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Chapter 1:
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Histological reminder of the structure of human skin
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Histological reminder of the structure of human skin
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The three constituents are, from top to bottom, the epidermis (coloured in red), the dermis (coloured in blue) and the hypodermis (or subcutaneous adipocytic tissue) packed with sudoriparous glands which are either small (eccrine glands) or large (apocrine glands). Hairs and small sebaceous glands are identifiable in the dermis (coloration : Masson blue trichromatic; enlargement : x 25).
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Skin from the axillary region
page: 3
alphabetical
Histological reminder of the structure of human skin
The three constituents are clearly recognisable from top to bottom : the epidermis (thin red border), the dermis (coloured in orange) and the subcutaneous adipocytic tissue. The fine hairs and the sebaceous glands are very numerous in the dermis, but one finds only a small number of sudoriparous glands (coloration : haemalun-eosinesafran; enlargement : x 25).
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It nicely illustrates the regional varieties of the integument, compared to the axillary skin.
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Skin from the forehead region
All the signs of physiological lightageing are present : disorganised epidermis, elastic transformation of the collagen fibres of the dermis. Under a thin strip of normal subepidermal collagen tissue (coloured in yellow) there appear large degenerated elastic collagen fibres (coloured in red), (coloration : haemalun-eosine-safran; enlargement : x 100).
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Skin from the face of an elderly subject
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page: 4
basic lesion
Histological reminder of the structure of human skin
page: 5
alphabetical
Histological reminder of the structure of human skin
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Close-up of the epidermis. This includes three cell types : the keratinocytes, the melanocytes and the cells of Langerhans. Two are recognisable on this photo : the keratinocytes very coherent among one another, and in the basal stratum several melanocytes surrounded by a light halo (coloration : haemalun-eosinesafran; enlargement : x 250).
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Structure of the epidermis
page: 6
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Histological reminder of the structure of human skin
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Close-up of the epidermis. Melanin coloured by the Fontana method. The melanocytes appear like crazed, dendritic cells in the basal stratum of the epidermis. They transfer the melanin to the keratinocytes, which are diffusely tattooed with it (enlargement: x 250).
basic lesion
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Structure of the epidermis
page: 7
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Histological reminder of the structure of human skin
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Close-up of the epidermis. Highlighting of the cells of Langerhans, which appear like dendritic cells covering all of the living epidermis. These cells belong to the line of histiocytic cells and play the immunological role of antigen-presenting cells (immunomarking OKT6 in peroxidase; enlargement : x 250).
basic lesion
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Structure of the epidermis
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page: 8
Chapter 2:
basic lesion
cause
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Basic lesions
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Macules
2.1
page: 9
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Basic lesions
Macules
basic lesion
The skin coloration varies from pale pink to dark red and disappears on vitropression. It is the result of more or less intense vasodilation (e.g. blushing from modesty).
cause
A macule is a non-infiltrated mark which differs in colour from adjacent skin.
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Erythematous macule
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Macules
page: 10
alphabetical
Basic lesions
cause basic lesion
These permanent marks, which disappear partially or completely on vitropression, result from the presence of an abundant network of dilated vessels in the superficial dermis (e.g. telangiectasia).
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Vascular macule
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Macules
page: 11
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Basic lesions
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Purpuric macule
basic lesion
cause
The red macules do not disappear on vitropression. They are the result of extravasation of blood into the dermis (e.g. Bateman's purpura). Their colour changes in time from red to ochre.
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Macules
page: 12
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Basic lesions
basic lesion
varying in size, their colour ranging from ochre to dark brown, corresponding to melanin hyperpigmentation in the epidermis (e.g. freckles).
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Pigmented macules
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Pigmentary macules
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Pigmentary macules
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page: 13
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Blueish-grey macules
basic lesion
are the result of melanin deposits extending more or less deeply into the dermis. (e.g. paresthetic notalgia)
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Macules
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Basic lesions
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Pigmentary macules
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page: 14
continued
Achromic macules
basic lesion
are white marks, varying in shape and size, which result from a decrease in the melanin content of the epidermis (e.g. vitiligo).
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Macules
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Basic lesions
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Papules
2.2
page: 15
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Basic lesions
Papules
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Papules are more or less well demarcated elevations of varying size. There are 3 papule types.
Epidermal papules
basic lesion
cause
These correspond to global thickening of the epidermis (e.g. plane warts).
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Papules
page: 16
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Basic lesions
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Dermal papules
basic lesion
cause
These correspond to oedematous, inflammatory, or proliferative thickening of the dermis (e.g. the weal of urticaria).
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Papules
page: 17
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Basic lesions
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Dermo-epidermal papules
basic lesion
cause
These correspond to a mixed thickening of the epidermis and dermis. (e.g. lichen planus)
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2.3
page: 18
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Nodules
Nodules
basic lesion
cause
Nodules are hemispherical elevations caused by inflammatory and oedematous infiltrations of the deep dermis and subcutis (e.g. rheumatoid nodule).
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Basic lesions
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2.4
page: 19
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Tubercles
Tubercles
basic lesion
cause
Tubercles are solid, prominent, circumscribed formations, superficially encased in the dermis. They sometimes ulcerate in the course of their development (e.g. lupus vulgaris [tuberculosis]).
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Basic lesions
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2.5
page: 20
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Vegetations
Vegetations
basic lesion
cause
Vegetations are filiform or lobulate excrescences, generally of soft consistency (e.g. condylomata acuminata).
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Basic lesions
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2.6
page: 21
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Warts
Warts
basic lesion
cause
Warts are vegetations covered with a more or less thick horny layer (e.g. common wart).
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Basic lesions
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2.7
page: 22
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Keratoses
Keratoses
basic lesion
cause
Keratoses consist of epidermal lesions characterized by a localized accumulation of keratin (e.g. cutaneous horn).
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Basic lesions
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2.8
page: 23
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Vesicles
Vesicles
basic lesion
cause
Vesicles are small cutaneous protuberances with a central cavity containing clear liquid. They are often hemispherical and their centre can be depressed (e.g. varicella).
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Basic lesions
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Bullae
2.9
page: 24
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Basic lesions
Bullae
basic lesion
cause
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Bullae are more voluminous elevations with a central cavity containing a clear, cloudy, or haemorrhagic liquid. They vary in dimensions and in tension: flaccid of firm bullae (e.g. bulla of a thermal burn).
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2.10
page: 25
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Pustules
Pustules
basic lesion
cause
Pustules are protuberances which vary in size and have a central cavity containing a purulent liquid. They occur as primary lesions or develop from vesicles or bullae (e.g. palmoplantar pustulosis).
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Basic lesions
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2.11
page: 26
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Scales
Scales
basic lesion
cause
Scales are aggregates of more or less dry horny cells formed by the superficial layers of the epidermis. They detach in fragments of varying size (e.g. ichthyosis).
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Basic lesions
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2.12
page: 27
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Crusts
Crusts
basic lesion
cause
Crusts are concretions of fairly hard consistency which result when exudative, haemorrhagic, or purulent lesions dry out (e.g. impetigo).
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Basic lesions
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Excoriations (or ulcerations)
2.13
page: 28
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Basic lesions
Excoriations (or ulcerations)
basic lesion
cause
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Excoriations are very superficial wounds. The dermis is exposed (e.g. excoriations caused by scratching).
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2.14
page: 29
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Fissures
Fissures
basic lesion
cause
Fissures are linear ulcers, with or without marginal hyperkeratosis, which break through the superficial dermis (e.g. athlete's foot).
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Basic lesions
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Ulcers
2.15
page: 30
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Basic lesions
Ulcers
basic lesion
cause
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Ulcers are more serious losses of substance, which penetrate deep into the dermis (e.g. slough).
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Gangrene
2.16
page: 31
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Basic lesions
Gangrene
basic lesion
cause
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Gangrene is tissue necrosis associated with loss of arterial or arteriolar blood supply (e.g. frostbite).
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Atrophy
2.17
page: 32
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Basic lesions
Atrophy
basic lesion
cause
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Atrophy consists of a reduction in skin thickness with loss of its firmness and elasticity (e.g. senile atrophy).
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2.18
page: 33
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Scars
Scars
basic lesion
cause
Scars are due to modifications of the dermis or epidermis and are a sign of a variable degree of fibrosis. They are the evidence of repair of a wound or of a loss of substance (e.g. scar after a burn).
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Basic lesions
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2.19
page: 34
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Sclerosis
Sclerosis
basic lesion
cause
Sclerosis means induration of the skin, which loses its normal suppleness. It is associated with coalescence of fibres in the dermis (e.g. morphoea).
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Basic lesions
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page: 35
Chapter 3:
basic lesion
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Eczemas
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Allergic contact dermatitis and irritation dermatitis Acute exudative contact dermatitis Acute exudative allergic contact dermatitis of the flexor surfaces of the forearms and arms after repeated application of an antiseptic lotion. Allergic reaction to hexamidine. Countless small translucent vesicles on a background of congestive erythema, rupturing and exuding a clear serous liquid.
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3.1
page: 36
cause
Allergic contact dermatitis and irritation dermatitis
basic lesion
Eczemas
alphabetical
page: 37
Chronic occupational contact dermatitis
basic lesion
Slightly keratotic, cracked, and infected scaly erythematous lesions of the back of the fingers in a mason. Allergic reactions to chromium salts present in cements.
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Allergic contact dermatitis and irritation dermatitis
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Eczemas
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Allergic contact dermatitis and irritation dermatitis
page: 38
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Eczemas
cause basic lesion
Acute erythematous papulovesicular allergic contact dermatitis of the backs of the hands in a physiotherapist. Allergic reaction to the lanolin contained in a massage cream. The right hand is more severely affected than the left.
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Vesicular contact dermatitis
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Allergic contact dermatitis and irritation dermatitis
page: 39
alphabetical
Eczemas
basic lesion
The diffuse erythema, with an unsharp and fragmented margin, is covered with small translucent vesicles.
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continued
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Vesicular contact dermatitis
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Allergic contact dermatitis and irritation dermatitis
page: 40
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Eczemas
cause basic lesion
Acute allergic contact dermatitis of the dorsal surface of the forefoot and toes. Allergic reaction to chromium salts used to tan shoe leather.
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Bullous contact dermatitis
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Allergic contact dermatitis and irritation dermatitis
page: 41
alphabetical
Eczemas
continued
basic lesion
cause
Bullae are formed on an erythematous vesicular background.
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Bullous contact dermatitis
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Allergic contact dermatitis and irritation dermatitis
page: 42
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Eczemas
cause basic lesion
Allergic contact dermatitis to the nickel in a jeans stud. At the point of contact there is a crusty greyish patch, partly eroded by excoriations caused by scratching.
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Crusted eczema
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page: 43
Crusted eczema
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Allergic contact dermatitis and irritation dermatitis
continued
basic lesion
cause
At the edges an erythematous papulovesicular eczema extends to an unclear margin.
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Eczemas
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Allergic contact dermatitis and irritation dermatitis
page: 44
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Eczemas
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Scaly dry erythematous contact dermatitis
basic lesion
cause
Allergic contact dermatitis of the eyelids caused by the use of an antiwrinkle cream. Allergic reaction to Kathon CG®, the cream's preservative. Diffused demarcated and itchy erythematous patches of eczema with fine scales.
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page: 45
alphabetical
Eczemas
cause basic lesion
Acute irritant dermatitis of the back of the hand and fingers, caused by contact with detergents. Diffuse itchy erythema. The margins of the erythema are distinct, corresponding to the zone of contact with the irritants.
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Acute irritant dermatitis
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page: 46
Cumulative insult dermatitis or chronic irritant dermatitis
basic lesion
Chronic irritant dermatitis of the back of the hand and fingers caused by contact with detergents. Scaly keratotic and chapped erythema causing pruritus and pain.
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Allergic contact dermatitis and irritation dermatitis
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Eczemas
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page: 47
Chronic palmar irritant dermatitis
basic lesion
Thick greyish or blackish keratotic patches, which are fissured and chapped. The clinical picture results from the combination of physical (friction, microtraumata) and chemical factors.
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Allergic contact dermatitis and irritation dermatitis
cause
Eczemas
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alphabetical
3.2
page: 48
Constitutional eczema or atopic dermatitis Atopic dermatitis of the face in an infant
basic lesion
Bright red oedematous patches of eczema with weeping vesicles. The margins are poorly defined. The lesions predominate on the convex areas of the face: forehead, cheeks, chin.
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Constitutional eczema or atopic dermatitis
cause
Eczemas
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page: 49
Infected retro-auricular dermatitis
basic lesion
Itchy exudative erythematous lesions of the retro-auricular groove, centred on a fissure at the base of the fold. Yellowish crusts are the sign of a microbial infection. These lesions, classical in childhood, can persist into adulthood.
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Constitutional eczema or atopic dermatitis
cause
Eczemas
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Constitutional eczema or atopic dermatitis
page: 50
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Eczemas
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Atopic dermatitis of childhood
basic lesion
cause
Very itchy exudative eczematous lesions of the eyelids and atopic angular cheilitis.
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page: 51
Atopic dermatitis of the folds in a child
basic lesion
Lichenified and very itchy patches in the knee flexures, transversed by scratch lines. In the present case similar lesions are present in other folds (e.g. of elbows, behind the ears, under the buttocks). The lesions can persist into adulthood.
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Constitutional eczema or atopic dermatitis
cause
Eczemas
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Constitutional eczema or atopic dermatitis
page: 52
alphabetical
Eczemas
Eczema of the nipples picture
Sign of atopic dermatitis in adulthood
basic lesion
cause
Acute exudative eczematous lesions of the nipple, the areola, and the periareolar region. The lesion margins are indefinite, the pruritus intense, and the course chronic. This is a classical sign of atopy in adulthood.
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Constitutional eczema or atopic dermatitis
page: 53
alphabetical
Eczemas
cause basic lesion
Atopic cheilitis affects the upper and lower lips and extends over the perioral region. Dry eczematous lesions causing chronic desquamation.
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Atopic cheilitis
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Atopic dermatitis in the adult: xerosis, lichenification and prurigo Very particular polymorphism of the lesions: skin dry and rough (xerosis), lichenified patches. There are also papules of various sizes, very strongly infiltrated, hard in consistency and often excoriated. These are prurigo papules (which used to be called "Besnier's prurigo").
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page: 54
cause
Constitutional eczema or atopic dermatitis
basic lesion
Eczemas
Constitutional eczema or atopic dermatitis
page: 55
alphabetical
Eczemas
cause basic lesion
Atopic conjunctivitis associated with blepharitis. This inflammation of the conjunctiva is embarrassing, sometimes painful, and often distressingly chronic. It is not unusual in the atopic adult.
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Atopic conjunctivitis
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Atopic dermatitis of the hands in the adult Chronic scaly erythematous eczema of the back of the hands. One quite characteristic feature is the irregular distribution (patchy pattern) of the lesions. Some fingers are affected, whereas others are not. The back of the hands is irregularly affected. This "disordered" topography of the lesions is frequently found in atopic dermatitis.
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alphabetical
page: 56
cause
Constitutional eczema or atopic dermatitis
basic lesion
Eczemas
Constitutional eczema or atopic dermatitis
page: 57
alphabetical
Eczemas
cause basic lesion
Rounded patch of dry scaly erythematous eczema on the cheek of a child. Spontaneous healing with a tendency to transient residual depigmentation, whence the name pityriasis alba. It occurs more frequently in atopic patients.
