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Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at studentconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. 2015v1.0 Dermatology AN ILLUSTRATED COLOUR TEXT Sixth Edition This page intentionally left blank Dermatology AN ILLUSTRATED COLOUR TEXT Sixth Edition David J. Gawkrodger DSc MD FRCP FRCPE Professor Emeritus in Dermatology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, U.K. and Michael R. Ardern-Jones BSc MB BS DPhil FRCP Associate Professor and Consultant Dermatologist, University of Southampton, Southampton General Hospital, Southampton, U.K. Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2017 © 2017 Elsevier Ltd. All rights reserved. Previous editions copyrighted: 2002, 2008, 2012 Elsevier Ltd. All rights reserved. First edition 1991 © Longman Group UK. Second edition 1997 © Pearson Professional. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). ISBN 978-0-7020-6849-2 [eBook 978-0-7020-6854-6] [Inkling 978-0-7020-6848-5] Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Senior Commissioning Editor: Jeremy Bowes Senior Content Development Specialist: Ailsa Laing Project Manager: Joanna Souch Designer/Design Direction: Miles Hitchen Illustration Manager: Amy Faith Heyden The publisher’s policy is to use paper manufactured from sustainable forests Printed in China Preface to the sixth edition There has been a near revolution in how trainee in dermatology. This is still the There is presently a greater emphasis than a published medical text is handled by its case, and the printed version has been ever before on skin cancer, its recognition users since we wrote the fifth edition of fully updated, but online publication has and management, and we have reflected this work in 2011. For this type of book, given us the chance to broaden the scope this in our content. Other areas that have there will be considerable usage online. of the book. We have added some developed into subspecialisms, which The content and presentation of the sixth material at a higher level that can be have required additional text, include edition of this book has been developed accessed by those that opt to use it, whilst genital dermatoses, psychodermatology, to accommodate readers’ likely use in the bolstering the basic strengths of the text cosmetic procedures, and advances in smartphone age. Our publishers, Elsevier, through the use of additional illustrations. dermatologic surgery. have been of considerable assistance in Online publishing has allowed us, We trust that our target audience of this task, providing the platform for the for each topic covered, to introduce medical students, family doctors, hospital delivery of an interactive, searchable and innovations. These include self- residents, specialty registrars in well illustrated text. assessment questions, flashcards, a dermatology or internal medicine, and In order to make use of the picture gallery of dermatological diseases specialist nurses will continue to find our opportunities offered by online and direct Internet links to other sources book helpful in the diagnosis and publication, we have increased the of information and reference. It has also management of patients with skin flexibility of the educational level of the been possible to highlight throughout the diseases. text. Previously we aimed to write and text, new treatments and dermatological illustrate a book that was suitable for emergencies. David J. Gawkrodger and medical students and general practitioners We are aware that the specialty of Michael R. Ardern-Jones but which would also appeal to the early dermatology is constantly changing. Sheffield and Southampton, 2015 Preface to the first edition Recent advances in publishing technology point’ summaries. This unique approach, three sections. The first presents a and book presentation demand that a which deals with each topic as an scientific basis for the understanding of modern text be attractively and concisely educational unit, allows the reader better and clinical approach to skin disease. The presented, in colour and at an affordable accessibility to the facts and greater ease second details the major dermatological price. This is essential for success in a in revision than is possible with a conditions, and the third outlines special very competitive market. In writing this conventional textbook. topics, such as photoageing and book, I have attempted to present an The book is aimed at medical students dermatological surgery, that are of current introductory dermatology text for the