About the Book

Easy-to-understand manual of Dermatology.
Provides an up-to-date account of clinical dermatology to meet the needs of trainee dermatologists and general practitioners.
Discusses the diseases of East and West in equal depth.
Diseases caused by bacteria, fungi, and parasites are discussed along with diseases common in the West such as inflammatory disorders and cutaneous malignancy.

About the Author

Zohra Zaidi MCPS Shernaz Walton MD FRCP (London)

Table of Contents:
1. The History of Dermatology 1 Ancient history 1 The middle ages 2 Modern age 3 Pioneer dermatologists 4 2. Skin: Structure, Function and Development 10 Skin types 10 Structure of the skin 10 Epidermis 11 Desmosomes 15 Physiology of keratinisation 16 Characteristics of epidermal differentiation 16 The cell cycle 16 Control of the epidermal proliferation 17 The other cells of the epidermis 18 Basement membrane complex 20 Epidermal appendages 22 Hair 25 Nail 29 Dermis 32 Cellular components of the dermis 37 The cutaneous vasculature 37 Lymphatic circulation 38 Cutaneous nerves 38 Muscles of the dermis 39 Subcutaneous tissue 39 Skin lines 40 Occurrence of skin disease in relation to racial and ethnic characteristics 41 Development of skin 42 Investigations for hereditary disorders of the skin 45 Functions of the skin 46 3. Approach Towards a Dermatological Patient 49 History taking 49 Examination 50 Some diagnostic hints 51 Special diagnostic procedures 51 Some clinical signs that help in diagnosis 52 Other laboratory investigations 52 Molecular diagnostics 53 Primary and secondary skin lesions 53 Commonly used descriptive terms in dermatopathology 56 xvi A Manual of Dermatology 4. Bacterial Infections 58 Infections caused by Staphylococcus aureus and Streptococcus haemolyticus 59 Ecthyma 64 Infections caused by mycobacteria 70 Tuberculosis 70 Localized tuberculosis 72 Tuberculids 74 Diagnosis of tuberculosis 75 Diseases caused by atypical mycobacteria 77 Leprosy 79 Infections caused by other gram-positive bacteria 87 Corynebacteria 88 Actinomyces 90 Infections caused by gram-negative bacteria 92 Meningococcal infection 93 Glanders (Farcy) 95 Melioidosis (Whitmore’s disease) 95 Tularemia (Ohara’s disease) 95 Plague 96 Brucellosis (Undulant fever) 97 Rhinoscleroma 97 Rat-bite fever 97 Rickettsia 98 Spirochaetes 100 Chlamydia 104 Mycoplasma 104 5. Fungal Infections 106 Superficial mycoses 107 Subcutaneous mycoses 128 Systemic mycoses 132 Opportunistic fungal infection 134 6. Viral Infections 136 Herpes virus infections 137 Poxvirus 148 Human papillomavirus 152 Bowenoid papulosis 157 Picorna virus 158 Myxovirus and paramyxovirus 159 Erythema infectiosum (Fifth disease) 161 Other cutaneous disorders associated with virus infections 161 7. Parasitic Infestation, Diseases Caused by Arthropods and Other Venomous Animals 163 Protozoal infestation 163 Trypanosomiasis 168 Toxoplasmosis 169 xvi A Manual of Dermatology Contents xvii Helminthic infestations 170 Platyhelminths 175 Diseases caused by arthropods 176 Reptiles and other venomous animals 191 Dermatoses caused by aquatic animals 192 8. Sexually Transmitted Diseases 195 Syphilis 195 Latent syphilis 199 Tertiary syphilis 199 Congenital syphilis 202 Gonorrhoea 204 Non-gonococcal urethritis 205 Chancroid 206 Granuloma inguinale 206 Lymphogranuloma venereum 207 Human immunodeficiency virus infection 209 9. Eczema 216 Pathogenesis of eczema 216 Clinical and histological features of eczema 217 Special characteristic of eczema 218 (Secondary dissemination) 218 Treatment of eczema 219 Classification 219 Common contact eczemas 223 Infective eczema 230 Photosensitive eczema 230 Endogenous eczema 230 Seborrhoeic dermatitis 239 Nummular eczema 243 Hypostatic eczema 244 Pompholyx 245 Lichen simplex chronicus 247 Pityriasis alba 248 Asteatotic eczema 249 Juvenile plantar dermatosis 250 Eczematous drug eruptions 250 Hand eczema 251 10. Keratinising and Papulosquamous Disorders 255 Psoriasis 255 Lichen planus 274 Lichen nitidus 280 Lichen striatus 281 Callosity and corn 284 Acrokeratosis verruciformis 