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Pityriasis alba
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Constitutional eczema or atopic dermatitis
page: 58
alphabetical
Eczemas
cause basic lesion
This condition, the site of which is generally the anterior third of the sole, always bilateral, and often symmetrical, is characterized by the triad of erythema, hyperkeratosis, and fissures.
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Juvenile plantar dermatosis
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Constitutional eczema or atopic dermatitis
page: 59
alphabetical
Eczemas
basic lesion
The skin often has a shiny collodion-like appearance. It often becomes worse in winter and is perhaps more common in atopic patients ("atopic winter feet").
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continued
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Juvenile plantar dermatosis
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Nummular dermatitis (discoid eczema)
3.3
page: 60
alphabetical
Eczemas
Nummular dermatitis (discoid eczema)
basic lesion
cause
Round erythematous plaque (nummulus = coin) covered with numerous weeping vesicles which develop into small crusts.
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Exudative variety
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Nummular dermatitis (discoid eczema)
alphabetical
page: 61
continued
Dry variety of nummular dermatitis
basic lesion
Several round or oval erythematous plaques, well demarcated and isolated from each other. Their diameter varies from one to several centimetres and they are covered in fine dry scales.
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Nummular dermatitis (discoid eczema)
cause
Eczemas
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Gravitational eczema
3.4
page: 62
alphabetical
Eczemas
Gravitational eczema
basic lesion
cause
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Patches of itchy erythematous dry eczema, often accompanied by scratches. The lesions are sometimes situated along the course of varicose vessels.
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Seborrhoeic dermatitis
3.5
page: 63
alphabetical
Eczemas
Seborrhoeic dermatitis
picture
Seborrhoeic dermatitis of the trunk
basic lesion
cause
Red circinate plaques in the presternal and/or interscapular region, covered in slightly itchy greasy scales. Very slight depigmentation occurs in the centre of the lesion.
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Seborrhoeic dermatitis of the hairline On the scalp it is characterized by diffuse itchy erythema covered in greasy scales. The lesions sometimes spread to the forehead, as in the present case, where they form what is commonly known as the corona seborrhoeica: erythematous patches dotted with steatoid scales, which, following the hairline, show scalloped and arched margins.
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alphabetical
page: 64
cause
Seborrhoeic dermatitis
basic lesion
Eczemas
alphabetical
page: 65
Seborrhoeic dermatitis of the face
basic lesion
The scaly erythematous lesions are well demarcated and have characteristic sites: hairline, nasolabial folds, vertical mediofrontal fold, and the free edges of the lower eyelids.
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Seborrhoeic dermatitis
cause
Eczemas
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Pompholyx
3.6
page: 66
alphabetical
Eczemas
Pompholyx
cause basic lesion
The vesicles of pompholyx are arranged in groups on the lateral sides of the fingers. They are hard to the touch, encased in the epidermis, translucent, and classically compared to grains of sago or to cooked tapioca. They are accompanied by intense itching.
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Pompholyx of the fingers
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page: 67
Bullous pompholyx of the palms (cheiro-pompholyx)
basic lesion
The vesicles encased in the palmar epidermis coalesce to form true bullae, which are sometimes haemorrhagic.
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Pompholyx
cause
Eczemas
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page: 68
Eczematous pompholyx of the palms
basic lesion
Eczematous pompholyx represents an association of pompholyx vesicles with scaly erythematous patches with diffuse margins. The itching is fierce and the course is characterized by successive, even subintrant episodes.
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Pompholyx
cause
Eczemas
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3.7
page: 69
Asteatotic eczema (or winter eczema, eczéma craquelé, or erythema craquelé)
basic lesion
Dry eczema with imprecise margins reminiscent of crazy paving. The cracks in the "paving" correspond to fissures of variable depth, with pinpoint bleeding. The name "erythema craquelé" is nowadays preferred to "eczéma craquelé".
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Asteatotic eczema
cause
Eczemas
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page: 70
Chapter 4:
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Urticarias
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Contact urticarias
4.1
page: 71
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Urticarias
Contact urticarias
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cause basic lesion
Urticarial weals occurring within minutes of putting on surgical latex gloves. These weals can spread beyond the actual site of contact because this is an immunoallergic urticaria (specific IgE are sometimes present). Generalized urticaria with systemic symptoms can therefore occur: allergic rhinitis, conjunctivitis, asthma-like attacks, anaphylactic shock, etc.
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Latex contact urticaria
Contact urticarias
page: 72
alphabetical
Urticarias
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Prick test with latex
basic lesion
cause
Diagnosis of latex contact urticaria: the prick test is performed with a lancet, using incubation liquid from the suspected latex gloves.
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Provocative use test with latex gloves In cases of doubt (prick test difficult to interpret), a provocation test can be performed, if necessary with the suspected glove. This will always be done initially with a finger-stall, which is slipped onto a moistened finger for 10 min. The provocation test must always be done in a hospital environment.
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page: 73
cause
Contact urticarias
basic lesion
Urticarias
Physical urticarias
4.2
page: 74
alphabetical
Urticarias
Physical urticarias
cause basic lesion
Drawing on the skin with a blunt tip produces a linear erythema with an oedematous component. The dermographism appears 5 to 10 min after the rubbing. It can be isolated or associated with chronic idiopathic urticaria.
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Dermographism
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Physical urticarias
page: 75
alphabetical
Urticarias
cause basic lesion
Very itchy deep oedema occurring several hours (6 to 12 hours) after strong pressure on a precise area, e.g. on palmar side. Feet can be affected after walking, as can buttocks after prolonged sitting.
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Pressure urticaria
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page: 76
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Urticarias
cause basic lesion
Eruption triggered by cold: the application of an ice-cube for 3 to 10 min systematically reproduces an urticarial weal. Nevertheless, in the present case it would be appropriate to perform a second test to eliminate aquagenic urticaria (with immersion of one hand in water at ambient temperature).
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Cold urticaria
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Physical urticarias
page: 77
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Urticarias
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This very rare variant of urticaria occurs within minutes on exposure to sunlight. The eruption can persist for three to four hours. Photobiological investigation very easily confirms the diagnosis (photosensitivity test positive with UVA and/or UVB).
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Solar urticaria
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Common urticarias (medicines, food, idiopathic)
4.3
page: 78
alphabetical
Urticarias
Common urticarias (medicines, food, idiopathic)
cause basic lesion
Eruption of oedematous urticated weals which can coalesce into broad patches. Itching is constant and can prevent sleep. This urticaria can be the first sign of anaphylactic shock.
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Urticated weals
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Common urticarias (medicines, food, idiopathic)
page: 79
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Urticarias
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cause basic lesion
Urticarial weals spread symmetrically over the body, most often blamed on medicines. Specific foods can sometimes trigger this type of urticaria (acute urticaria). Strawberries, shellfish, fish, certain cereals, milk, eggs, and some particular food additives are most frequently the cause. The diagnosis is based mainly on provocation tests (withdrawal and reintroduction of the suspected medicine or food).
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Papular urticaria
Common urticarias (medicines, food, idiopathic)
page: 80
alphabetical
Urticarias
cause basic lesion
The urticarial papules describe curlicues or geographical shapes. In this case, the cause would most often be a drug (aspirin, codeine, penicillin, etc.). Again, a withdrawal test with reintroduction, if appropriate, makes it possible to reach an exact diagnosis.
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Figured urticaria
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Common urticarias (medicines, food, idiopathic)
page: 81
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Urticarias
cause basic lesion
Not particularly itchy, deep urticaria mainly affecting the face (particularly eyelids and lips), the glottis, and even the larynx. This is an emergency which requires rapid therapeutic intervention (adrenaline and corticosteroids in particular). Iatrogenic causes are not uncommon.
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Hereditary angio-oedema
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Common urticarias (medicines, food, idiopathic)
page: 82
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Urticarias
cause basic lesion
Combination of urticaria with lesions of leucocytoclastic vasculitis. The urticarial lesions are more fixed than in classical urticaria. They last for 2 to 3 days and are frequently accompanied by joint pains and by fever. Reduced complement levels in blood are observed.
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Urticarial vasculitis
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page: 83
Chapter 5:
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Infectious viral diseases
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5.1
Herpes virus group
page: 84
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Infectious viral diseases
Herpes virus group
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Multiple vesicles arranged in a cluster on an erythematous background. The lesions are usually painful and in most cases preceded by a burning or itching sensation. The vesicles rupture spontaneously after a few days and drying occurs later. Recurrences are typical (recurrent herpes), usually at the same site.
basic lesion
Herpes of the face
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Type I herpes
Herpes virus group
page: 85
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Infectious viral diseases
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There are lesions which correspond to two stages of development: vesicles on an erythematous base on the prepuce (recent attack) and black crusts on the shaft (old attack). The lesions are itching and painful. The diagnosis is confirmed with liquid from a vesicle: smear for immunological diagnostics with the aid of monoclonal antibodies and culture.
basic lesion
Herpes of the penis
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Type II herpes (genital)
Herpes virus group
page: 86
alphabetical
Infectious viral diseases
Varicella and herpes zoster are associated with infection by the virus Herpes varicellae.
basic lesion
Vesicles on a background of healthy skin or surrounded by an erythematous ring, distinctly separated from each other, whose contents become cloudy secondarily.
cause
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Varicella
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Varicella
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page: 87
continued
basic lesion
The central umbilication is classical. They develop to form an adhesive crust which sometimes leaves a depressed scar when it detaches.
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Herpes virus group
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Infectious viral diseases
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Herpes virus group
page: 88
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cause basic lesion
Herpes zoster is associated with infection by the virus Herpes varicellae. Vesiculobullous dermatosis preceded and very often accompanied by considerable pain (especially in old people). The lesions are strictly unilateral and correspond to the tract of a nerve root. In the present case an intercostal nerve is involved ("fiery half-girdle").
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Zoster of the trunk
Herpes virus group
page: 89
alphabetical
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cause basic lesion
In the present case the topography of the lesions makes it possible to say that two branches are affected by the infectious process: the ophthalmic branch and the superior maxillary branch. The third branch, the inferior maxillary, is spared. The presence of vesicles on the nostril shows that the nasociliary nerve is involved.
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Ophthalmic nerve zoster
5.2
Papillomavirus group
page: 90
alphabetical
Infectious viral diseases
Papillomavirus group
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The papillomaviruses are responsible for the occurrence of various types of benign tumour, viral warts.
basic lesion
Small greyish keratotic tumours, rough to the touch, on the backs of the fingers. Common warts are contagious and autoinoculable.
cause
Common warts
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Papillomavirus group
page: 91
alphabetical
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basic lesion
cause
These warts are mainly located on the face and on the back of the hands or fingers. They are orange very slightly raised papules.
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Plane warts
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Plane warts
alphabetical
Papillomavirus group
continued
basic lesion
cause
The linear disposition is typical (Koebner's phenomenon caused by autoinoculation along scratch lines).
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Infectious viral diseases
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Papillomavirus group
page: 93
alphabetical
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cause basic lesion
Fleshy reddish formations on the genital organs. Condylomata acuminata are contagious (sexually transmitted disease) and can spread rapidly. The maceration is sometimes considerable.
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Condylomata acuminata
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Papillomavirus group
page: 94
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cause basic lesion
Distinctly demarcated keratotic formation which is often deeply embedded in the skin of the sole. The disappearance of dermatoglyphics all over the surface of plantar warts is typical and makes it possible to distinguish this lesion from a corn. A single plantar wart is classically known as myrmecia.
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Plantar wart
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page: 95
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cause basic lesion
Juxtaposition of numerous plantar warts forming a hyperkeratotic patch by spreading by degrees. These mosaic plantar warts are often painful (sensitivity to pressure during walking).
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Mosaic warts
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Papillomavirus group
page: 96
alphabetical
Infectious viral diseases
cause basic lesion
Small pedunculate papilloma mainly affecting the face (nose, side of the neck, and cheeks). Horny filiform warts are typically found in men (shaving, especially with a razor rather than an electric shaver, contributes to dissemination).
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Horny filiform wart
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5.3
Epstein-Barr virus
page: 97
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Epstein-Barr virus
cause basic lesion
Appearance of fine whitish striations on the sides of the tongue. Oral hairy leucoplakia is most often encountered in homosexual men suffering from AIDS. The term "hairy" is purely descriptive. The hairy appearance is associated with linear hyperplasia.
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Hairy leucoplakia
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5.4
Pox and parapox virus groups
page: 98
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Pox and parapox virus groups
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cause basic lesion
Small round papule with a smooth surface, often shiny, a few millimetres in diameter. There is often a small central depression (crater, often filled with creamy whitish material). These lesion most frequently affect children and can be secondarily accompanied by eczema around the lesion. Molluscum contagiosum is caused by a poxvirus.
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Molluscum contagiosum
Pox and parapox virus groups
page: 99
alphabetical
Infectious viral diseases
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cause basic lesion
Illustration of the phase of dissemination of the lesions. The topographical predilection for the axilla is characteristic. In some cases the mollusca contagiosa can become inflamed and there can be a superimposed infection. In adults molluscum contagiosum is often found in the genital area. An immunological status check is indispensable in the case of very numerous lesions (especially if found on the face).
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Multiple mollusca contagiosa
Pox and parapox virus groups
page: 100
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cause basic lesion
Red to violet pseudovesicular papule appearing on the dorsal face of a finger. The incubation period varies from three days to two weeks after contact with a sick animal (usually sheep). Regression without complications in about two weeks. A superimposed bacterial infection is not uncommon. ORF is caused by a parapoxvirus.
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ORF
5.5
Other viruses
page: 101
alphabetical
Infectious viral diseases
Other viruses
cause basic lesion
Maculopapular "butterfly-wing" eruption of the face giving a puffy appearance, like "butterfly wings". The biphasic development of the lesions on the face is typical.
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Erythema infectiosum
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Erythema infectiosum
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page: 102
continued
basic lesion
After the second bout there are often numerous pink polycyclic or circinate maculopapules, describing curlicues on the limbs. The eruption disappears in about ten days and is caused by Parvovirus B19.
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Other viruses
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Infectious viral diseases
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Other viruses
page: 103
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Infectious viral diseases
cause basic lesion
Maculopapular eruption, very pronounced on the face. Enanthema is also present. Some healthy skin areas can always be seen. There is often a superimposed ENT bacterial infection and injection of the conjuctivae. Measles is caused by a paramyxovirus.
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Measles
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Other viruses
page: 104
alphabetical
Infectious viral diseases
cause basic lesion
Intraoral enanthema of the anterior part of the mouth, with small greyish vesicles which rupture very rapidly. The pain caused can make it difficult to eat.
