Ethnic dermatology : clinical problems and pigmented skin PDF
Preview Ethnic dermatology : clinical problems and pigmented skin
Ethnic Dermatology A Ethnic Dermatology r c h e r Clinical Problems and Skin Pigmentation Clinical Problems and Skin Pigmentation Second edition Clive B Archer MD (Lond), PhD (Lond), FRCP Edin, FRCP (Lond) Clive B Archer Consultant Dermatologist and Honorary Clinical Senior Lecturer, Bristol Dermatology Centre, the Bristol Royal Infirmary (UBHT), and the University of Bristol, UK E Recognizing the enormous variety of skin diseases in lightly pigmented skin depends on the development of a number of visual skills that have to be t developed still further to recognize skin diseases in deeply pigmented skin h from different ethnic groups. The comparison of skin disorders in white and n deeply pigmented skin is in itself an important way of learning; by using i this book regularly, the reader will become familiar with the appearance of c common and uncommon skin diseases in people with varying degrees of D skin pigmentation. This beautifully illustrated text on ethnic dermatology provides a systematic approach to the diagnosis and management of a e wide variety of skin diseases; the second edition has been reorganized and updated to enforce its usefulness for the busy practitioner needing to r m compare important differences in the way skin diseases manifest themselves. ConTEnTS: • Disorders of the dermis a • Skin diseases and ethnic groups • Disorders of the vasculature and t • Disorders with epidermal change subcutaneous disorders • Disorders of the epidermal appendages • Dermatological aspects of internal o and related disorders medicine l • Disorders of the dermal–epidermal • Disorders of altered reactivity o interface and the dermis • Disorders of melanocytes • Disorders of epidermal and dermal– • non-melanocytic tumours g epidermal cohesion • Infectious diseases and infestations y with over 500 colour photographs FRoM REvIEwS oF THE FIRST EDITIon ‘This publication fulfils its stated goals by providing an ‘excellent pictorial reference of comparative dermatology …what sets this text apart ... is that it not only illustrates the characteristics and morphological features of a wide variety of cutaneous disorders in black skin, but perhaps even more importantly illustrates and contrasts these characteristics with the unique manifestations of corresponding disorders in patients with white skin.... This text is invaluable ....The photographs are superb’ Arch Dermato ‘This book contains enough really good pictures to be valuable, particularly to the trainee dermatologist, or to the practitioner .... I would certainly suggest that a place for this atlas should be found on the shelves of any dermatology department involved in training.’ Br J Second Dermatol edition ‘The text is informative and concise ... the format of the book is very practical and information is easy to access. The relevant inconography makes it a pleasure reading this book.’ Skin Research and Technology Second edition www.informahealthcare.com Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page i Ethnic Dermatology Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page ii Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page iii Ethnic Dermatology Clinical Problems and Skin Pigmentation Second Edition Clive B Archer , ( ), , ( ) MD PhD Lond FRCP Edin FRCP Lond Consultant Dermatologist and Honorary Clinical Senior Lecturer Bristol Dermatology Centre Bristol Royal Infirmary (UBHT) and University of Bristol Bristol UK Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page iv ©2008InformaUKLtd FirstpublishedintheUnitedKingdomin1995 Second edition published in the United Kingdom in 2008 by Informa Healthcare,Telephone House, 69–77 Paul Street,London,EC2A4LQ.InformaHealthcareisatradingdivisionofInformaUKLtd.RegisteredOffice:37/41 MortimerStreet,LondonW1T3JH.RegisteredinEnglandandWalesnumber1072954 Tel:+44(0)2070175000 Fax:+44(0)2070176699 Website:www.informahealthcare.com Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inany formorbyanymeans,electronic,mechanical,photocopying,recording,orotherwise,withoutthepriorpermission ofthepublisherorinaccordancewiththeprovisionsoftheCopyright,DesignsandPatentsAct1988orunderthe terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road,LondonW1P0LP. Althougheveryefforthasbeenmadetoensurethatallownersofcopyrightmaterialhavebeenacknowledgedinthispub- lication,wewouldbegladtoacknowledgeinsubsequentreprintsoreditionsanyomissionsbroughttoourattention. TheAuthorhasassertedhisrightundertheCopyright,DesignsandPatentsAct1988tobeidentifiedastheAuthor ofthisWork. ACIPrecordforthisbookisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Dataavailableonapplication ISBN-10:0415471192 ISBN-13:9780415471190 DistributedinNorthandSouthAmericaby Taylor&Francis 6000BrokenSoundParkway,NW,(Suite300) BocaRaton,FL33487,USA WithinContinentalUSA Tel:1(800)2727737;Fax:1(800)3743401 OutsideContinentalUSA Tel:(561)9940555;Fax:(561)3616018 Email:[email protected] Bookordersintherestoftheworld PaulAbrahams Tel:+44(0)2070176917 Email:[email protected] CompositionbyC&MDigitals(P)Ltd,Chennai,India PrintedandboundinIndiabyReplikaPressPvtLtd Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page v Contents Preface vii 1 Skindiseasesandethnicgroups 1 2 Disorderswithepidermalchange 20 3 Disordersoftheepidermalappendagesandrelateddisorders 52 4 Disordersofthedermal–epidermalinterfaceandthedermis 67 5 Disordersofepidermalanddermal–epidermalcohesion:blisteringdisorders 77 6 Disordersofthedermis 87 7 Disordersofthevasculatureandsubcutaneousdisorders 102 8 Dermatologicalaspectsofinternalmedicine 110 9 Disordersofalteredreactivity 126 10 Disordersofmelanocytes 138 11 Non-melanocytictumours 153 12 Infectiousdiseasesandinfestations 160 Index 193 Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page vi Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page vii Preface Doctors outside dermatology are often surprised that diagnosingskindiseasesindeeplypigmentedskinwere there are nearly 2000 different skin diseases. those with most experience of such patients, a fact Depending on variations in medical practice world- which is hardly surprising. This observation was rein- wide, skin disorders may present to a wide range of forcedwhenIlaterspentsometimeinEthiopia,where clinicians, including specialist dermatologists, trainee I met a number of European doctors working in vari- dermatologists, family practitioners (general practi- ous parts of Africa. ‘We know very well how to recog- tioners), and hospital doctors, in addition to other nize leprosy’ one of them said, ‘but when it comes to healthcareworkers. even the commonest of other skin diseases, we have Theaimsofthisbookonethnicdermatologyareto great difficulty, since nearly all of our medical school improve the diagnostic skills of doctors and other dermatologyteachingwasinwhiteskin’. healthcare workers, not only in patients with ‘white Recognizing the enormous variety of skin diseases in skin’ (white Caucasians) but also in patients from dif- white skin depends on the development of a number of ferent ethnic groups, and to provide an up-to-date visualskillsthathavetobedevelopedstillfurthertorecog- approachtotheinvestigationofpatientswithskindis- nizeskindiseasesindeeplypigmentedskinfromdifferent eases, before making some therapeutic suggestions. ethnicgroups.Thepurposeofthisbookistopresentasys- Ihaveusedtheterm‘ethnic’tomean‘originbybirthor tematicapproachtothediagnosisofawiderangeofskin descent rather than nationality, relating to race or cul- diseasesseeninblackandwhiteskin.Itisnotintendedto ture’ and not to denote ‘non-European’.The compari- be a comprehensive atlas of tropical medicine, but one son of skin disorders in white and deeply pigmented should always consider the possibility of diseases such as skinisanimportantwayoflearning.Byusingthisbook leprosyinpatientswhohavelivedintropicalcountries. regularly, the reader will become familiar with the IbeganBlackandWhiteSkinDiseaseswhenworking appearanceofcommonanduncommonskindiseasesin at the St John’s Institute of Dermatology in London. peoplewithvaryingdegreesofskinpigmentation.Even I was appointed as Consultant Dermatologist and ‘white’ skin is pigmented and different ethnic groups Honorary Clinical Senior Lecturer at Bristol Royal will have lighter or darker skin, ranging from the fair Infirmary (UBHT) and the University of Bristol in skin of Chinese Asians to the brown skin of Indian 1989.Iammostgratefultothemedicalphotographer Asians