Roxburgh's Common Skin Diseases

337 Pages·2010·9.8 MB·English

ROXBURGH’S
Common Skin Diseases
17th Edition
Ronald Marks
Emeritus Professor of Dermatology and
Former Head of Department of Dermatology
University of Wales College of Medicine
Cardiff, UK
Clinical Professor
Department of Dermatology and Skin Surgery
University of Miami School of Medicine
Miami, USA
Hodder Arnold • A member of the Hodder Headline Group • London
First published in Great Britain in 2003 by
Arnold, a member of the Hodder Headline Group,
338 Euston Road, London NW1 3BH
http://www.arnoldpublishers.com
Distributed in the United States of America by
Oxford University Press Inc.,
198 Madison Avenue, New York, NY10016
Oxford is a registered trademark of Oxford University Press
© 2003 Arnold
All rights reserved. No part of this publication may be reproduced or transmitted in any
form or by any means, electronically or mechanically, including photocopying, recording or any
information storage or retrieval system, without either prior permission in writing from
the publisher or a licence permitting restricted copying. In the United Kingdom such licences
are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP.
Whilst the advice and information in this book are believed to be true and accurate at the date
of going to press, neither the author nor the publisher can accept any legal responsibility or
liability for any errors or omissions that may be made. In particular (but without limiting the
generality of the preceding disclaimer) every effort has been made to check drug dosages;
however it is still possible that errors have been missed. Furthermore, dosage schedules are
constantly being revised and new side-effects recognized. For these reasons the reader is
strongly urged to consult the drug companies’ printed instructions before administering any of
the drugs recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN 0 340 76232 2
ISBN 0 340 76233 0 (International Students’ Edition – restricted territorial availability)
1 2 3 4 5 6 7 8 9 10
Commissioning Editor: Joanna Koster
Project Editor: Anke Ueberberg
Production Controller: Deborah Smith
Cover Designer: Terry Griffiths
Typeset in 10.5/12.5 Minion by Charon Tec Pvt. Ltd, Chennai, India
Printed and bound in India
What do you think about this book? Or any other Arnold title?
Please send your comments to
Contents
Preface viii
1 An introduction to skin and skin disease 1
An overview 1
Skin structure and function 2
Summary 11
2 Signs and symptoms of skin disease 12
Alterations in skin colour 12
Alterations in the skin surface 14
The size, shape and thickness of skin lesions 15
Oedema, fluid-filled cavities and ulcers 17
Secondary changes 19
Symptoms of skin disorder 20
Summary 23
3 Skin damage from environmental hazards 25
Damage caused by toxic substances 26
Injury from solar ultraviolet irradiation 27
Chronic photodamage (photoageing) 29
Summary 35
4 Skin infections 37
Fungal disease of the skin/the superficial mycoses/infections
with ringworm fungi (dermatophyte infections) 37
Bacterial infection of the skin 44
Viral infection of the skin 50
Summary 56
5 Infestations, insect bites and stings 58
Scabies 58
Pediculosis 63
Insect bites and stings 65
Helminthic infestations of the skin 69
Summary 70
iii
Contents
6 Immunologically mediated skin disorders 71
Urticaria and angioedema 71
Erythema multiforme 75
Erythema nodosum 77
Annular erythemas 77
Autoimmune disorders 77
Systemic sclerosis 80
Morphoea 82
Dermatomyositis 83
The vasculitis group of diseases 84
Blistering diseases 87
Dermatitis herpetiformis 89
Epidermolysis bullosa 90
Pemphigus 91
Drug eruptions 92
Summary 95
7 Skin disorders in AIDS, immunodeficiency and venereal disease 97
Infections 98
Skin cancers 99
Other skin manifestations 99
Psoriasis 100
Treatment of skin manifestations of AIDS 100
Drug-induced immunodeficiency 100
Other causes of acquired immunodeficiency 101
Congenital immunodeficiencies 101
Dermatological aspects of venereal disease 102
Summary 104
8 Eczema (dermatitis) 105
Atopic dermatitis 105
Seborrhoeic dermatitis 114
Discoid eczema (nummular eczema) 117
Eczema craquelée (asteatotic eczema) 118
Lichen simplex chronicus (circumscribed neurodermatitis) 119
Contact dermatitis 121
Venous eczema (gravitational eczema; stasis dermatitis) 125
Summary 126
9 Psoriasis and lichen planus 128
Psoriasis 128
Pityriasis rubra pilaris 142
Lichen planus 144
Summary 147
iv
Contents
10 Acne, rosacea and similar disorders 149
Acne 149
Rosacea 162
Perioral dermatitis 168
Summary 169
11 Wound healing and ulcers 171
Principles of wound healing 171
Venous hypertension, the gravitational syndrome and venous ulceration 173
Ischaemic ulceration 177
Decubitus ulceration 178
Neuropathic ulcers 179
Less common causes of ulceration 180
Diagnosis and assessment of ulcers 182
Summary 182
12 Benign tumours, moles, birthmarks and cysts 183
Introduction 183
Tumours of epidermal origin 184
Benign tumours of sweat gland origin 186
Benign tumours of hair follicle origin 188
Melanocytic naevi (moles) 188
Degenerative changes in naevi 192
Vascular malformations (angioma)/capillary naevi 194
Dermatofibroma (histiocytoma, sclerosing haemangioma) 197
Leiomyoma 198
Neural tumours 199