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Hand-foot-and-mouth-disease
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page: 105
alphabetical
Infectious viral diseases
basic lesion
Appearance of small oval vesicles about 3 to 4 millimetres in diameter on the hands and feet. The vesicles are greyish-white and surrounded by an erythematous halo.
cause
continued
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Hand-foot-and-mouth-disease
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Other viruses
page: 106
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There is a vaguely painful sensation. Disappearance is rapid; disseminated lymphadenopathy can be present. Similar lesions are sometimes found on the buttocks. The condition is generally caused by the Coxsackie A16 virus. Other coxsackie viruses may also be responsible.
basic lesion
continued
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Hand-foot-and-mouth-disease
Other viruses
page: 107
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cause basic lesion
Relatively modest erythematous macular eruption accompanied by suboccipital lymphadenopathy with considerable swelling. The pale pink colour and the unobtrusive effect on general health are other features to be borne in mind. In adults and adolescents the symptoms are often more prominent (fever and more pronounced rash). The pathogen is a togavirus.
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Rubella
5.6
Signs of AIDS on skin and mucosa
page: 108
alphabetical
Infectious viral diseases
Signs of AIDS on skin and mucosa
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Necrotic herpes zoster
basic lesion
cause
Multiple ulcers developing from necrotic patches. These ulcerated lesions have spread considerably.
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Gangrene; Ulcers
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page: 109
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Signs of AIDS on skin and mucosa
Necrotic herpes zoster
continued
basic lesion
cause
After several weeks, the ulcerated lesions have left slightly atrophic cicatrized patches.
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Infectious viral diseases
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Signs of AIDS on skin and mucosa
page: 110
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Infectious viral diseases
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Seborrhoeic dermatitis
basic lesion
cause
Seborrhoeic dermatitis, often severe and resistant to conventional treatments, can be seen in the course of an HIV infection. In the present case the involvement of the whole nasal pyramid was the first sign of HIV infection.
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Signs of AIDS on skin and mucosa
page: 111
alphabetical
Infectious viral diseases
cause basic lesion
In quite a number of cases prurigolike lesions (excoriated nodules) accompanied (or caused) by diffuse pruritus are observed. The involvement of the trunk is relatively typical.
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Prurigo
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Signs of AIDS on skin and mucosa
page: 112
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Infectious viral diseases
cause basic lesion
The dentogingival junction is the site of a purulent erythema (presence of fusiform and spiral bacteria). This periodontitis is painful and shows no tendency to regress spontaneously.
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Gingivitis
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Signs of AIDS on skin and mucosa
page: 113
alphabetical
Infectious viral diseases
cause basic lesion
Very numerous mollusca on the face, sometimes with a few lesions which are haemorrhagic in appearance, can be seen in AIDS. The mollusca are generally very deeply embedded in the skin. Curettage is relatively difficult. The mollusca show a marked tendency to multiply.
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Molluscum contagiosum
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Signs of AIDS on skin and mucosa
page: 114
alphabetical
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cause basic lesion
Purplish angiomatous papular lesion. The preferred involvement of the face is typical in AIDS patients. In the present case Kaposi's nodules are observed side by side with mollusca contagiosa.
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Kaposi's sarcoma
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Kaposi's sarcoma
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page: 115
continued
basic lesion
Kaposi's nodules can occur in large numbers all over the skin. These nodules keep distinct margins with angular edges. Here again the violet colour is characteristic. The nodules are generally completely painless.
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Signs of AIDS on skin and mucosa
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Infectious viral diseases
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Signs of AIDS on skin and mucosa
page: 116
alphabetical
Infectious viral diseases
cause basic lesion
Abnormally large or rapid spread of condylomata acuminata must always lead to a suspicion that the patient is seropositive for HIV. In the present case the condylomata spread all over the vulva and into the vaginal canal.
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Condylomata acuminata
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alphabetical
page: 117
Chapter 6:
basic lesion
cause
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Bacterial infections diseases
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6.1
Impetigo
page: 118
alphabetical
Bacterial infections diseases
Impetigo
cause basic lesion
Bullae with cloudy contents, often surrounded by an erythematous halo. These bullae rupture easily and are rapidly replaced by extensive crusty patches. Bullous impetigo is classically caused by Staphylococcus aureus .
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Bullous impetigo
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Impetigo
page: 119
alphabetical
Bacterial infections diseases
basic lesion
ß-Haemolytic streptococcus is most frequently found in this type of impetigo.
cause
Erythematous patches covered by a yellowish crust. Lesions are most frequently around the mouth. Lesions around the nose are very characteristic and require prolonged treatment.
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Non-bullous impetigo
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page: 120
alphabetical
6.2
Ecthyma
Ecthyma
basic lesion
cause
Slow and gradually deepening ulceration surmounted by a thick crust. The usual site of ecthyma are the legs. After healing there is a permanent scar. The pathogen is often a streptococcus. Ecthyma is very common in tropical countries.
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Bacterial infections diseases
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page: 121
alphabetical
6.3
Folliculitis
Folliculitis
basic lesion
cause
Inflammatory papule with a follicular pustule at its centre. The pathogen is usually a staphylococcus. Folliculitis is frequently multiple and classically located on the buttocks, thighs, or the face.
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Bacterial infections diseases
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page: 122
alphabetical
6.4
Furuncle (BOIL)
Furuncle (BOIL)
basic lesion
cause
Acute deep folliculitis starting with a painful erythematous papule with the appearance of a central pustule. After spontaneous or induced evacuation of the pus, the furuncle often leaves a permanent scar. The pathogen is Staphylococcus aureus .
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Bacterial infections diseases
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page: 123
alphabetical
6.5
Carbuncle
Carbuncle
basic lesion
cause
By definition, carbuncles result from the coalescence of several juxtaposed furuncles. A large painful lump is strewn with small pustules which emerge on the skin surface.
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Bacterial infections diseases
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page: 124
Erysipelas
basic lesion
Hot, painful, oedematous erythematous patches, accompanied by fever and malaise, typically caused by a streptococcus. Erysipelas can affect the face, and in this case the border against healthy skin is very distinct and raised: the "step" sign.
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6.6
Erysipelas
cause
Bacterial infections diseases
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continued
On the leg one observes extensive wide patches identical with those on the face but having a less accentuated margin. Again, the general health is affected, and there is always fever. A mixed infection is found in most cases (gram positive and/or gram negative bacteria). There is often a portal of entry, e.g. a lesion between the toes or a wound caused by trauma.
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Erysipelas
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page: 125
cause
Erysipelas
basic lesion
Bacterial infections diseases
page: 126
alphabetical
6.7
Orbital cellulitis
Orbital cellulitis
basic lesion
cause
Deep retro-orbital infection manifests itself on the skin with periorbital oedema accompanied by malaise and fever. This is evidently a serious condition, given the possibility of spreading towards the cavernous sinus.
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Bacterial infections diseases
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page: 127
Septic emboli
basic lesion
Small erythematous pustular lesions occurring simultaneously in a number of places. The general context depends on the starting point of these septic emboli (cardiac involvement in rheumatic fever, gonorrhoea in the process of dissemination, etc.).
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6.8
Septic emboli
cause
Bacterial infections diseases
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page: 128
alphabetical
6.9
Borrelia infections
Borrelia infections Erythema chronicum migrans or lyme disease
basic lesion
cause
Broad erythematous patch spreading outwards with a false appearance of healing at the centre.
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page: 129
Erythema chronicum migrans or lyme disease continued
basic lesion
Sometimes a small scar is found in the middle (trace of a tick bite). Erythema chronicum migrans is caused by Borrelia infection.
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Borrelia infections
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Bacterial infections diseases
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Borrelia infections
page: 130
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Bacterial infections diseases
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In some cases the Borrelia infection is clinically recognized by the presence of one or more pasty nodules, mainly on uncovered parts of the body, most typically on earlobes. This type of "pseudolymphoma" is also one of the Borrelia diseases. One can include this lesion among the forms of the old "lymphocytoma benigna cutis".
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Borrelia pseudolymphoma
page: 131
alphabetical
6.10
Proteus infection
Proteus infection
basic lesion
cause
In rare cases, if untreated contused lesions are present, a gram-negative microorganism such as Proteus or Pseudomonas can cause necrosis of the distal extremity of a finger.
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Bacterial infections diseases
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alphabetical
6.11
Cat-scratch disease
Cat-scratch disease
basic lesion
cause
More or less fluctuant nodules with ulceration and central crust, accompanied by lymphadenopathy with considerable swelling.
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Bacterial infections diseases
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Cat-scratch disease
alphabetical
Cat-scratch disease
continued
basic lesion
cause
The young patient was scratched by his cat a few weeks previously.
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Bacterial infections diseases
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page: 134
alphabetical
6.12
Intertrigo
Intertrigo
basic lesion
cause
Glazed erythematous patches with the appearance of "pages of a book", centred on the base of a large fold. Maceration and infection with common microorganisms are typical.
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Bacterial infections diseases
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Erythematous Macule
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6.13
Cutaneous tuberculosis
page: 135
alphabetical
Bacterial infections diseases
Cutaneous tuberculosis
basic lesion
cause
Large reddish-yellow lesion affecting the face and the earlobe. False appearance of healing at the centre.
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Lupus vulgaris
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Tubercles; Scars
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Lupus vulgaris
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page: 136
continued
basic lesion
Vitropression reveals characteristic orange-red coloration, which dermatologists at the beginning of the century compared to "barley sugar", a delicacy which has now gone out of fashion.
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Cutaneous tuberculosis
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Bacterial infections diseases
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Tubercles
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Cutaneous tuberculosis
page: 137
alphabetical
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Scofuloderma
basic lesion
cause
Chronic tuberculous cervical lymphadenopathy with skin ulceration.
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Ulcers; Scars
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page: 138
Complication of BCG vaccination
basic lesion
Non-specific abscess formation after BCG vaccination. This complication of BCG vaccination is generally the result of an injection made too deeply.
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Cutaneous tuberculosis
cause
Bacterial infections diseases
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Nodules
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Atypical mycobacterial infections Infection with mycobacterium marinum This condition is found mainly in fish fanciers (fish-tank disease) and classically appears in the form of a chain of nodules spaced like rosary beads, extending along the line of lymphatic drainage. These are more or less keratotic papulonodular lesions and/or ulcers. There is generally little pain. Deep biopsy with culture in a suitable medium very easily reveals the mycobacterium.
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Nodules; Ulcers
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alphabetical
page: 139
cause
6.14
Atypical mycobacterial infections
basic lesion
Bacterial infections diseases
alphabetical
page: 140
Infection with mycobacterium marinum continued
basic lesion
The papulonodules can be single or multiple. The latter form of the mycobacterial infection is sometimes known as sporotrichoid.
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Atypical mycobacterial infections
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Bacterial infections diseases
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Nodules; Ulcers
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Atypical mycobacterial infections
page: 141
alphabetical
Bacterial infections diseases
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Infection with mycobacterium fortuitum or chelonae
basic lesion
cause
Abscess and violet nodules occurring a few weeks after repeated injections as part of mesotherapy (in the treatment of "cellulitis").
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6.15
Corynebacterium infections
page: 142
alphabetical
Bacterial infections diseases
Corynebacterium infections
cause basic lesion
Broad and distinctly demarcated brownish or buff macule, with rounded margins, usually symmetrical and affecting either the groins or the axillae. These lesions are homogeneous and finely squamous. The pathogen is Corynebacterium minutissimum . Examination in Wood's light reveals coral-red fluorescence.
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Erythrasma
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Corynebacterium infections
page: 143
alphabetical
Bacterial infections diseases
cause basic lesion
This is a bacterial infection caused by corynebacteria. The axillary hairs are surrounded by small yellowish nodules corresponding to colonies of bacteria. There is little in the way of subjective symptoms. The sweat sometimes becomes yellowish.
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Trichomycosis axillaris
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Corynebacterium infections
page: 144
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Bacterial infections diseases
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Excoriations (or Ulcerations)
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Small serpiginous erosions of the horny layer with a punched-out appearance, mainly found on weight-bearing areas of the soles and causing an interruption in footprints. An associated plantar hyperhidrosis is often present. The erosions correspond to areas of desquamation in a block of the horny layer invaded by corynebacteria.
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Pitted keratolysis
alphabetical
page: 145
Chapter 7:
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Treponematoses and other sexually transmitted diseases
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page: 146
Syphilis Syphilitic chancre (primary sore)
basic lesion
Ulceration with erosion situated on the glans penis or sheath. Distinctly palpable induration. Considerable swelling of inguinal lymph nodes, usually unilateral.
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7.1
Syphilis
cause
Treponematoses and other sexually transmitted diseases
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Excoriations (or Ulcerations)
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Syphilitic chancre (primary sore)
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page: 147
continued
basic lesion
The characteristics of female chancre are identical with those in the male. In women the chancre is often accompanied by considerable oedema of the labia majora.
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Syphilis
cause
Treponematoses and other sexually transmitted diseases
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page: 148
Secondary syphilis (macular syphilid)
basic lesion
Occurring about six weeks after the start of the chancre, secondary syphilis appears in the form of pink oval macules with little or no scaling and no itching. These macules are located mainly on the trunk.
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Syphilis
cause
Treponematoses and other sexually transmitted diseases
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Syphilis
page: 149
alphabetical
Treponematoses and other sexually transmitted diseases
cause basic lesion
Dull red, sometimes brownish, very distinctly indurated papules, which are not itchy, located on the trunk and on the proximal regions of the limbs.
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Late secondary syphilis
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Dermal Papules
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Syphilis
page: 150
alphabetical
Treponematoses and other sexually transmitted diseases
cause basic lesion
Slightly reddish macules with peripheral desquamative collarette (Biett's collarette). These papular syphilids occur four to twelve months after the chancre.
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Papular syphilids
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Syphilis
page: 151
alphabetical
Treponematoses and other sexually transmitted diseases
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Genital gonorrhoea
basic lesion
cause
Diffuse redness of the glans, purulent urethral discharge, considerable dysuria, pollakiuria. Presence of two mollusca contagiosa, equally sexually transmitted.
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page: 152
Chapter 8:
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Mycoses
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Dermatophytoses
8.1
page: 153
alphabetical
Mycoses
Dermatophytoses
cause basic lesion
Round or oval lesion, as in the present case, with a distinctly raised margin, sometimes with fine vesicles, sometimes very scaly. There is often a false appearance of healing at the centre. These round lesions are generally slightly scaly. Pruritus is not always present as a subjective symptom. The lesions can be single.
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Tinea corporis
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page: 154
Tinea corporis
alphabetical
Dermatophytoses
continued
basic lesion
cause
The lesions can be multiple. The pathogen is generally Microsporum canis, or Trichophyton rubrum.
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Mycoses
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Dermatophytoses
page: 155
alphabetical
Mycoses
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cause
The dermatophytosis has the same appearance as on glabrous skin, but can assume an impressive clinical picture owing to it's spread.
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Tinea faciei
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page: 156
Tinea faciei
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Dermatophytoses
continued
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Mycoses
basic lesion
cause
The dermatophytosis can also assume a more or less atypical clinical picture owing to late diagnosis or unsuitable topical therapy with corticosteroids.
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Dermatophytoses
page: 157
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Mycoses
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Dermatophytosis of the inguinal fold (also called dhobi itch and Hebra's eczema marginatum). This dermatophytosis affects men more frequently than women. A very distinct vesicular border circumscribes a central red, sometimes brownish, central region, which is always scaly. The lesion typically spreads towards the inner thigh.
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Tinea cruris
Dermatophytoses
page: 158
alphabetical
Mycoses
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This condition affects the palms, most frequently on one hand. There is no substantial hyperkeratosis. An active margin may be noticeable at the wrist. Association with athlete's foot or eczema marginatum is typical, and it is a good idea to persevere in looking for this. Scraping with a curette generally yields plenty of horny, brittle, powdery material.
