifedipine. (b) Lichenoid drug reaction to nifedipine; note
swollen ankles which is a side effect of calcium channel blockers.
Erythema nodosum
Fixed drug eruption
Figure 7.8 Fixed drug eruption.
Severe drug reactions in the skin
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)
Figure 7.9 (a) Toxic epidermal necrolysis on the trunk. (b) Toxic epidermal necrolysis mucosal involvement.
Table 7.3 SCORTEN Parameters
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Figure 7.10 (a) DRESS swollen ears. (b) DRESS cutaneous eruption.
Acute generalized exanthematous pustulosis (AGEP)
Figure 7.11 (a) Acute generalised exanthematous pustulosis multiple pustules on an erythematous base. (b)
Acute generalised exanthematous pustulosis – inflammatory pustules which are non-follicular.
Further reading

CHAPTER 8 Immunobullous and Other Blistering Disorders
OVERVIEW
Introduction
Figure 8.1 Section through the skin with (a) intraepidermal blister and (b) subepidermal blister.
Pathophysiology
Differential diagnosis
Table 8.1 Differential diagnosis of immunobullous disorders – other causes of cutaneous blistering.
Development
Duration
Durability
Distribution
Box 8.1 Widespread blistering eruptions
Box 8.2 Localised blistering eruptions
Clinical features of immunobullous disorders
Table 8.2 Clinical features of immunobullous disorders.
Bullous pemphigoid
Figure 8.2 Bullous pemphigoid.
Figure 8.3 Urticated plaques in pre-bullous pemphigoid.
Figure 8.4 Bullous pemphigoid: showing mouth erosions.
Pemphigoid gestationis
Figure 8.5 Pemphigoid gestationis on the abdomen.
Mucous membrane pemphigoid (cicatricial pemphigoid)
Figure 8.6 Mucous membrane pemphigoid: scarring skin eruption.
Figure 8.7 Mucous membrane pemphigoid on the scalp.
Figure 8.8 Mucous membrane pemphigoid: eyes.
Pemphigus vulgaris
Figure 8.9 Pemphigus vulgaris on the trunk.
Figure 8.10 Pemphigus vulgaris in the mouth.
Dermatitis herpetiformis (DH)
Figure 8.11 Dermatitis herpetiformis on the knees.
Linear IgA
Figure 8.12 Linear IgA on the trunk.
Investigation of immunobullous disease
Table 8.3 Skin biopsy findings in immunobullous disorders.
Figure 8.13 Histopathology of bullous pemphigoid.
Figure 8.14 Histopathology of pemphigus vulgaris.
Figure 8.15 Immunofluorescence of bullous pemphigoid.
Figure 8.16 Immunofluorescence of pemphigus vulgaris.
Management of immunobullous disease
Further reading

CHAPTER 9 Connective Tissue Disease, Vasculitis and Related Disorders
OVERVIEW
Introduction
Connective tissue disease
Box 9.1 Investigations might include the following
Vasculitis
Figure 9.1 Vasculitis.
Figure 9.2 Bullous vasculitis with necrosis.
Box 9.2 Possible causes of cutaneous vasculitis
Polyarteritis nodosa (PAN)
Henoch–Schönlein purpura
Management of cutaneous vasculitis
Raynaud’s phenomenon
Systemic sclerosis (SSc)
Figure 9.3 Systemic sclerosis.
Box 9.3 CREST syndrome
Figure 9.4 Morphoea.
Figure 9.5 Calcinosis cutis.
Figure 9.6 CREST syndrome.
Lichen sclerosus (LS)
Figure 9.7 Lichen sclerosus.
Lichen planus (LP)
Figure 9.8 Lichen planus on the wrist.
Figure 9.9 Lichen planus in the mouth.
Figure 9.10 Bullous lichen planus
Lupus erythematosus (LE)
Box 9.4 Clinical variants of lupus erythematosus
Figure 9.11 Systemic lupus erythematosus: butterfly rash.
Figure 9.12 Extensive severe systemic lupus erythematosus.
Figure 9.13 Subacute lupus erythematosus.
Figure 9.14 Discoid lupus erythematosus.
Figure 9.15 Neonatal lupus erythematosus.
Dermatomyositis
Figure 9.16 Dermatomyositis rash on the ‘V’ of the neck.
Figure 9.17 Dermatomyositis of the hands.
Figure 9.18 Dermatomyositis: ragged cuticles.
Mixed connective tissue disease (MCTD)
Further reading

