Clinical Dermatology Notice
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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
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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 Department of Dermatology April T. Sanchez, MD University of Minnesota Medical School Dermatology Resident Minneapolis, Minnesota Department of Dermatology Chapters 31, 32, 33, 34, 35, 36, and 37 University of Texas Southwestern Medical Center Dallas, Texas Sarah Nakib, MD, MS Chapter 21 Assistant Professor Department of Dermatology Cindy Firkins Smith, MD Johns Hopkins University Clinical Professor Baltimore, Maryland Department of Dermatology Chapter 25 University of Minnesota Medical School Minneapolis, Minnesota R. Steven Padilla, MD Chapters 13, 23 Chair and Professor Department of Dermatology Carol Soutor, MD University of New Mexico School of Medicine Clinical Professor Albuquerque, New Mexico Department of Dermatology Chapter 9 University of Minnesota Medical School Minneapolis, Minnesota Amit G. Pandya, MD Chapters 2, 3, 4, 5, and 6 Professor Department of Dermatology David L. Swanson, MD University of Texas Southwestern Medical Center Associate Professor Dallas, Texas Department of Dermatology Chapter 21 Mayo Clinic Scottsdale Scottsdale, Arizona Chapter 18 CONTRIBUTORS ix
Erin Warshaw, MD, MS Christopher B. Zachary, MBBS, FRCP Professor Chair and Professor Department of Dermatology Department of Dermatology University of Minnesota Medical School University of California Minneapolis, Minnesota Irvine, California Chapter 8 Chapters 40
Barbara D. Wilson, MD Barrett Zlotoff, MD Associate Professor Assistant Professor Department of Dermatology Department of Dermatology Medical College of Wisconsin University of New Mexico School of Medicine Milwaukee, Wisconsin Albuquerque, New Mexico Chapter 28 Chapter 9 This page intentionally left blank Preface
Clinical Dermatology is the product of decades of interac- presentations that complement and expand the content in tion with our primary care and dermatology colleagues the textbook. It contains the following. and residents. It features concise, practical information • Videos with detailed demonstrations of common cuta- on the diagnosis and management of common skin dis- neous diagnostic and surgical procedures. orders. Diagnostic features, cost-effective management, • Clinical unknown cases with self-assessment questions evidence-based medicine, and patient-centered care are that cover challenging diagnostic and management emphasized. problems. • PowerPoint presentations that cover the diagnosis, eval- INTENDED AUDIENCE uation, and management of common skin disorders. Clinicians, residents, and medical students will find this These PowerPoints can be used for a rapid review of textbook helpful in expanding their understanding and cutaneous disease or by educators for teaching. management of skin disorders. Our advisory group, con- sisting of primary care physicians, residents, nurse practi- ACKNOWLEDGMENTS tioners, physician assistants, and medical students, was instrumental in the design and review of this textbook. We would like to thank our editors, Anne Sydor and Christina M. Thomas, the production supervisor, Sherri ORGANIZATION AND CONTENT Souffrance, and the project manager, Asheesh Ratra. We are grateful for contributions of photographs from Doctors Clinical Dermatology is divided into three sections. Whitney Tope, Spencer Holmes, Bruce Bart, Richard • Section One covers the principles of diagnosis, man- Steinberg, Cindy Vehe, Dan Kaplan, Marna Ericson, Valda agement of common skin disorders, and diagnostic and Kaye, Mark Wilke, Warren Goodman, David Ahrenholz, surgical procedures. and the residents of the University of Minnesota dermatol- • Section Two covers common skin disorders and selected ogy residency programs. We thank our reviewers Jamie less common disorders with high morbidity. The infor- Santilli, MD, Assistant Professor, University of Minnesota mation on each disease is formatted into ten sections: Department of Family Medicine and Community Health; introduction, pathogenesis, history, physical examina- Catherine Manabat, MD, medicine/dermatology resident; tion, laboratory findings, diagnosis, differential diagno- Sanober Amin, MD, PhD, dermatology resident; Cynthia sis, management, indications for consultation, and Olson, MD, Associate Professor, University of Minnesota patient information. Evidence-based reviews and Department of Dermatology; our medical student review- national and international guidelines are used when ers James Dorrian, Kathleen P. Lane, Matthew Majerus, available in the management sections. Julie Fox, Jaime Loso, Maria Smith, and Heather Haberman PA-C and Victoria Eddy NP. • Section Three focuses on the differential diagnosis of We want to especially acknowledge Robert W. Goltz, diseases in specific body regions based on history and MD, who was our mentor and chairman of the physical examination. This section also includes the dif- Department of Dermatology at the University of ferential diagnosis of purpura, fever and rash, hospital- Minnesota (1971 to 1985). His mastery of the art, science, acquired rashes, pruritus, and skin ulcers. A chapter on and practice of medicine influenced all who were privi- cosmetic dermatology completes this section. leged to train with him. The online learning center (www.LangeClinical We are especially grateful for our husbands’ support Dermatology.com) for this textbook contains multimedia and patience during this project.
xi This page intentionally left blank Section I. Fundamentals of Diagnosis and Treatment
Structure and Functions of the Skin Kimberly Bohjanen 1
Introduction to Chapter / 1 Sensation / 4 Barrier Function / 1 Temperature Regulation / 4 Immunologic Function / 1 Protection from Trauma / 5 Melanin Production and Protection from Identity and Aesthetics / 5 Ultraviolet Light Damage / 2 References / 5 Synthesis of Vitamin D / 4