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Appendix A: Table of Primary and Related Disorders

Bullae Erysipelas [Part III] multiforme [Part III] Fixed [Part III] [Part VI] Tinea (large, multiloculated) [Part III] Urticaria (bullae as secondary lesions) [Part III] Macules Actinic (erythematous) [Part V] Atypical nevi [Part V] Common benign nevi (pigmented) [Part V] Ephelides [Part V] Erysipelas (erythematous) [Part III] (erythematous) [Part III] Erythrasma [Part III] Fixed drug eruption [Part III] Halo nevi [Part V] Impetigo (deep red) [Part VI] Lentigines [Part V] Malignant [Part V] Nodules [Part VI] Basal cell (translucent, dome-shaped) [Part V] (dome-shaped) [Part V] Malignant melanoma [Part V] Molluscum (dome-shaped umbilicated) [Part II] (red) [Part VI] (indurated) [Part V] Verruca vulgaris [Part II] Acne (with or without comedones) [Part VI] Atopic [Part IV] Atypical nevi [Part V] Basal cell carcinoma (translucent, dome-shaped) [Part V] Developed dermal nevi (sharply defined) [Part V] DLE (sharply defined, raised, smooth, shiny) [Part IV] Early compound nevi (dome-shaped) [Part V] Erythema multiforme (erythematous) [Part III]

From: Current Clinical Practice: Skills for Primary Care: An Illustrated Guide D.J. Trozak, D.J. Tennenhouse, and J.J. Russell © Humana Press, Totowa, NJ

369 370 Appendices

Halo nevi [Part V] Keratoacanthoma (dome-shaped) [Part V] (flat-topped, angular, polygonal) [Part II] Malignant melanoma [Part V] Mature compound nevi (sharply defined) [Part V] Mature dermal nevi (pedunculated) [Part V] (small, erythematous) [Part II] Molluscum (dome-shaped umbilicated) [Part II] (rosy red) [Part II] (erythematous, scaling) [Part II] Rosacea (red) [Part VI] (papulovesicle at end of burrow) [Part II] Seborrheic dermatitis (red-brown, follicular) [Part II] [Part V] SLE (sharply defined, may coalesce) [Part IV] Squamous cell carcinoma (indurated) [Part V] Striae distensae (yellow papules as secondary lesions) [Part IV] Tinea (follicular) [Part III] Verruca vulgaris [Part II] Patches (erythematous) [Part V] Asteatosis [Part IV] [Part IV] Erythrasma [Part III] Malignant melanoma [Part V] Rosacea (erythematous) [Part VI] Seborrheic keratosis [Part V] Senile purpura (purple) [Part IV] Striae distensae (linear) [Part IV] Tinea [Part III] Toxicodendron dermatitis (linear) [Part IV] Plaques Actinic keratosis (thin) [Part V] Atypical nevi [Part V] Basal cell carcinoma [Part V] Congenital melanocytic nevi (pigmented) [Part V] Developed compound nevi [Part V] DLE (sharply defined, raised, smooth, shiny) [Part IV] Erysipelas (erythematous) [Part III] Erythema multiforme (erythematous) [Part III] Fixed drug eruption [Part III] (erythematous) [Part VI] Herpes zoster (erythematous) [Part VI] Impetigo (red) [Part VI] Lichen planus (coalescing papules) [Part II] Appendices 371

Malignant melanoma [Part V] Molluscum (tightly-grouped papules) [Part II] Pityriasis rosea (rosy red) [Part II] Psoriasis [Part II] SCLE (sharply defined) [Part IV] Seborrheic keratosis [Part V] SLE (edematous) [Part IV] Squamous cell carcinoma (indurated) [Part V] Tinea (indurated) [Part III] Toxicodendron dermatitis (linear) [Part IV] Urticaria (edematous) [Part III] Pustules Acne [Part VI] Herpes simplex (late) [Part VI] Herpes zoster (late) [Part VI] Miliaria (as secondary lesions) [Part II] Rosacea (dome-shaped) [Part VI] Tinea (follicular) [Part III] Vesicles Atopic dermatitis [Part IV] Erysipelas [Part III] Erythema multiforme [Part III] Fixed drug eruption [Part III] Herpes simplex [Part VI] Herpes zoster [Part VI] Impetigo (small, transient) [Part VI] Miliaria (crystalline, intra-dermal) [Part II] Scabies (papulovesicle at end of burrow) [Part II] Tinea (intra-dermal, small, grouped) [Part III] Toxicodendron dermatitis (linear) [Part IV] Appendix B: Table of Secondary Lesions and Related Disorders

Atrophy DLE (epidermal and dermal) [Part IV] Lichen planus [Part II] SCLE (epidermal) [Part IV] Senile purpura (epidermal) [Part IV] SLE (epidermal and dermal) [Part IV] Calcinosis SLE [Part IV] Crusting Acne (hemorrhagic) [Part VI] Atopic dermatitis [Part IV] Atypical nevi (malignant change) [Part V] Basal cell carcinoma [Part V] Herpes simplex [Part VI] Herpes zoster [Part VI] Impetigo [Part VI] Malignant melanoma (very late) [Part V] Molluscum (on involuting lesions) [Part II] Scabies [Part II] Toxicodendron dermatitis [Part IV] Actinic keratosis [Part V] Squamous cell carcinoma [Part V] Erosions Actinic keratosis [Part V] Atypical nevi (malignant change) [Part V] Basal cell carcinoma [Part V] Congenital melanocytic nevi [Part V] Erysipelas [Part III] Erythema multiforme [Part III] Fixed drug eruption [Part III] Herpes simplex [Part VI] Herpes zoster [Part VI] Lichen planus [Part II] Malignant melanoma (very late) [Part V] Squamous cell carcinoma [Part V] Eschar Acne [Part VI] Basal cell carcinoma (late) [Part V]

373 374 Appendices

Excoriations Atopic dermatitis [Part IV] Congenital melanocytic nevi [Part V] Molluscum [Part II] Scabies [Part II] Toxicodendron dermatitis [Part IV] Fissures Asteatosis [Part IV] Atopic dermatitis [Part IV] Psoriasis (intertriginous areas) [Part II] Seborrheic dermatitis (intertriginous areas) [Part II] Squamous cell carcinoma [Part V] Tinea (intertriginous areas) [Part III] Gangrene Erysipelas [Part III] Herpes zoster [Part VI] SLE [Part IV] Acne [Part VI] DLE [Part IV] Erythrasma [Part III] Fixed drug eruption [Part III] Herpes zoster [Part VI] Impetigo [Part VI] Lichen planus [Part II] Psoriasis [Part II] Senile purpura [Part IV] SLE [Part IV] Tinea [Part III] Hypopigmentation DLE [Part IV] Halo nevi (macular) [Part V] Impetigo [Part VI] Malignant melanoma [Part V] Pityriasis rosea (transient) [Part II] Psoriasis [Part II] SCLE [Part IV] SLE [Part IV] Tinea [Part III] Hypertrichosis Common benign nevi [Part V] Congenital melanocytic nevi [Part V] Impetiginization Asteatosis [Part IV] Erythema multiforme [Part III] Appendices 375

Miliaria [Part II] Scabies [Part II] Tinea [Part III] Toxicodendron dermatitis [Part IV] Lichenification Scabies [Part II] Erythrasma [Part III] Atopic dermatitis [Part IV] Necrosis Erythema multiforme [Part III] Herpes zoster [Part VI] SLE [Part IV] Papillomatosis Compound nevi [Part V] Squamous cell carcinoma [Part V] Purpura Erysipelas [Part III] Erythema multiforme [Part III] Urticaria [Part III] Scale Actinic keratosis (adherent scale) [Part V] Asteatosis (white scale) [Part IV] Atopic dermatitis (loose, white scale) [Part IV] Atypical nevi (malignant change) [Part V] Compound nevi (hyperkeratotic) [Part V] DLE (white adherent scale) [Part IV] Erythrasma (dry, velvety) [Part III] Impetigo (loose, white scale) [Part VI] Lichen planus [Part II] Malignant melanoma [Part V] Pityriasis rosea [Part II] Psoriasis (loose and silvery) [Part II] SCLE [Part IV] Seborrheic dermatitis (loose scale) [Part II] SLE (white adherent scale) [Part IV] Squamous cell carcinoma (adherent scale) [Part V] Tinea [Part III] Toxicodendron dermatitis [Part IV] Scarring Acne [Part VI] Atypical nevi (malignant change) [Part V] Basal cell carcinoma [Part V] DLE [Part IV] Herpes zoster [Part VI] Keratoacanthoma [Part V] 376 Appendices

Lichen planus [Part II] Molluscum (mild scarring) [Part II] Senile purpura (stellate) [Part IV] SLE [Part IV] Tinea [Part III] Sclerosis Basal cell carcinoma [Part V] SLE [Part IV] Telangectasia DLE [Part IV] Rosacea [Part VI] SCLE [Part IV] SLE [Part IV] Ulceration Actinic keratosis [Part V] Atypical nevi (malignant change) [Part V] Basal cell carcinoma (central) [Part V] Congenital melanocytic nevi (benign or malignant change) [Part V] Erysipelas [Part III] Malignant melanoma (very late) [Part V] Squamous cell carcinoma [Part V] Vegetation Keratoacanthoma [Part V] Part I: Color Photographs

377 PHOTO 1 PHOTO 2 Ephelides (), macules of with pigment A blue 3 mm macule caused by a deposit of graphite in the lower and basal cell layer. Note the in the following a pencil jab. Note the lack of lack of distortion of the lines. distortion of the skin lines.

PHOTO 3 PHOTO 4 A “coast of Maine” spot, a patch of melanin pigment in A patch of increased melanin in the upper dermis, the the lower epidermis and basal cell layer. Note the lack end result of a . Note the lack of of distortion of the skin lines. distortion of the skin lines.

