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Differential Diagnosis

1 Alopecia, Nonscarring Alopecia areata Anagen effluvium Androgenetic alopecia Cosmetic treatment Structural hair shaft disease Telogen effluvium Tinea capitis Trichotillomania (hair pulling) 2 Alopecia, Scarring Bacterial folliculitis Central centrifugal scarring alopecia Congenital (aplasia cutis) Discoid lupus erythematosus Folliculitis decalvans Lichen planopilaris Neoplasm Tinea capitis with inflammation (kerion) Trauma 3 Anhidrosis Central nervous system (CNS) lesions (medulla, hypothalamus, pons) Congenital sweat gland disorders Dehydration Drugs (anticholinergics) Hysteria…

Evaluation of Skin Disorders

A History and Physical Examination The initial step in the dermatologic evaluation involves obtaining a detailed dermatologic history. Box 1.1 describes pertinent questions. BOX 1.1 Dermatologic History From Goldstein BG, Goldstein AO: Practical Dermatology, ed 2, St. Louis, 1997, Mosby. A Initial Questions 1. When did the rash start? 2. What did it look like when it first started, and how has it changed? 3. Where…

Common clinical scenarios: Side-by-side comparisons of similar-appearing lesions that are benign or malignant

Introduction When you examine a skin lesion with dermoscopy, it might be obviously benign or malignant. There is also a gray zone of equivocal lesions. Gray-zone lesions will commonly be encountered by the novice dermoscopist. To help deal with this common situation, we offer a few suggestions. Learn the basics, practice the technique as often as possible, and develop a dermoscopic differential diagnosis. You have to…

Pattern analysis: Dermoscopic criteria for specific diagnoses

Dermoscopic analysis of pigmented skin lesions is based on four algorithms: pattern analysis; the ABCD rule; Menzies’ 11-point checklist; and the 7-point checklist. The common denominator of all these diagnostic algorithms is the identification and analysis of dermoscopic criteria found in the lesions. The majority of the dermatologists who participated in the second consensus meeting were proponents of pattern analysis. The basic principle is that pigmented…

Dermatologic Trivia

“I’m terrible at Trivial Pursuit. Everything I know is significant.” “There are three levels of knowledge: trivia, significa, and necessaria. Information that you may regard as trivial is likely to be regarded by your attending as necessary.” 1 The suffix -itis has come to mean inflammation. What is inflamed in “pruritis?” Nothing. The word is pruritus , not pruritis . It is derived from the Latin…

Nail Disorders

1 List the functions of the nails Nails protect the terminal phalanx and fingertip from traumatic impact Nails help to perform tasks that require manual dexterity Nails, while unparalleled in their ability to relieve itching, cause trauma to the skin Nails may serve an esthetic (beauty) function 2 Why are nails important in dermatology? Nails are observable and serve as a window into body function and…

Approaching the Pruritic Patient

Key Points: Pruritus 1. Chronic pruritus can be debilitating, causing great distress to patients. 2. A patient with no obvious reason for having chronic itch and no primary skin rash needs a full workup with a thorough history, physical examination, and laboratory and/or imaging studies to rule out underlying disease. 3. The pathophysiology of chronic itch involves a phenomenon of neural sensitization, which takes place at…

Psychocutaneous Diseases

Key Points 1. Up to 40% of all dermatologic patients have an associated psychiatric comorbidity. 2. Patients with cutaneous dysesthesia can present with many different complaints, but treatment is based on whether the symptoms are primarily pruritic or primarily painful. 3. When evaluating skin lesions that are self-inflicted, understanding the patient’s underlying motivation is essential for accurate diagnosis and treatment. 4. Patients with Morgellons present with…

Occupational Dermatology

1 What is the most common type of skin disease due to workplace exposures? Contact dermatitis accounts for more than 90% of occupational skin disease (OSD). The most common location of job-related contact dermatitis is the hands. It has been historically accepted that 80% of the contact dermatitis cases are irritant ( Fig. 66.1 ), while 20% are allergic ( Fig. 66.2 ). Recent studies challenged…