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Tinea manuum
page: 159
Tinea manuum
alphabetical
Dermatophytoses
continued
basic lesion
cause
It is characterized by diffuse redness and dryness with floury accentuation of flexural creases of the palms.
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Mycoses
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Dermatophytoses
page: 160
alphabetical
Mycoses
cause basic lesion
Fissured and scaly intertrigo of the space between the fourth and the fifth toes. There is often a small painful crack running along the base of the fold.
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Tinea pedum (athlete's foot)
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Dermatophytoses
page: 161
alphabetical
Mycoses
continued
basic lesion
cause
Sometimes the whole area is eroded, which is a sign of microbial infection.
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Tinea pedum (athlete's foot)
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Dermatophytoses
page: 162
alphabetical
Mycoses
basic lesion
The dermatophytosis can extend to the sole, which it affects more or less extensively. In some cases in which tinea manuum is associated with tinea pedis, three of the four limbs are affected (e.g. one hand and two feet).
cause
continued
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Tinea pedum (athlete's foot)
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Scales
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Dermatophytoses
page: 163
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Mycoses
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Scales
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The scalp is attacked by a dermatophyte. Children are affected most often. Large plaque of alopecia, presence of numerous short broken hairs, on a greyish and scaly base. The pathogen is most frequently Microsporum canis. Ringworm is characteristic of the prepubescent period: it is distinguished from alopecia or pseudo-alopecia by its floury appearance.
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Tinea capitis or ringworm
Dermatophytoses
page: 164
alphabetical
Mycoses
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Kerion
basic lesion
cause
Crusty and well demarcated suppurative patch sometimes tumour-like. Most typical site is the scalp in the child.
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Kerion
alphabetical
Dermatophytoses
continued
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Mycoses
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cause
Another most typical site is the beard in the adult.
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page: 166
Kerion
alphabetical
Dermatophytoses
continued
basic lesion
cause
The lesion evolves into a definitive scar. The pathogen is Trichophyton mentagrophytes or Trichophyton verrucosum.
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Mycoses
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Dermatophytoses
page: 167
alphabetical
Mycoses
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Onychomycosis due to dermatophytes
basic lesion
cause
Thickened and opaque nail, distal onycholysis. The nail becomes brittle. There is no associated paronychia.
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page: 168
Onychomycosis due to dermatophytes
continued
basic lesion
More rarely, dermatophytic onychomycosis involves the superficial layer of the nail plate and appears in the form of small opaque whitish patches which are well demarcated (appearance of leuconychia). The surface becomes more brittle as a result.
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Dermatophytoses
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Mycoses
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Candidiasis
8.2
page: 169
alphabetical
Mycoses
Candidiasis
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Thrush is the classical form of intraoral candidiasis, characterized by a whitish coating of creamy consistency covering bright red areas of erosion. Scraping with the curette removes the coating and exposes the erosion patches. The inner cheek surface and the tongue are affected. The surrounding mucosa is inflamed and there is a considerable burning sensation. The pathogen is Candida albicans.
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Thrush
Candidiasis
page: 170
alphabetical
Mycoses
cause basic lesion
Fissures, which are most frequently symmetrical, localized at the corners of the lips and surrounded by small impetigo-like crusts. Edentulous patients or patients with badly fitting dentures are most frequently affected. A superimposed bacterial infection is very common.
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Angular cheilitis
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Fissures
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Candidiasis
page: 171
alphabetical
Mycoses
cause basic lesion
More or less symmetrical exudative erythematous axillary patches with small satellite lesions. A peripheral desquamative collarette is often present.
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Candidal intertrigo
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Candidiasis
page: 172
continued
basic lesion
cause
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Candidal intertrigo
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Mycoses
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Candidiasis
page: 173
alphabetical
Mycoses
cause basic lesion
Symmetrical involvement of the external genitals with peripheral desquamative collarette and small punctiform erythematous satellite lesions which are sometimes somewhat pustular. Itching is generally severe. There is frequently an associated whitish leucorrhoea.
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Candidal vulvovaginitis
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Candidiasis
page: 174
alphabetical
Mycoses
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Candidal balanitis
basic lesion
cause
Glazed erythema surrounded by a fine whitish border, affecting the glans and the neck of the penis. Relatively intense burning. Recurrences are common.
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Candidal paronychia and subungual infection Thickened, brittle, and yellowish nail, accompanied by an inflamed nail fold which discharges a purulent exudate on pressure. Pain is typical. Some cases of candidal paronychia are preceded by irritant dermatitis, most frequently to vegetable or animal proteins (protein contact dermatitis).
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Pustules
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page: 175
cause
Candidiasis
basic lesion
Mycoses
Candidiasis
page: 176
alphabetical
Mycoses
cause basic lesion
Wide glazed erythematous patch over the whole area of genitals and buttocks with satellite lesions. The condition classically starts at the base of the folds (inguinal folds, cleft of the buttocks or anal region).
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Napkin candidiasis (infant)
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8.3
page: 177
alphabetical
Pityriasis versicolor
Pityriasis versicolor
basic lesion
cause
Small, well-demarcated buff or brownish patches located mainly on the trunk or the neck. Pruritus is moderate or absent.
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Mycoses
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Pityriasis versicolor
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page: 178
continued
basic lesion
Scraping with a curette reveals a scale becoming detached from a mass of scales: chip sign. The depigmented form can either be scaly from the beginning and thus contagious, or residual after exposure of pigmented pityriasis versicolor to the sun.
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Pityriasis versicolor
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Mycoses
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continued
In this case it is not contagious and represents only the aftermath of an old pityriasis versicolor after treatment. In cases of doubt, mycological examination reveals the presence of short mycelial filaments accompanied by colonies of small round spores (Malassezia furfur). Wood's light examination reveals the presence of a yellowish fluorescence.
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Pityriasis versicolor
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page: 179
cause
Pityriasis versicolor
basic lesion
Mycoses
Deep fungal infections
8.4
page: 180
alphabetical
Mycoses
Deep fungal infections
cause basic lesion
Multiple violet papulonodular lesions developing along the lines of lymphatic drainage, associated with infection with Sporothrix schenkii. The limbs are most frequently affected.
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Sporotrichosis
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Deep fungal infections
page: 181
alphabetical
Mycoses
cause basic lesion
Severe inflammatory swelling located most frequently on the foot, exuding a purulent material containing grains through fine breaks. The pathogens can be either eumycetes or actinomycetes.
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Mycetoma (Madura foot)
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page: 182
Chapter 9:
basic lesion
cause
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Parasitic diseases – arthropods
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page: 183
Human scabies
basic lesion
Parasitic disease caused by Sarcoptes scabiei. Blackish burrows from 5 to 15 mm in length, ending in a vesicle at one end ("mite hill"). The sides of the fingers and the anterior surfaces of the wrist are sites of predilection. Numerous marks of excoriation, sometimes accompanied by fine more or less translucent vesicles spread all over the skin.
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9.1
Human scabies
cause
Parasitic diseases – arthropods
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Human scabies
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Human scabies
continued
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Parasitic diseases – arthropods
basic lesion
cause
These excoriations are mainly the sign of very severe itching in the evening and at night.
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Human scabies
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page: 185
continued
basic lesion
Scabies nodules: very distinctly infiltrated, extremely itchy reddish nodules in the axillae, on the scrotum, and on the penis, persisting even after successful treatment.
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Human scabies
cause
Parasitic diseases – arthropods
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Human scabies
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Human scabies
continued
basic lesion
cause
In children the lesions usually affect the feet: numerous extremely itchy excoriated papules.
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Parasitic diseases – arthropods
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page: 187
alphabetical
9.2
Animal scabies
Animal scabies
basic lesion
cause
Numerous small itchy papules spread all over the skin, which regress spontaneously. There are no burrows. The patient's pet (cat or dog) is typically found to be infested.
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Parasitic diseases – arthropods
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9.3
Pediculosis (head lice)
page: 188
alphabetical
Parasitic diseases – arthropods
Pediculosis (head lice)
basic lesion
cause
picture
Wide impetigo-like patch at the nape of the neck caused by scratching, associated with very severe undiagnosed infestation.
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alphabetical
Pediculosis (head lice)
Pediculosis (head lice)
continued
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Parasitic diseases – arthropods
basic lesion
cause
Area of attachment of a nit to a hair.
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page: 190
Crab lice (pubic lice)
basic lesion
Excoriations and presence of louse eggs firmly attached to the pubic hairs. There are also crab lice (Phthirius pubis) grasping the public hairs. On the body, relatively discrete bluish grey macules (maculae caerulae) can sometimes be found.
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9.4
Crab lice (pubic lice)
cause
Parasitic diseases – arthropods
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Crab lice (pubic lice)
alphabetical
Crab lice (pubic lice)
continued
basic lesion
cause
These blue-grey macules correspond to the release of toxins by the crab louse in the course of successive bites.
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Parasitic diseases – arthropods
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9.5
Insect bites
page: 192
alphabetical
Parasitic diseases – arthropods
Insect bites
cause basic lesion
Immunological reactions to bites by harvest mites (larvae of Trombiculidae which feed on blood). Small itchy lesions, sometimes in a line, located anywhere on the skin, with predilection for constricted areas. The lesions sometimes rise to a point in the centre.
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Trombiculiasis
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Insect bites
page: 193
continued
basic lesion
cause
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Trombiculiasis
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Parasitic diseases – arthropods
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Infantile papular urticaria (strophulus) Occurring mainly in children, this type of papular urticaria occurs in the form of numerous small erythematous papules, sometimes with fine vesicles. The lesions are found mainly on the legs, are extremely itchy, and very likely to be excoriated. Sometimes a linear disposition is seen, which makes the diagnosis much more obvious. Infantile papular urticaria is caused by an ectoparasite with a cat or dog host. Basic Lesions:
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alphabetical
page: 194
cause
Insect bites
basic lesion
Parasitic diseases – arthropods
Insect bites
page: 195
alphabetical
Parasitic diseases – arthropods
cause basic lesion
Large inflammatory papules in a linear disposition. There is a distinct central acumination. Infestation is usually via a pet (cat or dog), which acts as the carrier.
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Flea bites
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Flea bites
alphabetical
Insect bites
continued
basic lesion
cause
In some cases the lesions become frankly bullous and even haemorrhagic.
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Parasitic diseases – arthropods
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Bullae
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alphabetical
9.6
Leishmaniasis
Leishmaniasis
basic lesion
cause
Large encrusted papular lesion surrounded by an inflammatory rim. There is no associated pain or lymphadenopathy. The course is chronic and the lesion is resistant to conventional antiseptic treatments.
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Leishmaniasis
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page: 198
continued
basic lesion
It is a protozoan infection caused by a species of Leishmania. The carrier is a Phlebotomus fly, which explains why in most cases the lesions of leishmaniasis are found on uncovered areas (especially the face).
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Leishmaniasis
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Leishmaniasis
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Leishmaniasis
continued
basic lesion
cause
After a few months the lesion subsides, leaving a scar of variable visibility.
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page: 200
Larva migrans (creeping eruption)
basic lesion
Inflammatory serpiginous line ending in a small, extremely itchy papule. Larva migrans is caused by a larva of an Ancylostoma species (hookworm) which migrates about 1 cm per day, thus extending the line of inflammation. In humans contact usually occurs on the beach (soil polluted with animal excreta). Cutaneous larva migrans is found mainly on the feet and the buttocks.
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9.7
Larva migrans (creeping eruption)
cause
Parasitic diseases – arthropods
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continued
basic lesion
cause
Larva migrans (creeping eruption)
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Larva migrans (creeping eruption)
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Parasitic diseases – arthropods
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page: 202
Tungiasis (chigger)
basic lesion
Itchy inflammatory nodule with a small blackish opening at the centre, found in the periungual region of a toe. Secondary superinfection (abscess formation) may be present. Tungiasis is caused by a flea which lives on blood: Tunga penetrans.
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9.8
Tungiasis (chigger)
cause
Parasitic diseases – arthropods
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Tungiasis (chigger)
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Tungiasis (chigger)
continued
basic lesion
cause
Infestation typically occurs on the feet (walking barefoot in areas where it is endemic, especially Africa and Central America).
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page: 204
Chapter 10:
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cause
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Psoriasis
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Clinical aspects
10.1
page: 205
alphabetical
Psoriasis
Clinical aspects Psoriasis vulgaris
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Erythematous form
basic lesion
cause
Very extensive psoriasis. Large confluent patches, mainly erythematous, covered in fine scales.
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Psoriasis vulgaris
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page: 206
continued
Scaly erythematous form
basic lesion
Psoriasis on the knees. Well demarcated scaly erythematous patches. Thick white scales with a shiny micaceous appearance.
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Clinical aspects
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Psoriasis
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Plaster-like psoriasis Extended psoriatic lesions on the trunk and the arms. In the present case the scales, which are thick and adherent, mask the erythema which appears here and there like a thin border at the edge of the lesions. The appearance of the scales is such that they are often referred to as cretaceous psoriasis or, more picturesquely "plaster-like scales".
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Psoriasis vulgaris
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page: 207
cause
Clinical aspects
basic lesion
Psoriasis
page: 208
Psoriasis vulgaris
alphabetical
Clinical aspects
continued
Characteristic clinical symptoms
basic lesion
cause
Patches resemble candle wax.
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Psoriasis
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Psoriasis vulgaris
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Clinical aspects
continued
Characteristic clinical symptoms
basic lesion
cause
Patches are bleeding after curettage.
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Psoriasis
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Clinical aspects
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Psoriasis vulgaris
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Psoriasis
continued
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Guttate psoriasis
basic lesion
cause
Guttate psoriasis consists of innumerable small scaly erythematous patches, a few millimetres across, which in the present case are distributed all over the skin.
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Psoriasis vulgaris
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Clinical aspects
continued
Guttate psoriasis
basic lesion
cause
In many cases it is an eruptive psoriasis of childhood or adolescence.
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Psoriasis
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Psoriasis vulgaris
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Psoriasis
continued
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Koebner's phenomenon (isomorphic reaction)
basic lesion
cause
Psoriatic lesions appear around a surgical scar.
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alphabetical
Psoriasis
basic lesion
Pustular psoriasis of the flexor surface of the forearm. Large erythematous patch with distinct margins, strewn with a scatter of flattened yellowish-white pustules arranged in confluent clusters.
cause
Body
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Psoriasis vulgaris
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Pustular psoriasis
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page: 214
continued
Feet
basic lesion
Plantar pustular psoriasis. Isolated pustules appear on a scaly erythematous base with distinct borders.
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Psoriasis
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Pustular psoriasis
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page: 215
continued
Feet
basic lesion
The most recent yellowish-white pustules are slightly raised, whereas the older pustules are brown and embedded in the horny layer of the epidermis.
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Clinical aspects
cause
Psoriasis
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Clinical aspects
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alphabetical
Psoriasis
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Psoriatic erythroderma
basic lesion
cause
The erythrodermic psoriasis has spread all over the body.
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alphabetical
Psoriasis
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Psoriatic erythroderma continued
basic lesion
cause
The erythrodermic psoriasis has spread all over the body without intervals of healthy skin.