PHOTO 5 PHOTO 6 A papular of the upper . The elevation consists A of the upper lid margin that is caused by a of proliferating epidermis. Note the normal skin lines benign cyst in the dermis. Note the shiny surface and are missing. effacement of the epidermis.

379 PHOTO 7 PHOTO 8 A nodular keratoacanthoma. The nodule consists of A nodule of erythema induratum on the shin. This proliferating epidermal cells and the surface lines are is caused by in the dermis and effaced by the debris in the central pit. subcutis. Note although it is easily palpated, there is minimal visible elevation.

PHOTO 9 PHOTO 10 A plaque of caused by a malignant Scaling pebbly plaques of metastatic breast carci- T-cell infiltrate in the dermis. formed by a confluence of papules.

PHOTO 11 PHOTO 12 Pinpoint vesicles on the left evolving to tense bullae Flat intra-epidermal pustules on the heel in a case of several centimeters in size in the center. pustular psoriasis.

380 PHOTO 13 PHOTO 14 Adnexal pustules occur within adnexal skin structures. Adherent white scale in lichen planus. In acne the terminal is affected.

PHOTO 15 PHOTO 16 Adherent brown scale in vulgaris. Silvery white, loosely adherent scale of psoriasis.

PHOTO 17 PHOTO 18 Greasy, yellow, loosely adherent scale of seborrheic Moist eroded lesion of erythema multiforme. dermatitis.

381 PHOTO 19 PHOTO 20 Crusted lesions of nonbullous impetigo. A moist impetiginized lesion of nummular eczema.

PHOTO 21 PHOTO 22 Sclerosis of the upper back in a case of scleredema. Excoriations on the wrist in atopic dermatitis. Note The sclerosis is due to an accumulation of the accentuated skin markings: a change referred to as mucopolysaccharide and fluid. Note the lichenification. “orange-peel” surface and the accentuation of the old . The skin cannot be pinched.

PHOTO 23 PHOTO 24 Linear canal-like fissures on the extremely dry skin of A large seborrheic keratosis with a papillomatous sur- an elderly patient. of epidermal origin.

382 PHOTO 25 PHOTO 26 Lichen amyloidosis. Infiltrates of amyloid substance in in the axilla. The surface projec- the dermis push up and produce papillomatosis. tions of epidermis and dermis produce soft smooth vegetations in this condition.

PHOTO 27 PHOTO 28 An eschar composed of scale, secretion and necrotic Dermal in malignant atrophic papulosis. tissue on the central surface of a basal cell carcinoma. The early papular lesions (left) evolve leaving der- mal atrophy. At edge is a rim of normal dermis.

PHOTO 29 PHOTO 30 Atrophy of the subcutaneous allows visualization of Ulcerations of the epidermis and upper dermis in a a sizable at the base of this depressed lesion of patient with a necrotizing . panatrophy. Epidermal and dermal atrophy are also present.

383 PHOTO 31 PHOTO 32 An elderly diabetic with wet streptococcal gangrene. Dry gangrenous infarcts in a case of severe necrotiz- ing vasculitis.

PHOTO 33 PHOTO 34 Hyperpigmentation from increased basal cell melanin Hyperpigmentation, in this instance hemosiderin pig- in a lesion known as a Becker’s . The focal ment free in the upper dermis from trauma on the toe change in hair growth is called hypertrichosis. of a jogger.

PHOTO 35 PHOTO 36 A patch of . Surrounding the inflamma- Segmental on the posterior would show tory center is a circular zone of partial pigment loss. absent melanin with special stains.

384 PHOTO 37 PHOTO 38 atrophicans vasculare associated with an Annular , note the similarity to a solitary underlying lymphoma. herald patch of pityriasis rosea.

PHOTO 39 PHOTO 40 Arciform lesions of tinea faciale. Polycyclic lesions in a patient with .

PHOTO 41 PHOTO 42 An iris lesion in a case of milker’s nodules (paravaccinia Serpiginous-shaped lesion of elastosis perforans ser- virus infection). piginosum.

385 PHOTO 43 PHOTO 44 A linear birthmark on the preauricular skin. Herpes zoster of the right mid cervical and upper tho- racic dermatome segments. Note the midline cutoff.

PHOTO 45 PHOTO 46 Two groupings of herpetic vesicles on the buttock skin. Netlike pigment deposition in . Color fails to blanch with diascopy indicating pig- ment within tissue as opposed to blood in a vessel.

PHOTO 47 PHOTO 48 A corymbiform . Pyogenic on the neck simulating a melanoma. Note the difference on the right after application of gentle pressure.

386 PHOTO 49 PHOTO 50 Wood’s lamp exam: Pink urine of porphyria cutanea KOH slide showing the long branching hyphae of a tarda, left; normal urine right. fungal infection.

PHOTO 51 PHOTO 52 KOH slide showing the short club-shaped hyphae and Segmented pseudohyphae and round chlamydospores clusters of spores in . of Candida albicans are occasionally seen in KOH preparations.

PHOTO 53 PHOTO 54 Tzanck smear from the base of a herpetic vesicle. Note Scabies prep. shows a mature mite with a matur- the large multinucleated giant cells and epidermal cells ing ovum. These are easily identified under low with enlarged (ballooned) nuclei. power.

387 Part II: Color Photographs

389 PHOTO 1 PHOTO 2 Grouped dome-shaped lesions of molluscum. Note the Grouped molluscum lesions on the of a white central core. child. Several lesions show a dimple and peripheral ridge. Mature lesion on the right shows distinct scale.

PHOTO 3 PHOTO 4 Dusky molluscum lesion which is starting to involute. Typical grouping of molluscum lesions on an inner Note the halo of inflammation at its base. thigh.

PHOTO 5 PHOTO 6 Molluscum smear, expressed contents of lesion float- Early wart on the palmar surface of the inter- ing in physiologic saline. Low and high power. rupts skin lines.

391 PHOTO 7 PHOTO 8 Pedunculated wart on composed of filiform Plantar wart shows dome-shaped papules which inter- papules. rupt skin lines. Note the fine scale and black ends of the thrombosed vessels.

PHOTO 9 PHOTO 10 Large filiform wart on the penile shaft. Corymbiform plantar wart.

PHOTO 11 PHOTO 12 on the and periungual tissue. Clustered partially treated warts on the .

392 PHOTO 13 PHOTO 14 Verrucae of the beard area in a young adult man. Dull red patches of seborrheic dermatitis along the scalp margin.

PHOTO 15 PHOTO 16 Yellow greasy scale at the scalp edge. White loose scale in the scalp.

PHOTO 17 PHOTO 18 Petaloid patches of seborrhea on the mid back. Early rosy-red papules of pityriasis rosea.

393 PHOTO 19 PHOTO 20 Rosy-red plaques of pityriasis rosea. Scale with free edge turned toward the center of the lesion.

PHOTO 21 PHOTO 22 Oval lesions in linear configuration, long axes follow Early papules of psoriasis with loose silvery scale. skin tension lines.

PHOTO 23 PHOTO 24 Plaques formed by centrifugal extension and conflu- Plaques. Some show white mica-like scale. ence.

394 PHOTO 25 PHOTO 26 Macular hyperpigmentation at the sites of resolved Positive Auspitz’s sign. Bleeding points where scale plaques. has been removed.

PHOTO 28 PHOTO 27 Nummular or coin-sized psoriasis lesions in a child. Guttate (small drop-like) lesions of psoriasis. Some have merged into plaques and others are becoming confluent.

PHOTO 29 PHOTO 30 Annular, polycyclic psoriasis lesions. Linear pits strongly support a diagnosis of psori- asis.

395 PHOTO 31 PHOTO 32 Violaceous, angular, flat-topped primary papules of Wickham’s stria in a mucosal lesion of lichen planus. lichen planus. Note the erosion on the right.

PHOTO 33 PHOTO 34 Hypertrophic lichen planus shows plaques with thick Plaques of lichen planus formed by coalescence of adherent white scale. papules. Note the satellite papules at the periphery.

PHOTO 35 PHOTO 36 Mucosal lichen planus. Note the deep violaceous color, Lacy pattern of oral lichen planus. Note the erosions Wickham’s stria, and the erosion on the top. at the extreme upper and lower edges of the photo.

396 PHOTO 37 PHOTO 38 Permanent scarring due to lichen planus of the nail Tiny crystalline vesicles of early miliaria. matrix.

PHOTO 39 PHOTO 40 Red papules of miliaria rubra. Early pustular lesions of miliaria rubra profunda.

PHOTO 41 PHOTO 42 Track of scabies at the base of the forefinger. Note the Linear scabies track at the base of the digit. vesicle.

397 PHOTO 43 PHOTO 44 Linear scabies track. Note the point of entry at the bot- Secondary papular scabies lesions with excoriations, tom of the photo. eczematization, and secondary infection.

PHOTO 45 Ectoparasite prep., shows mature eight-legged itch mite with ova. Ova alone may also be seen.

398 Part III: Color Photographs

399 PHOTO 1 PHOTO 2 Erythrasma showing brown macules and patches in the Tinea pedis and , so-called “two foot– inguinal crease area. Scale and early lichenification one hand disease.” Note the erythema and diffuse present. scale which is accentuated in the palmar creases. Also typical is the “moccasin” distribution on the lateral margins of the feet.

PHOTO 3 PHOTO 4 Inflammatory tinea of hair-bearing area. Note the par- Thick, secondarily infected kerion. Cervical nodes tial alopecia, scale, broken hairs and follicular pustules. were enlarged. Culture grew Microsporum canis.

PHOTO 5 PHOTO 6 Kerion site after 10 days of combined broad spectrum Chronic tinea barbae of the chin. Note the deep antibiotics, prednisone and systemic antifungal ther- inflammatory character of the nodules and the apy. Some scarring and permanent is scarring. expected.

