Dermatology in Clinical Practice

Transcription

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2 Dermatology in Clinical Practice

3 Zohra Zaidi Sean W. Lanigan Dermatology in Clinical Practice

4 Authors Dr. Zohra Zaidi 7 B 9th Zamzama St. Karachi Clifton Pakistan zohrazaidi@hotmail.com Dr. Sean W. Lanigan Consultant Dermatologist, Birmingham United Kingdom ISBN: e-isbn: DOI: / Springer Dordrecht Heidelberg London New York Library of Congress Control Number: Springer-Verlag London Limited 2010 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: estudio Calamar Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 The book is dedicated to my late brother Syed Hasan Nasir. He tragically died at the tender age of 29 years. We loved you a lot, but God loved you still more Dr. Zohra Zaidi This book is dedicated to my wife Hilary and my children Stuart and Eleanor for their support and encouragement Dr. Sean W. Lanigan

6 Preface Books on dermatology are either focused for medical students or for students of dermatology. A general practitioner sees a lot of skin patients; about 17% of their patients are related to skin disease. We therefore decided to write a book that should meet the needs of a general practitioner. To make the book helpful for the primary care physician, we have focused more on common skin problems and have discussed the diagnosis and treatment of these disorders in depth to help the general practitioner in diagnosing and treating them. The chapter on the management of skin diseases also gives the details of topical, systemic, and the physical modalities used in treating skin disease. Uncommon skin diseases are only mentioned where required. The chapter on cutaneous manifestations of systemic diseases will help the general practitioner to correlate the cutaneous signs of the common medical problems seen by them. Emphasis is laid on the bacterial, fungal, and parasitic disorders that are prevalent in tropical countries. We have included the common diseases of other continents, as the general practitioner especially of developed countries has patients from all over the world. Congenital and hereditary disorders are discussed with the corresponding chapters, which makes it easier for the reader to remember. A number of practical points are included with each subject, and history of dermatology is included where appropriate to make the subject interesting to read. The general practitioner refers a number of cases to the dermatology clinic for dermatological procedures such as phototherapy, cryosurgery, and lasers. These procedures are vii

7 viii Preface included in the appendix at the end of the book. This will help the practitioner to have a basic knowledge about the procedure to be performed on their patients. Skin rashes are often an enigma for beginners; a little insight into the subject with a clear understanding can make the rash so simple to diagnose. We have tried to make this book simple, practical, and easy to use. We hope that general practitioners find it helpful; it could also be of interest and benefit to medical students. Karachi, Pakistan Birmingham, UK Dr. Zohra Zaidi Dr. Sean W. Lanigan

8 Acknowledgments The authors thank the following consultants for contributing their photographs to the book: Dr. Badr Dhanani, Consultant Dermatologist, Institute of Skin Diseases, Karachi, Pakistan, Dr. Khalid Hussain, Consultant Dermatologist, Lincoln County Hospital, Lincoln, UK, Dr. Naseema Kapadia, Consultant Dermatologist, Aga Khan University, Karachi, Pakistan, Dr. Aziz Khan, Consultant Dermatologist, Dow Institute of Health Sciences, Karachi, Pakistan, Dr. Daulat Pinjani, Consultant Dermatologist, Institute of Skin Diseases, Karachi, Pakistan, Surgeon Captain Rehanuddin, Head, Department of Dermatology, PNS Shifa, Karachi, Pakistan, Dr. Zarnaz Wahid, Professor of Dermatology, Dow Institute of Health Sciences, Karachi, Pakistan, and Dr. Shernaz Walton, Consultant Dermatologist, Hull and East Yorkshire Hospital NHS Trust, UK and Esen Rizvi for graphics. ix

9 Contents Preface... Acknowledgments... vii ix 1 Skin: Structure and Function Structure Epidermis Dermoepidermal Junction Dermis Functions Immune System of the Skin The Stratum Corneum Cellular Components Langerhans Cells Keratinocytes T Cells Mast Cells Dermal Dendritic Cells Molecular Components Antigens and Haptens Super-Antigens Histocompatability Antigens Antibodies Cytokines Eicosanoids Cellular Adhesion Molecules (CAMs) Complement xi

10 xii Contents 2.4 Hypersensitivity Reactions Type I (Immediate) Type II (Cytotoxic Reaction) Type III (Immune Complex Disease) Type IV (Cell-Mediated or Delayed Hypersensitivity Reaction) Diagnosis of Skin Disease Approach to a Skin Patient History Taking Examination Primary and Secondary Lesions of the Skin Primary Lesions Secondary Lesions Special Lesions Bacterial Infections Impetigo Folliculitis/Furunculosis/Carbuncle Recurrent Furunculosis Erysipelas/Cellulitis Ecthyma Necrotizing Fasciitis Erythrasma Pitted Keratolysis Trichomycosis Axillaris Tuberculosis Leprosy (Hansen s Disease) Pseudomonas Infections Rocky Mountain Spotted Fever (RMSF) Lymes Disease (Erythema Chronicum Migrans) Sexually Transmitted Diseases (Bacterial) Syphilis Congenital Syphilis Gonorrhea Chancroid (Soft Chancre)... 71