but contains sufficient detail to be of use importance or that are poorly dealt with 1990s, using a format of individually to family practitioners, physicians in in other textbooks. designed double-page spreads, generously internal medicine, registrars or residents illustrated with colour photographs, line in dermatology and dermatological David J. Gawkrodger drawings, tables, bulleted items and ‘key nurses. The contents are divided into Sheffield 1992 Acknowledgements In the production of the sixth edition of Nottingham, Dr J. Bowling of Oxford Bunker (University College Hospital, this book it is a pleasure to acknowledge (dermoscopy images), the late Dr S.M. London), Dr P.K. Buxton, Dr G.B. Colver, the contribution of the publishing staff at Morley of Dundee, Dr M. Shah of the late Professor F.J.G. Ebling, Dr M.E. Elsevier, notably Jeremy Bowes, Alisa Burnley, Dr H.S. Ghura of Salford, and Kesseler, Dr Fiona Lewis (St Thomas Laing and Kim Benson. We are grateful to Dr A.J.G. McDonagh, Dr A.G. Messenger, Hospital, London), Dr C. McGibbon, colleagues who have advised on various Dr C. Yeoman, Mr D. Dobbs, Professor Dr A. McMillan, Mrs E. McVittie, Dr C.StJ. aspects of the book, especially to Dr S.S. Bleehen and Dr C.I. Harrington of O’Doherty, Dr Glenda Sobey (Sheffield Louise Ardern-Jones for her detailed Sheffield, and also Dr Efrem Eren, for Children’s Hospital), Miss M.J. Spencer, review. provision of autoantibody fluorescence Dr M.D. Talbot and the late Dr A.E. We thank colleagues who have images. Walker. generously provided figures for this and We are grateful to the following We also thank those patients who gave previous editions, including Dr E.C. for advice or for the provision of permission for their faces to be shown Benton of Edinburgh, Dr J.E. Bothwell illustrations: Professor R.StC. Barnetson, without eyebars. of Doncaster, Dr J.S.C. English of Dr G.W. Beveridge, Professor Chris Contents 1 Basic Principles 1 1 Microanatomy of the skin 2 6 Molecular genetics and the skin 12 11 Basics of medical therapy 22 2 Derivatives of the skin 4 7 Terminology of skin lesions 14 12 Epidemiology of skin disease 24 3 Physiology of the skin 6 8 Taking a history 16 13 Body image, the psyche and the skin 26 4 Biochemistry of the skin 8 9 Examining the skin 18 5 Inflammation, immunity and the skin 10 10 Practical clinic procedures 20 2 Diseases 27 Eruptions 28 14 Psoriasis – Epidemiology, 17 Eczema – Basic principles and irritant 21 Lichenoid eruptions 42 pathophysiology and contact dermatitis 34 22 Papulosquamous eruptions 44 presentation 28 18 Eczema – Allergic contact dermatitis 23 Erythroderma 46 15 Psoriasis – Management and and patch testing 36 24 Photodermatology 48 complications 30 19 Eczema – Atopic eczema 38 16 Psoriasis – Biologics 32 20 Eczema – Other forms 40 Infections 50 25 Bacterial infection – Staphylococcal and 28 Viral infections – Herpes simplex and 31 Yeast infections and related disorders 62 streptococcal 50 herpes zoster 56 32 Tropical infections and infestations 64 26 Other bacterial infections 52 29 Human immunodeficiency virus disease 33 Infestations 66 27 Viral infections – Warts and other viral and immunodeficiency syndromes 58 infections 54 30 Fungal infections 60 Disorders of specific skin structures 68 34 Sebaceous and sweat glands – Acne, 36 Disorders of nails 72 38 Leg ulcers 76 rosacea and other disorders 68 37 Vascular and lymphatic diseases 74 39 Pigmentation 78 35 Disorders of hair 70 Allergy and autoimmunity 80 40 Urticaria and angioedema 80 42 Connective tissue diseases 84 43 Vasculitis and the reactive erythemas 86 41 Blistering disorders 82 Internal medicine 88 44 Skin changes in internal conditions 88 45 Drug eruptions 90 46 Associations with malignancy 92 Inherited disorders 94 47 Keratinization and blistering 48 Neurocutaneous disorders and other syndromes 94 syndromes 96 Skin tumours 98 49 Benign tumours 98 53 Skin cancer – Squamous cell 55 Cutaneous T cell lymphomas and 50 Naevi 100 carcinoma 106 malignant dermal tumours 110 51 Skin cancer – Premalignant 54 Skin cancer – Malignant melanoma 108 disorders 102 52 Skin cancer – Basal cell carcinoma 104 3 Special Topics in Dermatology 111 56 Phototherapy 112 60 Paediatric dermatology 120 64 Genital dermatoses 128 57 Basic dermatological surgery 114 61 The skin in old age 122 65 Racially pigmented skin 130 58 Advanced dermatological surgery 116 62 The skin in pregnancy 124 66 Occupation and the skin 132 59 Cosmetics and cosmetic procedures 118 63 Genitourinary infections 126 67 Immunological tests 134 Index 136 This page intentionally left blank