CHAPTER 10 The Skin and Systemic Disease
OVERVIEW
Introduction
Box 10.1 Clues to a possible underlying systemic disease
Box 10.2 Characteristic rashes associated with underlying systemic disease
Skin reactions associated with infections
Figure 10.1 Toxic erythema reactive morbilliform rash.
Figure 10.2 Erythema multiforme.
Figure 10.3 Erythema nodosum.
Figure 10.4 Annular erythema.
Sarcoidosis
Figure 10.5 Nodular and plaque sarcoid.
Skin changes associated with hormonal imbalance
Figure 10.6 Melasma.
Figure 10.7 Acanthosis nigricans.
Figure 10.8 Necrobiosis lipoidica.
Figure 10.9 Granuloma annulare.
Thyroid disease
Table 10.1 Clinical signs of thyroid disease.
Figure 10.10 Pretibial myxoedema.
Skin changes associated with disorders of the gastrointestinal system and liver
Figure 10.11 Zinc deficiency.
Figure 10.12 Pyoderma gangrenosum.
Box 10.3 Associations of pyoderma gangrenosum
Figure 10.13 Dermatitis herpetiformis.
Liver disease and the skin
Box 10.4 Liver disease and the skin
Figure 10.14 Porphyria cutanea tarda.
Figure 10.15 Xanthomas in Alagille syndrome.
Pigmentation disorders
Hypopigmentation
Figure 10.16 Piebaldism.
Figure 10.17 Vitiligo.
Box 10.5 Autoimmune associations with vitiligo
Hyperpigmentation
Figure 10.18 Haemachromatosis.
Skin manifestations of underlying malignancy
Box 10.6 Skin markers of internal malignancy
Figure 10.19 Sezary syndrome (erythroderma with abnormal circulating Sezary cells).
Figure 10.20 Cutaneous B-cell lymphoma.
Box 10.7 Non-specific skin changes associated with malignant disease
Figure 10.21 Poikiloderma.
Pregnancy and the skin
Figure 10.22 Polymorphous eruption of pregnancy (PEP).
Figure 10.23 Pemphigoid gestationis.
Genetics and skin disease
Table 10.2 Abnormality underlying some inherited skin disorders.
Figure 10.24 Ichthyosis vulgaris.
Single gene disorders
Figure 10.25 Blashko’s lines.
Figure 10.26 Epidermal naevus following Blashko’s lines.
Further reading

CHAPTER 11 Leg Ulcers
OVERVIEW
Introduction
Figure 11.1 Venous leg ulcer.
Venous ulcers
Pathology
The skin
The blood vessels
Figure 11.2 Healthy valves in legs.
Figure 11.3 Incompetent valves in legs.
Figure 11.4 Varicose veins.
Incompetent valves
Risk factors for venous ulceration
Figure 11.5 Varicose eczema.
Clinical features
Figure 11.6 Atrophie blanche.
Figure 11.7 Lymphoedema.
Figure 11.8 Lipodermatosclerosis.
Local/topical treatments
Box 11.1 Treatment of venous leg ulcers
Figure 11.9 Compression bandaging.
Figure 11.10 Cleaning leg ulcers.
Arterial ulcers
Figure 11.11 Arterial ulcer.
Diabetic/neuropathic ulcers
Figure 11.12 Ulcers in diabetic foot.
Inflammatory conditions
Figure 11.13 Vasculitis and perniosis pre-ulceration.
Figure 11.14 Pyoderma gangrenosum.
Infectious ulcers
Malignant diseases
Figure 11.15 Squamous cell carcinoma in a chronic diabetic ulcer.
Trauma
Figure 11.16 Dermatitis artefacta.
Further Reading

CHAPTER 12 Acne and Rosacea
OVERVIEW
Introduction
What is acne?
Figure 12.1 (a) Sebaceous gland: pathology in acne. (b) Histology of acne.
Figure 12.2 Acne with closed comedones.
Figure 12.3 Acne with open comedones, cysts and scars.
Underlying causes
Hormones
Box 12.1 Factors causing acne
Fluid retention
Stress
Diet
Seasons
External factors
Iatrogenic factors
Figure 12.4 Perioral dermatitis.
Types of acne
Acne vulgaris
Figure 12.5 Acne vulgaris with inflammatory papules and pustules.
Figure 12.6 Acne keloidalis nuchae.
Box 12.2 Ladder of treatment for rosacea
Figure 12.7 Types of atrophic acne scars. (Notes: A, Boxcar; B, icepick and C, rolling).
Figure 12.8 ‘Ice-pick’ scars.
Figure 12.9 Keloid scars.
Acne excoriée
Figure 12.10 Acne excoriée.
Infantile acne
Acne conglobata/fulminans
Figure 12.11 Acne conglobata.
Figure 12.12 Acne fulminans.
Treatment of acne
Table 12.1 Treatment of acne.
Cleansers
Topical treatments
Systemic treatments
Figure 12.13 Dry lips as a result of oral Isotretinoin.
Figure 12.14 Classic rash on the dorsal hand secondary to taking oral Isotretinoin.
Rosacea
Figure 12.15 Rosacea.
Figure 12.16 Rosacea localised to the nose.
Figure 12.17 Rhinophyma.
Figure 12.18 Blepharitis.
Differential diagnosis of rosacea
Management
Further reading