Dermatologic Emergencies

1 “Dermatologic emergencies” sounds like an oxymoron. Are there dermatologic emergencies? Yes, while perhaps not as ubiquitous as other areas of medicine, there are some dermatologic emergencies. In some of these emergent conditions, the skin is the primary organ affected (pemphigus vulgaris [PV]), while in others, the cutaneous manifestations an important diagnostic clue to a severe underlying condition (meningococcemia). Prompt recognition of dermatologic emergencies is important…

Cultural Dermatology

1 A girl from southern India is anemic, and her school performance has declined. On examination, the child has dark, mascara-like makeup around her eyes. You suspect the makeup is the cause of these medical and social problems. What is the name of this traditional Indian eye makeup? Kohl is the Punjabi name for the eye makeup. It is also called kajal or surma in other…

Special Considerations in Skin of Color

1 What is “skin of color”? There are many ways to subcategorize humans. Widely recognized racial groups include Africans, African-Americans, Asians, Middle Easterners, Northern Europeans, Native Americans, Pacific Islanders, and Hispanics, to name a few. Even within a racial group, gradations exist with regard to skin pigmentation. Simply put, people with “skin of color” have darker skin tones than those of typical white skin. The term…

Disorders of the Oral Mucosa

1 What is the most common form of oral cancer? Squamous cell carcinoma, the most common form of oral cancer, is the sixth most frequent cancer encountered in the United States ( Fig. 62.1 ). Nearly 34,000 Americans are diagnosed with oral cavity squamous cell cancer each year, and if the oropharynx is included, that number increases by another 16,000 cases. More than 370,000 people are…

Disorders of the Male Genitalia

Key Points 1. Circumcision is the most effective treatment in uncircumcised men with Zoon's balanitis. 2. Circinate balanitis is a cutaneous manifestation of reactive arthritis (Reiter's disease). 3. Penile lichen sclerosus and, to a lesser extent, lichen planus may be associated with an increased risk of squamous cell carcinoma. 4. Pearly penile papules are angiofibromas and are not a sexually transmitted disorder. 5. Topical calcineurin inhibitors…

Disorders of the Female Genitalia

Nonneoplastic Epithelial Disorders of the Vulva 1 What is lichen sclerosus (also known as lichen sclerosus et atrophicus)? Lichen sclerosus (LS) ( Fig. 60.1 ) is an inflammatory condition that primarily affects the epidermis and the superficial dermis. The disease process results in thinned or atrophic white papules and plaques of the skin. It is estimated that LS affects 1:60 women. LS primarily affects the anogenital…

Dermatoses of Pregnancy

Specific Dermatoses of Pregnancy 1 Name four pregnancy-specific dermatologic disorders Polymorphic eruption of pregnancy (PEP) Pemphigoid gestationis Atopic eruption of pregnancy Intrahepatic cholestasis of pregnancy (ICP) Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol. 2006;54(3):395–404. 2 What is polymorphic eruption of pregnancy?…

Geriatric Dermatology

1 How common are skin disorders in elderly persons? Skin diseases appear more common in the geriatric population than the general population. This may be due to intrinsic skin aging and senescence, immune dysfunction, polypharmacy, and even cognitive and physical impairments that impact personal hygiene. One study revealed that 40% of Americans between the ages of 65 and 74 years had a skin disease significant enough…

Pediatric Dermatology

1 What is the purpose of a pediatric dermatologist? A pediatric dermatologist specializes in the diagnosis and management of diseases of the skin, hair, and nails in children. The clinical presentation and treatment of skin diseases are often different in the pediatric and adult populations. A pediatric dermatologist has expertise in the management of patients ranging in age from newborns to young adults. 2 When should…

Neonatal Infections

1 What are the TORCHES infections in a neonate? This acronym stands for several etiologic agents of congenital infections: T oxoplasmosis O ther (varicella-zoster virus [VZV], parvovirus B19, Zika virus) R ubella C ytomegalovirus (causes most morbidity and mortality) H erpes simplex virus, H uman immunodeficiency virus (HIV) E nteroviruses, E pstein-Barr virus S yphilis Boyer S, Boyer K. Update on TORCH infections in the newborn…