287 Follicular keratoses 288 Miscellaneous keratosquamous disorders 290 xviii A Manual of Dermatology Porokeratosis 294 Congenital disorders of keratinisation 296 11. Connective Tissue Disorders 307 Lupus erythematosus 307 Chronic discoid lupus erythematosus 308 Subacute lupus erythematosus 311 Systemic lupus erythematosus 311 Antiphospholipid syndrome 315 (Lupus anticoagulant syndrome) 315 Neonatal lupus erythematosus 316 Dermatomyositis 316 Scleroderma 319 Diffuse systemic sclerosis 321 Mixed connective tissue disease 324 Miscellaneous disorders of collagen tissue 325 Hereditary disorders of collagen and elastic tissue 328 Ehlers-Danlos syndrome 330 Marfran’s syndrome 331 Juvenile hyaline fibromatosis 331 12. Bullous Disorders 334 The pathogenic mechanisms of blister formation 334 Pemphigus 335 Other acantholytic bullous disorders 342 Pemphigoid 344 Dermatitis herpetiformis 348 Other subepidermal bullous disorders 352 Bullous disorders of children 354 13. Sarcoidosis 363 Aetiology 363 Histopathology 364 Clinical features 364 Diagnosis 366 Treatment 367 Course and prognosis 367 14. Amyloidosis 368 Aetiology 368 Histopathology 368 Clinical Features 369 Diagnosis 371 Treatment 371 Course and Prognosis 371 15. Diseases of Blood Vessels and Lymphatic System 373 Vasculitis 373 Classification 373 Contents xix According to the size of vessel involved 374 Cutaneous and systemic vasculitis 374 Neutrophilic vasculitis 374 Lymphocytic vasculitis 378 Granulomatous vasculitis 379 Vasculitis-miscellaneous 381 Erythemas of the skin 383 Other erythemas 387 Hypersensitivity syndromes (toxic erythemas) 392 Telangiectasia 393 Primary telangiectasia 393 Secondary telangiectasia 393 Disorders of the lymphatic system 396 Lymphoedema 396 16. Urticaria 399 Aetiology 399 Pathogenesis 400 Classification 400 Differential diagnosis 403 Treatment 404 Angioedema (Quincke’s oedema) 404 Mastocytosis 405 Papular urticaria 407 17. Purpura 408 Aetiology 408 Investigations 409 Systemic causes of purpura 410 Purpura of dermatological interest 412 Miscellaneous purpuric disorders 415 18. Leg Ulcers 417 Classification of leg ulcers 417 Venous ulcers 417 Arterial ulcer 421 Miscellaneous causes 422 19. Diseases of Pigmentation 425 Physiology of pigmentation 426 Generalised Hyperpigmentation 426 Localised Hyperpigmentation 427 Reticular pigmentation 430 Generalised Hypopigmentation 432 Localised Hypopigmentation 435 20. Skin and Ultraviolet Radiation 441 Sites of photosensitive eruption 442 Standard erythema dose 442 Ultraviolet radiation and its interaction with the skin 442 xx A Manual of Dermatology Effects of ultraviolet radiation on the skin at molecular level 443 Effects of solar radiation on the skin 445 Disorders of the skin caused by ultraviolet light 447 Classification 451 Treatment of porphyria 454 Photosensitisation due to abnormalities in DNA repair 457 Skin diseases aggravated by ultraviolet radiation 459 Protection and treatment of skin against UVR 459 21. Cutaneous Reactions to Cold 461 Reaction of skin to cold—physiology 462 Dermatoses association with cold sensitivity 465 22. Pruritus 469 Itch receptors 469 Central itch 469 Types of itch 469 Neural pathways of itching 470 Peripheral and central pharmacologic mediators of itch 470 Patterns of itching 472 Influence of skin temperature on itching 472 Causes of pruritus 472 Classification 473 Diagnosis and evaluation of the itching patient 477 Treatment 478 23. Disorders of the Sebaceous, Sweat and Apocrine Glands 480 Acne vulgaris 480 Rosacea 491 Perioral dermatitis 494 Tumours of the sebaceous glands 495 Diseases of the sweat glands 495 Diseases of the eccrine glands 496 Hyperhidrosis 496 Intertrigo 498 Pitted keratolysis 498 Anhidrosis 499 Tumours of the sweat glands 500 Congenital disorders of the sweat glands 503 Diseases of the apocrine glands 504 Hidradenitis suppurativa (acne inversa) 504 Apocrine bromhidrosis 506 Apocrine chromhidrosis 506 Fox-Fordyce disease 506 Apocrine hidrocystoma 507 Contents xxi 24. Hair Disorders 509 Approach to a patient with hair disorders 509 Hypertrichosis 