CHAPTER 13 Bacterial Infections
OVERVIEW
Introduction
Table 13.1 Common patterns of bacterial infection in the skin..
Clinical presentation
Bacterial investigations
Figure 13.1 Mulitple abscesses due to PVL Staphylococcus aureus infection.
General approach to management
Superficial infections
Figure 13.2 Impetigo with golden crusting.
Figure 13.3 Impetigo with bullae and erosions.
Figure 13.4 Bacterial folliculitis.
Figure 13.5 Pseudofolliculitis: forehead.
Figure 13.6 Acne keloidalis.
Figure 13.7 Erythrasma.
Deeper infections
Figure 13.8 Erysipelas.
Figure 13.9 Extending cellulitis.
Figure 13.10 Staphylococcus scalded skin syndrome.
Figure 13.11 Ecthyma.
Mycobacterial disease
Figure 13.12 Lupus vulgaris.
Figure 13.13 Erythema induratum (Bazin’s disease).
Figure 13.14 Sporotrichoid spread of Mycobacterium marinum.
Other infections
Figure 13.15 Bacillary angiomatosis.
Figure 13.16 Rocky mountain spotted fever.
Figure 13.17 Secondary syphilis.
Further Reading

CHAPTER 14 Viral Infections
OVERVIEW
Introduction
Herpes viruses
Herpes simplex
Figure 14.1 Inoculation herpes.
Figure 14.2 Herpes ‘cold sore’.
Figure 14.3 Herpes simplex vesicles on posterior pinna.
Box 14.1 Herpes simplex – points to note
Figure 14.4 Eczema herpeticum.
Varicella zoster virus
Figure 14.5 Varicella zoster virus chicken pox infection in an adult.
Figure 14.6 Herpes zoster in a dermatome (shingles).
Figure 14.7 Multidermatomal varicella zoster virus (shingles).
Box 14.2 Shingles – points to note
Figure 14.8 Mandibular nerve zoster.
Figure 14.9 (a) Herald patch of pityriasis rosea. (b) Rash of pityriasis rosea.
Poxviruses
Molluscum contagiosum
Figure 14.10 Molluscum contagiosum.
Figure 14.11 Histology showing molluscum bodies.
Figure 14.12 Orf.
Wart viruses
Figure 14.13 Filiform HPV wart.
Figure 14.14 Periungal hyperkeratotic HPV warts.
Figure 14.15 Plantar wart (verucca).
Treatment
Viral diseases with rashes
Box 14.3 Viral diseases with rashes
Figure 14.16 Koplick’s spots in measles.
Figure 14.17 Measles rash.
Figure 14.18 Rubella.
Figure 14.19 Erythema infectiosum.
Figure 14.20 Gianotti–Crosti syndrome.
Figure 14.21 Hand, foot and mouth disease.
Further reading

CHAPTER 15 HIV and the Skin
OVERVIEW
Introduction
Box 15.1 HIV and the skin
Stages of HIV
Primary HIV infection
Figure 15.1 Primary HIV infection: seroconversion rash.
Early stages
Late-stage HIV infection
Skin disorders in HIV
Seborrhoeic dermatitis
Figure 15.2 Seborrhoeic dermatitis.
Box 15.2 Skin disorders in HIV/AIDS
Psoriasis
Eosinophilic folliculitis
Figure 15.3 Eosinophilic folliculitis.
Nodular prurigo
Figure 15.4 Nodular prurigo.
Infections
Fungal infections
Figure 15.5 Flexural Candida infection.
Figure 15.6 Pseudomembranous Candida.
Bacterial infections
Figure 15.7 Bacillary angiomatosis.
Syphilis
Figure 15.8 Secondary syphilis.
Viral infections
Herpesviruses
Figure 15.9 HSV (immune reconstitution inflammatory syndrome, IRIS).
Figure 15.10 Oral hairy leukoplakia.
Figure 15.11 Kaposi’s sarcoma on the hard palate.
Figure 15.12 Kaposi’s sarcoma nodules.
Other viruses
Figure 15.13 Molluscum contagiosum.
Figure 15.14 Human papillomavirus warts: extensive.
Infestations
Figure 15.15 Crusted scabies on the hand.
Drug rashes
Figure 15.16 Toxic epidermal necrolysis.
Further reading

