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Clinical Dermatology PDF

453 Pages·2015·67.436 MB·English
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ClinicalDermatology RICHARD WELLER, HAMISH HUNTER AND MARGARET MANN FIFTHEDITION Clinical Dermatology FormymotherAlisonandforJulie,HiwotandGirma;Foz,JackandIsabella;Daniel andSamuel. Clinical Dermatology Richard B. Weller MD,FRCP(Edin) SeniorLecturer DepartmentofDermatology UniversityofEdinburgh Edinburgh,UK Hamish J.A. Hunter BSc(Hons),MBChB,MRCP(UK)(Derm) ClinicalResearchFellowinDermatology UniversityofManchester Manchester,UK Margaret W. Mann MD,FAAD AssistantProfessorofDermatology DirectorofAestheticDermatology AssociateDirectorofDermatologicSurgery UniversityHospitals/CaseWesternSchoolofMedicine Cleveland,OH,USA FIFTH EDITION Thiseditionfirstpublished2015©2015byJohnWiley&SonsLtd. Registeredoffice: JohnWiley&Sons,Ltd,TheAtrium,SouthernGate,Chichester, WestSussex,PO198SQ,UK Editorialoffices: 9600GarsingtonRoad,Oxford,OX42DQ,UK TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 111RiverStreet,Hoboken,NJ07030-5774,USA Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthow toapplyforpermissiontoreusethecopyrightmaterialinthisbookpleaseseeourwebsiteat www.wiley.com/wiley-blackwell Therightoftheauthorstobeidentifiedastheauthorsofthisworkhasbeenassertedin accordancewiththeUKCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem, ortransmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recording orotherwise,exceptaspermittedbytheUKCopyright,DesignsandPatentsAct1988,without thepriorpermissionofthepublisher. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks. Allbrandnamesandproductnamesusedinthisbookaretradenames,servicemarks, trademarksorregisteredtrademarksoftheirrespectiveowners.Thepublisherisnot associatedwithanyproductorvendormentionedinthisbook.Itissoldontheunderstanding thatthepublisherisnotengagedinrenderingprofessionalservices.Ifprofessionaladviceor otherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbesought. Thecontentsofthisworkareintendedtofurthergeneralscientificresearch,understanding, anddiscussiononlyandarenotintendedandshouldnotberelieduponasrecommendingor promotingaspecificmethod,diagnosis,ortreatmentbyhealthsciencepractitionersforany particularpatient.Thepublisherandtheauthormakenorepresentationsorwarrantieswith respecttotheaccuracyorcompletenessofthecontentsofthisworkandspecificallydisclaim allwarranties,includingwithoutlimitationanyimpliedwarrantiesoffitnessforaparticular purpose.Inviewofongoingresearch,equipmentmodifications,changesingovernmental regulations,andtheconstantflowofinformationrelatingtotheuseofmedicines,equipment, anddevices,thereaderisurgedtoreviewandevaluatetheinformationprovidedinthe packageinsertorinstructionsforeachmedicine,equipment,ordevicefor,amongother things,anychangesintheinstructionsorindicationofusageandforaddedwarningsand precautions.Readersshouldconsultwithaspecialistwhereappropriate.Thefactthatan organizationorWebsiteisreferredtointhisworkasacitationand/orapotentialsourceof furtherinformationdoesnotmeanthattheauthororthepublisherendorsestheinformation theorganizationorWebsitemayprovideorrecommendationsitmaymake.Further,readers shouldbeawarethatInternetWebsiteslistedinthisworkmayhavechangedordisappeared betweenwhenthisworkwaswrittenandwhenitisread.Nowarrantymaybecreatedor extendedbyanypromotionalstatementsforthiswork.Neitherthepublishernortheauthor shallbeliableforanydamagesarisingherefrom. LibraryofCongressCataloging-in-PublicationData Weller,RichardP.J.B.,author. Clinicaldermatology/RichardB.Weller,HamishJ.A.Hunter,MargaretW.Mann.–Fifth edition. p.;cm. PrecededbyClinicaldermatology/RichardP.J.B.Weller... [etal.].4thed.2008. Includesbibliographicalreferencesandindex. ISBN978-0-470-65952-6(pbk.) I.Hunter,HamishJ.A.,author. II.Mann,MargaretW.,author. III.Title. [DNLM:1.SkinDiseases–diagnosis. 