401 PHOTO 7 PHOTO 8 Tinea faciale with advancing scaling margin. Tinea of the neck with a very subtle advancing mar- gin. Color change is partially due to inappropriate use of a topical corticoid.

PHOTO 9 PHOTO 10 Extensive tinea corporis. Note the advancing margin Tinea corporis showing the classic concentric lesions and concentric margins at the lower edge. of ringworm.

PHOTO 11 PHOTO 12 Tinea near the ankle. Note the subtle advancing mar- Boggy nodular tinea on the dorsum of the hand and gin, inflammatory pustules, papules and nodules. wrist.

402 PHOTO 13 PHOTO 14 with advancing margin extending from the Diffuse tinea of the sole. Note the margin that inguinal crease onto the inner thigh. extends in a moccasin-like fashion across the instep. Also note the scale and fissures at the base of the toes.

PHOTO 15 PHOTO 16 Deep-seated vesicles on the instep in a case of tinea Tinea unguium causing distal separation, dystrophy pedis. KOH prep. was positive. can and discoloration of the nail plate. cause identical lesions which are KOH negative.

PHOTO 17 PHOTO 18 Tinea unguium showing white superficial onycho- Positive KOH preparation. Long, refractile, branching mycosis of nail 3 and distal subungual involvement of hyphae. nail 2.

403 PHOTO 19 PHOTO 20 Vesicular on the hand caused by an inflam- Wheals of common urticaria. The lesions vary in size, matory tinea pedis. These vesicles are KOH negative. are palpably raised and the centers show a pink or white color depending on the degree of edema.

PHOTO 21 PHOTO 22 Common showing papules and confluent Hives with polycyclic borders. plaques. Some of the more edematous lesions have white centers.

PHOTO 23 PHOTO 24 Early fixed drug eruption in the form of an indurated Fixed drug eruption in the form of a dusky, violet- plaque of the and upper cheek. brown plaque on the dorsum of the foot. Underlying tendons are not visible.

404 PHOTO 25 PHOTO 26 Acute bullous fixed drug reaction to sulfa. Persisting hyperpigmentation after resolution of the fixed acute drug reaction in photo 25.

PHOTO 27 PHOTO 28 Plaque of sharply marginated, tender erysipelas in a of the shin. Ill-defined patches of tender classic location. warm erythema.

PHOTO 29 PHOTO 30 Erysipelas which has become vesicular. Erythema multiforme showing early papular and developing plaque lesions with dusky centers.

405 PHOTO 31 PHOTO 32 Enlarged view of erythematous plaque lesions showing Vesiculobullous erythema multiforme. early hemorrhage in the center.

PHOTO 33 PHOTO 34 Target or iris lesions of erythema multiforme on the Hemorrhagic crusted lesions of the vermilion margin palmar skin. of the .

PHOTO 35 Close-up of a target lesion on the palmar surface of the digit.

406 Part IV: Color Photographs

407 PHOTO 1 PHOTO 2 Early DLE. Photo shows a plaque with a papule above. A discrete plaque of DLE near the sideburn. Early The lesions are becoming confluent. Note the accentu- white scale is evident and in the center it shows a dis- ation of the hair follicle openings, the loss of normal tinct follicular pattern. skin surface pattern and shiny surface.

PHOTO 3 PHOTO 4 Developed plaque of DLE with thick adherent white DLE of forehead at hairline shows an advancing scale. Central scale has become mounded and brown- indurated margin with telangiectatic vessels. Central ish-yellow. area shows hypopigmentation where activity of dis- ease has burned out.

PHOTO 5 PHOTO 6 Pigmentary changes in chronic scarring DLE. Hypopigmented scar at the hairline in chronic DLE.

409 PHOTO 7 PHOTO 8 Punched out DLE scar. Note the typical white base Scarring DLE of the scalp often results in permanent with telangiectatic blood vessels. alopecia.

PHOTO 9 PHOTO 10 Discoid lesion in sideburn shows a margin with ery- DLE lesions suggest a butterfly pattern, but are absent thema and telangectasia, a white depressed center and over the upper central face and show asymmetry on peripheral scale. the upper lip.

PHOTO 11 PHOTO 12 DLE flare following an acute . Squamous cell carcinoma of the nasal ala arising in a burned out DLE lesion.

410 PHOTO 13 PHOTO 14 SCLE, extensive lesions were present on other light- Close-up of lesions in photo 13. Note the sharp mar- exposed sites (see photo 17). Note the papulosquamous gins, mixture of papules and plaques, telangiectatic character and the mixture of sharply demarcated vessels and the loose central white scale. papules and plaques.

PHOTO 15 PHOTO 16 SCLE: Extensive chest lesions. Many are developing Sharply demarcated papules and plaques. Lesion with an annular configuration. biopsy site exhibits areas of central gray-white hypopigmentation and atrophy.

PHOTO 17 PHOTO 18 SCLE onset with skin lesions showing distinct photo- Butterfly of . In this instance the patient has accentuation. Covered skin areas were clear. SCLE without evidence of .

411 PHOTO 19 PHOTO 20 Pruritic papular eruption extensor surface of limb in a Papular erythema on the dorsum of the . Similar patient with SLE. changes are seen in cases of dermatomyositis.

PHOTO 21 PHOTO 22 Ragged cuticle, opaque nailbed with absence of the The results of severe peripheral vascular involvement lunula and prominent tortuous in the proxi- in a case of SLE. mal nail fold. These changes are seen in SLE and other major connective tissue diseases.

PHOTO 23 PHOTO 24 DLE-like lesion on the foot in a patient with SLE. Linear plaques and patches of erythema typical of toxicodendron dermatitis.

412 PHOTO 25 PHOTO 26 Linear streaks and patches of vesicles also typical of a Secondary infection with honey-colored exudate, fis- plant-acquired allergic contact dermatitis. suring, scale and crusting. This can occur with any acute eczematous process.

PHOTO 27 PHOTO 28 Confluent dermal edema common with secondary Early patchy linear toxicodendron dermatitis with transfer or airborne exposure to the antigen. vesicles can simulate early Herpes zoster with mini- mal neuritis.

PHOTO 29 PHOTO 30 Perioral eczema in a young woman with atopic der- Eczema of the hands in a man with classic flexural atopic matitis. Note the mild wrinkling and lichenification lat- dermatitis. Note the focal lesions which began as rings of erally; also note the reaction is limited to an area pruritic vesicles. Also note the lichenification, excoriations, reached by the tongue. painful fissures, crusting and paronychial involvement.

413 PHOTO 31 PHOTO 32 Eczema of the proximal nail fold. Note the edema, loss Scalp eczema shows erythema, white scale, excoria- of the cuticle and the early rippling of the nailplates on tions and secondary impetiginization. digits 3 and 4.

PHOTO 33 PHOTO 34 Allergic shiners. Morgan-Dennie’s line of the lower eyelid.

PHOTO 35 PHOTO 36 Pityriasis alba in the active phase as a scaling pink Pityriasis alba, the erythema has resolved leaving sub- patch. tle pigment loss.

414 PHOTO 37 PHOTO 38 Atopic palmar markings. Delayed white dermographism in an area of active atopic dermatitis. Note the “A,” “T,” and partial “O.”

PHOTO 39 PHOTO 40 Ichthyosis, “like fish scale” on the shin of a patient on the of an atopic person. with atopic dermatitis.

PHOTO 41 PHOTO 42 Buffed nails from scratching. Early atopic dermatitis shows patches of erythema, papules and papulovesicles.

415 PHOTO 43 PHOTO 44 Lichenified eczema of the antecubital fossa. Note the Xerotic skin is dull, scaly and shows fine wrinkling indistinct margins and excoriations. with focal areas of erythema.

PHOTO 45 PHOTO 46 More severe xerosis with fissuring erythema and early Long canal-like fissures with exudate in the base. impetiginization.

PHOTO 47 PHOTO 48 Craquelé or crazy-pavement pattern. Irregular patches of purpura following minor trauma. Note also the epidermal atrophy from chronic solar damage. Patchy tan pigment is left from prior episodes. 416 PHOTO 49 PHOTO 50 More advanced atrophy, small foci of purpura and Light transverse stria in a teen-aged weightlifter. white stellate from epidermal tears.

PHOTO 51 PHOTO 52 Extensive fan-shaped stria on the lower back in a Dark wide stria from abuse of potent topical steroids. patient on long-term, high-dose systemic steroids.

417 Part V: Color Photographs

419 PHOTO 1 PHOTO 2 Field of early 1–4 mm seborrheic keratosis. Yellow-tan Seborrheic keratosis. Typical mature, “stuck on” yel- color, dull, stuck on, some show comedones on surface. low-tan lesion. Note multiple tiny early SKs in the field.

PHOTO 3 PHOTO 4 Developed brown-black seborrheic keratosis, stuck on Typical ephelides in a teenager of Celtic heritage. with inflammation at the base. Contrast with smaller 1–3 mm yellow-tan SKs in field.

PHOTO 5 PHOTO 6 Non-solar . Individual lesions are clinically Front and back view of a man with extensive solar- indistinguishable from junctional nevi. induced lentigines. Note the scar on the left upper anterior where an in situ melanoma was discovered.

421 PHOTO 7 PHOTO 8 Junctional nevus, right lower corner, developed com- Early compound nevi lower center, mature compound pound nevi right upper and left lower corners. or developed dermal nevus upper center.

PHOTO 9 PHOTO 10 Mature pink-tan dermal nevi, center, contrast color and Mature soft dermal nevus lower eyelid. Compare with reflectance with several dull yellow and grey-tan SKs pedunculated SKs on the upper lid and outer canthus. in the same field.

PHOTO 11 PHOTO 12 Large nevus with a mammillated cerebriform surface. Mature benign compound or dermal nevus with scale.

