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Lasers in Dermatology

Introduction ■ Laser is an acronym for light amplification by the stimulated emission of radiation. ■ Laser light is a monochromatic (single wavelength), coherent (waves in phase), and collimated (waves travel in parallel) form of energy. ■ In the skin, laser energy is absorbed by chromophores, which include water, melanin, oxygenated hemoglobin, and certain tattoo pigments. ■ Newer, more modern laser technology uses selective photothermolysis to…

Cutaneous Manifestations of Internal Disease

Acquired Cutaneous Paraneoplastic Syndromes Description ■ Some cutaneous signs are specific enough to warrant a search for occult malignancy. ■ Acquired cutaneous paraneoplastic syndromes involve cutaneous findings associated with or related to internal malignancy. ■ This chapter will discuss pruritus, dermatomyositis, Sweet's syndrome, carcinoid syndrome, glucagonoma syndrome, paraneoplastic pemphigus, and the sign of Leser–Trélat. Table 22.1 Cutaneous Lesions and Internal Malignancy: Paraneoplastic Syndromes * Syndrome Clinical…

Neonatal Disease

Erythema Toxicum Neonatorum Description ■ Erythema toxicum neonatorum is a common benign transient pustular eruption seen in the newborn period. History ■ Erythema toxicum neonatorum occurs more commonly in healthy term infants than in premature and low birth weight infants. ■ The cause of erythema toxicum neonatorum is unknown. Skin Findings ■ Erythema toxicum neonatorum lesions appear as “blotchy” macules that develop into superficial pink papules…

Hair and Nail Diseases

Androgenic Alopecia (Male Pattern Baldness) Description ■ Androgenic alopecia is premature loss of hair of the central scalp. History ■ Alopecia is a physiologic reaction induced by androgens in genetically predisposed men. ■ The pattern of inheritance is probably polygenic. ■ It can begin any time after puberty and usually is fully expressed by the time the patient is in his 40s. Skin Findings ■ Terminal…

Vascular Tumors and Malformations

Infantile Hemangiomas Description ■ Infantile hemangiomas are benign red, purple, or blue vascular neoplasms occurring within the first year of life; they consist of proliferating endothelial-like cells. ■ Terms such as strawberry hemangioma and cavernous hemangioma should be discarded because they have been used to describe both vascular growths and vascular malformations. History ■ Infantile hemangiomas are the most common vascular tumor of infancy, occurring in…

Benign Melanocytic Neoplasms and Melanoma

Acquired Melanocytic Nevi (Moles) Description ■ Acquired melanocytic nevi are common benign skin tumors composed of melanocyte-derived nevus cells. History ■ Acquired melanocytic nevi are more common in whites than Asians and Africans. ■ Numbers of acquired melanocytic nevi peak in early adolescence, slowly increase in number until age 30 years, and then regress in elderly people. ■ Genetic factors, as well as environmental influences, such…

Premalignant and Malignant Nonmelanoma Skin Tumors

Basal Cell Carcinoma Description ■ Basal cell carcinoma is a skin cancer derived from the basal layer of keratinocytes of the epidermis. ■ It is the most common cutaneous malignancy and most common cancer in humans. ■ If left untreated, basal cell carcinomas will locally invade surrounding skin, destroying underlying tissue. ■ Rarely, basal cell carcinomas can metastasize. History ■ Basal cell carcinoma may occur at…

Benign Skin Tumors

Seborrheic Keratosis Description ■ A seborrheic keratosis is a common, benign, persistent epidermal lesion with variable clinical appearance. ■ It is one of the most common benign growths seen on the skin. ■ These keratoses have multiple clinical variations and can be easily be confused with other cutaneous malignancies. History ■ Seborrheic keratoses are unusual before 30 years of age. ■ Most people develop at least…

Light-Related Diseases and Disorders of Pigmentation

Sun-Damaged Skin, Actinic-Damaged Skin, and Photoaging Description ■ Sun-damaged skin is easily recognizable and shows specific skin findings, resulting from damage due to ultraviolet radiation (UVR). History ■ Acute exposure to UVR results in sunburn and is especially caused by ultraviolet B (UVB) radiation. ■ Chronic UVR exposure results in photoaging and skin cancer. ■ Light-colored skin, genetic disorders (e.g., xeroderma pigmentosum), and certain medications (e.g.,…