11 Contents xiii 5 Superficial Fungal Infections Tinea Pedis Tinea Manuum Tinea Capitis Tinea Corporis Tinea Cruris Tinea Barbae Onychomycosis (Tinea of the Nails) Tinea Incognito Pityriasis Versicolor (Furfuracea) Pityrosporum Folliculitis (Malassezia Folliculitis) Candidiasis Subcutaneous Fungal Infections Madura Foot (Mycetoma) Sporotrichosis Deep Fungal Infections Cryptococcosis Histoplasmosis Blastomycosis Coccidioidomycosis Treatment of Deep Mycosis Viral Infections Herpes Simplex Herpes Zoster (Shingles) Varicella (Chickenpox) Warts Molluscum Contagiosum Hand Foot and Mouth Disease Erythema Infectiosum (Fifth Disease) HIV Infection (AIDS) Post Exposure Prophylaxis Parasitic Infestations and Diseases Caused by Arthropods Scabies Norwegian Scabies Animal Scabies

12 xiv Contents Other Mites Pediculosis Pediculosis Capitis Peduculosis Corporis Pediculosis Pubis Leishmaniasis Myiasis Filariasis Onchocerciasis (River Blindness) Insect Bites Prophylaxis Papular Urticaria Eczema Source of Injurious Agent Acute Eczema Subacute Eczema Chronic Eczema Exogenous Endogenous Eczemas Keratinizing and Papulosquamous Disorders Psoriasis Etiology Histopathology Parapsoriasis Lichen Planus Etiology Histopathology Pityriasis Rosea Pityriasis Rubra Pilaris (PRP) Parapsoriasis Follicular Keratoses Keratosis Pilaris Lichen Spinulosis Hyperkeratosis of the Palms and Soles Corns Congenital Disorders of Keratinization

13 Contents xv Darier s Disease Ichthyosis Diseases of Connective Tissue Lupus Erythematosus Chronic Discoid Lupus Erythematosus (CDLE) Subacute Cutaneous Lupus Erythematosus (SCLE) Systemic Lupus Erythematosus Dermatomyositis (DM) Adult Dermatomyositis Childhood Dermatomyositis Scleroderma Morphea CREST Syndrome Systemic Sclerosis Mixed Connective Tissue Disorder Miscellaneous Disorders of Connective Tissue Keloids Knuckle Pads (Holoderma) Hereditary Disorders of Connective Tissue Pseudoxanthoma Elasticum Cutis Laxa Ehler Danlos Syndrome Bullous Disorders: Autoimmune and Childhood Bullous Dermatoses Pemphigus Pemphigoid Dermatitis Herpetiformis (DH): Duhring Brocq Disease Acquired Epidermolysis Bullosa (Epidermolysis Bullosa Acquisita) Congenital Bullous Disorders Epidermolysis Bullosa

14 xvi Contents Chronic Bullous Disease of Childhood (Childhood Linear IgA Disease) Acrodermatitis Enteropathica (AE) Vasculitis, Common Erythemas, and Lymphatic Disorders Approach to a Patient with Vasculitis Leucocytoclastic Vasculitis Cuteneous Manifestations Systemic Manifestations Henoch Schonlein Purpura (HSP) Polyarteritis Nodosa Pyoderma Gangrenosum Giant Cell Arteritis Erythema Multiforme Erythema Nodosum (EN) Common Localized Erythemas Flushing and Blushing Erythema Palmare Generalized Nonspecific Erythemas Scarlatiniform Erythema Morbilliform Erythema Pigmented Purpuric Dermatosis (PPD) Schamberg s Disease Lymphatic Disorders Lymphangitis Lymphoedema Exanthems and Hypersensitivity Syndromes Exanthems Measles (Rubeola, Morbilli) Rubella (German Measles) Scarlet Fever Hand, Foot and Mouth Disease Hypersensitivity Syndromes (Toxic Erythemas) Kawasaki s Disease Toxic Shock Syndrome

15 Contents xvii Staphylococcal Scalded Skin Syndrome (Ritter s Disease) Toxic Epidermal Necrolysis (TEN) Urticaria Mastocytosis Pruritus Etiology Evaluation of the Itching Patient General Guidelines Leg Ulcers Venous Ulcers Arterial Ulcers Decubitis Ulcers (Bedsore) Neuropathic Ulcers Disorders of Pigmentation Albinism Vitiligo Melasma (Chloasma) Freckles Acanthosis Nigricans (AN) Periocular Hyperpigmentataion Disorders of Ultraviolet Radiation and Injuries Due to Cold Direct Effect of Sunlight on the Skin Sunburn Tanning Epidermal Thickening Vitamin D Production Immunological Effects Chronic Effects of Ultraviolet Radiation Protection Against Ultraviolet Radiation