422 PHOTO 13 PHOTO 14 Mature compound nevus with long terminal hair Mature compound nevus. The dark spots are keratotic growth. plugs or comedones.

PHOTO 15 PHOTO 16 Halo nevus of Sutton. Note the central regressing pink- Depigmented macule at site of totally regressed brown compound nevus with an achromic border. nevus. Same patient as photo 15.

PHOTO 17 PHOTO 18 Primary lesion in patient with atypical mole syndrome. Atypical nevus close-up. Note the irregular shape, Irregular shape and color. Mammillated surface with an color and margins. indistinct macular margin. Compare with other typical benign junctional moles in the same photo.

423 PHOTO 19 PHOTO 20 Atypical mole syndrome. Note the irregular and vari- Atypical mole syndrome. Note the irregular and vari- able appearance of the nevi. able appearance of the nevi.

PHOTO 21 PHOTO 22 Medium-sized CMN. Note the mammillated surface, Medium-sized CMN. Note the speckled surface, dis- irregular but not truly notched border, dark terminal tinct but irregular margins and the central pink-tan hair and speckling. Lesion is a uniform plaque. benign compound component.

PHOTO 23 PHOTO 24 Congenital melanotic nevus, medium sized. Note the An acquired congenital pattern nevus. raised mammillated surface. Contrast with the 5 mm compound nevus at the bottom of the photo.

424 PHOTO 25 PHOTO 26 Giant congenital melanotic nevus (bathing trunk type). Superficial spreading malignant melanoma. Asym- Note the speckled variable color and elevation. metric, irregular border and color, size exceeds 6 mm. Note the central raised papule, a sign of invasion.

PHOTO 27 PHOTO 28 maligna. Irregular pigmentation, irregular Acral lentiginous melanoma of the nail bed. Note the margins and the lesion is typically quite large. Entire asymmetry and blush of lighter brown pigment at the surface is still macular and lesion is still in situ. periphery. Skin markings are still retained.

PHOTO 29 PHOTO 30 SSMM. Note the notched, pseudopod-like border. SSMM, shows loss of skin markings, irregular border, Lesion is asymmetric and size exceeds 6 mm. Contrast asymmetry and a developing central papular area. its highlighted surface with the dull yellow-tan SK Compare with the mature dermal nevus at the bottom. immediately adjacent.

425 PHOTO 31 PHOTO 32 Early SSMM. Some asymmetry, speckling, drama- SSMM. Asymmetric, irregular notched border, color tically contrasting color areas, early border notching. varies from white to pink to blue-grey to brown and Size exceeds 6 mm. brown-black. Nodule at lower edge indicates vertical growth.

PHOTO 33 PHOTO 34 LMM of the nasal bridge. Note the asymmetry, size, presenting as a deeply pigmented irregular color and areas of speckling. Border is also rapidly growing lesion with loss of skin lines. Deep notched. color correlates with depth.

PHOTO 35 PHOTO 36 Nodular melanoma with irregular base. Erythematous actinic keratosis with a fine adherent yel- low scale. Note the tiny bleeding point where scale has been removed. Lesion is easier to detect by palpation than by vision.

426 PHOTO 37 PHOTO 38 Actinic keratosis of helix shows focal erythema, adher- Cutaneous horn of antihelix. This one had a squa- ent white and brown scale. mous cell carcinoma at the base. Note the thick white AK near the apex of the helix.

PHOTO 39 PHOTO 40 White actinic of the lower lip with scale. Keratoacanthoma on dorsum of hand. Note the dull Central area shows erosion and ulceration. central core and dilated surface vessels. Note also the adjacent AK with white scale and the chronic actinic damage.

PHOTO 41 PHOTO 42 Keratoacanthoma of upper lip. Nodular keratoacanthoma.

427 PHOTO 43 PHOTO 44 Depression and epithelial tags at the site of a regress- Translucent papular BCC of temple. Note the devel- ing keratoacanthoma. oping central dell and compare with the yellow-tan SK above.

PHOTO 45 PHOTO 46 Translucent papular BCC of nasal bridge with dilated Nodular basal cell. Note the small erosions and vessels. depressed areas. Also note the translucent character and dilated surface vessels.

PHOTO 47 PHOTO 48 Nodular BCC with central erosion and prominent sur- Yellow-pink scaling depression of upper lip is actu- face vessels. ally a sizable BCC.

428 PHOTO 49 PHOTO 50 Subtle yellow-pink plaque with loss of skin markings BCC presenting as a white plaque. is actually a superficial BCC.

PHOTO 51 PHOTO 52 Red plaque BCC with central dell, raised thready bor- BCC presenting as a red plaque with loss of skin der and erosion. lines, surface erosions and scale.

PHOTO 53 PHOTO 54 BCC with areas of regression and pigmentation. Nodular BCC with pigmented areas. Differential would include nodular melanoma.

429 PHOTO 55 PHOTO 56 BCC which has ulcerated and spread peripherally. BCC with central rodent and peripheral exten- sion.

PHOTO 57 PHOTO 58 Neglected BCC covers most of the scalp and extends Early SCC. Note the deep indurated quality of the into bone. Shows erosions, ulceration, crusting, scar- papule. ring and eschar formation.

PHOTO 59 Large nodular ulcerating SCC.

430 Part VI: Color Photographs

431 PHOTO 1 PHOTO 2 Non-bullous impetigo with early small vesicles (upper Ruptured vesicle leaving a moist burnished red base. photo.) and older lesions which have ruptured, enlarged and coalesced.

PHOTO 3 PHOTO 4 Bullous impetigo shows grouped vesicles of various Impetigo. Early are clear while the older cen- sizes. tral is clouding as inflammatory cells accumu- late.

PHOTO 5 PHOTO 6 Scaling plaque of impetigo with areas of spontaneous Lesion of bullous impetigo with a peripheral hemor- resolution. rhagic crust.

433 PHOTO 7 PHOTO 8 Herpetic that had been recurrent for over a Periocular Herpes simplex. decade before the diagnosis was made. Multiple hospi- talizations and courses of antibiotics were given need- lessly for the accompanying viral .

PHOTO 9 PHOTO 10 Herpes. Grouped umbilicated vesicles on an erythe- Solitary lesion of Herpes genitalis on the penile shaft. matous urticarial base. Note the two warts in the foreground.

PHOTO 11 PHOTO 12 A typical location for Herpes genitalis in female vic- Eroded triggered by lip . Today tims. Lesions are clouding and becoming pustular. this complication can be prevented with prophylactic antiviral therapy.

434 PHOTO 13 PHOTO 14 Tzanck smear shows multinucleated syncytial giant High power view of giant cell and with cells and epidermal cells with ballooned nuclei typical ballooned nuclei. of herpes virus cytopathic effect.

PHOTO 15 PHOTO 16 Hemorrhagic and necrotic zoster of the ophthalmic Ramsay-Hunt syndrome with vesicles in the concha branch of the fifth cranial . Note Hutchinson’s accompanied by severe pain in the ear. sign is present and there is injection of the sclera of the right eye.

PHOTO 17 PHOTO 18 Ramsay-Hunt syndrome (same case) demonstrating a Sacral Herpes zoster of left segments S-2, 3, 4. complete facial nerve paralysis on the same side.

435 PHOTO 19 PHOTO 20 Generalized Herpes zoster in a patient with chronic Hemorrhagic zoster in a patient with advanced lymphocytic leukemia. myeloma. Suppression of the is responsible for the absence of the inflammatory base.

PHOTO 21 PHOTO 22 Groups of vesicle traveling down a nerve segment on Herpes zoster in the same case as photo 21 with seg- the arm and forearm. mental lesions on the palm.

PHOTO 23 PHOTO 24 Segmental zoster with sharp midline cutoff. Positive Tzanck smear shows giant cells, balloon cells Umbilicated vesicle and pustules are present. and acute inflammatory cells.

436 PHOTO 25 PHOTO 26 Early grade I comedonal acne. Closed comedones and More advanced grade I acne with closed cysts, and occasional open comedones are present. open and closed comedones.

PHOTO 27 PHOTO 28 Open and closed comedones with a single inflamed Early grade II acne also shows inflammatory follicu- papule in the center of the photo. lar papules and pustules.

PHOTO 29 PHOTO 30 Inflammatory papules and pustules that are coalescing Nodules, cysts, and sinus tracts of grade III acne. into nodules. Note also the appearance of ice-pick scar- ring.

437 PHOTO 31 PHOTO 32 Grade III acne. Large inflammatory papules have Post-acne pigmentation. The erythema component become confluent to form cysts and sinus tracts. Note will fade within 3-4 months; the tan melanin compo- also scattered crusts and eschars. nent may take months or years to diminish.

PHOTO 33 PHOTO 34 Acne of the upper back and shoulder causing hyper- Typical facial acne, mild grade II. trophic scarring.

PHOTO 35 PHOTO 36 Moderate grade II acne of the upper back. Mild grade II acne on the central chest.

438 PHOTO 37 PHOTO 38 Erythematous telangiectatic rosacea; only occasional Papulopustular rosacea with a component of sebor- papules and pustules are evident. Erythema is the pre- rheic dermatitis. dominant finding.

PHOTO 39 PHOTO 40 Severe rosacea with inflammatory nodules. Severe papulopustular rosacea with dome-shaped pustules and nodules.

PHOTO 41 Rosacea. Edema causing a shiny orange-peel appear- ance to the upper cheek.

