Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Lupus Erythematosus

General A multisystem AI-CTD disorder that prominently affects the skin. Broadly divided into systemic lupus erythematosus (SLE), cutaneous lupus erythematosus (CLE), and drug-induced lupus erythematosus (DI-LE) ( Fig. 33.1 ). CLE is further classified into specific and nonspecific skin lesions, based on the histopathologic presence ( specific ) or absence ( nonspecific , Table 33.1 ) of an “interface dermatitis”; however, this is not a perfect…

Disorders of Eccrine and Apocrine Glands

Eccrine and apocrine glands represent the two major types of sweat glands (see Fig. 91.1 ). Eccrine Glands Functional from birth and activated by thermal stimuli via the hypothalamic sweat center; while their major function is thermoregulation by evaporative heat loss, they are also activated by emotional stimuli. Innervated by sympathetic fibers that have acetylcholine as their major neurotransmitter. Generalized distribution, with greatest concentration on the…

Folliculitis

The folliculitides are divided into superficial and deep forms ( Table 31.1 ). Table 31.1 Classification of the folliculitides. Superficial folliculitides Deep folliculitides Infectious Furuncles Sycosis ( Table 31.3 ) 1. Barbae ( Fig. 31.2 B) 2. Lupoid 3. Mycotic ( Fig. 31.7 ) 4. Herpetic Pseudofollicultis barbae Acne keloidalis Hidradenitis suppurativa ∗ Bacterial 1. Staphylococcus aureus ( Fig. 31.2 ) 2. Gram-negative bacilli 3. Hot…

Acne Vulgaris

Common pilosebaceous disorder that occurs in ∼85% of individuals 12–24 years of age and 15–35% of adults (especially women) in their 30s–40s. Preadolescent acne affecting children between 7 and 11 years of age has also become more common due to the trend for earlier onset of puberty. Clinical presentations range from mild comedones to severe, explosive eruptions of suppurative nodules associated with systemic manifestations. May result…

Vesiculopustular and Erosive Disorders in Newborns and Infants

This chapter covers classic transient neonatal eruptions as well as several infectious diseases and other disorders that present with vesiculopustules in the neonatal period or early infancy. Table 28.1 provides a more complete differential diagnosis of vesiculopustules, bullae, erosions, and ulcerations in neonates. Table 28.1 Differential diagnosis of neonatal vesiculopustules, bullae, erosions, and ulcers. This list is not exhaustive, as other rare diseases such as ankyloblepharon–ectodermal…

Other Vesiculobullous Diseases

There are a number of disorders that can present with vesicles and bullae, including exaggerated insect bite reactions ( Fig. 27.1 ; see Ch. 20 ), autoimmune and inherited blistering diseases (see Chapter 23, Chapter 24, Chapter 25, Chapter 26 ), porphyrias (see Ch. 41 ), the Stevens–Johnson syndrome–toxic epidermal necrolysis spectrum (see Ch. 16 ), and phototoxicity, from sunburn to phototoxic drug reactions (e.g. due…

Pemphigus

Chapters 23–25 review the major autoimmune bullous diseases ( Table 23.1 ). Because of the overlap in their clinical presentations, histopathologic examination of lesional skin as well as direct immunofluorescence (DIF) of perilesional skin are usually required in order to establish a specific diagnosis ( Figs 23.1–23.3 ). Indirect immunofluorescence (IIF; Fig. 23.2B ) and/or ELISA of sera provide additional helpful information; for example, the latter…

Pregnancy Dermatoses

There are several dermatoses that occur either during pregnancy or immediately postpartum, in particular polymorphic eruption of pregnancy, pemphigoid gestationis, and atopic eruption of pregnancy. Pruritus due to intrahepatic cholestasis of pregnancy leads to nonspecific skin lesions, including excoriations due to scratching. Impetigo herpetiformis simply represents pustular psoriasis occurring during pregnancy, and this may be related to the relative hypocalcemia of pregnancy. Lastly, there are physiologic…

Neutrophilic Dermatoses

This group of disorders, in an untreated state, is characterized by infiltrates of neutrophils within the skin. In addition, these dermatoses lack an identifiable infectious etiology, despite the presence of neutrophils ( Fig. 21.1 ). There can be significant overlap in the clinical presentations of the neutrophilic dermatoses; for example, in a patient with acute myelogenous leukemia, bullous pyoderma gangrenosum may be difficult to distinguish from…

Eosinophilic Dermatoses

As with the group of disorders known as neutrophilic dermatoses, there is significant overlap in the cutaneous findings of entities where eosinophils play a role – from papular urticaria triggered by arthropod bites to Wells syndrome and hypereosinophilic syndrome ( Fig. 20.1 ; Table 20.1 ). The exception is granuloma faciale, which has a more specific presentation. Open full size image Fig. 20.1 Evaluation of adult…

Vasculitis

Vasculitis is characterized by an inflammatory infiltrate that targets blood vessels and leads to destruction of their walls. Cutaneous vasculitis can occur in isolation or together with involvement of other organs; in the latter scenario, skin findings may represent important signs of systemic disease. Cutaneous vasculitides are classified based on the size of the vessels affected, which determines the morphology of the skin lesions ( Table…

Purpura and Disorders of Microvascular Occlusion

Purpura represents visible hemorrhage into the skin or mucous membranes; in contrast to erythema due to vasodilation, it is nonblanching upon application of external pressure. Purpura can be primary , where hemorrhage is an integral part of lesion formation, or secondary , where there is hemorrhage into established lesions due to factors such as venous hypertension, gravity, or thrombocytopenia. As purpuric lesions fade, their color evolves…

Figurate Erythemas

A number of cutaneous diseases can have an annular, arciform, or polycyclic configuration, from urticaria to granuloma annulare and tinea corporis ( Table 15.1 ). Sites of involvement, rate of expansion, and characteristics of the border assist in narrowing the differential diagnosis, along with histopathologic examination of the active edge. This chapter discusses in more detail the classic figurate erythemas. Table 15.1 Additional entities that can…

Urticaria and Angioedema

Urticaria and angioedema can occur at any age and are estimated to have an overall lifetime prevalence of 10–25%. Urticaria (hives) is characterized by wheals : evanescent, pale to pink-red, edematous papules or plaques ( Fig. 14.1 ); lesions often have central clearing, a peripheral erythematous flare, and associated pruritus. Individual wheals last <24 hours, which can be documented by outlining them with ink. Angioedema represents…