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Particular local forms
10.2
page: 218
alphabetical
Psoriasis
Particular local forms
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Palmoplantar psoriasis
basic lesion
cause
Palmar psoriasis. Scaly erythematous patches with distinctly rounded contours. The covering scales are thick and nacreous.
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alphabetical
Psoriasis
cause basic lesion
Inverse psoriasis of an axilla. The psoriatic eruption consists of a continuous plaque which is bright red, shiny, smooth, and not very scaly, with a well-circumscribed margin.
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Flexural psoriasis
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Psoriasis
cause basic lesion
The picture, which is very complete, includes distal onycholysis with yellow coloration, cup-shaped depressions in the central area, and advanced disintegration of the nail plate in the proximal area. In addition, classical psoriatic lesions have invaded the whole of the nail fold.
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Psoriasis of the nails
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Psoriasis
basic lesion
cause
The round, scaly erythematous patches spread beyond the hairline to invade the cervical region.
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Psoriasis of the scalp
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Psoriasis of the face (seborrhoeic psoriasis)
basic lesion
Psoriasis of the face is rare and is usually found predominantly in the seborrhoeic regions: wings of the nose, area between the eyebrows, hairline. It is often called "seborrhoeic psoriasis".
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Particular local forms
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Psoriasis
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Psoriasis
basic lesion
Erythematous and slightly glazed plaques with distinct margins, scattered over the upper surface of the tongue. The picture is quite similar to that described by the term geographical tongue (or benign migratory glossitis or lingual erythema migrans).
cause
1. Psoriasis of the tongue
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Mucosal psoriasis
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Mucosal psoriasis
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page: 224
continued
2. Psoriasis of the glans penis
basic lesion
Large red and well-circumscribed plaques, neither infiltrated nor scaly, with a chronic course. They present problems of differential diagnosis, as they have to be distinguished from balanitis of other origins.
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Particular local forms
cause
Psoriasis
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page: 225
Chapter 11:
basic lesion
cause
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Other skin diseases
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11.1
Pityriasis rosea
page: 226
alphabetical
Other skin diseases
Pityriasis rosea
basic lesion
cause
picture
The eruption consists of pink oval patches measuring 1 to 3 cm in diameter, with fine scaling in a peripheral collarette. The initial lesion, looking like an oval medallion, can usually be recognized by its larger size (diameter 5 to 6 cm) and its accentuated margin.
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Pityriasis rosea
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Pityriasis rosea
continued
basic lesion
cause
Its oblique orientation on the trunk is characteristic.
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Other skin diseases
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Parapsoriasis Pityriasis lichenoides ("guttate parapsoriasis")
basic lesion
The polymorphic eruption is spread over the trunk and the limbs. It consists of red or brownish and more or less scaly maculopapular lesions. The characteristic feature is a brownish macule covered with an adherent scale, which detaches in one piece.
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11.2
Parapsoriasis
cause
Other skin diseases
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Parapsoriasis
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alphabetical
Other skin diseases
cause basic lesion
The eruption affects the trunk and the limbs, it is polymorphic: papulopustular lesions, necrotic, often haemorrhagic lesions, crusts, varioloid scars.
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Varioloid parapsoriasis
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Parapsoriasis
page: 230
alphabetical
Other skin diseases
continued
basic lesion
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Varioloid parapsoriasis
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page: 231
Chronic superficial scaly dermatitis (digitate dermatosis)
basic lesion
The lesions are oval, 2 to 5 cm in diameter, well-circumscribed, flat and yellowish pink with fine scaling. These patches are disposed in lines, the position of which is fairly stereotyped: slanting along the ribs on the trunk, longitudinal on the limbs.
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Parapsoriasis
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Other skin diseases
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Premycotic or prereticulotic eruption with large plaques
basic lesion
The lesions consist of wide plaques (10 to 20 cm in diameter) located on the trunk and the base of the limbs. Their appearance is polymorphic: sepia-coloured scaly erythematous plaques, atrophic or even poikilodermal lesions.
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Parapsoriasis
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page: 233
Lichen planus Simple cutaneous lichen planus
basic lesion
The basic lesion is a firm reddishviolet polygon. The surface, which has a sheen in oblique illumination, is covered with fine greyish striations known as Wickham's striae.
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11.3
Lichen planus
cause
Other skin diseases
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Lichen planus
Simple cutaneous lichen planus continued
basic lesion
cause
One of the preferred sites is the flexor surface of the forearm.
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Lichen planus
Simple cutaneous lichen planus continued
basic lesion
cause
Papules may appear along the excoriations caused by scratching (Koebner's phenomenon).
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Lichen planus
page: 236
alphabetical
Other skin diseases
cause basic lesion
The lesions are white and reticulated. Their preferred site is the tongue and the lower posterior part of the cheeks ("fern-leaf" appearance).
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Oral lichen planus
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Oral lichen planus
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Lichen planus
continued
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Other skin diseases
basic lesion
cause
A rare form is erosive lichen planus: painful red ulcerations with no tendency towards spontaneous healing. The ulcers are surrounded by a lichen-like whitish border.
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Lichen planus
page: 238
alphabetical
Other skin diseases
cause basic lesion
The lesions are oval or coalescent, infiltrated, and pink or violet in colour. Their surface is hyperkeratotic. The skin disease classically affects the front of the legs.
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Hypertrophic lichen planus
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Lichen planus
page: 239
alphabetical
Other skin diseases
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continued
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Hypertrophic lichen planus
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Lichen planus
page: 240
alphabetical
Other skin diseases
basic lesion
cause
Dorsal pterygium and flaps of nail at the sites.
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Lichen planus of the nails
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alphabetical
11.4
Graft versus host disease (GVHD)
Graft versus host disease (GVHD)
basic lesion
cause
In the subacute stage the graft's reaction against the host can appear as a lichenoid eruption. The lesions are spread all over the skin.
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Other skin diseases
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Graft versus host disease (GVHD)
Graft versus host disease (GVHD) continued
basic lesion
cause
The lesions are spread all over the skin and can involve the mucosa.
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Other skin diseases
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alphabetical
11.5
Lichenification
Lichenification
basic lesion
cause
Well-demarcated thick itchy hyperkeratotic patch on the ankle, forming a grid of scratch lines. The term neurodermatitis is sometimes used to describe this phenomenon.
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alphabetical
11.6
Subacute prurigo
Subacute prurigo
basic lesion
cause
The excoriated papules are disposed symmetrically on the extensor surfaces of the limbs, the upper back, and sometimes on the face and the scalp.
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Subacute prurigo
page: 245
continued
basic lesion
cause
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Subacute prurigo
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Other skin diseases
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11.7
Lupus erythematosus
page: 246
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Other skin diseases
Lupus erythematosus
basic lesion
The eruption consists of erythematous patches covered with an adherent hyperkeratotic layer, predominantly at the hair follicles. It resolves into cicatricial atrophy.
cause
1. Face
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Discoid lupus erythematosus
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Lupus erythematosus
page: 247
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Other skin diseases
1. Face
basic lesion
The erythema is associated with severe oedema, producing one or more swollen patches with distinct margins, a smooth surface, and an oedematous consistency. A rare form is lupus erythematosus tumidus.
cause
continued
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Discoid lupus erythematosus
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Lupus erythematosus
page: 248
alphabetical
Other skin diseases
2. Scalp
basic lesion
This consists of erythematous and somewhat atrophic alopecic plaques which heal with scarring.
cause
continued
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Discoid lupus erythematosus
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Lupus erythematosus
page: 249
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Other skin diseases
cause basic lesion
The eruption corresponds to a profuse form consisting of erythematous and somewhat scaly polycyclic annular plaques which resolve to leave depigmentation and telangiectasia.
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Subacute lupus erythematosus
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Lupus erythematosus
page: 250
alphabetical
Other skin diseases
basic lesion
The eruption is in the form of slightly oedematous erythematous sheets, without atrophy or follicular hyperkeratosis. The lesions are often symmetrical and located on areas exposed to the sun ("butterfly" appearance).
cause
1. Face
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Systemic lupus erythematosus
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Lupus erythematosus
page: 251
alphabetical
Other skin diseases
2. Fingers
basic lesion
The site of the lesions on the fingers is usually around the nails. The lesions are usually erythematous and telangiectatic, sometimes violet (chilblain-like in appearance).
cause
continued
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Systemic lupus erythematosus
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11.8
Jessner and Kanof disease
page: 252
alphabetical
Other skin diseases
Jessner and Kanof disease
basic lesion
cause
picture
The eruption consists of more or less tumid smooth erythematous papules with a flat surface and no scaling. These lesions tend to be located on the face, neck, and the upper trunk.
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11.9
Dermatomyositis
page: 253
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Other skin diseases
Dermatomyositis
basic lesion
cause
Diffuse oedematous and telangiectatic erythema of the face. The lesions are usually found predominantly on the eyelids.
picture
1. Face
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Dermatomyositis
page: 254
Dermatomyositis
alphabetical
Other skin diseases
continued
picture
2. Hands and fingers
basic lesion
cause
Lesions or purplish erythema predominantly on the dorsal surface of the hand and finger joints, mainly in the supraarticular regions.
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Scleroderma
page: 255
alphabetical
Other skin diseases
11.10 Scleroderma
basic lesion
The condition consists of one or more indurated nacreous white plaques which have a sheen in oblique light. They are bordered by a mauve band (lilac ring) which disappears as the lesions develop.
cause
1. Plaque lesions
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Localized morphoea
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Scleroderma
page: 256
Localized morphoea
alphabetical
Other skin diseases
continued
picture
2. Bands
basic lesion
cause
This variant of morphoea is characterized by a paramedian band of sclerosis and atrophy. In some cases actual facial hemiatrophy develops.
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Scleroderma
page: 257
alphabetical
Other skin diseases
cause basic lesion
Systemic sclerosis is found mainly on the face and on the extremities. The facial expression seems fixed. The tapering of the nose and narrowing of the mouth, surrounded by radial furrows, aggravate the lack of expression.
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Systemic sclerosis
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Systemic sclerosis
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Scleroderma
continued
basic lesion
cause
The sclerodactyly is characterized by tapering of the fingers, which become fixed in flexion. There are painful ulcerations on the pulps.
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Lichen sclerosus
page: 259
alphabetical
Other skin diseases
11.11 Lichen sclerosus
basic lesion
cause
Well-circumscribed shiny white papules resembling mother-ofpearl, with a slight depression at the centre, sometimes clustered in plaques with fragmented margins.
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Skin (glabrous skin)
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Lichen sclerosus
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page: 260
continued
Vulva
basic lesion
The vulval mucosa assumes a nacreous white shiny appearance. There are sometimes areas of bruising.
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Lichen sclerosus
cause
Other skin diseases
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Lichen sclerosus
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Lichen sclerosus
continued
Glans penis
basic lesion
cause
Porcelain-white patches which are either disseminated or, more often, located around the meatus.
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Other skin diseases
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Sarcoidosis
page: 262
alphabetical
Other skin diseases
11.12 Sarcoidosis
cause basic lesion
Small, round, well-circumscribed elevations, either isolated or multiple, measuring 1 to 3 mm in diameter. Their colour is red, violet, or sepia. They appear yellowish on vitropression.
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Papular form
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Sarcoidosis
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page: 263
continued
Nodular form
basic lesion
Larger lesions (diameter 5 to 10 mm). These are smooth, firm, violet or brownish red, and have the same appearance of yellowish lupoid infiltration on vitropression.
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Sarcoidosis
cause
Other skin diseases
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Sarcoidosis
alphabetical
page: 264
continued
Angiolupoid form
basic lesion
This very rare clinical variant consists of a tumid, round or oval, reddish violet infiltration appearing on the nose.
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Sarcoidosis
cause
Other skin diseases
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Sarcoidosis
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page: 265
continued
Scar sarcoidosis
basic lesion
Development of sarcoid nodules around foreign matter contained in a scar. These nodules sometimes appear in the context of active systemic sarcoidosis. Sometimes, however, they represent a simple local granulomatous reaction.
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Sarcoidosis
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page: 266
11.13 Granuloma annulare
basic lesion
Small, firm, well-circumscribed nodules with a smooth surface, which are normal or pink in colour and show little inflammation. They are clustered in rings which spread outwards from the centre. The ring does not generally exceed a diameter of 1 to 2 cm. Giant annular granulomas (several centimetres in diameter) are much more rare.
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Granuloma annulare
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Nodules
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alphabetical
Necrobiosis lipoidica
11.14 Necrobiosis lipoidica
basic lesion
cause
Large sclerotic and atrophic pretibial plaque with distinct margins, red and telangiectatic. Its surface is shiny, which explains the "hot spot" on the photograph.
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Necrobiosis lipoidica
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Necrobiosis lipoidica
continued
basic lesion
cause
The centre of the plaque is smooth, with a cicatricial appearance which is often yellowish owing to an excess of fat.
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page: 269
11.15 Vasculitis
basic lesion
The term vasculitis is used collectively for diseases associated with inflammation of the walls of blood vessels in the skin and other organs. The classification of vasculitis is usually based on two features: the calibre of the affected vessels and the type of inflammatory reaction. Urticarial vasculitis is included in the section on urticaria.
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Vasculitis
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Dermal Papules
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page: 270
Cutaneous vasculitis (allergic vasculitis)
basic lesion
Histologically, cutaneous vasculitis is characterized by infiltration of polymorphonuclear neutrophils, which are often pyknotic, into and around the vessel walls, hence the often-used term leucocytoclastic vasculitis. It occurs in two main welldefined forms: purpuric and necrotic.
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Vasculitis
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Cutaneous vasculitis (allergic vasculitis)
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page: 271
continued
Purpuric form
basic lesion
In this form the lesions essentially correspond to infiltrated purpuric papules, which affect mainly the legs and which can extend over other skin areas.
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Vasculitis
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Cutaneous vasculitis (allergic vasculitis)
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page: 272
continued
Necrotic form
basic lesion
Purpuric papules coexist with vesiculobullous, pustular, or necrotic lesions, hence the old name used in the French literature: "Gougerot's triad".
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Vasculitis
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page: 273
Atrophie blanche (livedo vasculitis)
basic lesion
Picture of chronic vasculitis of the ankle regions, characterized by purpura which necroses rapidly, leaving very small painful ulcerations bordered by a violet ring.
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Vasculitis
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Purpuric Macule; Gangrene
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continued
basic lesion
cause
Atrophie blanche (livedo vasculitis)
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Vasculitis
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Vasculitis
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cause basic lesion
The clinical appearance is generally polymorphic, combining cutaneous nodules, livedo, infiltrated purpura, and necrotic ulcerations. These cutaneous signs are part of general systemic illness (weight loss, fever, aching all over the body).
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Polyarteritis nodosa
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Vasculitis
page: 276
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cause basic lesion
Very rare vasculitis characterized by the appearance of red or violet papules, plaques, and nodules distributed symmetrically over the extensor surfaces of the limbs. The course is chronic and successive episodes are accompanied by fever.
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Erythema elevatum diutinum
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Erythema nodosum
page: 277
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11.16 Erythema nodosum
basic lesion
cause
Painful red nodules found mainly on the extensor surfaces of the legs, usually accompanied by fever and pains in the joints.
