Talking Points in Dermatology - III

156 Pages·1988·2.61 MB·English

by  A. G. Messenger (auth.), Julian L. Verbov JP, MD, FRCP. FIBiol (eds.)

TALKING POINTS IN
DERMATOLOGY -III
Other titles in the New Clinical Applications Series:
Dermatology (Series Editor Dr J. L. Verbov)
Dermatological Surgery
Superficial Fungal Infections
Talking Points in Dermatology - I
Treatment in Dermatology
Current Concepts in Contact Dermatitis
Talking Points in Dermatology - II
Tumours, Lymphomas and Selected Paraproteinaemias
Relationships in Dermatology
Cardiology (Series Editor Dr D. Longmore)
Cardiology Screening
Rheumatology (Series Editors Dr J. J. Calabro and Dr W. Carson
Dick)
Ankylosing Spondylitis
Infections and Arthritis
Nephrology (Series Editor Dr G. R. D. Catto)
Continuous Ambulatory Peritoneal Dialysis
Management of Renal Hypertension
Chronic Renal Failure
Calculus Disease
Pregnancy and Renal Disorders
Multisystem Diseases
Glomerulonephritis I
Glomerulonephritis II
NEW
CLINICAL
APPLICATIONS
DERMATOLOGY
TALKING POINTS IN
DERMATOLOGY-III
Editor
JULIAN L. VERBOV
JP, MD, FRCP. FIBiol
Consultant Dermatologist
Royal Liverpool Hospital,
Liverpool, UK
KLUWER ACADEMIC PUBLISHERS
DORDRECHT / BOSTON / LONDON
Distributors
for the United States and Canada: Kluwer Academic Publishers, PO Box
358, Accord Station, Hingham, MA 02018--0358, USA
for all other countries: Kluwer Academic Publishers Group, Distribution
Center, PO Box 322, 330 AH Dordrecht, The Netherlands
British Library Cataloguing in Publication Data
Talking points in dermatology. - III
1. Medicine. Dermatology
I. Verbov, Julian II. Series
616.5
ISBN-13: 978-94-010-7687-6 e-ISBN -13: 978-94-009-2631-8
DOl: 10.1007/978-94-009-2631-8
Library of Congress Cataloging in Publication Data
Talking points in dermatology-III.
(New clinical applications. Dermatology)
Includes bibliographies and index.
l. Skin-Diseases. I. Verbov, Julian. II. Title:
Talking points in dermatology-3. III. Series.
[DNLM: l. Skin Diseases. WR 140 T14611]
RL72.T35 1988 616.5 88-26672
Copyright
© 1988 by Kluwer Academic Publishers
Softcover reprint of the hardcover 1st edition 1988
All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without prior permission
from the publishers, Kluwer Academic Publishers BV, PO Box 17, 3300
AA Dordrecht, The Netherlands.
Published in the United Kingdom by Kluwer Academic Publishers,
PO Box 55, Lancaster, UK
Kluwer Academic Publishers BV incorporates the publishing programmes
of D. Reidel, Martinus Nikhoff, Dr W. Junk and MTP Press.
CONTENTS
List of Authors
VI
Series Editor's Foreword Vll
About the Editor
V111
1. Alopecia Areata
A. G. Messenger
2. Pregnancy Eruptions 29
s. S. Mendelsohn
3. Lichen Planus 53
R. A. C. Graham-Brown
4. Juvenile Plantar Dermatosis 79
R.M. Graham
5. Cutaneous Responses to Arthropods 103
G. S. Walton
6. Computer Applications in Dermatology 125
A. Y. Finlay
Index 145
v
AUTHORS
Dr A. Y. Finlay Dr S. S. Mendelsohn
Senior Lecturer in Consultant Dermatologist
Dermatology Chester Royal Infirmary
Department of Medicine Nicholas Street
(Dermatology) Chester
University of Wales College of CHl2AZ
Medicine
Heath Park, Cardiff Dr A. G. Messenger
CF44XN Consultant Dermatologist
Royal Hallamshire Hospital
Dr R. M. Graham Glossop Road
Consultant Dermatologist Sheffield
James Paget Hospital SIO 2JF
Lowestoft Road
Great Yarmouth Mr G. S. Walton
NR366LA Senior Lecturer
Department of Veterinary
Dr R. A. C. Graham-Brown Clinical Science
Consultant Dermatologist University of Liverpool
The Leicester Royal Infirmary Leahurst
Leicester Neston
LE15WW S. Wirral
L64 7TE
VI
SERIES EDITOR'S FOREWORD
This is the ninth volume in the New Clinical Applications Der
matology Series. Some important topics that merit discussion are
included in this book. Dr Messenger discusses clinicopathological
aspects of the common disorder, alopecia areata. Dr Mendelsohn
gives a straightforward, clear account of pregnancy eruptions. Dr
Graham-Brown gives a comprehensive yet concise survey of that
strange condition, lichen planus. Dr Graham treats us to a thorough
appraisal of the enigmatic juvenile plantar dermatosis. Mr Walton
takes an experienced comprehensive look at ectoparasites of import
ance to man and the concluding chapter by Dr Finlay provides a
concise, helpful insight into how modern technology can aid der
matology.
JULIAN VERBOV
VII
ABOUT THE EDITOR
Dr Julian Verbov is Consultant Dermatologist to Liverpool Health
Authority and Honorary Clinical Lecturer in Dermatology at the
University of Liverpool.
He is a member of the British Association of Dermatologists, repre
