Dermatology: Diseases and Therapy

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Overview

Dermatology: Diseases and Treatment is designed to provide the busy clinician with an organized, condensed and practical approach to the patient with a skin problem. It includes the elements of diagnosis for hundreds of the most common cutaneous problems and provides recommendations for the management of these conditions. Also included are detailed descriptions of the most commonly used medications in dermatology today.
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Editorial Reviews

From The Critics
Reviewer: Patricia Wong, MD (Stanford University Medical Center)
Description: Dr. Levine has devised a handy paperback summarizing the differential diagnoses for several hundred dermatologic eruptions and lesions. Readers do have to have some basic knowledge of dermatology in order to properly take advantage of the information. The book is organized alphabetically by disease entities, so readers must have an idea of what the diagnosis is in order to proceed with the suggested evaluation and treatment guidelines. The information is enriched by the author's experienced clinician.
Purpose: The purpose is to help dermatology residents as well as dermatologists and other physicians develop a feel for the possible diagnoses to consider when evaluating a patient with a rash or skin lesion.
Audience: The audience is medical students, dermatology residents, and general practitioners.
Features: The differential diagnoses are the best feature. The distillation of the most salient clinical features associated with a particular entity is also a strength. The last section of the book discusses therapies and their attendant side-effects, dosages, and drug interactions. I would have liked it if the author had elaborated further in the differential diagnosis section on clinical tips on how to differentiate between the different diseases.
Assessment: A number of books discuss therapy, clinical presentation, and pathophysiology in a synopsis format. This one differs in that the differential diagnosis is well thought out and in many ways is more important. Knowing what you are treating is most of the challenge, not the therapy.
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Product Details

  • ISBN-13: 9780521709330
  • Publisher: Cambridge University Press
  • Publication date: 7/31/2007
  • Series: Cambridge Pocket Clinicians Series
  • Pages: 466
  • Product dimensions: 5.98 (w) x 8.98 (h) x 0.79 (d)

Read an Excerpt

Dermatology: Diseases and Therapy
Cambridge University Press
978-0-521-70933-0 - Dermatology: Diseases and Therapy - by Norman Levine
Excerpt



PART ONE

Diseases




ACANTHOSIS NIGRICANS

ALTERNATE DISEASE NAME

■ None

HISTORY

■ Gradual onset of asymptomatic areas of darkening & thickening of the skin

■ History or family history of diabetes mellitus and/or insulin resistance, often in overweight pts

■ Associated w/ endocrinopathies, such as hyperandrogenemia, or an autoimmune disease such as systemic lupus erythematosus, scleroderma, Sjögren syndrome or Hashimoto thyroiditis

■ More common in people w/ darker skin pigmentation

■ Rapidly evolving subset in adults associated w/ internal malignancy, particularly of the GI tract, where skin changes precede the malignancy diagnosis in 1/3 of cases

PHYSICAL EXAMINATION

■ Symmetrical, hyperpigmented, velvety plaques, occurring in intertriginous areas, such as axillae & groin, on the nipples & on the neck

■ Vulva is most commonly affected site in females in those who are hyperandrogenic & obese

■ Skin tags in the vicinity of the plaques

■ Physical findings identical for both the malignant & benign forms

DIFFERENTIAL DIAGNOSIS

■ Becker nevus

■ Confluent & reticulated papillomatosis of Gougerot & Carteaud

■ Dowling-Degos disease

■ Seborrheic keratosis

■ Ichthyosis hystrix

■ Linear epidermal nevus

■ Parapsoriasis en plaque

■ Pemphigus vegetans

■ Pellagra

LABORATORY WORK-UP

■ In adult-onset type, perform basic workup for underlying malignancy

■ In early-onset disease, particularly in obese pts, obtain serum insulin level & hemoglobin A1C

MANAGEMENT

■ Weight reduction in obese pts

■ Treat underlying malignancy, if present

SPECIFIC THERAPY

■ None

CAVEATS AND PITFALLS

■ Advise that pt is at risk for diabetes, even if there is no evidence at present.


