This page intentionally left blank Clinical Dermatology Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of such information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. a LANGE medical book Clinical Dermatology Carol Soutor, MD Clinical Professor Department of Dermatology University of Minnesota Medical School Minneapolis, Minnesota Maria K. Hordinsky, MD Chair and Professor Department of Dermatology University of Minnesota Medical School Minneapolis, Minnesota New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by McGraw-Hill Education, LLC. All rights reserved. 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THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contents Contributors vii 16. Benign Tumors and Vascular Lesions 141 Preface xi 17. Actinic Keratosis, Basal, and Squamous Cell Carcinoma 154 I. FUNDAMENTALS OF DIAGNOSIS AND TREATMENT 1. Structure and Functions of the Skin 1 18. Nevi and Melanoma 163 2. Morphology and Terminology 19. Hair Disorders 175 of Skin Lesions 6 20. Nail Disorders 188 3. History and Physical Examination of the Skin, Hair, and Nails 15 21. Pigment Disorders 195 4. Diagnostic Procedures 20 22. Immunobullous Diseases 204 5. Principles of Diagnosis 25 23. Erythema Multiforme, Stevens– Johnson Syndrome, Toxic Epidermal 6. Principles of Management 31 Necrolysis, Staphylococcal Scalded Skin Syndrome 210 7. Dermatologic Procedures 38 24. Skin Signs of Systemic Disease 219 II. DISEASE-BASED CHAPTERS III. PROBLEM-BASED CHAPTERS 8. Dermatitis 47 25. The Differential Diagnosis of Purpura 229 9. Psoriasis and Other Papulosquamous Diseases 60 26. Pruritus in Patients with No Underlying Skin Disease 238 10. Superficial Fungal Infections 71 27. Fever and Rash 243 11. Viral Infections of the Skin 88 28. Hospital-Acquired Rashes 253 12. Bacterial Infections 97 29. Leg Ulcers 259 13. Infestations and Bites 104 30. Skin Diseases of the Scalp 265 14. Urticaria and Drug Rashes 117 31. Skin Diseases of the Face 268 15. Acne, Rosacea, and Related Disorders 128 32. Skin Diseases of the Arms 272 v vi CONTENTS 33. Skin Diseases of the Hands 274 38. Diseases of the Oral Cavity 290 34. Skin Diseases of the Trunk 277 39. Diseases of the Genitals and Perineum 315 35. Skin Diseases of the Legs 280 40. Cosmetic Concerns 323 36. Skin Diseases of the Feet 283 Index 329 37. Skin Diseases Involving Multiple Body Regions 285 Contributors Rehana L. Ahmed, MD, PhD Neal Foman, MD, MS Assistant Professor Clinical Associate Professor Department of Dermatology Department of Dermatology University of Minnesota Medical School University of Minnesota Medical School Minneapolis, Minnesota Minneapolis, Minnesota Chapter 26 Chapter 29 Bruce Bart, MD Noah Goldfarb, MD Professor Internal Medicine and Dermatology Resident Department of Dermatology University of Minnesota Medical School University of Minnesota Medical School Minneapolis, Minnesota Minneapolis, Minnesota Chapters 31, 32, 33, 34, 35, 36, and 37 Chapters 11, 12 Khaled M. Hassan, MD Andrea Bershow, MD Mohs Micrographic Surgery Assistant Professor Procedural Dermatology Fellow University of Minnesota Medical School Dermatologic SurgiCenter Minneapolis, Minnesota Philadelphia, Pennsylvania Chapters 10, 20 Chapter 40 Kimberly Bohjanen, MD H. Spencer Holmes, MD Associate Professor Clinical Professor Department of Dermatology Department of Dermatology University of Minnesota Medical School University of Minnesota Medical School Minneapolis, Minnesota Minneapolis, Minnesota Chapters 1, 22 Chapter 15 Caleb Creswell, MD Kristen Hook, MD Clinical Assistant Professor Assistant Professor Department of Dermatology Department of Dermatology University of Minnesota Medical School University of Minnesota Medical School Minneapolis, Minnesota Minneapolis, Minnesota Chapter 14 Chapters 8, 27 Bart Endrizzi, MD, PhD Maria K. Hordinsky, MD Assistant Professor Chair and Professor Department of Dermatology Department of Dermatology University of Minnesota Medical School University of Minnesota Medical School Minneapolis, Minnesota Minneapolis, Minnesota Chapters 7, 16 Chapters 19, 30 John Fenyk, MD Laura E. Keck, MD Professor Dermatology Resident Department of Dermatology Department of Dermatology University of Minnesota Medical School University of New Mexico School of Medicine Minneapolis, Minnesota Albuquerque, New Mexico Chapter 24 Chapter 9 vii viii CONTRIBUTORS Phoebe Koch, MD Scott Prawer, MD Park Nicollet Clinic Clinical Assistant Professor Dermatology Department Department of Dermatology St. Louis Park, Minnesota University of Minnesota Medical School Chapter 39 Minneapolis, Minnesota Chapters 10, 12 Ioannis G. Koutlas, DDS, MS Associate Professor Steven Prawer, MD Division of Oral and Maxillofacial Pathology Clinical Professor University of Minnesota Medical School Department of Dermatology Minneapolis, Minnesota University of Minnesota Medical School Chapter 38 Minneapolis, Minnesota Chapter 10 Peter K. Lee, MD, PhD Associate Professor Monica Rani, MD Department of Dermatology Instructor University of Minnesota Medical School Departments of Dermatology and Medicine Minneapolis, Minnesota Northwestern University Chapter 17 Feinberg School of Medicine Chicago, Illinois Steven W. Lin, MD Chapter 25 Dermatology Resident