CHAPTER 16 Fungal Infections
OVERVIEW
Introduction
Investigations
Box 16.1 Principles of diagnosis
General features of fungi in the skin
Figure 16.1 Animal ringworm.
Figure 16.2 Tinea capitis: Microsporum.
Scalp and face
Figure 16.3 Patchy alopecia in tinea capitis caused by Trichyophyton tonsurans.
Figure 16.4 Extensive alopecia and inflammation caused by T. tonsurans infection.
Figure 16.5 Kerion in T. tonsurans tinea capitis.
Figure 16.6 ‘Id reaction’ after commencing oral treatment for tinea capitis.
Figure 16.7 Tinea incognito.
Figure 16.8 Seborrhoeic dermatitis.
Feet (and hands)
Figure 16.9 Tinea pedis.
Figure 16.10 Toeweb tinea pedis.
Trunk
Figure 16.11 Tinea corporis.
Figure 16.12 Tinea cruris.
Figure 16.13 Pityriasis versicolor with hyperpigmented scaling.
Figure 16.14 Pityriasis versicolor with hypopigmented scaling.
Nails
Figure 16.15 Onychomycosis caused by Trichophyton rubrum.
Figure 16.16 Candida onychomycosis.
Yeast infections
Figure 16.17 Candida infection in the groin.
Figure 16.18 Candida albicans stomatitis.
Deep fungal infections
Figure 16.19 Fusarium infection in a bone marrow recipient.
Figure 16.20 Deep fungal infection.
Systemic antifungal drugs
Further reading

CHAPTER 17 Insect Bites and Infestations
OVERVIEW
Insect bites and stings
Figure 17.1 Papular and inflammatory insect bite reactions.
Figure 17.2 Linearity of insect bite reactions.
Figure 17.3 Bulla bite reaction.
Figure 17.4 Persistent insect bite reaction.
Box 17.1 Clinical features of bites
Box 17.2 Risk factors for bites
Delusions of parasitosis
Figure 17.5 Parasitophobia specimens.
Allergic reaction to bites
Management of bite reactions
Prevention of bites
Insect bites transmitting parasites
Table 17.1 Skin lesions associated with insect bites.
Lyme disease
Figure 17.6 Tick bite reaction.
Figure 17.7 Erythema chronicum migrans in Lyme disease.
Spider bites
Figure 17.8 Spider bite (Nigeria).
Wasp and bee stings
Treatment
Infestations
Scabies (Sarcoptes scabiei)
Box 17.3 Scabies – points to note
Diagnosis
Figure 17.9 Scabies burrows.
Scabies in children
Figure 17.10 Scabies nodules in a child.
Figure 17.11 Scabies on sole of an infant.
Crusted scabies
Figure 17.12 Crusted scabies on buttocks.
Management
Box 17.4 Management of scabies
Lice
Head lice
Figure 17.13 Head lice.
Figure 17.14 Pediculosis (head lice) causing an irritant rash on the posterior neck and upper back.
Management
Body lice
Management
Pubic lice
Figure 17.15 Pubic lice on eyelashes.
Management
Cutaneous larva migrans
Figure 17.16 Cutaneous larva migrans.
Further Reading

CHAPTER 18 Tropical Dermatology
OVERVIEW
Introduction
Bacterial infections
Leprosy
Figure 18.1 Spectrum of clinical disease in leprosy. BB, mid-borderline leprosy; BL, borderline lepromatous
leprosy; BT, borderline tuberculoid leprosy; LL, lepromatous leprosy; TT, tuberculoid leprosy.
Figure 18.2 Tuberculoid leprosy: hypopigmented patches.
Figure 18.3 Tuberculoid leprosy.
Figure 18.4 Lepromatous leprosy.
Figure 18.5 Borderline leprosy.
Diagnosis
Box 18.1 Bacterial index (BI)
Treatment
Cutaneous leishmaniasis
Box 18.2 Cutaneous leishmaniasis
Acute leishmaniasis
Figure 18.6 Acute leishmaniasis.
Chronic leishmaniasis
Figure 18.7 Chronic leishmaniasis.
Diffuse cutaneous leishmaniasis
Figure 18.8 Diffuse cutaneous leishmaniasis.
Diagnosis
Treatment
Superficial fungal infections
Figure 18.9 Superficial fungal infection.
Table 18.1 Tropical fungal infections of the skin.
Figure 18.10 Tinea imbricata.
Deep fungal infections
Mycetoma (Madura foot)
Figure 18.11 Madura foot.
Diagnosis
Treatment
Fungal mycetoma
Bacterial mycetoma
Chromoblastomycosis
Figure 18.12 Chromoblastomycosis.
Blastomycosis
Histoplasmosis
Figure 18.13 Histoplasmosis in HIV infection.
Infestations
Tungiasis
Figure 18.14 Tungiasis.
Subcutaneous myiasis
Figure 18.15 Myiasis: larva.
Filariasis
Figure 18.16 Lymphoedema of the legs in filariasis.
Treatment
Onchocerciasis
Figure 18.17 ‘Leopard skin’ in onchocerciasis.
Risk factors for being infected
Diagnosis
Treatment
Loiasis (Loa loa)
Diagnosis
Treatment
Dracunculiasis
Further Reading