ACNE KELOIDALIS

ALTERNATE DISEASE NAME

■ Acne keloidalis nuchae

■ Folliculitis keloidalis

■ Folliculitis keloidalis nuchae

■ Acne keloid

HISTORY

■ Occurs mainly in men of African descent, after puberty & before age 50

■ Begins as chronic folliculitis of posterior neck & occipital scalp

■ May be related to close shaving of hair and/or irritation from clothing

PHYSICAL EXAMINATION

■ Firm, dome-shaped, follicular papules on nape of neck and/or on occipital scalp

■ Papules coalesce into sclerotic plaques

■ Scarring alopecia & subcutaneous abscesses w/ draining sinuses later in the course

DIFFERENTIAL DIAGNOSIS

■ Folliculitis

■ Acne vulgaris

■ Perifolliculitis capitis

■ Nevus sebaceous

■ Keloid

■ Pediculosis capitis

■ Squamous cell carcinoma

■ Basal cell carcinoma

LABORATORY WORK-UP

■ Skin biopsy if there is doubt of the diagnosis

■ Culture for bacterial pathogens if there are pustules

MANAGEMENT

■ Avoid potential trauma to neck & posterior scalp area, such as close-cropped hairstyles, tight-fitting hats

■ Surgical excision

■ Destruction by laser or liquid nitrogen cryotherapy

■ Intralesional corticosteroids

■ Systemic antibiotics for secondary bacterial infection or as anti-inflammatory agent

SPECIFIC THERAPY

■ Tetracycline 500 mg PO BID; alternative is doxycycline 100 mg PO BID

■ CO2 laser vaporization followed by intralesional triamcinolone (5–10 mg/mL) or imiquimod 5% cream applied daily for 6–8 wks

■ Triamcinolone (5–10 mg/mL) intralesional after softening the site w/ light liquid nitrogen cryotherapy

■ Punch excision of individual papules

■ Horizontal elliptical excision w/ or w/out primary closure

CAVEATS AND PITFALLS

■ Once scarring has occurred, the skin does not return to normal.


ACNE VULGARIS

ALTERNATE DISEASE NAME

■ Acne varus

HISTORY

■ Peak incidence at puberty but may begin in first decade

■ Women often have sustained activity until late 30’s

■ Severity may have genetic component

■ Flares may occur in times of stress

PHYSICAL EXAMINATION

■ Lesions in areas w/ abundant sebaceous follicles: face, back, upper chest wall

■ Closed comedos (whitehead) & open comedos (blackhead)

■ Inflammatory papules, pustules, nodules & cysts

■ Draining sinuses

■ Postinflammatory scars

■ Hormonal component: flares w/ menses

DIFFERENTIAL DIAGNOSIS

■ Acne aestivalis

■ Rosacea

■ Perioral dermatitis

■ Folliculitis

■ Acne medicamentosa

■ Occupational acne

■ Tropical acne

■ Acne cosmetica

■ Syndrome of Favre-Racouchot

■ Flat warts

■ Trichostasis spinulosa

LABORATORY WORK-UP

■ None

MANAGEMENT

■ Systemic antibiotics

■ Topical antibiotics

■ Topical retinoids

■ Azelaic acid

■ Isotretinoin

■ Hormonal therapy

■ Acne surgery

SPECIFIC THERAPY

■ Tetracycline 250–500 mg PO BID

■ Doxycycline 100 mg PO QD-BID

■ Minocycline 50–100 mg PO BID

■ Erythromycin 250–500 mg PO BID

■ Topical 1% clindamycin solution, cream, gel or lotion applied BID; use w/ benzoyl peroxide to minimize drug resistance

■ Topical 2% erythromycin solution, cream, lotion or gel applied BID; use w/ benzoyl peroxide to minimize drug resistance

■ Benzoyl peroxide 5–10% gel or cream applied BID

■ Tretinoin 0.025% cream applied HS; alternative is adapalene 0.1% gel applied HS

■ Isotretinoin 1 mg/kg per day PO for 5 months; advise about strict contraception in women

■ Spironolactone 100–200 mg PO per day in women only

■ Oral contraceptives, particularly DesogenTM or Ortho Tri-CyclenTM

■ Acne surgery, including comedo expression; incision & drainage of fluctuant cysts & abscesses; chemical peel; microdermabrasion; intralesional triamcinolone 2–4 mg/mL

CAVEATS AND PITFALLS

■ Use isotretinoin only in severe scarring acne, unresponsive to other measures.

■ Erythromycin has high incidence of early drug resistance.

■ Doxycycline may produce sun sensitivity.

■ Spironolactone may produce menstrual irregularity.

■ Benzoyl peroxide may cause bleaching of clothes.