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The eruption
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Nodules
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Erythema nodosum
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Erythema nodosum
continued
Regression
basic lesion
cause
The nodules resolve in about ten days and turn blue and yellow, like bruises.
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Nodules
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alphabetical
Nodular vasculitis (panniculitis)
11.17 Nodular vasculitis (panniculitis)
basic lesion
cause
Firm cyanotic nodules with little inflammation, located on the lower third of the legs. They occur in women, usually overweight women suffering from chronic venous insufficiency.
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11.18 Pyoderma gangrenosum Superficial ulceration with circular margins, bordered by a firm inflammatory swelling, which is undermined by deep-seated purulent lesions. The condition can be idiopathic or associated with various internal diseases, in particular, diseases of the digestive tract such as Crohn's disease or ulcerative colitis. The illustrations correspond to two stages of development of the same lesion in a leg.
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page: 280
cause
Pyoderma gangrenosum
basic lesion
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Pyoderma gangrenosum
page: 281
alphabetical
Other skin diseases
continued
basic lesion
cause
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Pyoderma gangrenosum
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11.19 Erythema multiforme Erythema multiforme is a syndrome of the skin and mucosa associated with various aetiological circumstances, among which herpes infections occupy an important place. Non-bullous "target" form Dull red, round, symmetrical maculopapules on the backs of the hands. The characteristic configuration is like a target or butterfly.
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page: 282
cause
Erythema multiforme
basic lesion
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Erythema multiforme
page: 283
alphabetical
Other skin diseases
Erythema multiforme
continued
basic lesion
cause
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Non-bullous "target" form
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Erythema multiforme
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page: 284
continued
Bullous form
basic lesion
The maculopapules in a butterfly configuration are bullous in the centre and can follow a necrotic course. The mucous membranes are sometimes affected.
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Erythema multiforme
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page: 285
Erythema multiforme
continued
Stevens-Johnson syndrome
basic lesion
This is the most severe form of erythema multiforme. In addition to the cutaneous symptoms there are severe erosive mucosal lesions affecting the lips, buccal cavity, and sometimes the genital organs. The clinical picture is severe, with fever and alterations of the general condition.
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Erythema multiforme
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Ulcers
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Sweet's syndrome (acute febrile neutrophilic dermatosis)
11.20 Sweet's syndrome (acute febrile neutrophilic dermatosis)
basic lesion
cause
Well-circumscribed infiltrated erythematous plaques, depressed at the centre, appearing on the limbs. Raised temperature, aching joints, abdominal pain, and neutrophilia accompany the skin symptoms.
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Bullous pemphigoid
page: 287
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11.21 Bullous pemphigoid
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Early stage
basic lesion
cause
Large urticaria-like polycyclic patches, bordered by a few firm bullae of varying size and containing a clear liquid.
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Bullous pemphigoid
page: 288
Bullous pemphigoid
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Further development
basic lesion
cause
Presence of very numerous firm bullae of varying size, some of which are haemorrhagic. Some bullae rupture, leaving extensive skin erosions.
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11.22 Autoimmune forms of pemphigus Two forms of autoimmune pemphigus are distinguished, according to the preferred site of separation of epidermal cells from each other: "deep" pemphigus (pemphigus vulgaris and pemphigus vegetans) on the one hand and "superficial" pemphigus (pemphigus erythematosus) on the other.
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Autoimmune forms of pemphigus
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Pemphigus vulgaris basic lesion
Skin Presence of superficial flaccid bullae, which rupture easily to expose extensive erosions.
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Pemphigus vulgaris
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page: 290
continued
Oral
basic lesion
Dragging painful erosions of the buccal mucosa of the inside of the cheeks, the palate, and the dental cuffs, exposing a bright red surface without a fibrinous coating. Similar erosions can occur in other bullous diseases, but in pemphigus they are more constant and more characteristic.
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Autoimmune forms of pemphigus
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Autoimmune forms of pemphigus
page: 291
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cause basic lesion
Crusty, scaly, erythematous plaques of the seborrhoeic regions on the face and the trunk, which are sometimes itchy. These lesions represent the development of superficial bullae.
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Pemphigus erythematosus
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Autoimmune forms of pemphigus
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continued
basic lesion
cause
This variant is also characteristic of drug-induced pemphigus (d-penicillamine).
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Pemphigus erythematosus
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page: 293
11.23 Benign familial chronic pemphigus (Hailey-Hailey disease)
basic lesion
Erosive vesiculobullous lesions which become covered with small yellowish crusts. The lesions are clustered in well-defined plaques traversed by very characteristic parallel fissures. The preferred sites of these lesions are the sides of the neck, the axillae, and the inguinogenital region.
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Benign familial chronic pemphigus (Hailey-Hailey disease)
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Vesicles; Bullae; Fissures
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page: 294
11.24 Dermatitis herpetiformis
basic lesion
Urticaria -like erythematous or papular lesions surmounted by vesicles and bullae, clustered in a herpetiform ring. The symmetry of the lesions, the constant pruritus, and the association with a glutensensitive enteric disease are the other peculiarities of this rare skin disease.
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Dermatitis herpetiformis
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Dermatitis herpetiformis
page: 295
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basic lesion
cause
continued
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Dermatitis herpetiformis
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Dermal Papules; Vesicles; Bullae
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page: 296
11.25 Linear IgA bullous disease
basic lesion
Large firm bullae containing a clear liquid, occurring on normal or erythematous skin. The usual sites are the lower part of the trunk, buttocks, perineum, and the thighs. This chronic bullous skin disease of children and adults is characterized by linear deposits of IgA in direct immunofluorescence.
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Linear IgA bullous disease
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11.26 Epidermolysis bullosa Simple epidermolysis bullosa (non-dystrophic)
basic lesion
Clear bullae of various sizes, triggered by trauma and by persistent friction, which heal without leaving a trace. The usual sites are the hands, feet, elbows, and knees in the adult and the bottom in the infant.
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Epidermolysis bullosa
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Simple epidermolysis bullosa (non-dystrophic) continued
basic lesion
There is no abnormality of the teeth or the nails. The condition is transmitted in the autosomal dominant mode.
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Epidermolysis bullosa
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Dystrophic forms of epidermolysis bullosa
basic lesion
In dystrophic forms of epidermolysis bullosa, of which there are a number of variants, the traumatic bullae leave atrophic scars and milia when they heal. Some joints can be fixed in flexion.
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Epidermolysis bullosa
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Dystrophic forms of epidermolysis bullosa
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page: 300
continued
basic lesion
Certain abnormalities of the teeth or the nails are sometimes associated. The mode of transmission varies according to the form of the disease.
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Epidermolysis bullosa
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11.27 Diabetic bullae
basic lesion
Translucent bullae of various sizes, haemorrhagic in rare cases, without inflammatory areola, which are usually multiple, found especially on the extremities, particularly on the feet. The condition tends to occur in complicated cases of diabetes of all types.
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Diabetic bullae
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11.28 Porphyria cutanea tarda
basic lesion
The preferred sites of porphyria cutanea tarda lesions are areas exposed to light, such as the backs of the hands and the face. On the backs of the hands the condition is characterized by several symptoms associated with increased skin fragility: serous or haemorrhagic bullae, erosions after various traumas, milia.
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Porphyria cutanea tarda
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Porphyria cutanea tarda
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Other skin diseases
basic lesion
On the face the condition is characterized mainly by hypertrichosis of the malar regions and a diffuse brownish pigmentation.
cause
continued
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Porphyria cutanea tarda
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Bullous phytophotodermatitis (Meadow dermatitis)
basic lesion
Erythematous vesicular or bullous eruption reproducing the pattern of a grass or leaf. Sun, humidity, and contact with the plant are the three prerequisites for the appearance of the skin condition.
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Porphyria cutanea tarda
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Vesicles; Bullae
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Acne and rosacea
page: 305
alphabetical
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11.29 Acne and rosacea
cause basic lesion
Acne vulgaris (adolescent acne) essentially includes three types of lesion: comedones, papules and pustules. To these can be added nodules and cysts.
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Acne vulgaris
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Acne and rosacea
page: 306
Acne vulgaris
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Papulopustular acne
basic lesion
cause
Papulopustular acne essentially comprises isolated or confluent papules and very inflamed papulopustules. It is often associated with seborrhoea. Comedones are never absent.
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Acne vulgaris
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page: 307
continued
Comedo acne
basic lesion
Comedo acne is characterized by a distinct preponderance of comedones over the lesions of adolescent acne. The comedones are either open (blackheads) or closed (whiteheads). Blackheads are the prominent lesions in this illustration. Cosmetic acne often takes the form of this variant.
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Acne and rosacea
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Nodular and cystic acne In addition to the basic lesions just mentioned (comedones, papules and pustules), this form of acne presents epidermal cysts of follicular origin and inflamed nodules resulting from the rupture of these cysts. The nodules can develop into abscesses, which leave indurated, pitted, or retractile scars when they dry out.
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Acne vulgaris
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page: 308
cause
Acne and rosacea
basic lesion
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Acne and rosacea
page: 309
alphabetical
Other skin diseases
cause basic lesion
The lesions are polymorphic and numerous: multiple comedones, follicular cysts, pustules, nodules, and abscesses developing to form fistulae, haemorrhagic ulcers, then pitted scars and adhesions bridging the scars.
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Acne conglobata
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Acne conglobata
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Acne and rosacea
continued
basic lesion
cause
This form of acne classically affects the face and trunk, but it can also spread to the arms and the buttocks.
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Infantile acne (acne infantum) This variant of acne, of indeterminate origin, appears in infants aged between 3 and 6 months. It is usually severe, but in most cases fades in 1 to 2 years. It is characterized by the presence of comedones, papules, and pustules, found mainly on the cheeks. It should be distinguished from a much more rare variety of acne: neonatal acne (acne neonatorum).
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page: 311
cause
Acne and rosacea
basic lesion
Other skin diseases
Acne and rosacea
page: 312
alphabetical
Other skin diseases
basic lesion
The blotchy form comprises erythema and telangiectasia affecting the nose, cheeks and sometimes the forehead and chin. Flushes appear in various circumstances: in the presence of stress or a change in ambient temperature, after the consumption of alcohol, hot drinks, or hot food.
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Blotchy form
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Rosacea
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Rosacea
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page: 313
continued
Papulopustular form
basic lesion
Inflamed papules and aseptic pustules appear on a background of telangiectatic erythema, but never comedones (which necessarily leads to rejection of the term "acne rosacea").
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Acne and rosacea
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Acne and rosacea
page: 314
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cause basic lesion
This is characterized by the appearance of micropapules and micropustules on a base of erythema and oedema, mainly around the mouth, separated from the lips by a border of healthy skin. The lesions can sometimes spread to the nasolabial folds.
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Perioral dermatitis
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Drug-induced eruptions
page: 315
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11.30 Drug-induced eruptions
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Well-circumscribed pigmented erythematous patch occurring 48 h after the ingestion of a drug, in this case phenacetin. The lesion resolves into a residual pigmentation which disappears gradually. Reintroduction of the drug causes a recurrence, invariably at the same site. In some cases the centre of the lesion can be bullous (fixed bullous toxic dermatitis).
picture
Fixed pigmented erythema
alphabetical
page: 316
Maculopapular exanthema (morbilliform eruption)
basic lesion
Eruption characterized by dull red congestive patches on the skin. These vary in size and run together into sheets. Two prominent characteristics are the usual symmetry of the lesions and their itchiness. The present case is an ampicillin rash.
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Drug-induced eruptions
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Lyell's syndrome (toxic epidermal necrolysis) Detachment of large pieces of epidermis, leaving extensive areas of erosion. The eruption usually spreads all over the skin. All mucous membranes are involved in the necrolytic process. The situation is similar to that of major burns. The drug responsible in this particular case was sulfonamide.
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page: 317
cause
Drug-induced eruptions
basic lesion
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Drug-induced eruptions
page: 318
alphabetical
Other skin diseases
cause basic lesion
Drug-induced lichenoid eruption caused by methyldopa. The clinical picture is quite similar to that of lichen planus, but the lesions are often more red and scaly.
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Lichenoid eruptions
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Lichenoid eruptions
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Drug-induced eruptions
continued
basic lesion
cause
The distribution of the lesions is symmetrical and more diffuse than in most forms of lichen planus.
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Other skin diseases
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Drug-induced phototoxic eruption
basic lesion
Drug-induced phototoxic eruption associated with the ingestion of a tetracycline. Erythematous oedematous lesions whose pattern corresponds strictly to the skin areas exposed to sunlight. The borders of the lesions are as if "cut with a knife".
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Drug-induced eruptions
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Drug-induced photoallergic eruption Drug-induced photoallergic reaction associated with the ingestion of a phenothiazine. The symptoms comprise erythema, confluent papules, and plaques of weeping vesicular eczema. The lesions, which are accompanied by severe itching, spread beyond the areas exposed to the sun, in contrast to the phototoxic reactions.
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page: 321
cause
Drug-induced eruptions
basic lesion
Other skin diseases
Drug-induced eruptions
page: 322
alphabetical
Other skin diseases
cause basic lesion
This drug-induced eruption is associated in the present case with intramuscular injections of vitamin B12. It is clinically monomorphic, i.e. it is characterized by the presence of papules and pustules and by the absence of comedones.
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Acneiform facial eruption
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Drug-induced eruptions
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cause basic lesion
Psoriatiform eruption associated with the ingestion of a ß-blocker. In certain cases this is an aggravation of existing psoriasis. The lesions are not usually very scaly. They can be itchy. There is an increasingly large number of suspected groups of drugs.
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Psoriatiform eruption
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Drug-induced eruptions
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cause basic lesion
Induced lupus usually assumes the appearance of subacute or systemic lupus. It is reversible when the treatment is stopped and recurs if the treatment is reintroduced. In this case the suspected drug is an anticonvulsant.
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Drug-induced lupus
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Drug-induced eruptions
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cause basic lesion
Prolonged systemic use of corticosteroids leads to a reduction in collagen tissue, culminating in atrophy of the skin. This occurs particularly on the extensor surfaces of the forearms. The atrophy is accompanied by purpura, ecchymoses, and also by these three unusual star-shaped false scars resulting from an internal tear in the dermal tissue (without a wound).
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Cortisone atrophy
page: 326
alphabetical
Drug-induced eruptions
Bromide and iodide eruptions (Halide eruptions)
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basic lesion
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Very rare reactions to the use of drugs containing bromide or iodine. Bromide and iodide eruptions appear as plaques and lumps with infiltration and vegetation, which are sometimes covered in pustules and crusts. The illustration is of a bromide eruption caused by bromazepam.
Nodules; Pustules; Crusts
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Other skin diseases
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Drug-induced eruptions
page: 327
alphabetical
Other skin diseases
cause basic lesion
Gingival hyperplasias are often provoked by a drug. The drugs most frequently blamed are anticonvulsants (phenytoin, sodium valproate) and cyclosporin, as in the present case.
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Gingival hyperplasia
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Vegetations
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Drug-induced eruptions
page: 328
alphabetical
Other skin diseases
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Pigmented Macules
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A specifically female skin disease, melasma is hyperpigmentation appearing on the upper part of the face (temples and forehead), but sparing the hairline. It is generally bilateral, but never perfectly symmetrical. Its colour varies from light to dark brown. Melasma occurs in pregnancy or during treatment with hormonal contraceptives. It becomes more pronounced in summer and the aggravating influence of exposure to solar ultraviolet is evident.
