Atlas of Dermatology in Internal Medicine
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1 Atlas of Dermatology in Internal Medicine
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3 Néstor P. Sánchez Editor Atlas of Dermatology in Internal Medicine
4 Editor Néstor P. Sánchez Professor of Dermatology and Dermatopathology and Chairman Department of Dermatology University of Puerto Rico School of Medicine Medical Sciences Campus San Juan, Puerto Rico Associate Editors Adisbeth Morales-Burgos, MD Assistant Professor, Department of Dermatology University of Puerto Rico School of Medicine Medical Sciences Campus San Juan, Puerto Rico Mark Pittelkow, MD Professor of Dermatology Mayo Graduate School of Medicine Mayo Clinic, Rochester, Minnesota Martin Charles Mihm, MD Professor of Pathology and Dermatology Department of Dermatology and Department of Pathology Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Lilliam S. Chiqués Colón, MD Assistant Professor Department of Medicine University of Puerto Rico School of Medicine Medical Sciences Campus San Juan, Puerto Rico ISBN e-isbn DOI / Springer New York Dordrecht Heidelberg London Library of Congress Control Number: Springer Science+Business Media, LLC 2012 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
5 This book is dedicated to my loving family, especially to my wife, Nelly, my children, Dara, Fitz and Vannesa, and to my grandchildren, Diego, Hugo, Néstor, Gustavo, Natalia, and Marco. Furthermore, to the families of all the contributing authors and associate editors who illuminated this book with knowledge and wisdom.
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7 Preface Dermatology is a fascinating field based in the skills of clinical observation and clinicopathologic correlation to diagnose diseases. We wish to bring the art and science of dermatology into a practical resource. In this spirit, we created Atlas of Dermatology in Internal Medicine. Skin reflects the health of the body and its diseases are often a manifestation of systemic conditions. To know skin disorders is of paramount importance for other specialties. We are committed to creating an excellent tool to assist in the diagnosis and management of common cutaneous manifestations of systemic diseases. Atlas of Dermatology in Internal Medicine is organized to reflect current knowledge in dermatology relevant to Internal Medicine. It provides a comprehensive review and updated information on the diagnosis and treatment of common cutaneous manifestations of systemic diseases. To facilitate the diagnosis of frequently encountered skin diseases, a gallery of illustrations combined with disease descriptions and their current therapeutic information are included. This book welcomes internists and other specialists in medicine interested in learning more about clinical dermatology. We are proud to present our work. We hope this text will provide a timely addition to the field of Internal Medicine. We would like to thank the authors who contributed in this book. Néstor P. Sánchez Adisbeth Morales vii
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9 Acknowledgments I was extremely fortunate to have extraordinary teachers who enlightened the path of my training in Dermatology and Dermatopathology. Dr. Rodolph L. Baer Master of Dermatology, Professor Emeritus of NYU Skin and Cancer. My late Professor and mentor during my Residency in NYU. Dr. A. B. Ackerman Master of Dermatology and Dermatopathology. My early inspiration in the jungle of Dermatology. A spectacular human being. Dr. Alfred Kopf Master of Dermatology and role model. Dr. Thomas B. Fitzpatrick Master of Dermatology and innovator. My late mentor while at Harvard. Source of knowledge, inspiration and leadership. Dr. Martin Charles Mihm Master of Dermatology and Dermatopathology. My dear teacher, friend and role model. Physician by excellence and humanitarian. Dr. Harold Perry Master of Dermatology. Great inspiration for me while at Mayo Clinic. Dr. Richard Winkelmann Master of Dermatology and Dermatopathology. My mentor and innovator. Great physician and thinker. Dr. Arnold Schroeter Master of Dermatology and Dermatopathology, who trusted me during my early years in dermatology. A great mentor. Dr. Mark Pittelkow Master of Dermatology. Friend, extraordinary thinker and exceptional human being. Dr. Jorge L. Sánchez Master of Dermatology and Dermatopathology. Role model, who first inspired me. ix
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11 Contents Cutaneous Manifestations of Connective Tissue Diseases... 1 Lesliane E. Castro-Santana, José González Chávez, Jennifer Rullán, and Rachelle E. Seijo-Montes Cutaneous Manifestations of Pulmonary Disease Jennifer Rullán, Rachelle E. Seijo-Montes, Annie Vaillant, and Néstor P. Sánchez Cutaneous Manifestations of Renal Disease Lilliam S. Chiqués Colón and Rosbel González Rivera Cutaneous Manifestations of Gastrointestinal Diseases María I. Vázquez-Roque and Wilfredo E. De Jesús-Monge Cutaneous Manifestations of Common Endocrine Disease Inés M. Hernández and Yanira Marrero Cutaneous Manifestations of Internal Malignancy and Paraneoplastic Syndromes Zelma C. Chiesa-Fuxench, Liliana Ramírez, and Néstor P. Sánchez Cutaneous Manifestations of Infectious Diseases Elena Montalván Miró and Néstor P. Sánchez Cutaneous Manifestations of HIV Disease Humberto M. Guiot, Carlos G. Sánchez Sergenton, Carlos J. Sánchez Rivera, and Rosbel González Rivera Cutaneous Disorders in the Intensive Care Unit Tania M. González Santiago and Jacobo M. Orenstein Cardona Index xi
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13 Contributors Jacobo M. Orenstein Cardona, MD, PhD Candidate Center for Translational Science Activities, Mayo Clinic Rochester, MN Lesliane E. Castro-Santana, MD Department of Rheumatology, University of Puerto Rico José González Chávez, MD Department of Dermatology, University of Puerto Rico Lilliam S. Chiqués Colón, MD Department of Medicine, University of Puerto Rico Zelma C. Chiesa-Fuxench, MD Department of Dermatology, University of Puerto Rico Humberto M. Guiot, MD Department of Medicine, University of Puerto Rico Inés M. Hernández, MD Department of Medicine, University of Puerto Rico Wilfredo E. De Jesús-Monge, MD, MSc Department of Medicine, University of Puerto Rico Yanira Marrero, MD Department of Endocrinology, University of Puerto Rico Martin Charles Mihm, MD Professor of Pathology and Dermatology, Department of Dermatology and Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Elena Montalván Miró, MD Department of Dermatology, University of Puerto Rico xiii
14 xiv Contributors Adisbeth Morales-Burgos, MD Department of Dermatology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Mark Pittelkow, MD Professor of Dermatology, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota Liliana Ramírez, MD Department of Medicine, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Carlos J. Sánchez Rivera, MD Department of Medicine, University of Puerto Rico Rosbel González Rivera, MD Department of Dermatology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Jennifer Rullán, MD Department of Dermatology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Néstor P. Sánchez, MD Professor of Dermatology and Dermatopathology and Chairman, Department of Dermatology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Tania M. González Santiago, MD Mayo Clinic Department of Dermatology Residency, Rochester, MN Rogelio Mercado Seda, MD Department of Dermatology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Carlos G. Sánchez Sergenton, MD Department of Medicine, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico Rachelle E. Seijo-Montes, MD Department of Dermatology, University of Puerto Rico Annie Vaillant, MD Department of Obstetrics and Gynecology, San Juan City Hospital, Medical Sciences Campus, San Juan, Puerto Rico María I. Vázquez-Roque, MD, MSc Department of Medicine, University of Puerto Rico
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