439 Index

A secondary lesions, 288 self-medication, 288 Acne vulgaris, 345 , 289 configuration, 348 supplemental history, 288 differential diagnosis, 356 supporting data, 289 distinguish from rosacea, 364 therapy, 290 distribution, 348 AD, see Atopic dermatitis evolution of disease process, 346 Adnexal pustule, illustration, 10 evolution of skin lesions, 346 AIDS macrodistribution illustrations, 349 distinguish from pityriasis rosea, 81 onset, 345 in relation to pityriasis rosea, 78 physical exam, 347 in relation to tinea, 125 primary lesions, 347 AK, see Actinic keratosis provoking factors, 347 Allergic contact dermatitis secondary lesions, 348 distinguish from erysipelas, 157 self-medication, 347 distinguish from tinea pedis, 132 supplemental history, 347 Allergic vasculitis supporting data, 348 distinguish from erythema multiforme, 168 therapy, 348 ALMM (acral lentiginous ) Acne-like drug eruptions , distinguish from , distinguish from acne vulgaris, 357 131 ACPN (acquired “congenital pattern” melanotic ANA (antinuclear antibody) nevus) Anesthetics, topical therapy Acquired ichthyosis basics, 44 distinguish from asteatotic eczema, 217 Angioneurotic edema enteropathica distinguish from erysipelas, 158 distinguish from seborrheic dermatitis, 67 Anhidrotic resembling Actinic keratosis, 287 atopic dermatitis, 211 differential diagnosis, 291 Annular configuration distinguish from common skin cancers, squa- basics, 18 mous cell carcinoma, 309 erythema multiforme, 164 distinguish from lentigines, 248 illustrations, 10 distinguish from Seborrheic keratosis, 238 impetigo, 319 distribution, 288 lichen planus, 95 evolution of disease process, 287 , subacute cutaneous, evolution of skin lesions, 288 182 macrodistribution, illustrations, 289 psoriasis, 86 onset, 287 tinea, 125 physical exam, 288 urticaria, 138 primary lesions, 288 ANS, see Atypical nevus syndrome provoking factors, 288

441 442 Index

Antihistamines Atopic eczema, see atopic dermatitis systemic therapy Atrophy basics, 45 basics, 14 topical therapy dermal, illustration, 15 basics, 44 epidermal, illustration, 15 Antipruritics subcutaneous, illustration, 15 topical therapy Autoimmune diseases in relation to Lichen pla- basics, 45 nus, 94 Arciform configuration, B basics, 19 illustration, 19 Bacterial tinea, 125 distinguish from seborrheic dermatitis, 73 Asteatotic eczema, 213 distinguish from tinea cruris, 132 configuration, 215 distinguish from tinea pedis, 132 differential diagnosis, 217 Bacterial distribution, 215 distinguish from Herpes simplex recidivans, evolution of disease process, 214 333 evolution of skin lesions, 214 Basal cell carcinoma macrodistribution, illustrations, 216 distinguish from keratoacanthoma, 296 onset, 213 distinguish from melanocytic nevi, acquired, physical exam, 215 257 primary lesions, 215 distinguish from , provoking factors, 214 56 secondary lesions, 215 distinguish from verruca vulgaris, 64 self-medication, 214 Basal cell carcinoma, see common skin cancers supplemental history, 215 distinguish from common skin cancers, squa- supporting data, 215 mous cell carcinoma, 309 therapy, 215 Basal cell epithelioma, see common skin cancers Ataxia resembling atopic dermati- Bateman’s purpura, see senile purpura tis, 211 BCC, see Basal cell carcinoma (epithelioma) Atopic dermatitis, 199 Bedbug bites complications, 200 distinguish from toxicodendron dermatitis, configuration, 203 196 differential diagnosis, 210 Biopsy distinguish from seborrheic dermatitis, 67, 74 elliptical incision, basics, 33 distribution, 203 elliptical incision, illustration, 34 evolution of disease process, 200 excisional, basics, 35 evolution of skin lesions, 201 excisional, illustration, 35 macrodistribution, illustrations, 204, 205, 206 incisional, basics, 31 onset, 200 punch, illustration, 32 physical exam, 203 saucerization, basics, 33 primary lesions, 203 saucerization, illustration, 34 provoking factors, 202 shave incision, basics, 32 secondary lesions, 203 shave incision, illustration, 33 self-medication, 202 skin, basics, 30 supplemental history, 203 Bowen’s epithelioma supporting data, 203 basal cell carcinoma/epithelioma, 304 therapy, 203 distinguish from common skin cancers types, 200 squamous cell carcinoma, 309 Index 443

Bulla configuration, 302 basics, 8 differential diagnosis, 304 illustration, 10 distribution, 302 evolution of disease process, 300 distinguish from erythema multiforme, 167 evolution of skin lesions, 301 distinguish from impetigo, 322 macrodistribution, illustrations, 302 Butterfly rash, lupus erythematosus, systemic onset, 299 illustration, 186 physical exam, 301 primary lesions, 301 C provoking factors, 301 Cafe-au-lait spots secondary lesions, 301 distinguish from melanocytic nevi, congeni- self-medication, 301 tal, 268 skin biopsy, 303 Caine anesthetics skin phototypes, table, 299 topical therapy, basics, 44 supplemental history, 301 Calcinosis supporting data, 303 basics, 16 therapy, 303 Cancers, common skin, see common skin can- Common skin cancers, squamous cell carci- cers noma, 305 , thrombosed configuration, 307 distinguish from malignant melanoma, 284 differential diagnosis, 308 Celiac disease resembling atopic dermatitis, 211 distribution, 307 Cellulitis, see erysipelas evolution of disease process, 305 Chancroid evolution of skin lesions, 305 distinguish from Herpes simplex recidivans, macrodistribution, illustrations, 307 333 onset, 305 Chronic facial edema, rosacea, 361 physical exam, 306 Cicatrix or scar, basics, 14 primary lesions, 306 Clostridial infection provoking factors, 305 distinguish from erysipelas, 158 secondary lesions, 306 CMN, see Congenital melanotic nevus self-medication, 306 Coast of Maine spots skin biopsy, 308 distinguish from melanocytic nevi, congeni- supplemental history, 306 tal, 268 supporting data, 308 Cold sores, see Herpes simplex recidivans therapy, 308 Color examination Configuration basics, 22 basics, 18 Common benign nevi recognizing 18 distinguish from melanocytic nevi, congeni- Congenital pattern melanocytic nevi, see tal, 268 melanocytic nevi, congenital Common compound nevi Contact allergens distinguish from common skin cancers, basal distinguish from toxicodendron dermatitis, cell carcinoma/epithelioma, 304 195 Common nevi Contact dermatitis distinguish from melanocytic nevi, acquired distinguish from atopic dermatitis, 210 atypical, 263 distinguish from erysipelas, 157 Common skin cancers, 299 distinguish from tinea pedis, 132 Common skin cancers, basal cell carcinoma/ Cornu cutaneum epithelioma basics, 16 444 Index

Corymbiform configuration Doxepine, topical therapy basics, 22 basics, 44 illustration, 22 Drug eruption, fixed, see fixed drug eruption verruca vulgaris, 61 Drug eruptions in relation to pityriasis rosea, 78 Creams, basics, 39 distinguish from tinea pedis, 132 vehicles, 39 E Crust basics, 11 Ectoparasite exam illustration, 13 basics, 30 Cryptococcosis Eczema distinguish from molluscum contagiosum, 56 asteatotic, 213 Cutaneous horn distinguish from tinea pedis, 132 basics, 16 nummular Cutaneous T-cell lymphoma distinguish from asteatotic eczema, 217 distinguish from atopic dermatitis, 211 distinguish from atopic dermatitis, 210 distinguish from common skin cancers, D basal cell carcinoma/epithelioma, , see Seborrheic dermatitis 304 Dermal atrophy distinguish from pityriasis rosea, 81 illustration, 15 distinguish from psoriasis vulgaris, 90 Dermal lesions, 115, 173 distinguish from seborrheic dermatitis, 73 distinguish from tinea corporis, 132 distinguish from melanocytic nevi, acquired, Eczema herpeticum 257 Herpes simplex recidivans, 327 Elliptical incision biopsy distinguish from erythema multiforme, 167 basics, 33 Dermatofibroma illustration, 34 distinguish from malignant melanoma, 284 ELND (elective lymph node ) Dermatophyte infections in relation to lichen EM, see Erythema multiforme planus, 94 Emollients, topical therapy Dermatophytosis, intertriginous basics, 43 distinguish from erythrasma, 120 Enhancers, topical therapy, basics, 44 Dermatophytosis, see Tinea Ephelides, 241 Diagnostic aids configuration, 242 basics, 22 differential diagnosis, 242 Diagnostic data distinguish from lentigines, 248 basics, 29 distribution, 242 supporting, 29 evolution of disease process, 241 Diascopy evolution of skin lesions, 241 basics, 24 onset, 241 Discoid configuration physical exam, 241 Lupus erythematosus, 178 primary lesions, 241 Discoid lupus erythematosus provoking factors, 241 distinguish from actinic keratosis, 292 secondary lesions, 242 Distribution self-medication, 241 basics, 16 supplemental history, 241 recognizing, 16 supporting data, 242 DLE , see lupus erythematosus, discoid therapy, 242 Index 445