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Melasma (chloasma)
11.31 Skin disorders caused by physical agents Benign summer photodermatitis Small acuminate erythematous papules, a few millimetres in diameter, and papulovesicles clustered on the extensor surface of the arms (as in the present case), legs, and exposed areas of the neck and the chest. The eruption usually spares the face. It occurs a few hours after sunbathing.
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Dermal Papules
Sunlight, Ultraviolet Radiation last screen viewed
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alphabetical
page: 329
cause
Skin disorders caused by physical agents
basic lesion
Other skin diseases
Skin disorders caused by physical agents
page: 330
alphabetical
Other skin diseases
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Erythematous Macule; Dermal Papules
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Small erythematous papules or oedematous plaques appearing on exposed parts of the body, especially the face (forehead, nose, cheekbones), behind the ears, the exposed area of neck and chest, and the extensor surfaces of the limbs. In more than 70% of the cases the eruption appears in spring. The patient does not have to be unaccustomed to the sun. The condition appears in the course of everyday life, whether the sky is clear or cloudy.
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Polymorphic light eruption
Skin disorders caused by physical agents
page: 331
alphabetical
Other skin diseases
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Erythematous Macule
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Erythematous and cyanotic infiltrations of the toes which may become covered with clear or haemorrhagic bullae, ulcerations, or small crusts. Chilblains are purple and painful in the cold, but become red and itchy when the sufferer enters a heated room. Chilblains are most common in young women, but they are seen at all ages in both sexes. Other sites include the heels, ankles, knees, ears, etc.
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Chilblains
alphabetical
page: 332
Chapter 12:
basic lesion
cause
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Topographical dermatology
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12.1
Alopecia
page: 333
alphabetical
Topographical dermatology
Alopecia
cause basic lesion
Alopecia areata of the scalp is characterized by the appearance of round or oval, smooth, shiny patches of alopecia which gradually increase in size. The patches are usually homogeneously glabrous and are bordered by a peripheral scatter of short brokenoff hairs known as exclamationmark hairs.
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Alopecia areata
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Alopecia areata
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page: 334
continued
basic lesion
Alopecia areata of the occipital region, known as ophiasis, is more resistant to regrowth. Other hair regions can also be affected: eyebrows, eyelashes, beard, and the axillary and pubic regions. In some cases the alopecia can be generalized: this is known as alopecia totalis (scalp) and alopecia universalis (whole body).
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Alopecia
cause
Topographical dermatology
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Alopecia
page: 335
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Topographical dermatology
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Atrophy; Scars
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Pseudopelade consists of circumscribed alopecia which varies in shape and in size, with more or less distinct limits. The skin is atrophic and adheres to the underlying tissue layers. This unusual cicatricial clinical appearance can be symptomatic of various other conditions: lupus erythematosus, lichen planus, folliculitis decalvans. Some cases are idiopathic and these are known as pseudopelade.
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Pseudopelade
Alopecia
page: 336
alphabetical
Topographical dermatology
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cause basic lesion
Plucking of the hair on a large scale. In trichotillomania the alopecia has irregular, "geographic" margins which may be distinct or indefinite. The area of alopecia can be entirely glabrous or dotted with clumps of broken hairs of very different lengths, and either smooth or covered irregularly with small excoriations or crusts caused by scratching. Similar lesions can appear on the nails (onychotillomania).
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Trichotillomania
Alopecia
page: 337
alphabetical
Topographical dermatology
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cause basic lesion
This alopecia, known generally as baldness, occurs in adulthood both in men, where it affects the temporal regions (photo) and/or the crown, and in women, where it is confined to the central area of the scalp, in a longitudinal band which extends from the forehead to the crown. In females alopecia always leaves a large number of healthy hairs which are scattered irregularly over the alopecic area.
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Androgenetic alopecia
alphabetical
page: 338
Mucosal diseases Aphtae, aphthosis, Behçet's disease
basic lesion
Small "punched-out" ulcerations of the buccal mucosa, characterized by a yellowish base resembling the colour of fresh butter and by an erythematous inflammatory halo. Often very painful, aphthae are accompanied by lymphadenopathy.
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12.2
Mucosal diseases
cause
Topographical dermatology
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Ulcers
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page: 339
alphabetical
Mucosal diseases
Aphtae, aphthosis, Behçet's disease continued
basic lesion
cause
Aphthae can occur on the genital mucosa (bipolar aphthosis).
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Topographical dermatology
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Ulcers
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alphabetical
page: 340
Aphtae, aphthosis, Behçet's disease continued
basic lesion
Behçet's disease is a severe condition with the additional characteristics of aphthae on the skin and an isomorphic reaction to injections.
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Mucosal diseases
cause
Topographical dermatology
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Pustules
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Mucosal diseases
page: 341
alphabetical
Topographical dermatology
cause basic lesion
Black hairy tongue comprises hypertrophy of the villi on the upper surface of the tongue. These are loaded with oxidized keratin, which explains the brown or black colour of the lesion. It can occur after the use of certain drugs, such as antibiotics or metronidazole, for example.
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Black hairy tongue
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Vegetations
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Mucosal diseases
page: 342
alphabetical
Topographical dermatology
cause basic lesion
The upper surface of the tongue is criss-crossed by deep grooves running in various directions. The lingual papillae are often hypertrophic and inflamed. On discovery of this anatomical peculiarity the subjects often complain of a painful sensation (glossodynia).
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Scrotal / fissured tongue
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Geographic tongue (benign migratory glossitis) Well-defined patches denuded of papillae, surrounded by an unobtrusive whitish border. The spread of these areas is eccentric and their appearance changes from one day to the next. This could be a variant of lingual psoriasis. Association with scrotal tongue is common.
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Ulcers
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alphabetical
page: 343
cause
Mucosal diseases
basic lesion
Topographical dermatology
12.3
Cheilitis
page: 344
alphabetical
Topographical dermatology
Cheilitis
cause basic lesion
Allergic contact dermatitis connected with the application of a lipstick containing balsam of Peru. The eczematous condition extends far beyond the limits of the vermilion zone of the lips, to spread out over the surrounding skin.
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Allergic contact cheilitis
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Erythematous Macule; Scales
Chemical Agents last screen viewed
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page: 345
Cheilitis caused by systemic use of isotretinoin
basic lesion
Cheilitis caused by ingestion of isotretinoin. This is a fissured, scaly, erythematous cheilitis which is dependent on the isotretinoin dose administered. There are sometimes associated episodes of epistaxis.
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Cheilitis
cause
Topographical dermatology
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Erythematous Macule; Scales; Fissures Chemical Agents last screen viewed
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12.4
Miscellaneous
page: 346
alphabetical
Topographical dermatology
Miscellaneous
cause basic lesion
Hereditary skin disease with a characteristic topography (sides of the face, trunk). Multiple small greyish-brown papules are observed, keratotic, dry, and very adherent. These papules can run together to form extensive brownish plaques. The lesions have a very distinct tendency to increase during the months of sunshine.
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Darier's disease
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Epidermal Papules; Keratoses
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Miscellaneous
page: 347
continued
basic lesion
cause
picture
Darier's disease
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Topographical dermatology
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None specific
Sunlight, Ultraviolet Radiation last screen viewed
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Miscellaneous
page: 348
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Topographical dermatology
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Scales
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Condition transmitted by a dominant gene, sometimes associated with atopic dermatitis. The whole of the skin is affected, sprinkled with small dry scales, which vary in number. Improvement during the months of sunshine is typical. Acquired ichthyosis must always make one think of a paraneoplastic syndrome (e.g. underlying Hodgkin's disease).
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Ichthyosis vulgaris
alphabetical
page: 349
Sex-linked (recessive) ichthyosis
basic lesion
Also called ichthyosis nigricans, this variant of ichthyosis is found only in boys, does not spare the major skin folds, and presents in the form of wide, adherent, blackish scales.
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Miscellaneous
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Topographical dermatology
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Scales
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page: 350
continued
basic lesion
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Sex-linked (recessive) ichthyosis
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Miscellaneous
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Topographical dermatology
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Scales
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alphabetical
page: 351
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Keratoses
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Hereditary palmoplantar keratoderma (Thost-Unna syndrome) Appearing very early in life (between the 4th and 8th week), this palmoplantar keratoderma represents the model of a disease with autosomal dominant transmission. There are extensive yellowish keratotic plaques, accompanied by large cracks in flexural creases of the palms. This keratoderma is distinctly demarcated and does not extend to the wrist. The keratotic lesions are accentuated by an inflammatory border. There is sometimes associated hyperhidrosis.
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Miscellaneous
basic lesion
Topographical dermatology
Miscellaneous
page: 352
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Topographical dermatology
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Keratoses
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Association of diffuse orangeyellow palmoplantar keratoderma with a scoring of small fissures and horny follicular papules producing a grid on the skin. On palpation it feels abrasive (like emery paper). The pinkish papules are pointed at the top and surmounted by a small horny follicular plug. The course is usually chronic. Episodes of erythroderma may be seen as time goes on.
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Pityriasis rubra pilaris
Miscellaneous
page: 353
alphabetical
Topographical dermatology
continued
basic lesion
cause
picture
Pityriasis rubra pilaris
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Keratoses
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Miscellaneous
page: 354
alphabetical
Topographical dermatology
cause basic lesion
Extremely common skin disease surrounded by a fine erythematous border, characterized by slight hyperkeratosis of the hair follicle orifices. This "condition" is transmitted by an autosomal dominant gene and is usually seen on the cheeks and the temples.
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Keratosis pilaris
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Keratoses
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Keratosis pilaris
alphabetical
page: 355
continued
basic lesion
In adults the exterior surfaces of the arms and anterior surfaces of the thigh are most frequently affected. The affected areas feel abrasive on palpation. Exposure to sunlight attenuates the condition.
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Miscellaneous
cause
Topographical dermatology
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Keratoses
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Erythema annulare centrifugum (Darier's)
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Erythematous Macule
Extensive annular lesions of the arms with the appearance of healing at the centre. The distinctly infiltrated erythematous margins spread slowly outwards. Having appeared suddenly, this condition has become chronic, each ring developing over several weeks at a rate of 2 to 3 mm per week. It should be noted that when two rings join together they never overlap. There is no pruritus. It is always important to check for a possible underlying cause, though in a number of cases erythema annulare centrifugum remains idiopathic.
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alphabetical
page: 356
cause
Miscellaneous
basic lesion
Topographical dermatology
Erythema annulare centrifugum (Darier's)
continued
Among the potential causes the following should be remembered: remote infectious foci, viral diseases, Hodgkin's disease, visceral cancer, autoimmune thyroiditis, lupus erythematosus, liver disease, etc. In the present case it was viral hepatitis B which, after an acute episode, subsequently developed into chronic active hepatitis.
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Erythematous Macule
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alphabetical
page: 357
cause
Miscellaneous
basic lesion
Topographical dermatology
12.5
Leg ulcers
page: 358
alphabetical
Topographical dermatology
Leg ulcers
cause basic lesion
Extensive ulceration with pliant borders and outlines which vary from one case to the next. The base of the ulcer is granular in some places and sanious and necrotic in others. Surrounding trophic disorders are evident: gravitational purpura, atrophie blanche.
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Venous leg ulcer
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Ulcers; Atrophy
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Venous leg ulcer
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page: 359
continued
basic lesion
This type of ulcer can be the result of a varicose disorder or a postphlebitic syndrome. It represents more than 80% of leg ulcer cases. It affects women most frequently and there is an evident hereditary factor. The pains vary individually in intensity and are improved by lying down.
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Leg ulcers
cause
Topographical dermatology
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Ulcers
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Leg ulcers
page: 360
alphabetical
Topographical dermatology
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Crusts; Ulcers
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cause basic lesion
Punched-out ulceration which is most often unilateral. Its site is near the ankle. There is no associated trophic disorder. The pulse in the foot can be felt only with difficulty. Ischaemic ulcers develop rapidly and cause intense pain which is often aggravated by lying down. They are much less common than venous ulcers and can be found in diabetes, arteriosclerosis, or Buerger's disease.
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Ischaemic (arterial) leg ulcer
Leg ulcers
page: 361
alphabetical
Topographical dermatology
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Purpuric Macule; Crusts; Ulcers; Atrophy None specific last screen viewed
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Slow and relatively superficial ulceration with jagged and irregular margins. There is surrounding pigmentary and purpuric angiodermatitis, sometimes associated with small patches of atrophie blanche. The pains are often intense and persistent, and are not influenced by lying down. Diabetes and arteriosclerosis promote this condition.
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Ulcer caused by capillaritis
Neurotrophic leg ulcer (perforating ulcer) Deep circular, punched-out ulcer found at the bearing surface of the metatarsal joint. The base is necrotic. There is no tendency towards spontaneous cicatrization. There is virtually no pain. In the present case it is caused by diabetes with a major neuropathological component. Other neurological conditions can be responsible (e.g. syringomyelia).
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Ulcers
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alphabetical
page: 362
cause
Leg ulcers
basic lesion
Topographical dermatology
page: 363
alphabetical
Leg ulcers
continued
basic lesion
cause
Neurotrophic leg ulcer (perforating ulcer)
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Topographical dermatology
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Ulcers
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Pathomimicry Skin self-mutilation simulated disease Extensive escharotic ulceration of the back of the hand, caused intentionally with caustic soda. The margins are distinct, the angular edges and the configuration "surprising". The appearance of the lesion was very rapid and recurrences at the same site are typical.
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Crusts; Ulcers; Scars
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alphabetical
page: 364
cause
12.6
Pathomimicry
basic lesion
Topographical dermatology
Skin self-mutilation simulated disease
alphabetical
page: 365
continued
basic lesion
The course is usually capricious, spontaneous healing retarded, and persistence indefinite. In the present case the patient acted voluntarily with intent to deceive, for her own advantage (extension of sick leave from work).
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Pathomimicry
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Topographical dermatology
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Crusts; Ulcers; Scars
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Self-mutilation, pathomimicry Ulceration of exogenous origin on the face, with distinct margins and "aberrant" configuration. This particular topography is rarely found in cases of disease simulation. True pathomimicry is caused by the patient who is "unconscious" of it or shows "dual consciousness".
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Crusts; Ulcers
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alphabetical
page: 366
cause
Pathomimicry
basic lesion
Topographical dermatology
page: 367
Self-mutilation, pathomimicry
alphabetical
Pathomimicry
continued
basic lesion
cause
Major psychological disturbances are present. There is no evident intention to take financial advantage of the condition.
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Topographical dermatology
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Crusts; Ulcers
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alphabetical
page: 368
Chapter 13:
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cause
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Benign skin tumours
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13.1
Epidermal tumours
page: 369
alphabetical
Benign skin tumours
Epidermal tumours
cause basic lesion
Excrescences of varying size, covered with a greasy, scaly keratotic layer which is not very adherent. They can have various colours: yellow, sepia, grey, dark brown, or pure black. Each lesion seems to be "placed" on the skin surface, is well-circumscribed, has no underlying infiltration.
