Clinical Dermatology, 4th edition PDF
Preview Clinical Dermatology, 4th edition
978140514663_1_pretoc.qxd 12/10/07 3:17 PM Page i Clinical Dermatology Clinical Dermatology, Fourth Edition By Richard P.J.B. Weller, John A.A. Hunter, John A. Savin and Mark V. Dahl © 2008 Richard Weller, John Hunter, John Savin, Mark Dahl . ISBN: 978-1-405-14663-0 978140514663_1_pretoc.qxd 12/10/07 3:17 PM Page ii In memory of John Savin, 1935–2006 978140514663_1_pretoc.qxd 12/10/07 3:17 PM Page iii Clinical Dermatology Richard P.J.B. Weller MD, FRCP (Edin) Senior Lecturer Department of Dermatology University of Edinburgh Edinburgh, UK John A.A. Hunter OBE BA MD FRCP (Edin) Professor Emeritus of Dermatology University of Edinburgh Edinburgh, UK John A. Savin MA MD ChB FRCP DIH Former Consultant Dermatologist The Royal Infirmary Edinburgh, UK Mark V. Dahl BA MD Professor of Dermatology and former Chairman College of Medicine Mayo Clinic Arizona Scottsdale, AZ, USA, and Professor Emeritus and former Chairman University of Minnesota Medical School Minneapolis, MN, USA Fourth Edition 978140514663_1_pretoc.qxd 12/10/07 3:17 PM Page iv © 1989, 1995, 2002, 2008 Richard Weller, John Hunter, John Savin, Mark Dahl Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 1989 Second edition 1995 Third edition 2002 Fourth edition 2008 1 2008 Library of Congress Cataloging-in-Publication Data Clinical dermatology / Richard Weller . . . [et al.]. — 4th ed. p. ; cm. Rev. ed. of: Clinical dermatology / J.A.A. Hunter, J.A. Savin, M.V. Dahl. 2nd ed. 1995. Includes bibliographical references and index. ISBN 978-1-4051-4663-0 (alk. paper) 1. Skin—Diseases. 2. Dermatology. I. Weller, Richard, MD. II. Hunter, J.A.A. Clinical dermatology. [DNLM: 1. Skin Diseases—diagnosis. 2. Skin Diseases—therapy. WR 140 C6413 2007] RL71.H934 2007 616.5—dc22 2007018995 ISBN-13: 978-1-4051-4663-0 A catalogue record for this title is available from the British Library Set in 9/12pt Palatino by Graphicraft Limited, Hong Kong Printed and bound in Singapore by Fabulous Printers Pte Ltd Commissioning Editor: Martin Sugden Editorial Assistant: Jennifer Seward Development Editor: Rob Blundell Production Controller: Debbie Wyer For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. Blackwell Publishing makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check that any product mentioned in this publication is used in accordance with the prescribing information prepared by the manufacturers. The author and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this book. 978140514663_1_pretoc.qxd 12/10/07 3:17 PM Page v Contents Introduction 1 1 Skin disease in perspective 4 2 The function and structure of the skin 10 3 Diagnosis of skin disorders 34 4 Disorders of keratinization 47 5 Psoriasis 54 6 Other papulosquamous disorders 71 7 Eczema and dermatitis 79 8 Reactive erythemas and vasculitis 104 9 Bullous diseases 118 10 Connective tissue disorders 131 11 Disorders of blood vessels and lymphatics 146 12 Sebaceous and sweat gland disorders 162 13 Regional dermatology 177 14 Racially pigmented skin 205 15 Dermatology of different age groups 216 16 Infections 221 17 Infestations 258 18 Skin reactions to light 268 19 Disorders of pigmentation 277 20 Skin tumours 289 21 The skin in systemic disease 323 22 Cosmetic dermatology 335 23 The skin and the psyche 342 24 Other genetic disorders 348 25 Drug eruptions 356 26 Medical treatment of skin disease 364 27 Physical forms of treatment 371 Formulary 1 Topical treatments 381 Formulary 2 Systemic medication 393 Index 407 v 978140514663_1_pretoc.qxd 12/11/07 5:28 PM Page vii Preface to the fourth edition Another five years has flown by and more than We have introduced three new chapters into this enough has happened in the world of dermato- edition. That on racial skin differences reflects the logy to warrant this, the fourth, edition of Clinical cosmopolitan world in which we live and should Dermatology. make interpretation of skin disorders in different The original editorial team felt that our book would ethnic groups easier. In chapter 15 we bring together be refreshed and energised by a younger co-editor! the skin conditions encountered in different age Richard Weller was approached, as his background groups, and add two more to Shakespeare’s seven bridges clinical and academic dermatology; happily, ages – those of the foetus and the pregnant woman. he agreed to join and even lead the team. We have Our third newcomer is that on cosmetic dermatology. always felt that our book was a little different from We hope that this chapter will allow family doctors our competitors in that we try to provide more to keep one step ahead of their patients who, aided science behind diseases and their treatment than by a myriad of TV programmes, seem to know much is usual in such short primers. We also make no about keeping ten years younger. apologies that we aim to enthuse family doctors (for We have also updated every chapter on its own whom we are primarily writing) to enjoy the chal- merit and have tried to include important recent lenge of diagnosing and treating skin conditions that advances. The role of the new ‘biologicals’ in the they see only too often. At the same time we hope treatment of psoriasis and their side effects, fillagrin that there is more than enough in the following pages gene mutations in atopic eczema, recently recognized to whet the appetite of budding dermatologists, drug eruptions, the science behind the different types bright undergraduate students and even physicians of phototherapy and new lasers, the prevention of and looking beyond their own specialty. protection against infections after dermatological 2006 was an especially sad year for us. John Savin, surgery, are but a few. our colleague, co-editor and, above all, friend died Finally, we acknowledge that the quickest way in August. As usual, he was ahead of the game that most family doctors can now learn more about in rewriting ‘his’ chapters and editing ‘ours’! His a topic is by electronic communication. The first name, of course, remains on the front cover of this references under ‘Further reading’ at the end of each edition. We miss him enormously but still feel him chapter therefore provide directions to guidelines, looking over our shoulders when we struggle to reviews and treatments that can be easily accessed describe some complex problem in simple plain on the internet. English; we hope that this edition will continue to We welcome you to our fourth edition. reflect his way with words. R.P.J.B.W., J.A.A.H. and M.V.D. Edinburgh and Scottsdale, 2007 vii 978140514663_1_pretoc.qxd 12/11/07 5:28 PM Page viii Preface to the first edition Some 10% of those who go to their family doctors do aand of course their patients. We make no apolo- so with skin problems. We have seen an improve- gies for our emphasis on diagnosis and manage- ment in the way these have been managed over the ment, and accept that we cannot include every last few years, but the subject still baffles many med- remedy. Here, we mention only those preparations ical studentsaon both sides of the Atlantic. They we have found to be useful and, to avoid too many find it hard to get a grip on the soggy mass of facts trade names, we have tabulated those used in the served up by some textbooks. For them we have UK and the USA in a Formulary at the back of the tried to create an easily-read text with enough detail book. to clarify the subject but not enough to obscure it. We have decided not to break up the text by quot- There are many doctors too who are puzzled by ing lists of references. For those who want to know dermatology, even after years in practice. They have more there are many large and excellent textbooks still to learn how to look at the skin with a trained on the shelves of all medical libraries. eye. Anyone who denies that clinical dermatology is While every effort has been made to ensure that a visual specialty can never have practised it. In this the doses mentioned here are correct, the authors book we have marked out the route to diagnostic suc- and publishers cannot accept responsibility for any cess with a simple scheme for recognizing primary errors in dosage which may have inadvertently skin lesions using many diagrams and coloured entered this book. The reader is advised to check plates. dosages, adverse effects, drug interactions, and We hope that this book will help both groupsa contraindications in the latest edition of the British students and doctors, including some in general National Formulary or Drug Information (American medicine and some starting to train as dermatologists Society of Hospital Pharmacists). 