511 Hirsutism 512 Non-cicatricial alopecia 519 Alopecia areata 523 Cicatricial alopecia 528 Pseudopelade of Brocq 528 Folliculitis decalvans 529 Dissecting cellulitis of the scalp (Perifolliculitis capitis abscedens et suffodiens) 529 Structural defects of the hair 531 Miscellaneous conditions of the scalp 535 Tumorus of the hair follicle 537 Hair cosmetics 539 25. Nail Disorders 544 Nail changes in systemic disease 544 Nail changes due to cutaneous disorders 546 Discolouration (chromonychia) 549 Diseases of the nail fold 550 Abnormalities of the nail plate 552 Tumours adjacent to and under the nail 554 Congenital nail disorders 554 26. Diseases of the Subcutaneous Fat 557 Panniculitis 558 Weber-Christian disease 560 Rothman-Makai syndrome 561 Panniculitis and pancreatic disease 561 (Nodular fat necrosis) 561 ?1-antitrypsin deficiency-associated panniculitis 562 Sclerosing panniculitis 563 Dercums disease (Adiposis dolorosa) 563 Lipodystrophy 563 Cellulite 565 27. Tumours of the Skin 567 Malignant tumours of the skin 567 Cutaneous T-cell lymphoma (Mycosis fungoides) 583 Primary cutaneous B-cell lymphomas 585 Premalignant dermatoses 588 Benign tumours of the skin 592 Tumours associated with congenital diseases 600 28. Naevi and Malformations 605 Epidermal naevi 605 Epidermal keratinocytic naevi 606 Follicular naevi 609 Naevus sebaceous 610 Epidermal naevus syndrome 610 xxii A Manual of Dermatology Vascular naevi 611 Venous malformation 616 Naevus anemicus 616 Blue rubber bleb naevus syndrome 617 Maffucci syndrome 617 Melanocytic naevi 617 Atypical naevus (Dysplastic naevus) 622 Dysplastic nevus syndrome 623 Spitz naevi (Juvenile melanoma) 624 Naevus achromicus 624 Lymphatic malformations 625 Connective tissue naevi 626 Angiokeratomas 627 29. Malnutrition and Skin 630 Hypovitaminosis A 630 Hypervitaminosis A 631 Vitamin B complex 631 Vitamin D 634 Vitamin K 634 Vitamin E (a-tocopherol) 635 Vitamin C (Ascorbic acid) 635 Minerals 635 Essential fatty acids 637 Marasmus 638 Kwashiorkor 639 Plummer-Vinson syndrome 639 Obesity 640 30. Primary Cutaneous Immunodeficiency 641 Innate immunity 641 Adaptive immunity 642 Humoral immunity 643 Classification of harmful allergic reaction 645 Cell-mediated immunity 646 Laboratory diagnosis and assessment of immunological disorders 647 When to suspect immunodeficiency 648 Disorders of phagocytosis 649 Disorders of the thymus and T lymphocytes 651 Diseases due to deficiency of antibodies 651 Combined antibody and T-cell deficiency 652 Severe combined immunodeficiency 653 31. Cutaneous Manifestations of Systemic Diseases 655 Diabetes mellitus 655 Liver disease 657 Pancreatic disease 659 Cutaneous manifestations of malabsorption states 660 Contents xxiii Miscellaneous disorders of gastrointestinal tract 660 Renal disease 661 Rheumatoid arthritis 663 Hyperthyroidism 664 Hypothyroidism 664 Cushing’s syndrome 664 Addison’s disease 665 Xanthomatosis (hyperlipidemias) 665 Disorders of lipid metabolism 667 Disorders of amino acid metabolism 669 Mucopolysaccharidosis 671 Calcinosis cutis 672 Angiokeratoma with systemic disease 673 Cutaneous manifestations of immunosuppression 674 Cutaneous manifestations of internal malignancy 675 32. Systemic Effects of Cutaneous Disease: Erythroderma 678 Causes of erythroderma 678 Manifestations cutaneous 679 Manifestations systemic 679 Treatment of erythroderma 680 33. Ages of Man and their Dermatoses 682 Neonatal dermatology 682 Transient neonatal dermatoses 683 Neonatal dermatoses 684 Specific neonatal dermatoses 685 Panniculitis in neonates 687 Oedema of the newborn 688 Cutaneous changes in pregnancy 688 Specific dermatoses of pregnancy 689 Cutaneous changes at menopause 691 Skin disorders of menopause 692 The ageing skin 692 Skin changes in the ageing skin 693 Histological features of the ageing skin 695 Dermatoses of the elderly 695 Premature ageing syndromes 695 Diagnosis of ageing syndromes 698 Methods of improving the skin in ageing 698 34. Skin and Sports 700 Skin diseases that prevent sports 700 Diseases transmitted to other players 701 