Epidermal atrophy Erythrasma, 117 illustration, 15 configuration, 118 Epidermal lesions, 115, 173 differential diagnosis, 119 Epithelial nevi distinguish from tinea pedis, 132 distinguish from melanocytic nevi, congeni- distribution, 118 tal,, 268 evolution of disease process, 117 Equipment list for examination, basics, 25 evolution of skin lesions, 117 Erosion intertriginous basics, 11 distinguish from tinea cruris, 132 illustration, 13 macrodistribiution, illustrations, 119 Erysipelas, 153 onset, 117 configuration, 155 physical exam, 118 differential diagnosis, 157 primary lesions, 118 distribution, 155 provoking factors, 117 evolution of disease process, 153 secondary lesions, 118 evolution of skin lesions, 154 self-medication, 117 macrodistribution, illustrations, 156 supplemental history, 118 onset, 153 supporting data, 118 physical exam, 154 Eschar primary lesions, 154 basics, 13 provoking factors, 154 illustration, 15 secondary lesions, 155 Examination equipment self-medication, 154 basics, 25 supplemental history, 154 list for, 25 supporting data, 155 Excisional biopsy therapy, 155 basics, 35 Erysipeloid illustration, 35 distinguish from erysipelas, 157 Excoriations Erysipelothrix insidiosa infection basics, 12 distinguish from erysipelas, 157 F Erythema multiforme, 161 configuration, 164 FDE, see Fixed drug eruption differential diagnosis, 167 blisters, see Herpes simplex recidivans direct , 164 Fissures distribution, 164 basics, 12 evolution of disease process, 162 illustration, 13 evolution of skin lesions, 162 Fixed drug eruption, 147 Herpes simplex recidivans, 327 configuration, 149 macrodistribution, illustration, 165 distribution, 149 onset, 161 drugs causing, table, 148 physical exam, 163 evolution of disease process, 147 primary lesions, 163 evolution of skin lesions, 147 provoking factors, 163 foods causing, table, 148 secondary lesions, 163 macrodistribution, illustrations, 150 self-medication, 163 onset, 147 skin biopsy, 164 physical exam, 149 supplemental history, 163 primary lesions, 149 supporting data, 164 provoking factors, 148 therapy, 164 secondary lesions, 149 446 Index

self-medication, 148 Herpes genitalis, see Herpes simplex recidivans supplemental history, 148 Herpes labialis supporting data, 149 distinguish from impetigo, 322 therapy, 149 see Herpes simplex recidivans Foams Herpes simplex recidivans, 325 basics, 40 complement fixation tests, 329 vehicles, 40 complications, 327 Follicular configuration configuration, 329 seborrheic dermatitis, 69 differential diagnosis, 332 Freckles, see Ephelides distinguish from Herpes zoster, 343 Fungus infection distribution, 329 deep evolution of disease process, 326 distinguish from molluscum contagiosum, evolution of skin lesions, 328 56 onset, 326 in relation to lichen planus, 94 physical exam, 328 intertriginous primary lesions, 328 distinguish from erythrasma, 120 provoking factors, 328 superficial, see Tinea rapid immunofluorescent tests for Herpes, 330 secondary lesions, 328 G self-medication, 328 Gangrene skin biopsy, 329 basics, 14 supplemental history, 328 Gels supporting data, 329 basics, 39 therapy, 330 vehicles, 39 Tzanck smear, 329 Graft versus host reactions in relation to lichen Herpes zoster, 335 planus, 94 complement fixation tests, 339 Gram-negative complications, 337 distinguish from acne vulgaris, 357 configuration, 339 distinguish from tinea barbae, 131 differential diagnosis, 343 Gram-negative toe web infection distinguish from toxicodendron dermatitis, 196 distinguish from tinea pedis, 132 distribution, 339 Grouped configuration divisions of trigeminal nerve, illustrations, 337 actinic keratosis, 289 evolution of disease process, 335 basics, 21 evolution of skin lesions, 338 Herpes simplex recidivans, 329 onset, 335 illustration, 22 physical exam, 338 impetigo, 319 postherpetic neuralgia treatment, 342 lichen planus, 95 primary lesions, 338 miliaria rubra, 102 provoking factors, 338 molluscum contagiosum, 53 rapid immunofluorescence test, 340 rosacea, 362 secondary lesions, 339 verruca vulgaris, 61 self-medication, 338 H skin biopsy, 339 supplemental history, 338 Halo melanoma supporting data, 339 distinguish from melanocytic nevi, acquired, therapy, 340 halo nevi, 258 Tzanck smear, 339 Hand, foot, and mouth disease viral culture, 339 distinguish from erythema multiforme, 167 Index 447

Heterozygous cystic fibrosis resembling atopic of scalp, distinguish from tinea capitis, 131 dermatitis, 211 onset, 317 History-taking basics physical exam, 319 evolution of disease process, 3 primary lesions, 319 evolution of skin lesions, 4 provoking factors, 318 onset, 3 secondary lesions, 319 provoking factors, 4 self-medication, 319 self-medication, 4 supplemental history, 319 supplemental review from general history, 4 supporting data, 319 HIV (human immunodeficiency virus) therapy, 321 Hives, see Urticaria Incisional biopsy HSV (Herpes simplex virus) basics, 31 HSV-1 (Herpes simplex virus, Type 1) Indicated supporting diagnostic data HSV-2 (Herpes simplex virus, Type 2) basics, 29 HTLV type-1 associated infective dermatitis Infantile seborrheic dermatitis resembling atopic dermatitis, 211 onset, 67 Hurler’s syndrome resembling atopic dermatitis, Intra-epidermal pustule 211 illustration, 10 Hyperpigmentation Intralesional steroid therapy basics, 14 basics, 45 illustration, 15 Iris configuration Hypertrichosis, basics, 12 basics, 19 Hypopigmentation erythema multiforme, 164 basics, 14 illustration, 20 illustration, 16 melanocytic nevi, acquired halo nevi, 258 Hypotrichosis J basics, 12 HZV (Herpes zoster virus) Junctional nevi distinguish from lentigines, 247 I Jung’s disease resembling atopic dermatitis, 211 Ichthyosis distinguish from asteatotic eczema, 217 K Immunodeficiencies KA, see Keratoacanthoma distinguish from seborrheic dermatitis, 67 Keratoacanthoma, 293 primary, 67 configuration, 295 , in molluscum differential diagnosis, 296 contagiosum, 52 distinguish from common skin cancers, squa- Impetiginization mous cell carcinoma, 309 basics, 11 distinguish from molluscum contagiosum, 56 Impetigo, 317 distinguish from verruca vulgaris, 64 configuration, 319 distribution, 295 differential diagnosis, 322 evolution of disease process, 293 distinguish from Herpes simplex recidivans, evolution of skin lesions, 294 332 macrodistribution, illustrations, 295 distribution, 319 onset, 293 evolution of disease process, 317 physical exam, 294 evolution of skin lesions, 318 primary lesions, 294 macrodistribution, illustrations, 320, 321 provoking factors, 294 nonbullous, distinguish from atopic dermatitis, secondary lesions, 294 210 448 Index

self-medication, 294 self-medication, 94 skin biopsy, 296 skin biopsy, 96 supplemental history, 294 supplemental history, 94 supporting data, 296 supporting data, 96 therapy, 296 therapy, 97 KOH exam Lichen planus-like drug eruptions basics, 29 distinguish from lichen planus, 98 in relation to lichen planus, 94 L Langerhan’s cell histiocytosis distinguish from atopic dermatitis, 210 distinguish from seborrheic dermatitis, 67 distinguish from seborrheic dermatitis, 74 LCMN (Large congenital melanotic nevus) Lichenification LE, see Lupus erythematosis basics, 12 Lentigines, 245 Lighting configuration, 246 basics, 23 differential diagnosis, 247 examination, 23 distinguish from ephelides, 242 Linear configuration distribution, 246 basics, 19 evolution of disease process, 245 illustrations, 20 evolution of skin lesions, 245 lichen planus, 95 macrodistribution, illustrations, 247 molluscum contagiosum, 53 onset, 245 striae distensae, 226 physical exam, 246 toxicodendron dermatitis, 193 primary lesions, 246 Liver disease in relation to lichen planus, 94 provoking factors, 246 Liver spots, 235 secondary lesions, 246 LM, see self-medication, 246 LMM () supplemental history, 246 LN2 (liquid nitrogen) supporting data, 246 Lotions therapy, 246 basics, 39 Lentigo maligna vehicles, 39 distinguish from lentigines, 248 LP, see Lichen planus Leukoderma Lupus erythematosis basics, 16 differential diagnosis, 187 illustration, 16 discoid and systemic Lichen planus, 93 distinguish from rosacea, 364 configuration, 95 distinguish from lichen planus, 99 differential diagnosis, 98 distinguish from psoriasis vulgaris, 89 direct immunofluorescence, 96 distinguish from tinea faciale, 131 distribution, 95 serologic testing, 178 evolution of disease process, 93 Lupus erythematosus, discoid evolution of skin lesions, 94 antinuclear antibody, 178 general laboratory testing, 97 configuration, 178 macrodistribution, illustrations, 96 direct immunofluorescence, 178 onset, 93 distribution, 178 physical exam, 94 evolution of disease process, 176 primary lesions, 94 evolution of skin lesions, 176 provoking factors, 94 onset, 176 secondary lesions, 95 physical exam, 177 primary lesions, 177 Index 449

provoking factors, 176 Macule secondary lesions, 177 basics, 8 self-medication, 176 illustration, 9 skin biopsy, 178 Magnification supplemental history, 176 basics, 23 supporting data, 178 examination, 23 therapy, 179 Malignant lesions, 233 Lupus erythematosus, subacute cutaneous Malignant melanoma, 271 antinuclear antibody, 183 AJCC revised melanoma staging system configuration, 182 partial, table, 276 direct immunofluorescence, 183 Breslow breakpoints, table, 275 distribution, 182 Clark’s levels of melanoma, table, 274 evolution of disease process, 181 configuration, 279 evolution of skin lesions, 181 current recommended excision margins, macrodistribution, illustration, 183 table, 281 onset , 181 differential diagnosis, 284 physical exam, 182 distinguish from seborrheic keratosis, 239 primary lesions, 182 distribution, 278 provoking factors, 181 evolution of disease process, 274 secondary lesions, 182 evolution of skin lesions, 276 self-medication, 182 favored sites for melanoma, illustrations, skin biopsy, 183 279, 280 supplemental history, 182 follow-up, table, 283 supporting data, 183 melanoma size, illustration, 278 therapy, 183 nodular, growth phases, illustration, 273 Lupus erythematosus, systemic onset, 271 butterfly rash pathology report, 281 illustration, 186 physical exam, 277 configuration, 186 primary lesions, 278 direct immunofluorescence, 186 provoking factors, 276 distribution, 185 secondary lesions, 278 evolution of disease process, 184 self-medication, 276 evolution of skin lesions, 184 skin biopsy, 279 onset, 184 superficial spreading, growth phases, illustra- physical exam, 185 tion, 272 primary lesions, 185 supplemental history, 276 provoking factors, 184 supporting data, 279 secondary lesions, 185 therapy, 281 self-medication, 185 traditional three-stage melanoma staging skin biopsy, 186 system, table, 275 supplemental history, 185 MC, see Molluscum contagiosum supporting data, 186 MCMN (medium congenital melanotic nevus) therapy, 187 Melanocytic nevi, 251 Lymphoma, cutaneous T-cell Melanocytic nevi, acquired atypical distinguish from atopic dermatitis, 211 configuration, 261 differential diagnosis, 263 M distribution, 261 Macroanatomic distribution evolution of disease process, 259 basics, 17 evolution of skin lesions, 260 450 Index