CHAPTER 19 Hair and Scalp
OVERVIEW
Introduction
Hair cycle
Figure 19.1 (a) Diagrammatic cross-section of hair at various growth phases. (b) Hair growth cycle.
Hair loss
Non-scarring alopecias
Androgenetic alopecia
Figure 19.2 Female androgenetic alopecia.
Alopecia areata
Figure 19.3 Alopecia areata.
Figure 19.4 Exclamation mark hairs.
Figure 19.5 Nail pitting associated with alopecia areata.
Other non-scarring alopecias
Telogen effluvium
Table 19.1 Causes of telogen effluvium.
Tinea capitis
Figure 19.6 Tinea capitis.
Figure 19.7 Kerion.
Scarring alopecia
Primary causes
Lymphocytic disorders
Figure 19.8 Discoid lupus erythematosus.
Figure 19.9 Lichen planopilaris.
Figure 19.10 Pseudopelade of Brocq.
Neutrophilic disorders
Figure 19.11 Folliculitis decalvans.
Secondary causes of scarring alopecia
Table 19.2 Causes of scarring alopecia.
Excessive hair
Hirsutism
Figure 19.12 Hirsutism.
Table 19.3 Causes of hirsutism.
Management
Hypertrichosis
Figure 19.13 Hypertrichosis.
Table 19.4 Hypertrichosis due to drugs.
Skin disease involving the scalp
Figure 19.14 Seborrhoeic dermatitis.
Figure 19.15 Pityriasis amiantacea.
Further Reading

CHAPTER 20 Diseases of the Nails
OVERVIEW
Introduction
Figure 20.1 Section through finger.
Changes of shape and attachment
Pitting
Figure 20.2 (a) Pitting of nail and (b) pitting of nail appearance with dermatoscope.
Subungual hyperkeratosis
Oily spot
Onycholysis
Figure 20.3 Onycholysis due to manicure beneath the nail.
Nail plate thickening
Figure 20.4 Onycholysis and hyperkeratosis of nail plate in psoriasis.
Transverse ridges
Irritant dermatitis (eczema)
Beau’s line
Nail loss (onychomadesis)
Longitudinal splits
Figure 20.5 Longitudinal ridge and partial split termed canaliform dystrophy of Heller. Matrix inflammation
with nail fold trauma can play a part.
Figure 20.6 Darier’s disease.
Transverse (lamellar) splits
Pustules in the periungual skin
Koilonychia
Clubbing
Figure 20.7 Clubbing with loss of the angle between the proximal nail fold and the base of the nail.
Changes of colour
Nail bed changes
Leukonychia
Figure 20.8 Apparent leuconychia.
Nail plate changes
Figure 20.9 Yellow nail syndrome.
Figure 20.10 Linear melanonychia.
Box 20.1 Pigmented streaks in nails
Common dermatoses and the nail unit
Figure 20.11 Nail psoriasis with onycholysis, pitting and arthritis of the distal interphalangeal joint of
the little finger.
Figure 20.12 Eczema causing inflammatory matrix changes and compounded by picking with surrounding eczema
and loss of intact nail.
Figure 20.13 Lichen planus.
Figure 20.14 Nail dystrophy with alopecia areata comprising multiple small, regular, pits.
Figure 20.15 Dystrophy due to lupus.
Figure 20.16 Pterygium formation with lupus.
Infection
Bacterial infection of periungual tissues
Figure 20.17 Chronic paronychia with alteration of nail plate shape and discolouration secondary to nail
fold inflammation and microbial colonisation.
Fungal nail infection
Figure 20.18 Fungal infection with superficial pattern (fourth toe) and distal and subungual pattern on the
little toe.
Trauma
Figure 20.19 Chronic rubbing trauma to the proximal nail fold leads to a ‘habit-tic’ pattern of
longitudinal dystrophy.
General diseases affecting the nails
Nail changes in systemic illness
Acute illness
Chronic illness
Lesions adjacent to the nail
Figure 20.20 Mucoid cyst, also called myxoid pseudocyst.
Figure 20.21 In situ melanoma with progressive pigmentation of nail plate.
Figure 20.22 Subungual exostosis of the big toe.
Treatment of nail conditions
Nail Cosmetics
Further Reading