Connective Tissue Diseases

Lupus Erythematosus General Description ■ Cutaneous lupus erythematosus is a disease with a wide spectrum of manifestations ranging from solitary chronic skin lesions in chronic cutaneous lupus erythematosus (CCLE), to widespread polymorphous lesions in subacute cutaneous lupus erythematosus (SCLE), to multiple-organ involvement in systemic lupus erythematosus (SLE). Lupus is thought to be a dysregulation of T cells causing the activation of B cells, producing a variety…

Vesicular and Bullous Diseases

Dermatitis Herpetiformis Description ■ Dermatitis herpetiformis (DH) is a chronic pruritic vesicular rash commonly occurring on the extensor surfaces and is a manifestation of gluten sensitivity. History ■ In adults, DH is twice as common in males. ■ In children, females are more commonly affected. ■ Most patients with DH are of northern European descent. ■ DH rarely occurs in Asians and Africans. Skin Findings ■…

Infestations and Bites

Scabies Description ■ Scabies is a parasitic infestation of the skin caused by the mite Sarcoptes scabiei var. hominis. ■ It is characterized by an intensely pruritic eruption and may be the etiology of “the 7-year itch.” History ■ Patients with scabies complain of a rash with unremitting itching and an inability to stop scratching, even while being examined. ■ It is uncommon for scabies to…

Hypersensitivity Syndromes and Vasculitis

Erythema Multiforme Description ■ Erythema multiforme is a relatively common, acute—often recurrent—inflammatory disease characterized by target-shaped skin lesions. History ■ Commonly, erythema multiforme is associated with herpes simplex, Mycoplasma pneumoniae, and upper respiratory tract infections, although erythema multiforme may be associated with many conditions ( Table 11.1 ). Table 11.1 Etiologic Factors for Developing Erythema Multiforme From Samin F, Auluck A, Zed C, Williams PM. Erythema…

Exanthems and Drug Reactions

Nonspecific Viral Rash Description ■ An exanthem is a rash that occurs as a sign of a systemic disease. A viral exanthem is a rash that arises because of a viral infection. ■ Most viruses produce similar rashes, leading to the term nonspecific viral rash . History ■ Nonspecific viral rashes are the most common viral exanthems and are challenging to diagnose. ■ Historic elements such…

Fungal Infections

Candidiasis (Moniliasis) Description ■ Candida albicans and a few other Candida species are capable of producing skin and mucous membrane infections. ■ The organism lives among the normal flora of the mouth, vaginal tract, and lower gastrointestinal tract. ■ Candida species reproduce through the budding of oval yeast forms, forming elongated pseudohyphae. ■ Decreased cell-mediated immunity, compromised skin barrier, and changes in normal skin flora predispose…

Viral Infections

Warts (Verruca Vulgaris) Description ■ Warts are benign epidermal proliferations caused by human papillomavirus (HPV) infection, a double-stranded DNA virus, which infects skin and mucous membranes. ■ There are more than 150 different types of HPV. New subtypes are defined by DNA hybridization. Some subtypes are associated with a particular location and characteristic clinical and pathologic presentation. ■ Transmission is by simple contact, often at sites…

Sexually Transmitted Infections

Syphilis Description ■ Syphilis is a sexually transmitted infectious disease caused by the spirochete Treponema pallidum. ■ The infection can affect any organ and may mimic various other diseases; thus it has been called the “great imitator.” ■ If left untreated syphilis can infect and damage the heart, aorta, brain, eyes, and bones and can be fatal. ■ Syphilis passes through three distinct stages: primary infectious,…

Bacterial Infections

Impetigo Description ■ Impetigo is a common, highly contagious, superficial skin infection produced by Streptococcus pyogenes, Staphylococcus aureus, or a combination of both bacteria. ■ Bullous impetigo and nonbullous impetigo represent two clinical forms of the disease. ■ S. aureus is the cause in about 80% of cases, and group A streptococcus in 20% to 30%. History ■ Impetigo may occur after a minor skin injury,…

Psoriasis and Other Papulosquamous Diseases

Psoriasis Description ■ Psoriasis is a common chronic inflammatory disorder caused in large part by abnormal T-lymphocyte function. ■ Pink to red papules and plaques with thick white scale may be localized or widespread, involving the scalp, elbows, and knees. ■ Psoriasis may be isolated to the scalp, nails, and skinfolds. ■ Although psoriasis persists throughout life, patients may experience extended periods of remission. History ■…

Acne, Rosacea, and Related Disorders

Acne Description ■ Acne is a papular or pustular eruption involving the face, chest, and back. History ■ Acne may occur at any age but is more common in the teenage years and may persist well into adulthood. ■ Twenty percent of affected individuals develop severe acne resulting in scarring. ■ Acne can run in families, and those with a family history of acne often develop…