senting the British Society for Paediatric Dermatology on its Executive
Committee. He is Editor of the Proceedings of the North of England
Dermatological Society. He is a Fellow of the Zoological Society of
London and a member of the Society of Authors. He is a popular
national and international speaker and author of more than 200
publications. His special interests include paediatric dermatology,
inherited disorders, dermatoglyphics, pruritus ani, cutaneous poly
arteritis nodosa, therapeutics, drug abuse, and medical humour. He
organizes the British Postgraduate Course in Paediatric Dermatology
and is a member of the Editorial Board of Clinical and Experimental
Dermatology.
VIII
1
ALOPECIAAREATA
A. G. MESSENGER
INTRODUCTION
The first account of alopecia areata is usually ascribed to Celsus.
Writing in the first century AD, he described two patterns of hair loss
under the heading' Areae' The first, known as alopecia (from the
1.
Greek alopekia meaning 'fox-mange') ' ... spreads in no certain form.
It is found in the hair of the head and in the beard.' The second type,
known as ophiasis, ' ... begins at the hinder part of the head ... it
creeps with two heads to the ears ... ' However, it was not until the
latter half of the nineteenth century that alopecia areata was clearly
delineated from tinea capitis, and claims that alopecia areata was
caused by various microorganisms continued to appear into the early
years of the present century. A variety of theories as to the cause of
alopecia areata have been proposed since that time. These have
included endocrine dysfunction, reflex irritation and trophoneurosis.
Currently, the most popular view is that alopecia areata is an auto
immune disease but, although there are grounds for believing that
immunological mechanisms are involved in the disease, most of the
evidence that alopecia areata is caused by autoimmunity is cir
cumstantial. A particular problem, both in terms of understanding
the aetiology and in the development of better forms of treatment,
has been our poor understanding of the pathogenesis. Much research
work has concentrated on various non-specific immunological abnor
malities in the peripheral blood, while the target organ - the hair
follicle - has been relatively neglected. This imbalance is now being
TALKING POINTS IN DERMATOLOGY
corrected and this review will be devoted mainly to clinicopathological
aspects of alopecia areata and to the progress that has been made in
the development of model systems. Treatment will not be discussed,
as this has been well reviewed recently2.
CLINICAL FEATURES
Alopecia areata usually presents as one or more discrete patches of
hair loss. This occurs most commonly on the scalp or beard but any
hair-bearing skin can be affected. The bald patches enlarge cen
trifugally and may coalesce. Large numbers of telogen hairs can be
plucked with minimal traction from around the periphery of enlarging
bald patches. The roots of these hairs may have a well-formed club
or show an abnormally tapered appearance. The hair shafts often have
a localized zone of weakness between 2 and 4 mm above the root. This
can cause focal narrowing of the hair shaft and lead to angulation or
fracture, giving rise to the characteristic 'exclamation mark' hair. The
scalp itself appears normal with preservation of the follicular orifices,
although there is sometimes slight erythema. Occasionally, alopecia
areata presents with a diffuse hair loss. This can be difficult to dif
ferentiate from other causes of diffuse hair loss at the initial consul
tation, but the usual rapid course of diffuse alopecia areata, often
resulting in alopecia totalis, together with other features such as excla
mation mark hairs and nail changes, will usually enable the correct diag
nosis to be made. Nail abnormalities occur in a small proportion of
cases and are usually, though not always, associated with extensive
hair loss. The exact frequency is difficult to determine and depends on
what criteria are used for assessing minimal involvement. In a series
collected in Sheffield by Dr R. E. Church (personal communication),
20 out of 168 cases of alopecia areata (12%) and 14 out of 30 cases
of alopecia totalis (47%) showed changes in the nails. Fine stippled
pitting of the nail plate is the most common finding; other changes
include longitudinal ridging and roughening of the nail plate and
erythema of the lunula.
The course of alopecia areata is very variable. In the majority of
cases with circumscribed disease, recovery occurs within a year. The
regrowing hair is fine and may be non-pigmented or hypopigmented
2