Handbook of Dermatology Handbook of Dermatology: A Practical Manual Margaret W. Mann © 2009 by Margaret W. Mann, David R. Berk, Daniel L. Popkin, and Susan J. Bayliss. ISBN: 978-1-405-18110-5 Handbook of Dermatology A Practical Manual Margaret W. Mann, MD Department of Dermatology University of California, Irvine Irvine, California, USA David R. Berk, MD Division of Dermatology Washington University St Louis, Missouri, USA Daniel L. Popkin, MD, PhD Department of Immunology The Scripps Research Institute La Jolla, California, USA Susan J. Bayliss, MD Division of Dermatology Washington University St Louis, Missouri, USA This edition fi rst published 2009, © 2009 by Margaret W. Mann, David R. Berk, Daniel L. Popkin, and Susan J. Bayliss Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientifi c, Technical and Medical business to form Wiley-Blackwell. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Handbook of dermatology : a practical manual / Margaret W. Mann ... [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4051-8110-5 (pbk. : alk. paper) 1. Dermatology—Handbooks, manuals, etc. 2. Skin— Diseases—Handbooks, manuals, etc. I. Mann, Margaret W. [DNLM: 1. Skin Diseases—diagnosis—Handbooks. 2. Skin Diseases—therapy—Handbooks. 3. Dermatologic Agents—therapeutic use—Handbooks. WR 39 H2357 2008] RL74.H36 2008 616.5—dc22 2008015533 ISBN: 978-1-4051-8110-5 A catalogue record for this book is available from the British Library. Set in 6.5/8.5 Frutiger by Macmillan Publishing Solutions Printed in Singapore by Fabulous Printers Pte Ltd Contents Preface, xi Dedication, xii Abbreviations, xiii Part 1 General Dermatology Work-up Quick Reference, 3 Direct immunofl uorescence – where to biopsy?, 3 False positive/negative DIFs, 4 Biopsy for GVHD, 4 The Dermatologic Differential Algorithm, 4 Alopecia Work-Up, 5 Associations, 5 Cicatricial or non-cicatricial?, 5 Aphthosis Classifi cation and Workup, 9 Morphologic classifi cation, 9 Classifi cation by cause, 9 Work-up for complex apthae, 9 Treatment, 9 Amyloidoses, 10 Xanthomas, 11 Hyperlipoproteinemias: Fredrickson Classifi cation, 12 Histiocytosis, 13 Lupus Erythematosus, 17 Systemic lupus erythematosus criteria (4 of 11), 17 Acute cutaneous lupus erythematosus, 17 Subacute cutaneous lupus erythematosus, 17 Chronic cutaneous lupus erythematosus, 17 Autoantibody sensitivities and specifi cities, 18 Antinuclear Antibodies, 20 Autoantibodies in Connective Tissue Diseases, 21 Vasculitis, 22 Treatment of ANCA-associated vasculitis, 22 Anti-neutrophil cytoplasmic antibody, 23 Small vessel vasculitis, 24 Medium ( small) vessel vasculitis, 26 Large vessel vasculitis, 27 Cryoglobulinemia, 28 CTCL Classifi cation, 29 Mycosis fungoides variants, 29 MF (TNMB) staging, 31 MF treatment algorithm, 32 Cutaneous B-cell Lymphoma, 33 v Leukemia cutis, 33 Monoclonal Gammopathies, 34 Melanoma – Classifi cation, 35 Breslow depth, 36 Melanoma – staging and survival, 36 Melanoma – treatment guidelines, 37 Infectious Disease, 39 Viruses and diseases, 39 Human papillomavirus, 41 Other viral diseases, 42 Mycoses, 45 Vector-borne diseases, 52 Creatures in dermatology, 58 Immunology, 63 Complement, 63 Complement defi ciencies, 64 Angioedema and complement levels, 64 Th profi les, 65 Bullous Disorders, 65 Intracorneal/subcorneal, 65 Intraepidermal blisters, 66 Suprabasilar blisters, 66 Subepidermal with little infl ammation, 66 Subepidermal with lymphocytes, 67 Subepidermal with eosinophils, 67 Subepidermal with neutrophils, 67 Subepidermal with mast cells, 68 Epidermolysis bullosa, 68 Major bullous diseases – clinicopathologic fi ndings, 71 Glands, 75 Disorders or Drugs Associated with Skeletal, Ocular, and/or Nail Findings, 77 Dermatoses of Pregnancy, 88 Neonatal Vesiculopustular Eruptions, 90 Genital Ulcers, 95 Common Contact Allergens, 96 Features suggestive of specifi c irritant/toxin, 100 Plants and dermatoses, 100 Vitamin Defi ciencies/Hypervitaminoses, 103 Genodermatoses, 107 Gene list, 107 Chromosome abnormalities, 133 Tumors, 134 Disorders of cornifi cation, 136 vi Disorders of hair, nail, ectoderm, 139 Tumor syndromes, 144 Disorders of connective tissue, 146 Disorders of metabolism, 149 Disorders of pigmentation, 154 Disorders of vascularization, 156 Immunodefi ciency syndromes, 159 Miscellaneous, 162 Dermoscopy, 163 Pathology, 165 Histochemical staining, 165 Immunohistochemical staining, 167 Pathologic bodies, 170 Other derm path buzzwords, patterns, DDx, 175 Part 2 Surgery Surgical Margins Guidelines, 183 Indications for Mohs micrographic surgery, 183 Guideline for Prophylactic Antibiotics, 184 Algorithm for antibiotic prophylaxis, 185 Guideline for Prophylactic Antivirals, 186 Anesthetics, 186 Dose calculation, 186 Tumescent anesthesia, 186 Topical anesthetic, 187 Adverse reaction to local anesthetics, 187 Local anesthetic, 188 Nerve blocks, 189 Surgical Anatomy, 189 Anatomy of the face, 189 Anatomy of the nail, 193 Danger zones in surgery, 194 Dermatomal distribution of sensory nerves, 196 Anatomy of the lower extremity venous system, 197 Cutaneous Reconstruction, 198 Undermining depths in reconstruction, 199 Dangerzone of the neck: Erbs point, 196 Second intention, 199 Simple linear closure, 200 Transposition fl ap, 201 Advancement fl ap, 204 Interpolation fl ap, 206 Rotation fl ap, 207 Skin graft, 208 vii Sutures, 210 Absorbable, 210 Non-absorbable, 211 Suture removal time, 212 Electrosurgery, 212 Wound Healing, 212 Wound dressing, 213 Antiseptic Scrubs, 214 Lasers, 216 Laser principles, 217 Thermal relaxation time, 217 Laser treatment of tattoo pigment, 218 Photoinduced eye injury, 218 Photodynamic Therapy, 220 Basic principles, 220 Applications, 220 Photosensitizer properties and options, 220 UV Spectrum, 222 UV Protection Measurements, 223 UV Associations/Specifi cities, 223 Glogau Wrinkle Scale, 224 Fitzpatrick Skin Type, 224 Peeling Agents, 224 TCA peel, 225 TCA peel frost level, 225 Jessner solution, 225 Baker-Gordon phenol, 226 Cook total body peel, 226 Pre-peel prep, 226 Post-peel wound care, 226 Botulinum