978140514663_1_pretoc.qxd 12/11/07 5:28 PM Page ix Acknowledgements We are grateful to Stuart Taylor and Rob Blundell of 7.17), M.J. Tidman (20.52), E.C. Benton (16.20 and Blackwell publishing for their help and encourage- 20.61), G.W. Beveridge (21.17), R. Dawber (27.9) and ment in preparing this book. Dr Gina Pitts provided Mr Auf Quaba (20.14). We are grateful to them all. invaluable feedback on the cosmetic dermatology chapter and Dr Sharnika Abeyakirthi on the leprosy Disclaimer section. Many of the clinical photographs come from the collection of the Department of Dermato- Although every effort bas been made to ensure that logy at the Royal Infirmary of Edinburgh and we drug doses and other information are presented wish to thank all those who presented them. Dr Kate accurately in this publication, the ultimate respons- Coleman (22.1 and 22.2), and Mr Anas Nasaan (22.4 ibility rests with the prescribing physician. Neither the and 22.5) generously provided illustrations for publisher nor the authors can be held responsible the cosmetic dermatology chapter, as did Q-Med for any consequences arising from the use of informa- AB (22.3). Dr C. Crutchfield of the University of tion contained herein. Any product mentioned in Minnesota provided all the pictures for Chapter 14. this publication should be used in accordance Other colleagues who have kindly supplied pictures with the prescribing information prepared by the are Drs P.K. Buxton (7.12), O.M.V. Schofield (7.14 and manufacturers. 978140514663_4_000.qxd 12/10/07 3:14 PM Page 1 Introduction Our overall aim in this book has been to make and becoming more fashionable in the UK. Family dermatology easy to understand by the many busy doctors who are asked about this topic can find their doctors who glimpsed it only briefly, if at all, during answers in our new chapter on cosmetic dermatology their medical training. All too often the subject has (Chapter 22). been squeezed out of its proper place in the under- We do not pretend that all of the problems in graduate curriculum, leaving growing numbers who the classification of skin diseases have been solved quail before the skin and its reputed 2000 conditions, in this book. Far from it; some will remain as long each with its own diverse presentations. They can as their causes are still unknown, but we make see the eruptions clearly enough, but cannot describe no apology for trying to keep our terminology as or identify them. There are few machines to help simple as possible. Many doctors are put off by them. Even official ‘clinical guidelines’ for treatment the cumbersome Latin names left behind by earlier are no use if a diagnosis has not been made. Their patients quickly sense weakness and lose faith. We hope that this book will give them confidence in their ability to make the right diagnosis and then to prescribe safe and effective treatment. An understanding of the anatomy, physiology and immunology of the skin (Chapter 2) is the bedrock on which all diagnostic efforts must be based. Remembering Osler’s aphorism that ‘We miss more by not seeing than by not knowing’, the identification and description of primary skin lesions and the patterns these have taken up on the skin sur- face follow (Chapter 3) and will lead to a sensible working diagnosis. After this has been achieved, investigations can be directed along sensible lines (Chapter 3) until a firm diagnosis is reached. Then, and only then, will the correct line of treatment snap into place. General rules for the choice of topical treat- ments are dealt with in Chapter 26, while more specific information on topical and systemic drugs is covered in the chapters on individual conditions. Correct choices here will be repaid by good results. Patients may be quick to complain if they are not doing well; equally they are delighted if their eruptions can be seen to melt rapidly away. Many of them are now joining in the quest for cosmetic Describe the primary lesion. What is your diagnosis? perfection that is already well advanced in the USA Turn over the page to find the answer. Clinical Dermatology, Fourth Edition By Richard P.J.B. Weller, John A.A. Hunter, John A. Savin and Mark V. Dahl 1 © 2008 Richard Weller, John Hunter, John Savin, Mark Dahl . ISBN: 978-1-405-14663-0
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