to the dark brown, almost black skin of Afro- Stuart Robertson of the Department of Education at Caribbeans,African-AmericansorAfricans. the St John’s Institute of Dermatology, St Thomas’ This book has evolved from Black and White Skin Hospital, London for his invaluable help, and to the Diseases: an Atlas and Text*. As in that book, I have Consultant staff of St John’s, past and present, for defined deeply pigmented or ‘black’ skin broadly to accesstothecollectionofphotographsat theStJohn’s include people of African, Black or African-American, InstituteofDermatology. Afro-Caribbean,IndianorAustralasianorigin. InmytimeasAcademicVicePresidentoftheBritish From an early stage in my dermatology training, AssociationofDermatologists,Iwouldliketoacknowl- I realized that those dermatologists who were best at edgethosewhomostinfluencedmyearlydermatology *ArcherCB,RobertsonSJ.BlackandWhiteSkinDiseases:anAtlasandText. Oxford:BlackwellScience,1995. Prelims Archer-8051:Prelims Archer-8051.qxp 8/27/2008 8:05 PM Page viii viii———ETHNICDERMATOLOGY thinking,inparticularMac(DM)MacDonald,Charles Photography. Before moving to Bristol, I spent a most (RS) Wells, and Rod Hay of Guy’s Hospital, London, interesting2yearsasResearchFellowwithJonHanifin and Malcolm Greaves, Etain Cronin, Gerald Levene, attheOregonHealthSciencesUniversity,Portlandand Neil Smith, and EdwardWilson Jones of the St John’s wasmuchinfluencedbythesystematicapproachtothe Institute of Dermatology, London. Many photographs teachingandlearningofdermatologyintheUSA. arefromthecollectioninBristolandIammostgrate- fulforthesupportofmycolleaguesintheDepartments CliveBArcher of Dermatology and Medical Illustration and 2008 01 Archer-8051:01 Archer-8051.qxp 8/1/2008 6:45 PM Page 1 CHAPTER 1 Skin diseases and ethnic groups SKINPIGMENTATION Familyhistory DERMATOLOGICALPROBLEMSINBLACKSKIN Socialhistory Diagnosticdifficulties Examiningthepatient Pigmentaryresponsestodiseasesortreatments Morphology Prominentfollicularanddermalinflammation Distribution NORMALVARIANTSINBLACKSKIN Clinicalinvestigations CLINICALASSESSMENT Dermatoscopy Dermatologicalhistory Wood’slight Generalhistory The‘acarushunt’ Pastmedicalhistory Dermatology is historically a general medical thefairskinofChineseAsianstothebrownskinof specialty,supportedbyabroadrangeofclinicaland IndianAsianstothedarkbrown,almostblackskin basicscienceresearch.Inrecentyearstherehasbeen ofAfro-Caribbeans,African-AmericansorAfricans. an increasing emphasis on the surgical aspects of I have defined deeply pigmented or ‘black’ skin managing skin disorders.This trend is partly due to broadly to include people of African, Black or the success of skin cancer public information pro- African-American, Afro-Caribbean, Indian, or grammes. Dermatology continues to be one of the Australasian origin. mostpopularcareeroptionsamongstyoungdoctors Recognizingtheenormousvarietyofskindiseases worldwide. inwhiteskindependsonthedevelopmentofanum- Theaimofthisbookonethnicdermatologyisto ber of visual skills, which have to be developed still improve the diagnostic and investigation skills of further to recognize skin diseases in deeply pig- doctors and other healthcare workers, not only in mentedskinfromdifferentethnicgroups.Sincethe patients with ‘white skin’ (white Caucasians) but numberofdifferentskindiseaseshasbeenestimated alsoinpatientsfromdifferentethnicgroups.Ihave at nearly 2000, one should not expect to develop used the term ‘ethnic’ to denote ‘origin by birth or instantexpertise.Forexample,itispossibletoman- descent rather than nationality, relating to race or age a patient appropriately without detailed knowl- culture’. By using this book regularly, the reader edgeofallofthebenignadnexaltumours,butIam will become familiar with the appearance of com- afraid the old adage that ‘there are only two skin mon and uncommon skin diseases in people with diseases, those that are steroid-responsive and those varying degrees of skin pigmentation. Even ‘white’ that are not’ does display a rather outdated lack of skin is pigmented, and different ethnic groups will learning! A reasonable knowledge of dermatology have more deeply pigmented skin, ranging from is essential for all doctors who look after patients. 1
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