2.SkinDiseases–therapy. WR140] RL71 616.5–dc23 2014032478 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsin printmaynotbeavailableinelectronicbooks. Setin9.25/11.5ptMinionbyAptaraInc.,NewDelhi,India 1 2015 Contents PrefacetotheFifthEdition,vii Acknowledgements,viii Introduction,ix 1 SkinDiseaseinPerspective,1 2 TheFunctionandStructureoftheSkin,7 3 DiagnosisofSkinDisorders,30 4 DisordersofKeratinization,45 5 Psoriasis,52 6 OtherPapulosquamousDisorders,68 7 EczemaandDermatitis,76 8 ReactiveErythemasandVasculitis,99 9 BullousDiseases,113 10 ConnectiveTissueDisorders,126 11 DisordersofBloodVesselsandLymphatics,140 12 SebaceousandSweatGlandDisorders,156 13 RegionalDermatology,171 14 RacialSkinDifferences,197 15 TheSkinatDifferentAges,208 16 Infections,214 17 Infestations,249 18 SkinReactionstoLight,258 19 DisordersofPigmentation,267 20 SkinTumours,278 21 TheSkininSystemicDisease,311 22 CosmeticDermatology,323 23 TheSkinandthePsyche,334 v vi Contents 24 OtherGeneticDisorders,342 25 DrugEruptions,351 26 MedicalTreatment,359 27 PhysicalFormsofTreatment,366 28 Dermoscopy,385 Formulary1:TopicalTreatments,397 Formulary2:SystemicMedication,410 Index,427 Preface to the Fifth Edition ClinicalDermatologyisnowquarterofacenturyold,and cosmetic dermatology; an evolution we have tried to thisfiftheditionisthefirstnottoincludeanyoftheorig- reflectbyenhancingthesesectionsofourbook.Thebio- inal authors. Hamish Hunter is one of the two British logicsrevolution,nowwellembeddedinourpractice,has authorsandhasaninterestininflammatorydermatoses beenagratifyingexampleofhowabasicscienceunder- and the brain–skin axis. Margaret Mann has joined the standinghasledtorealimprovementsintherapyforour teamasourAmericanauthorbringingparticularexper- patients;truly‘benchtobedside’.Wehopethatthearrival tiseindermatologicsurgeryandcosmeticdermatology. ofBRAFinhibitorsformelanomamaybeasignofsimilar While the authors may have changed, we hope that the improvementsincareforourmelanomapatients.Every bookretainsitsoriginalfeelasanapproachableanduse- chapterhasbenefitedfrombeingrevisedandupdatedand ful text to the practicing clinician, but underpinned by togethertheyreflectchangesinavigorousandscientifi- thesciencebehindthedisease.Asalwayswehavestriven callygroundedspeciality. to make the text enjoyable and useful to a wide audi- Wehopeyouenjoythelatesteditionofourbook.All ence, whether medical students, family doctors or neo- medical textbooks are a snapshot of the state of the art phytedermatologists. when written, but we trust that you will find this book Dermatology as a speciality has grown enormously usefulforatleastthenextfiveyears! sincethefirstedition.Theconstantimprovementsinour understanding of skin disease and developments in the RichardWeller,Edinburgh treatments are both exciting and, it must be admitted, MargaretMann,Cleveland sometimes a little daunting for the editors! Traditional HamishHunter,Manchester medical dermatology has been joined by surgical and vii Acknowledgements Manypeoplehavehelpedintheproductionofthisbook. toourfriendsandcolleagueswhohavegenerouslypro- FirstofcoursewemustthankJohnHunter,thelateJohn videdillustrationsandfeedback.Manyoftheclinicalpho- SavinandMarkDahlwhowrotethefirsteditionaquarter tographscomefromthecollectionsoftheDepartmentof ofacenturyagoandhavebeenresponsibleforeachsub- Dermatology at the Royal Infirmary of Edinburgh, and sequenteditionuntilnow.Weareimmenselygratefulthat wewishtothankallthosewhopresentedthem.DrKelly theyhaveentrustedtheirtexttous,andhopethatwehave Nelson of Duke University kindly supplied all the der- liveduptothestandardthattheyset. moscopic pictures in Chapter 28. Drs Nelson and Meg Martin Sugden, latterly Oliver Walter and Jennifer GerstenblithofCaseWesternUniversityprovidedinvalu- Seward have chivvied and supported us through the able feedback on the dermoscopy chapter and Dr Amr delayedgestationofourmanuscript.Wearealsograteful GoharofCairoontheacnechapter. viii

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