Cutaneous injuries due to sport 701 Injuries due to mechanical trauma 701 Heat-induced injuries 704 Cold-induced injuries 705 Injuries due to the sun 705 xxiv A Manual of Dermatology Contact dermatitis 705 Miscellaneous 706 Skin diseases aggravated by sports 708 35. Skin and Psychiatry 710 Classification of psychocutaneous disorders 710 Psychiatric disorders with dermatologic symptoms 710 Dermatologic disorders that are exacerbated by psychophysiological mechanisms 714 Approach to patients with psychocutaneous disorders 714 36. Diseases of the Oral Cavity 716 Ulcers of the oral cavity 717 White lesions of the oral mucosa 723 Black/brown pigmented lesions of the oral mucosa 727 Red lesions of the oral mucosa 729 Tumours of the oral cavity 730 Cheilitis 732 37. Cutaneous Manifestation of Diseases of External Genitalia 736 Specific disorders of female external genitalia 736 Specific disorders of male external genitalia 740 38. Miscellaneous Disorders 744 Poikiloderma 744 Acanthosis nigricans 745 Pyoderma gangrenosum 747 Malignant atrophic papulosis 748 Sweet’s syndrome (Acute febrile neutrophilic dermatosis) 749 Jessner’s lymphocytic infiltration 751 Pseudolymphomas 751 Lymphomatoid papulosis 752 Gangrene of the skin 752 Treatment of gangrene 755 Histiocytosis 756 Mucinosis 759 Necrobiotic disorders 761 Perforating disorders 763 Piezogenic papules 766 Rieter’s disease 767 Prurigo 771 Atrophy of the skin 772 Anetoderma 773 Cutis verticis gyrata 775 Pachydermoperiostosis 776 Ainhum 777 Pseudoainhum 777 Relapsing polychondritis 777 Cutaneous manifestations of drug abuse 778 Contents xxv 39. Occupational Dermatoses 782 Occupational hand dermatitis 782 Contact urticaria 783 Infections 783 Acne 784 Malignancy 785 Heat 785 Cold 785 Vibration syndrome 785 Connective tissue disorders 786 Importance of occupational skin diseases 786 Diagnosis of occupational skin disease 786 Treatment and prevention of occupational skin disease 787 Prognosis of occupational skin disease 788 40. Injuries Due to Burn 789 Assessment of damage caused by burns 789 Clinical assessment of a burn injury 790 Factors to be considered in assessing burn injury 791 Special types of burn 791 Complication of burns 792 Treatment 792 Referral to a burn unit 794 41. Fundamentals of Topical Therapy and Some Common Dermatological Preparations 795 Principles of topical therapy 795 Amount to be dispensed 795 Percutaneous absorption 796 Frequency of application 797 Ingredients in topical preparations 797 Topical preparations 797 Some common dermatological formulae 799 42. Systemic Therapy 804 Corticosteroids 804 Antifungals 810 Retinoids 814 Psoralens 817 Immunosuppressive and cytotoxic drugs 819 Immunobiologics 824 Intravenous immunoglobulin 827 Topical immunomodulators 828 Antimalarials 830 Dapsone 832 Antiviral drugs 833 Ribavirin 837 Promise of the future: Gene therapy 837 xxvi A Manual of Dermatology 43. Cutaneous Drug Reactions 840 Classification of drug reactions 840 Approach to diagnosis of drug reactions 841 Skin lesions in drug reaction 841 Severe skin reactions 843 Uncommon reactions 845 Prevention 849 44. Physical Modalities in Cutaneous Therapy 850 Biopsy 850 Curettage 852 Shave excision 852 Electrocautery 853 Electrolysis 853 Thermolysis 853 Iontophoresis 853 Mohs surgery 854 Cryosurgery 854 Lasers 857 Intense pulsed light 862 Photodynamic therapy 862 Cosmetic dermatology 863 Filling agents 866 Botox injections 867 45. Radiotherapy in Dermatology 869 Types of ionising radiation used in dermatology 869 Treatment regimens 871 Postradiation changes in the skin 871 Indications for radiation 872 Side effects of radiotherapy and skin care 873 Appendices—Differential diagnosis Appendix 1: Generalized Eruptions 875 Appendix 2: Hair Disorders 877 Appendix 3: Face 879 Appendix 4: Upper and Lower Limb 881 Appendix 5: Flexures 882 Appendix 6: Lesions Differentiated by Colour 883 Appendix 7: Lesions Differentiated by Appearance and Texture 884 Appendix 8: Vascular Reactions 885 Appendix 9: Nail Disorders 886 Appendix 10: Miscellaneous 888 Bibliography 891 Index 895