Lipoma 200
Collagen and elastic tissue naevi 200
Mast cell naevus and mastocytosis 201
Cysts 202
Treatment of benign tumours, moles and birthmarks 204
Summary 205
13 Malignant disease of the skin 207
Introduction 207
Non-melanoma skin cancer 207
Melanoma skin cancer 219
Lymphomas of skin (cutaneous T-cell lymphoma) 224
Summary 226
14 Skin problems in infancy and old age 227
Infancy 227
Old age 233
Summary 237
v
Contents
15 Pregnancy and the skin 238
Physiological changes in the skin during pregnancy 238
Effects of pregnancy on intercurrent skin disease 240
Effects of intercurrent maternal disease on the fetus 240
Skin disorders occurring in pregnancy 241
Summary 242
16 Disorders of keratinization and other genodermatoses 243
Introduction 243
Xeroderma 245
Autosomal dominant ichthyosis 246
Sex-linked ichthyosis 247
Non-bullous ichthyosiform erythroderma 249
Bullous ichthyosiform erythroderma (epidermolytic hyperkeratosis) 251
Lamellar ichthyosis 252
Collodion baby 252
Other disorders of keratinization 254
Other genodermatoses 256
Summary 257
17 Metabolic disorders and reticulohistiocytic proliferative disorders 259
Porphyrias 259
Necrobiotic disorders 265
Reticulohistiocytic proliferative disorders 266
Summary 267
18 Disorders of hair and nails 268
Disorders of hair 268
Disorders of the nails 276
Summary 279
19 Systemic disease and the skin 281
Skin markers of malignant disease 281
Endocrine disease, diabetes and the skin 285
Skin infection and pruritus 288
Androgenization (virilization) 289
Nutrition and the skin 291
Skin and the gastrointestinal tract 292
Hepatic disease 292
Systemic causes of pruritus 293
Summary 293
20 Disorders of pigmentation 295
Generalized hypopigmentation 296
Localized hypopigmentation 297
vi
Contents
Hyperpigmentation 299
Summary 302
21 Management of skin disease 303
Psychological aspects of skin disorder 303
Skin disability 305
Topical treatments for skin disease 305
Surgical aspects of the management of skin disease 309
Systemic therapy 311
Phototherapy for skin disease 314
Summary 316
Bibliography 317
Index 319
vii
Preface
Recognition and treatment of skin disease is an important part of the practice of
medicine. These skills should form an essential part of the undergraduate cur-
riculum because skin disorders are common and often extremely disabling in one
way or another. Apart from the fact that all physicians will inevitably have to cope
with patients with rashes, itches, skin ulcerations, inflamed papules, nodules and
tumours at some point in their careers, skin disorders themselves are intrinsically
fascinating. The fact that their progress both in development and in relapse can be
closely observed, and their clinical appearance easily correlated with their path-
ology, should enable the student or young physician to obtain a better overall view
of the way disease processes affect tissues.
The division of the material in this book into chapters has been pragmatic,
combining both traditional clinical and ‘disease process’ categorization, and after
much thought it seems to the author that no one classification is either universally
applicable or completely acceptable.
It is important that malfunction is seen as an extension of normal function
rather than as an isolated and rather mysterious event. For this reason, basic struc-
ture and function of the skin have been included, both in a separate chapter and
where necessary in the descriptions of the various disorders.
It is intended that the book fulfil both the educational needs of medical stu-
dents and young doctors as well as being of assistance to general practitioners in
their everyday professional lives. Hopefully it will also excite some who read it suf-
ficiently to want to know more, so that they consult the appropriate monographs
and larger, more specialized works.
In this new edition of Roxburgh’s Common Skin Diseases account has been taken
of recent advances both in the understanding of the pathogenesis of skin disease
and in treatments for it. Please forgive any omissions as events move so fast it is
really hard to catch up!
viii
C H A P T E R
An introduction to skin 1
and skin disease
An overview 1
Skin structure and function 2
Summary 11
An overview
Skin is an extraordinary structure. We are absolutely dependent on this 1.7 m2 of
barrier separating the potentially harmful environment from the body’s vulnerable
interior. It is a composite of several types of tissue that have evolved to work in
harmony one with the other, each of which is modified regionally to serve a differ-
ent function (Fig. 1.1). The large number of cell types (Fig. 1.2) and functions of
the skin and its proximity to the numerous potentially damaging stimuli in the
environment result in two important considerations. The first is that the skin is
frequently damaged because it is right in the ‘firing line’ and the second is that
Stratum corneum
SC (15␮m)
E (35–50␮m)
Granular cell layer
HF D (1–2mm)
ESG
SFL
Malpighian layer
Figure 1.1 Simple three-dimensional plan view of the Basal layer
skin. HF ⫽ hair follicle; ESG ⫽ eccrine sweat gland;
SC ⫽ stratum corneum; E ⫽ epidermis; D ⫽ dermis; Figure 1.2 Diagram of the basic structure of the
SFL ⫽ subcutaneous fat layer. epidermis.
1