CHAPTER 21 Benign Skin Tumours
OVERVIEW
Introduction
Table 21.1 Differential diagnosis of common benign skin tumours.
Pigmented benign tumours
Seborrhoeic keratoses
Figure 21.1 Seborrhoeic keratoses on the trunk, there is a melanoma on the right upper shoulder (shown by
the arrow).
Figure 21.2 Seborrhoeic keratoses.
Dermatosis papulosa nigra (DPN)
Figure 21.3 Dermatosis papulosa nigra.
Skin tags
Figure 21.4 Skin tags.
Lentigines (freckles)
Figure 21.5 Lentigines.
Melanocytic naevi
Congenital melanocytic naevi
Figure 21.6 Congenital melanocytic naevus.
Figure 21.7 Mongolian blue spot.
Acquired melanocytic naevi
Figure 21.8 Junctional naevus.
Figure 21.9 Compound naevus.
Figure 21.10 Intradermal naevus.
Figure 21.11 Blue naevus.
Figure 21.12 Spitz naevus.
Figure 21.13 Halo naevus.
Figure 21.14 Becker’s naevus.
Dermatofibroma
Figure 21.15 Dermatofibroma.
Benign vascular tumours
Figure 21.16 Naevus flammeus neonatorum.
Figure 21.17 Sturge–Weber syndrome.
Figure 21.18 (a) Cavernous (strawberry) haemangioma and (b) ulcerating and bleeding cavernous haemangioma
suitable for treatment with systemic β blockers.
Figure 21.19 Spider naevi.
Figure 21.20 Campbell de Morgan spots.
Figure 21.21 Pyogenic granuloma.
Benign tumour papules
Figure 21.22 Syringomas.
Figure 21.23 Trichoepitheliomas.
Figure 21.24 Apocrine hidrocystomas.
Figure 21.25 Milia.
Figure 21.26 Sebaceous gland hyperplasia.
Benign tumour nodules
Figure 21.27 Lipoma.
Figure 21.28 Leiomyoma on scalp vertex.
Figure 21.29 Epidermoid cyst.
Figure 21.30 Eccrine poroma.
Figure 21.31 Keloid scar secondary to ear piercing.
Benign tumour plaques
Figure 21.32 Naevus sebaceous.
Figure 21.33 Epidermal naevus.
Figure 21.34 Inflammatory linear verrucous epidermal naevus (ILVEN).
Further Reading

CHAPTER 22 Premalignant and Malignant
Skin tumours
OVERVIEW
Introduction
Premalignant skin tumours
Actinic keratoses
Figure 22.1 Sun-damaged skin with multiple actinic keratoses.
Management
Bowen’s disease
Figure 22.2 Bowen’s disease
Malignant skin tumours
Basal cell carcinoma (BCC)
BCC types
Figure 22.3 Nodular-type basal cell carcinoma above the eye.
Figure 22.4 Nodular basal cell carcinoma histology.
Figure 22.5 Recurrent nodular basal cell carcinoma.
Figure 22.6 Superficial basal cell carcinoma.
Figure 22.7 Pigmented basal cell carcinoma.
Figure 22.8 Morphoeic basal cell carcinoma.
Management of BCC
Squamous cell carcinoma (SCC)
Figure 22.9 Squamous cell carcinoma: early stages on the pinna.
Figure 22.10 Hyperkeratotic rapidly enlarging squamous cell carcinoma.
Figure 22.11 Squamous cell carcinoma histology.
Figure 22.12 Keratoacanthoma.
Management of SCC
Moles/naevi: benign or malignant?
Box 22.1 The ABCDE of malignant pigmented lesions
Dysplastic naevi
Figure 22.13 Dysplasic naevus.
Melanoma
Incidence
Sun exposure
Pre-existing moles
Types of melanoma
Figure 22.14 Superficial spreading malignant melanoma.
Figure 22.15 Benign solar lentigo.
Figure 22.16 (a) Lentigo maligna pre-imiquimod treatment and (b) lentigo maligna midway through treatment
with topical imiquimod.
Figure 22.17 Lentigo maligna melanoma.
Figure 22.18 Nodular malignant melanoma.
Figure 22.19 Acral malignant melanoma.
Figure 22.20 Amelanotic malignant melanoma.
Figure 22.21 Dysplastic malignant melanoma.
Prognosis
Figure 22.22 (a) Melanoma with surrounding satellites and (b) melanoma with local metastases in transit.
Table 22.1 Prognosis in melanoma.
Treatment of melanoma
Sentinel lymph node biopsy (SLNB)
Adjuvant therapies for melanoma
Cutaneous lymphoma
Figure 22.23 Mycosis fungoides.
Figure 22.24 Primary cutaneous B-cell lymphoma.
Other cutaneous malignancies
Figure 22.25 Paget’s disease of the nipple.
Further Reading

