Oxford handbook of medical dermatology

718 Pages·2016·30.146 MB·English

by  Susan Burge, Rubeta Matin, Dinny Wallis

OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Medical
Dermatology
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Oxford Handbook of
Medical
Dermatology
Second Edition
Susan Burge
Honorary Consultant Dermatologist
Oxford University Hospitals NHS Foundation Trust
and Honorary Senior Clinical Lecturer, University of
Oxford, UK
Rubeta Matin
Consultant Dermatologist
Oxford University Hospitals NHS Foundation Trust
and Honorary Senior Clinical Lecturer, University of
Oxford, UK
Dinny Wallis
Consultant Rheumatologist
University Hospital Southampton NHS Foundation
Trust, UK
1
1
Great Clarendon Street, Oxford, OX2 6DP,
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First Edition published 2011
Second Edition published 2016
Impression: 1
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v
Foreword to the
second edition
If you are faced with a challenging skin problem, then pull this brilliant
and magical book from your bag, or search it with your electronic device:
the answer will be there. It is packed with top tips, information gems and
clinical pearls. Whether you are a student needing a logical and clear way
to understand dermatology, if you are in primary care faced with a diag-
nosis that requires a quick refresh of your memory, or a hospital doctor
or dermatology trainee dealing with emergencies and complex cases,
this book will become your friend and companion.
This new edition introduces fresh new writing on eczema and tumours,
a new chapter on genetic skin diseases and expansion of the tropical
diseases section. Dinny Wallis has updated the rheumatology disorders
and vasculitis. Rubeta Matin has joined the team from Oxford bringing
expertise in immunosuppression. The whole book is right up to date so
experienced consultant dermatologists will find it a useful quick refer-
ence for managing complex diseases. The text flows and draws in the
reader who will quickly be absorbed, oblivious to passing time.
The question and answer format, the text boxes and the clarity of
the writing make the second edition of Sue Burge’s Oxford Handbook of
Medical Dermatology the go-to small dermatology textbook. The British
Society of Medical Dermatology gives this as a prize to the best UK train-
ees at their meeting each year. This is the book to get if you truly wish to
understand dermatology.
Nick Levell
President: British Association of Dermatologists (2016–18);
Director of Dermatology, Consultant Dermatologist,
Norfolk and Norwich University Hospital;
Specialty National Lead (Dermatology), National Institute
of Health Research, UK
vi
Foreword to the
first edition
Dr Susan Burge and I first (really) met as senior registrars to the
Department of Dermatology in Oxford in 1981. It soon became appar-
ent to me that Susan’s most commonly asked question was ‘why?’, always
spoken in a most expressive Northern Irish accent. Usually there was no
easy answer which of course indicated why she had asked the question
in the fi rst place. If an answer was preferred it had to make sense, be
logical and simple. Any flannel would meet with short shrift! This story
refl ects the (senior) author’s enquiring mind and need for knowledge to
be imparted in a sound, simple and logical way. It therefore comes as no
surprise that the format of the new textbook is prompted by questions:
What should I look for? What should I do?
Dermatology is arguably the most clinical of all medical specialties
because it relies less on investigation and more on good old fashioned
observation and interpretation of symptoms and signs for diagnosis.
Dermatology practice is sometimes criticized for being simply a ‘spot
diagnosis’ and for using outdated Latin terminology. The diagnosis and
management of skin disease, however, demands a logical ordering and
structuring of clinical information in such a way that makes it a most stim-
ulating intellectual exercise which has few equals among other medical
specialties.
In this new book Susan and Dinny, who is currently in specialist training
in rheumatology, bring a refreshingly new approach to learning derma-
tology. The combination of old and young authors (forgive me Susan!)
brings a nice balance of wisdom and practicality—exactly what the junior
doctor requires.