onset, 259 primary lesions, 265 physical exam, 261 provoking factors, 265 primary lesions, 261 secondary lesions, 266 provoking factors, 260 self-medication, 265 secondary lesions, 261 skin biopsy, 266 self-medication, 260 supplemental history, 265 skin biopsy, 261 supporting data, 266 supplemental history, 260 therapy, 267 supporting data, 261 Melanoma, nodular therapy, 261 distinguish from common skin cancers, squa- Melanocytic nevi, acquired halo nevi mous cell carcinoma, 309 configuration, 258 Melanoma, see malignant melanoma differential diagnosis, 258 Microanatomic distribution distribution, 258 basics, 16 evolution of disease process, 257 Miliaria ,rubra, 101 evolution of skin lesions, 258 configuration, 102 onset, 257 differential diagnosis, 103 physical exam, 258 distribution, 102 primary lesions, 258 evolution of disease process, 101 provoking factors, 258 evolution of skin lesions, 101 secondary lesions, 258 macrodistribution, illustration, 103 self-medication, 258 onset, 101 supplemental history, 258 physical exam, 102 supporting data, 258 primary lesions, 102 therapy, 258 provoking factors, 102 Melanocytic nevi, acquired secondary lesions, 102 configuration, 254 self-medication, 102 differential diagnosis, 256 supplemental history, 102 distribution, 254 supporting data, 102 evolution of disease process, 252 therapy, 102 evolution of skin lesions, 252 MM, see Malignant melanoma onset, 251 Moles, see Melanocytic nevi physical exam, 253 Molluscum contagiosum, 51 primary lesions, 253 biopsy, 53 provoking factors, 253 configuration, 53 secondary lesions, 254 diagnostic data, 53 self-medication, 253 differential diagnosis, 56 skin biopsy, 254 distinguish from common skin cancers, basal supplemental history, 253 cell carcinoma/epithelioma, 304 supporting data, 254 distinguish from common skin cancers, squa- therapy, 255 mous cell carcinoma, 308 Melanocytic nevi, congenital distinguish from keratoacanthoma, 296 configuration, 266 distribution, 53 differential diagnosis, 268 evolution of disease process, 51 distribution, 266 evolution of skin lesions, 52 evolution of disease process, 264 immunosuppression, 52 evolution of skin lesions, 265 macrodistribution, illustrations, 54, 55, 56 onset, 264 onset, 51 physical exam, 265 physical exam, 52 Index 451

primary lesions, 52 provoking factors, 52 distinguish from melanocytic nevi, congeni- secondary lesions, 53 tal, 268 Self-medication, 52 smear, 53 distinguish from melanocytic nevi, congeni- supplemental history, 52 tal, 268 therapy, 53 NM (nodular melanoma) Nodular melanoma distinguish from melanocytic nevi, congeni- distinguish from common skin cancers, basal tal, 268 cell carcinoma/epithelioma, 304 Monilia, intertriginous distinguish from common skin cancers, squa- distinguish from erythrasma, 120 mous cell carcinoma, 309 seborrheic dermatitis, 73 Nodule tinea cruris, 132 basics, 8 Moniliasis illustration, 9 distinguish from tinea pedis, 132 Nonbullous impetigo distinguish from atopic dermatitis, 210 distinguish from common skin cancers, basal Nonsolar lentigo cell carcinoma/epithelioma, 304 distinguish from melanocytic nev, acquired, 256 N NSAID (nonsteroidal anti-inflammatory drugs) Nail bed carcinoma Nummular eczema distinguish from verruca vulgaris, 64 distinguish from asteatotic eczema, 217 Nail bed hemorrhage distinguish from atopic dermatitis, 210 distinguish from malignant melanoma, 284 distinguish from common skin cancers, basal Nail lichen planus cell carcinoma/epithelioma, 304 distinguish from tinea unguium, 132 distinguish from pityriasis rosea, 81 Nail monilia distinguish from psoriasis vulgaris, 90 distinguish from tinea unguium, 132 distinguish from seborrheic dermatitis, 73 Nail psoriasis distinguish from tinea corporis, 132 distinguish from tinea unguium, 132 O Necrosis basics, 11 Occlusive therapy Necrotizing fasciitis basics, 40 distinguish from erysipelas, 158 Ocular Herpes simplex, Herpes simplex Nephrotic syndrome resembling atopic dermati- recidivans, 327 tis, 211 Ocular rosacea, rosacea, 360 Netherton’s syndrome resembling atopic derma- Ointments titis, 211 basics, 39 Nevi, common vehicles, 39 distinguish from melanocytic nevi, acquired Old age spots, 235 atypical, 263 P Nevi, common benign distinguish from melanocytic nevi, congenital, Papillomatosis 268 basics, 12 Nevi, common compound illustration, 13 distinguish from common skin cancers, basal Papular lesions, 49 cell carcinoma/epithelioma, 304 Papule Nevi, melanocytic, 251 basics, 8 illustration, 9 452 Index

Papulo-pustular lesions, 315 evolution of disease process, 77 Papulo-squamous lesions, 49 evolution of skin lesions, 78 Papulo-vesicular lesions, 49 macrodistribution, illustrations, 79 Paronychia, bacterial onset, 77 distinguish from Herpes simplex recidivans, physical exam, 78 333 primary lesions, 78 Parvovirus B19 infection provoking factors, 78 distinguish from lupus erythematosus, 187 secondary lesions, 79 Patch self-medication, 78 basics, 8 supplemental history, 78 illustration, 9 supporting data, 80 PCR (polymerase chain reaction) therapy, 80 Pediculosis capitis Pityriasis versicolor distinguish from seborrheic dermatitis, 74 distinguish from erythrasma, 119 Pemphigoid, bullous distinguish from seborrheic dermatitis, 73 distinguish from erythema multiforme, 167 Planar warts distinguish from impetigo, 322 distinguish from seborrheic keratosis, 238 Percutaneous absorption Plant dermatitis basics, 38 distinguish from toxicodendron dermatitis, Perioral dermatitis 195 distinguish from acne vulgaris, 356 Plantar distinguish from rosacea, 364 distinguish from verruca vulgaris, 64 Petaloid configuration, seborrheic dermatitis, Plaque 69\ basics, 8 Phenylketonuria resembling atopic dermatitis, illustration, 10 211 Poikiloderma PHN (postherpetic neuralgia) basics, 16 Physical examination Poison ivy, see Toxicodendron dermatitis basics, 7 Poison oak, see Toxicodendron dermatitis primary lesions, 8 Poison sumac, see Toxicodendron dermatitis Phytophotodermatitis Polycyclic configuration distinguish from toxicodendron dermatitis, basics, 19 195 erythema multiforme, 164 Pigmented basal cell carcinoma illustration, 19 distinguish from malignant melanoma, 284 impetigo, 319 distinguish from seborrheic keratosis, 239 lupus erythematosus, subacute cutaneous, Pigmented lesions, 233 182 Pityriasis alba psoriasis, 86 distinguish from tinea corporis, 132 tinea, 125 Pityriasis rosea, like drug eruptions urticaria, 138 distinguish from pityriasis rosea, 80 Postherpetic neuralgia, Herpes zoster, 337 Pityriasis rosea, 77 Potassium hydroxide exam configuration, 80 basics, 29 differential diagnosis, 80 Potency of topical steroids, table, 42 distinguish from lupus erythematosus, 187 PR, see Pityriasis rosea distinguish from psoriasis vulgaris, 89 Pramoxine, topical therapy distinguish from seborrheic dermatitis, 73 basics, 44 distinguish from tinea corporis, 132 Pre-malignant lesions, 233 distribution, 79 Prickly heat, see Miliaria rubra Index 453