CHAPTER 23 Practical Procedures and Skin Surgery
OVERVIEW
Cryotherapy
Box 23.1 Cryotherapy – practical points
Application technique
Figure 23.1 Cryotherapy.
Risks and precautions
Skin lesions suitable for freezing
Viral warts
Seborrhoeic keratoses
Papillomas and skin tags
Actinic keratosis
Bowen’s disease
Basal cell carcinoma
Electrosurgery
Electrocautery
Electrodessication (diathermy or hyfrecation)
Figure 23.2 Electrodessication during surgery.
Curettage
Figure 23.3 Spoon curettage.
Box 23.2 Curettage – practical points
Technique
Risks and precautions
Diagnostic biopsies
Shave biopsy
Punch biopsy
Figure 23.4 Punch biopsy tools.
Figure 23.5 Punch biopsy: injecting local anaesthetic.
Figure 23.6 Punch biopsy: tool insertion.
Figure 23.7 Punch biopsy: plug of skin.
Figure 23.8 Punch biopsy: raising a plug of skin.
Figure 23.9 Punch biopsy: specimen taken.
Incisional biopsy
Figure 23.10 Incisional biopsy: marked area for sampling.
Surgical excision
Figure 23.11 Surgical excision: ‘skin wrinkle lines’ of the trunk.
Figure 23.12 Surgical excision: ‘skin wrinkle lines’ of the limbs.
Figure 23.13 Surgical excision: ‘skin wrinkle lines’ of the face.
Technique
Figure 23.14 Surgical excision of BCC from lower back. Ellipse design including a 4-mm margin.
Figure 23.15 Surgical excision of BCC: removal of specimen illustrating the defect.
Figure 23.16 Surgical excision of BCC: after suturing, showing wound eversion.
Box 23.3 Surgical excision
Box 23.4 Suturing
Figure 23.17 Placement of epidermal sutures. Source: Robinson et al., 2005. Reprinted with permission of
Elsevier.
Figure 23.18 Methods of placing buried dermal sutures. Source: Robinson et al., 2005. Reprinted with
permission of Elsevier.
Mohs’ micrographic surgery
Further Reading

CHAPTER 24 Lasers, Intense Pulsed Light and Photodynamic Therapy
OVERVIEW
Laser treatment
Laser science
Table 24.1 The acronym ‘LASER’.
Preoperative assessment
Table 24.2 Possible complications of laser treatment.
Table 24.3 Suitable lasers for specific skin disorders.
Perioperative anaesthesia
Postoperative care
Laser safety
Vascular lesions
Figure 24.1 Port wine stain (a) before and (b) after treatment with a pulsed dye laser.
Figure 24.2 Bruising following pulsed dye laser treatment.
Pigmented lesions
Figure 24.3 Café au lait macule (a) before and (b) after treatment with a Q-switched Nd-YAG laser.
Tattoos
Table 24.4 Laser selection by colour for tattoo removal.
Figure 24.4 Tattoo subjected to laser removal. (a) Before treatment. (b) Fading of tattoo and ‘laser
snow’ following Q-switched Nd-YAG laser treatment.
Hair removal
Laser resurfacing
Fractional laser treatment
Dermabrasion and Chemical peels
Intense pulsed light
Photodynamic therapy
Figure 24.5 Superficial basal cell carcinoma on the lower back. (a, b) Before treatment with Hetvix
photodynamic therapy (PDT). (c) Six months after PDT. Figures courtesy of Dr Andrew Morris, University
Hospital of Wales, Cardiff.
Further Reading