ACROANGIODERMATITIS

ALTERNATE DISEASE NAME

■ Pseudo-Kaposi’s sarcoma

■ Mali disease

HISTORY

■ Longstanding history of venous stasis (w/ bilateral involvement), arteriovenous shunt for hemodialysis, or arteriovenous malformation (w/ unilateral involvement)

PHYSICAL EXAMINATION

■ Confluent, violaceous or brown-black papules & plaques over distal legs

■ Occasional erosions, ulcerations and/or bleeding

DIFFERENTIAL DIAGNOSIS

■ Kaposi’s sarcoma

■ Stasis dermatitis

■ Contact dermatitis

■ Lichen planus

■ Lupus erythematosus

■ Benign pigmented purpura

■ Cutaneous vasculitis

LABORATORY WORK-UP

■ Skin biopsy for routine light microscopy to rule out Kaposi’s sarcoma

■ Plethysmography, Doppler ultrasonography & oscillography to assess venous flow & to detect vascular malformations

MANAGEMENT

■ Compression therapy

■ Correct underlying venous disease

SPECIFIC THERAPY

■ Unna boots

■ Sequential compression device, 30–40 mm, applied 30–45 minutes per day

■ Surgical excision of shunts if there is arteriovenous malformation

CAVEATS AND PITFALLS

■ Goal of therapy is to reduce edema.

ACROCHORDON

ALTERNATE DISEASE NAME

■ Skin tag

■ Soft wart

■ Fibroepithelial polyp

HISTORY

■ Slow-growing asymptomatic lesions, most frequently on neck & axillae

■ More common in obese pts

■ May be associated w/ acanthosis nigricans

PHYSICAL EXAMINATION

■ Round, soft, pedunculated papules, which are either flesh-colored or hyperpigmented

■ May be tender or bleed when traumatized

DIFFERENTIAL DIAGNOSIS

■ Wart

■ Neurofibroma

■ Seborrheic keratosis

■ Melanocytic nevus

■ Melanoma

■ Fibroepithelioma of Pinkus

■ Pseudosarcomatous polyp

LABORATORY WORK-UP

■ None

MANAGEMENT

■ Surgical removal

SPECIFIC THERAPY

■ Scissors excision; use local anesthesia for broad-based lesions

■ Liquid nitrogen cryotherapy; advise about post-procedure hypopigmentation

■ Destruction by electrodesiccation; advise about possible scarring

■ Dichloroacetic acid applied sparingly; advise about burning sensation after application

CAVEATS AND PITFALLS

■ Removal for cosmetic reasons only.


ACRODERMATITIS ENTEROPATHICA

ALTERNATE DISEASE NAME

■ Zinc deficiency syndrome

■ Zinc depletion syndrome

■ Transient symptomatic zinc deficiency

■ Self-limiting acrodermatitis enteropathica

■ Danbolt-Closs syndrome

HISTORY

■ Symptoms occur within the first few months after birth, often shortly after discontinuation of breast-feeding

■ Development of marked irritability, variable diarrhea & nonspecific dermatitis

PHYSICAL EXAMINATION

■ Presents as red patches and/or scaly plaques

■ Evolution into crusted, vesiculobullous, erosive & pustular plaques

■ Periorificial & acral distribution on face, scalp, hands, feet & anogenital areas

■ Alopecia of scalp & eyebrows

DIFFERENTIAL DIAGNOSIS

■ Seborrheic dermatitis

■ Atopic dermatitis

■ Biotin & multiple decarboxylase deficiencies

■ Essential fatty acid deficiencies

■ Langerhans cell histiocytosis

■ Mucocutaneous candidiasis

■ Glucagonoma syndrome

■ Cystic fibrosis

LABORATORY WORK-UP

■ Plasma or serum zinc level

MANAGEMENT

■ Zinc supplementation

SPECIFIC THERAPY

■ Elemental zinc 50 mg PO per day

CAVEATS AND PITFALLS

■ May develop secondary bacterial or candidal skin infection.

■ Lifetime zinc therapy needed.


ACROKERATOELASTOIDOSIS

ALTERNATE DISEASE NAME

■ Acrokeratoelastoidosis marginalis

■ Acrokeratoelastoidosis of Costa

■ Acrokeratoderma hereditarium punctatum

■ Hereditary papulotranslucent acrokeratoderma

HISTORY

■ Gradual onset of small papules over margins of hands & feet, usually after puberty

■ Remains stable once fully developed

PHYSICAL EXAMINATION

■ Keratotic translucent papules that arise on margins of hands & feet, in a linear distribution

DIFFERENTIAL DIAGNOSIS

■ Keratoelastoidosis marginalis

■ Focal acral hyperkeratosis

■ Flat warts

■ Acrokeratosis verruciformis of Hopf

LABORATORY WORK-UP

■ None

MANAGEMENT

■ No effective therapy

SPECIFIC THERAPY

■ None

CAVEATS AND PITFALLS

■ None





© Cambridge University Press
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Table of Contents

Part I. Diseases; Part II. Therapy.

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