Professor Peter Mortimer
Professor of Dermatological Medicine to the University of London,
Consultant Skin Physician to St George’s Hospital, London,
and the Royal Marsden Hospital,
London
vii
Preface
The second edition of this Handbook still provides a practical introduc-
tion to dermatology, with an emphasis on the medical aspects of the spe-
cialty. Skin problems are hugely variable (>2500 diagnoses), but we hope
this little book will help you to make sense of what you find and will pro-
vide you with a framework for analysing clinical signs, so that you develop
your diagnostic expertise. Dermatology trainees should find the book
particularly useful, as may hospital doctors in other medical specialties
faced with assessing skin problems, but it also includes much that will be
of value to those working in the community and to medical students.
The content has been updated, and we have tried to make it even
more comprehensive. We include a new chapter on dermatogenetics
and have added to other sections, particularly those on skin in infancy
and childhood, cutaneous reactions to drugs, skin tumours, and skin and
rheumatology.
We discuss common and important skin problems, such as skin failure
and emergency dermatology, eczema, psoriasis, blisters, vasculitis, and
pustular rashes, but also include some fascinating rarities that we hope
may inspire you to read more. Each topic includes answers to the clini-
cal questions ‘What should I ask?’, ‘What should I look for?’, and ‘What
should I do?’. Management guidelines have been incorporated, where
possible.
The expanded tumour chapter will help you to recognize and manage
skin tumours, including those in immunosuppressed individuals, as well
as to advise on photoprotection, but the Handbook does not include
information on surgical techniques in dermatology.
Chapters on skin problems in the medical specialties should be of par-
ticular interest to physicians working in those disciplines. We introduce
skin conditions that you may encounter when working in specialties such
as rheumatology, haematology, nephrology, endocrinology, and gas-
troenterology. The section on medical management introduces topical
treatments, occlusion, and wet dressings, as well as discussing the sys-
temic drugs commonly used in dermatology.
Illustrations complement the text, but the emphasis is on enabling you
to make sense of the findings using your clinical skills, rather than match-
ing findings to pictures.
We hope that you will find this book useful when you are asked to see
someone with a puzzling skin problem and that there will be a place for it
in your pocket, in the outpatient clinic, or on the ward.
Please send back your comments or criticisms, so that we can improve
the book in future editions. You can send your comments to us via the
OUP website M http://w ww.oup.co.uk.
viii
Acknowledgements
Once more, we would like to thank the Oxford dermatology trainees
(now consultants) who inspired the book. It is still used in our regular
Tuesday morning teaching.
We are very grateful to these colleagues who provided invaluable advice
on individual chapters and answered our questions so patiently:
Andrew Brent and Chris Conlon (infections)
Fiona Browne (genetics)
James Burge (neurology)
Caroline Champagne (hair)
Susan Cooper (eczema and mucosal disorders)
Sarah Felton and Sheru George (photodermatology)
Rachael Morris- Jones (infestations and parasites)
Celia Moss (neurofibromatosis)
Graham Ogg (immunology)
Vanessa Venning (blisters)
Sarah Walsh (severe drug reactions).
ix
Contents
Symbols and abbreviations xi
1 Structure and function of the skin  1
2 The history in dermatology  17
3 Examination of the skin  37
4 What is the diagnosis?  53
5 Skin failure and emergency dermatology  99
6 Bacterial and spirochaetal infections  129
7 Viral and fungal infections  149
8 Infestations and parasites  171
9 Psoriasis  189
10 Eczema and lichen planus  211
11 Urticaria and erythema  227
12 Pustular rashes  241
13 Blisters  259
14 Oral and genital mucosae  277
15 Leg ulcers and lymphoedema  291
16 Sun and skin  319
17 Tumours  341
18 Cutaneous reactions to drugs  365
19 Skin and rheumatology  393
20 Vasculitis  435
21 Panniculitis  455
22 Skin and diabetes and endocrinology  465
23 Skin and renal disease  491
24 Skin and gastroenterology  505
25 Skin and chest diseases  523