Primary lesions Reticulated configuration, lichen planus, 95 basics, 8 Retiform configuration recognizing, 8 basics, 22 Pseudofolliculitis barbae illustration, 22 distinguish from acne vulgaris, 357 Rhinophyma, rosacea, 360 Rhus dermatitis, see Toxicodendron dermatitis distinguish from malignant melanoma, 284 RIF (rapid immunofluorescence test) Psoriasis vulgaris, 83 Ringworm, see tinea configuration, 86 Rosacea , rosacea, 361 differential diagnosis, 89 Rosacea, 359 distinguish from common skin cancers, basal complications, 360 cell carcinoma/epithelioma, 304 configuration, 362 distinguish from lupus erythematosus, 187 differential diagnosis, 364 distinguish from pityriasis rosea, 81 distinguish from acne vulgaris, 356 distinguish from seborrheic dermatitis, 73 distinguish from lupus erythematosus, 187 distinguish from tinea capitis, 131 distribution, 362 distinguish from tinea corporis, 132 evolution of disease process, 359 distribution, 85 evolution of skin lesions, 361 evolution of disease process, 83 macrodistribution, illustration, 363 evolution of skin lesions, 84 onset, 359 macrodistribution, illustration, 86 physical exam, 362 onset, 83 primary lesions, 362 physical examination, 85 provoking factors, 361 primary lesions, 85 secondary lesions, 362 provoking factors, 84 self-medication, 361 secondary lesions, 85 supplemental history, 361 self-medication, 85 supporting data, 362 supplemental history, 85 therapy, 362 therapy, 87 S Punch biopsy basics, 31 Saucerization biopsy illustration, 32 basics, 33 Purpura illustration, 34 basics, 14 Scabies preparation illustration, 15 basics, 30 Pustule Scabies, 105 basics, 8 configuration, 107 illustration, 10 differential diagnosis, 110 PV, see Psoriasis vulgaris distinguish from atopic dermatitis, 210 distribution, 107 distinguish from malignant melanoma, 284 evolution of disease process, 106 evolution of skin lesions, 106 R macrodistribution, illustrations, 108, 109, 110 Recognizing configuration onset, 105 basics, 18 physical exam, 107 Recognizing distribution primary lesions, 107 basics, 16 provoking factors, 106 Regions of skin permeability secondary lesions, 107 illustration, 38 self-medication, 106 454 Index

supplemental history, 107 distribution, 236 supporting data, 108 evolution of disease process, 235 therapy, 108 evolution of skin lesions, 235 Scale macrodistribution, illustrations, 237 basics, 11 onset, 235 Scar or Cicatrix physical exam, 236 basics, 14 primary lesions, 236 SCC (squamous cell carcinoma) provoking factors, 236 SCL (subacute cutaneous lupus erythematosus) secondary lesions, 236 Sclerosis self-medication, 236 basics, 12 skin biopsy, 237 illustration, 13 supplemental history, 236 SCMN (small congenital melanotic nevus) supporting data, 237 SD, see Seborrheic dermatitis therapy, 237 Sebaceous hyperplasia Secondary lesions distinguish from common skin cancers, basal basics, 10 cell carcinoma/epithelioma, 304 recognizing, 10 Seborrheic blepharitis, therapy, 72 Selective IGA deficiency resembling atopic Seborrheic dermatitis, 67 dermatitis, 211 and AIDS, 68 Senile purpura, 219 configuration, 69 configuration, 220 diagnostic data, 69 distribution, 220 differential diagnosis, 73 evolution of disease process, 219 distinguish from atopic dermatitis, 210 evolution of skin lesions, 219 distinguish from atopic dermatitis, 210 macrodistribution, illustrations, 221 distinguish from lupus erythematosus, 187 onset, 219 distinguish from pityriasis rosea, 81 physical exam, 220 distinguish from psoriasis vulgaris, 89 primary lesions, 220 distinguish from tinea capitis, 131 provoking factors, 220 distribution, 69 secondary lesions, 220 evolution of disease process, 67 self-medication, 220 evolution of skin lesions, 68 supplemental history, 220 macrodistribution, illustrations, 70 supporting data, 220 onset, 67 therapy, 220 physical exam, 68 Serologic testing for Lupus erythematosus, 178 primary lesions, 68 Serpiginous configuration provoking factors, 68 basics, 19 secondary lesions, 69 illustration, 20 self-medication, 68 tinea, 125 supplemental history, 68 urticaria, 138 therapy, 71 Sex-linked agammaglobulinemia resembling Seborrheic keratosis, 235 atopic dermatitis, 211 configuration, 236 Shave incision biopsy differential diagnosis, 238 basics, 32 distinguish from actinic keratosis, 291 illustration, 33 distinguish from common skin cancers, squa- , see Herpes zoster mous cell carcinoma, 309 SK, see Seborrheic keratosis distinguish from lentigines, 248 Skin biopsy, basics, 30 distinguish from melanocytic nevi, acquired, Skin cancers, common, see common skin cancers 257 Index 455

Skin permeability physical exam, 224 regions of, illustration, 38 primary lesions, 224 Skin phototypes, common skin cancers, basal provoking factors, 224 cell carcinoma/epithelioma, table, 299 secondary lesions, 225 SLE, see Systemic lupus erythematosus self-medication, 224 SLNB (sentinel lymph node biopsy) supplemental history, 224 Solar keratosis, see actinic keratosis supporting data, 226 Solar lentigines therapy, 227 distinguish from actinic keratosis, 291 Striae gravidarum, see Striae distensae distinguish from melanocytic nevi, acquired, Subacute cutaneous configuration, lupus erythe- atypical, 263 matosus, 182 distinguish from seborrheic keratosis, 238 Subcutaneous atrophy Specific history illustration, 15 basics, 3 Superficial spreading basal cell carcinoma SPF (sun protection factor) distinguish from common skin cancers, squa- Spitz’s nevus mous cell carcinoma, 309 distinguish from malignant melanoma, 284 Supporting diagnostic data Squamous cell carcinoma, see Common skin basics, 29 cancers in relation to pityriasis rosea, 78 Squamous cell carcinoma Syphilis, secondary distinguish from actinic keratosis, 292 distinguish from lichen planus, 99 distinguish from keratoacanthoma, 296 distinguish from pityriasis rosea, 81 distinguish from molluscum contagiosum, 56 distinguish from psoriasis vulgaris, 89 distinguish from seborrheic keratosis, 238 distinguish from seborrheic dermatitis, 74 distinguish from verruca vulgaris, 64 Systemic steroid therapy SSMM (superficial spreading malignant mela- basics, 45 noma) T Staphylococcal folliculitis distinguish from tinea barbae, 131 Tactile examination Steroid purpura basics, 23 distinguish from senile purpura, 221 Taking a basic history, see History-taking basics Steroid rosacea Targetoid configuration, erythema multiforme, distinguish from rosacea, 364 164 Steroid therapy TB (tinea barbae) intralesional, basics, 45 TC (tinea corporis) systemic, basics, 45 TCa (tinea capitis) Steroids, topical TCr (tinea cruris) basics, 40 Telangectasia potency of, table, 42 basics, 16 , see striae distensae TF (tinea faciale) Striae distensae, 223 Therapy configuration, 226 basics, 37 differential diagnosis, 228 Thrombosed capillary aneurysm distribution, 225 distinguish from malignant melanoma, 284 evolution of disease process, 224 Tinea, 121 evolution of skin lesions, 224 configuration, 125 macrodistribution, illustrations, 225, 226, differential diagnosis, 131 227, 228 distribution, 125 onset, 223 evolution of disease process, 122 456 Index

evolution of skin lesions, 123 antihistamines onset, 122 basics, 44 physical exam, 125 antipruritics primary lesions, 125 basics, 45 provoking factors, 124 doxepine secondary lesions, 125 basics, 44 self-medication, 124 emollients supplemental history, 125 basics, 43 supporting data, 126 enhancers therapy, 126 basics, 44 Tinea barbae pramoxine description, 122 basics, 44 differential diagnosis, 131 vehicles Tinea capitis basics, 39 description, 122 Toxicodendron dermatitis, 191 differential diagnosis, 131 configuration, 193 Tinea circinata differential diagnosis, 195 distinguish from impetigo, 322 distinguish from Herpes zoster, 343 Tinea corporis, 122 distribution, 193 annular evolution of disease process, 192 distinguish from lupus erythematosus, 187 evolution of skin lesions, 192 differential diagnosis, 132 onset, 192 distinguish from atopic dermatitis, 211 physical exam, 193 distinguish from pityriasis rosea, 81 primary lesions, 193 Tinea cruris provoking factors, 193 description, 122 secondary lesions, 193 differential diagnosis, 132 self-medication, 193 Tinea faciale, 122 supplemental review, 193 differential diagnosis, 131 supporting data, 194 distinguish from lupus erythematosus, 187 therapy, 194 Tinea manuum TP (tinea pedis) description, 122 Trichotillomania differential diagnosis, 132 distinguish from tinea capitis, 131 Tinea pedis TU (tinea unguium) description, 122 Tuberculosis differential diagnosis, 132 distinguish from tinea barbae, 131 Tinea unguium Tzanck preparation description, 122 basics, 30 differential diagnosis, 132 U Tinea versicolor distinguish from erythrasma, 119 Ulceration, distinguish from seborrheic dermatitis, 73 basics, 14 TM, see Tinea manuum illustration, 15 Topical steroids Urticaria, 135 basics, 40 acute, therapy, 139 potency of, table, 42 chronic intermittent, therapy, 141 Topical therapy chronic anesthetics therapy, 141 basics, 44 differential diagnosis, 142 Index 457

evolution of disease process, 135 evolution of skin lesions, 59 evolution of skin lesions, 136 macrodistribution, illustrations, 61, 62 onset, 135 onset, 59 other types, 142, 143, 144, 145 physical examination, 60 physical exam, 137 primary lesions, 60 primary lesions, 137 provoking factors, 59 provoking factors, 136 secondary lesions, 60 radiologic studies, 138 self-medication, 60 secondary lesions, 137 skin biopsy, 61 self-medication, 137 supplemental history, 60 skin biopsy, 138 therapy, 62 skin testing, 138 supplemental history, 137 distinguish from verruca vulgaris, 64 supporting data, 138 Vesicle therapy, 139 basics, 8 illustration, 10 V Vesiculo-bullous lesions, 315 Varicella Viral distinguish from impetigo, 322 distinguish from, 103 Vegetating lesions VV, see Verruca vulgaris distinguish from keratoacanthoma, 296 W Vegetation basics, 13 Warts, see Verruca vulgaris illustration, 15 Winter itch, see Asteatotic eczema Vehicles, topical therapy Wiskott-Aldrich syndrome resembling atopic basics, 39 dermatitis, 211 Verruca vulgaris, 59 Woods lamp examination configuration, 61 basics, 24 diagnostic data, 61 Z differential diagnosis, 64 distinguish from common skin cancers, squa- Zosteriform configuration mous cell carcinoma, 309 basics, 19 distribution, 60 Herpes zoster, 339 evolution of disease process, 59 illustrations, 21