CHAPTER 25 Wound Management and Bandaging
OVERVIEW
Introduction
Wounds
Figure 25.1 Deep necrotic wound secondary to calciphylaxis being debrided. Source: Grey et al., 2010.
Reprinted with kind permission of Wounds UK.
Wound types
Figure 25.2 Wound healing continuum. Grey et al. (2010). Reprinted with kind permission of Wounds UK.
Table 25.1 Wound types and suitable dressings.
Dressings
Dressings
Types of wound dressings
Figure 25.3 Wound dressing categories.
Non- or low adherent dressings
Figure 25.4 Non-adherent dressings.
Film dressings
Figure 25.5 Film dressings allow wound monitoring.
Hydrogel dressings
Figure 25.6 Hydrogel dressings.
Hydrocolloid dressings
Figure 25.7 Hydrocolloid dressings.
Hydrofibre dressings
Figure 25.8 Hydrofibre dressings.
Alginate dressings
Polyurethane foam dressings
Figure 25.9 Foam dressings.
Antimicrobial dressings
Figure 25.10 Antimicrobial dressings.
Odour-controlling dressings
Cavity dressings
Figure 25.11 Cavity dressings.
Larvae therapy
Figure 25.12 Larvae therapy.
Honey dressings
Figure 25.13 (a) Necrotic wound pre honey dressing and (b) necrotic wound 1 week post honey dressing.
Capillary action dressing
Topical negative pressure dressings (TNP)
Newer products available
Super-absorbent dressings
Alginogels
PHMB
MMPs
Adverse effects of dressings
Bandages
Definitions relating to bandaging
Classification of bandages
Type I
Figure 25.14 (a) Sternal wound and (b) sternal wound with topical negative pressure dressing.
Figure 25.15 Type I retention bandage to hold non-adherent dressings in place.
Type II
Figure 25.16 Type II light support bandage made from elasticated viscose.
Type III
Figure 25.17 Markings on bandages to ensure consistent tension (a) incorrect tension (oval) (b) correct
tension (circle).
Type IIIa
Type IIIb
Type IIIc
Type IIId
Application of bandages
Preparation for compression bandaging
The four-layer compression system for ankle circumference 18–25 cm
Figure 25.18 (a) Four layers need to be applied for Type III compression and (b) Four-layers can be seen in
place (from the knee downwards) – first layer orthopaedic wool; second layer cotton crepe; third layer
elastic extensible bandage; fourth layer cohesive bandage.
Two-layer compression
Figure 25.19 Coban for two-layer compression.
Figure 25.20 KTwo for two-layer compression.
Application of two layer bandage
Two-layer long stretch bandages: Class 3c
Two-layer short stretch bandages: Class 3c
Two-layer reduced bandage system
Rubber sensitivity
Tubular bandages
Medicated paste bandages
Figure 25.21 Medicated bandages with zinc paste and calamine.
Patient information
Further Reading

CHAPTER 26 Formulary
OVERVIEW
Introduction
Topical therapy
Emollients
Table 26.1 Comparison of formulations for topical therapy.
Topical immunomodulatory treatments
Topical corticosteroids
Mode of action
Classification of topical steroids
Table 26.2 Relative potency of topical corticosteroids.
Side effects of topical steroids
Figure 26.1 Liberal application of a potent topical steroid resulting in striae formation.
Figure 26.2 Perioral dermatitis caused by local application of topical steroids.
Figure 26.3 Potent topical steroid induced atrophy and acne.
Calcineurin inhibitors
Topical antimicrobials
Table 26.3 Topical antimicrobials used in the treatment of superficial infections.
Miscellaneous topical therapy used in the treatment of psoriasis
Table 26.4 Miscellaneous preparations used in the treatment of psoriasis.
Topical anti-proliferative agents
Topical 5 fluorouracil
Topical diclofenac
Topical imiquimod
Topical ingenol mebutate
Miscellaneous agents
Keratolytics
Sunscreens
Cosmetic camouflage
Phototherapy
Systemic therapy
Drugs used for infectious disorders
Antibacterial drugs
Table 26.5 Antibiotics used in dermatology, their method of action, indications and complications.
Antifungal drugs
Antiviral drugs
Antiparasite drugs
Systemic immunomodulatory drugs
Corticosteroids
Methotrexate
Azathioprine
Ciclosporin
Mycophenolate mofetil
Systemic retinoids
Table 26.6 Side effects of systemic retinoids.
Antihistamines
Miscellaneous drugs
Dapsone
Antimalarials
Biological therapies
Biologics used in the treatment of psoriasis
Biologics used in metastatic melanoma
Biologics in eczema
Miscellaneous
Further Reading
Back Matter
Index