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Seborrhoeic keratosis / wart
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Warts; Keratoses
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Epidermal tumours
page: 370
alphabetical
Benign skin tumours
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continued
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Seborrhoeic keratosis / wart
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Warts; Keratoses
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Epidermal tumours
page: 371
alphabetical
Benign skin tumours
cause basic lesion
The epidermal naevus appears in the form of raised papuloverrucous lesions, rough to the touch and sometimes fragmented. It is usually disposed in continuous linear bands following the Blaschko's classical lines, to be interrupted over the midline.
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Verrucous epidermal naevus
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Warts; Keratoses
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Epidermal tumours
page: 372
alphabetical
Benign skin tumours
continued
basic lesion
cause
The colour is that of normal skin, sometimes greyish or brownish.
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Verrucous epidermal naevus
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Warts; Keratoses
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alphabetical
page: 373
Inflammatory linear verrucous epidermal naevus (ILVEN)
basic lesion
ILVEN appears in the form of psoriatiform scaly erythematous patches, which are sometimes lichenoid or verrucous, disposed in linear bands following Blaschko's lines (like the lesions of verrucous epidermal naevus).
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Epidermal tumours
cause
Benign skin tumours
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Erythematous Macule; Warts; Pustules; Scales; Gangrene None specific last screen viewed
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alphabetical
page: 374
Inflammatory linear verrucous epidermal naevus (ILVEN) continued
basic lesion
Inflammatory episodes can occur, causing exacerbation of pruritus, more or less severe excoriations, secondary eczematization, and even areas of necrosis.
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Epidermal tumours
cause
Benign skin tumours
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Erythematous Macule; Warts; Pustules; Scales; Gangrene None specific last screen viewed
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Becker's naevus (pigmented and hairy epidermal naevus) Hyperpigmented unilateral plaque, the preferred site of which is the chest or the shoulder, sometimes covered in hairs. It appears most often in young adults after exposure to the sun. It corresponds to a late epithelial (epidermal and follicular) naevus with secondary epidermal melanin hyperpigmentation.
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Pigmented Macules
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alphabetical
page: 375
cause
Epidermal tumours
basic lesion
Benign skin tumours
Epidermal tumours
page: 376
alphabetical
Benign skin tumours
picture
Clear cell acanthoma
basic lesion
cause
Small, round and domed firm tumour, which is generally isolated, pink in colour, usually with a moist surface. The diagnosis of this lesion is essentially histopathological.
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Nodules
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Epidermal tumours
page: 377
alphabetical
Benign skin tumours
cause basic lesion
Very well defined nodule surmounted by a central horny plug. Its growth is rapid, the maximum size of the lesion being reached in a few weeks. The lesion usually regresses spontaneously in a few months.
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Kerato-acanthoma
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Nodules
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page: 378
Spectacle frame acanthoma (fissured acanthoma)
basic lesion
Well-circumscribed, slightly pink retro-auricular papulonodule, 1-2 cm in diameter, surrounded by an inflammatory halo. The lesion is divided in two by a groove (fold).
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Epidermal tumours
cause
Benign skin tumours
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Nodules; Fissures
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page: 379
alphabetical
Epidermal tumours
Spectacle frame acanthoma (fissured acanthoma) continued
basic lesion
cause
Acanthoma occurs in the weeks or months after the patient starts wearing a new spectacle frame.
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Benign skin tumours
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Nodules; Fissures
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13.2
Follicular and sebaceous tumours
page: 380
alphabetical
Benign skin tumours
Follicular and sebaceous tumours
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Nodules
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cause basic lesion
Inflammatory subcutaneous nodule, often with a punctiform opening at its centre, through which malodorous whitish or yellowish material can be expressed. It is a single or multiple lesion which occurs especially in seborrhoeic areas, within the context of acne vulgaris or nodulocystic acne. Epidermoid cysts are sometimes wrongly called "sebaceous cysts".
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Epidermoid cyst
Follicular and sebaceous tumours
page: 381
alphabetical
Benign skin tumours
cause basic lesion
Generally located on the scalp, it appears in the form of a subcutaneous nodule covered with non-adherent pink and glabrous skin. The cysts are sometimes multiple. They range from pea-size to egg-size and are colloquially known as wens.
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Trichilemmal cyst (pilar cyst)
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Nodules
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Follicular and sebaceous tumours
page: 382
alphabetical
Benign skin tumours
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Dermal Papules
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cause basic lesion
Milia are very superficial small white elevations which occur in various circumstances. In newborn babies they appear as innumerable small white dots on the face, as illustrated in the photograph, caused by transient retention of sebum. They disappear spontaneously in a few weeks. In adolescents and adults they are commonly seen on the cheeks, the eyelids, and the nose, and are due to clogging of follicles.
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Milia
Follicular and sebaceous tumours
page: 383
alphabetical
Benign skin tumours
cause basic lesion
Translucent, flattened or globular papular formations, 2 to 5 mm in diameter, pink or white in colour and sometimes surmounted by fine telangiectasias. Their preferred site is the face (nose, nasolabial folds, cheeks, forehead, chin). These are generally multiple and hereditary lesions, appearing from childhood or in adolescence.
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Trichoepithelioma
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Dermal Papules
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Follicular and sebaceous tumours
page: 384
alphabetical
Benign skin tumours
basic lesion
cause
These adenomas correspond to senile adenomatous hyperplasia of the sebaceous glands.
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Senile sebaceous adenoma
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Dermal Papules
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Follicular and sebaceous tumours
page: 385
alphabetical
Benign skin tumours
continued
basic lesion
Small yellowish umbilicate formations, 3 to 6 mm in diameter, occurring on seborrhoeic areas of the face (forehead, temples, cheeks) in both sexes after the age of fifty.
cause
continued
picture
Senile sebaceous adenoma
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Dermal Papules
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Follicular and sebaceous tumours
page: 386
alphabetical
Benign skin tumours
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Nodules
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cause basic lesion
This is a tumour on the scalp or the face, which is often congenital. Its appearance changes with age. During childhood there is an oval or pink and slightly raised alopecic plaque. Starting from puberty the surface becomes mamillated and warty, and assumes the characteristic orange-yellow colour. In adulthood it can, in exceptional cases, give rise to a basal-cell carcinoma.
picture
Jadassohn's sebaceous naevus
13.3
Sweat gland tumours
page: 387
alphabetical
Benign skin tumours
Sweat gland tumours
picture
Syringoma
basic lesion
cause
Small, always multiple lesions measuring 1 to 3 mm in diameter and forming smooth, fleshcoloured papules generally occurring on the face (especially the eyelids), chest, neck, and axillae.
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Dermal Papules
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Sweat gland tumours
page: 388
alphabetical
Benign skin tumours
cause basic lesion
Solitary benign congestive tumour bleeding in pinpoint haemorrhages, the wide base of which is encircled by a keratin collar. Its preferred site is the area of the sole around the heel.
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Eccrine poroma
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page: 389
Eccrine poroma
alphabetical
Sweat gland tumours
continued
basic lesion
cause
In differential diagnostics it must be distinguished from pyogenic granuloma and achromic malignant melanoma.
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Benign skin tumours
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Nodules
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Sweat gland tumours
page: 390
alphabetical
Benign skin tumours
cause basic lesion
Multiple benign tumours, often familiar, appearing on the scalp, which becomes mamillated and embossed (turban-like tumours). The surface of these tumours is smooth, glabrous, normal or pink in colour, with telangiectasias. There is no adherence to deep layers.
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Cylindroma
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13.4
Connective tissue tumours
page: 391
alphabetical
Benign skin tumours
Connective tissue tumours
cause basic lesion
Nodular intradermal tumour 5 to 6 mm in diameter, firm to the touch, generally located on the legs. Its surface is pigmented to varying degree and often slightly keratotic. A dermatofibroma can sometimes be caused by an insect bite.
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Dermatofibroma
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Nodules
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Dermatofibroma
alphabetical
page: 392
continued
basic lesion
An unusual variant is the pastillelike fibroma, a pink shiny nodule with a smooth surface surrounded by a very fine scaly collarette separated from the tumour by a groove.
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Connective tissue tumours
cause
Benign skin tumours
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Nodules
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Connective tissue tumours
page: 393
alphabetical
Benign skin tumours
cause basic lesion
Small tumour situated on the fingers or toes, more rarely on the palms and soles. Like the pastille fibroma, it is a solitary domed lesion, sometimes elongated and pedunculate, surrounded by a fine demarcating border. The surface is slightly warty. It is perhaps caused by a trauma.
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Acquired digital fibrokeratoma
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Warts
Mechanical Factors last screen viewed
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Connective tissue tumours
page: 394
alphabetical
Benign skin tumours
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Scars
Mechanical Factors last screen viewed
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cause basic lesion
Red and taut fibrous tumour with a smooth surface, slightly dented and sometimes surrounded by pseudopodia-like extensions called crab legs. They are very often itchy, painful, or tender. Post-traumatic keloids secondary to wounds, burns, vaccinations, or inflammatory skin lesions (such as adolescent acne) are distinguished from spontaneous keloids, which are more common in black people.
picture
Keloid
alphabetical
page: 395
Skin tag (acrochordon, molluscum pendulum)
basic lesion
Small and very soft fleshy mass, on average 3 to 5 mm in diameter, implanted in the skin by a thin stalk. These lesions are often multiple and their preferred sites are the axillae or inguinal flexures, the neck, the eyelids, and the orbital area.
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Connective tissue tumours
cause
Benign skin tumours
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Connective tissue tumours
page: 396
alphabetical
Benign skin tumours
cause basic lesion
Single or multiple papulonodular yellow, orange or brown lesion of soft consistency, usually appearing on the face, scalp, trunk, and the base of the limbs. It occurs most frequently in neonates and infants, but can also be seen in children and even in adults.
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Juvenile xanthogranuloma
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Nodules
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Connective tissue tumours
page: 397
alphabetical
Benign skin tumours
cause basic lesion
Small hemispherical papules, from a few millimetres to a centimetre in diameter, pink or orange in colour, sometimes very yellow on vitropression. The preferred sites are the elbows, knees, and buttocks.
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Tuberous xanthoma
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Dermal Papules; Nodules
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page: 398
Tuberous xanthoma
alphabetical
Connective tissue tumours
continued
basic lesion
cause
A rare variant (eruptive xanthoma) is found in cases of severe hypertriglyceridaemia.
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Benign skin tumours
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Dermal Papules; Nodules
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Connective tissue tumours
page: 399
alphabetical
Benign skin tumours
basic lesion
cause
Flattened and clearly delimited yellowish or orange plaques around the eyes. This is one of the variants of xanthoma planum.
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Xanthelasma palpebrarum
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Dermal Papules
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Connective tissue tumours
page: 400
alphabetical
Benign skin tumours
cause basic lesion
Single or multiple benign tumours the colour of normal skin, which develop from subcutaneous fat. They are soft in consistency and they can attain a large size.
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Lipoma
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Nodules
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Connective tissue tumours
page: 401
alphabetical
Benign skin tumours
cause basic lesion
Benign tumours originating from the smooth muscles connected with hair follicles, genitals, nipples, or blood vessels. Leiomyomas are single or multiple, contractile, nodular tumours, which are red, pink, or brownish in colour.
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Leiomyoma
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Nodules
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Connective tissue tumours
page: 402
alphabetical
Benign skin tumours
This is the most common form, encountered in all age groups. It produces a fairly monomorphic eruption of smooth violet or brown itchy macules or maculopapules. The reactivity of the lesions to certain stimuli, such as rubbing, is very characteristic (Darier's sign). Basic Lesions:
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Erythematous Macule; Pigmented Macules; Dermal Papules None specific last screen viewed
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cause
Urticaria pigmentosa
basic lesion
The term mastocytosis covers all lesions caused by the proliferation of mast cells in skin.
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Cutaneous mastocytosis
Connective tissue tumours
page: 403
alphabetical
Benign skin tumours
continued
Mastocytoma
picture
Cutaneous mastocytosis
basic lesion
cause
Single firm tumour, orange in colour, occurring only in children.
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Erythematous Macule; Pigmented Macules; Dermal Papules None specific last screen viewed
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Connective tissue tumours
page: 404
alphabetical
Benign skin tumours
basic lesion
Nodules which are of normal skin colour or pink. Their firmness can vary. Their essential characteristic is that they are readily depressible.
cause
Neurofibroma
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Neural crest diseases
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Neural crest diseases
alphabetical
page: 405
continued
Von Recklinghausen neurofibromatosis
basic lesion
This is the most common form of systemic neural crest disease. It is essentially characterized by the combination of café au lait spots, “freckling", and cutaneous neurofibromas.
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Connective tissue tumours
cause
Benign skin tumours
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Pigmented Macules; Nodules
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Neural crest diseases
alphabetical
page: 406
continued
Von Recklinghausen neurofibromatosis
basic lesion
The "principal tumour" is a neurofibroma which is very large in relation to all those surrounding it. This hereditary condition is transmitted by an autosomal dominant gene with high penetrance and variable expression.
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Connective tissue tumours
cause
Benign skin tumours
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Pigmented Macules; Nodules
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Connective tissue tumours
page: 407
Neural crest diseases
alphabetical
Benign skin tumours
continued
picture
Bourneville's tuberous sclerosis (epiloia)
cause
Tuberous sclerosis is a condition with autosomal dominant transmission, characterized by various isolated or associated clinical signs and symptoms.
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Nodules
basic lesion
a. Angiofibroma Small, firm, pink or red tumid nodules covered in fine telangiectases and distributed symmetrically over the face: nasolabial folds, cheeks, perioral region.
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Connective tissue tumours
page: 408
Neural crest diseases
alphabetical
Benign skin tumours
continued
picture
b. Periungual fibromas (Koënen's tumours)
basic lesion
cause
Very rare horny angiofibromas of the toes.
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Warts
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page: 409
Neural crest diseases
alphabetical
Connective tissue tumours
continued
picture
c. Shagreen patch
cause
Raised patch with an irregular outline and surface, covered with pale "orange-skin". Its preferred site is the lumbosacral region. d. Achromic patches Fairly regular macules 1 to 10 cm in diameter, oval, rounded, or more characteristically in the shape of an ash leaf. They are white and do not have a hyperaemic or pigmented halo.
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basic lesion
Benign skin tumours
Connective tissue tumours
page: 410
alphabetical
Benign skin tumours
Angioma picture
Spider telangiectasis
basic lesion
cause
Vascular star, composed of a red central point, sometimes raised and pulsatile, and arborizations radiating outwards. The arborizations disappear on vitropression.
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Vascular Macule
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Angioma
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page: 411
continued
picture
Hereditary haemorrhagic telangiectasia (Osler-Rendu-Weber disease) Autosomal dominant disease, characterized by telangiectases of the skin and mucous membranes, often not appearing until after puberty. The telangiectatic macules are poorly defined and the arborizations, in contrast to spider telangiectasis, are not symmetrical. They occur predominantly on the face, hands, buccal mucosa, the lips, and the tongue. Basic Lesions:
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Vascular Macule
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cause
Connective tissue tumours
basic lesion
Benign skin tumours
Angioma
alphabetical
page: 412
continued
Angioma planum
basic lesion
Congenital erythematous macule of varying intensity, extent, and shape. The colour varies from pale pink to dark red. Its preferred site is the face and the limbs, but it can spread to the mucosa. From the fourth decade of life the angioma thickens and superficial violet nodules can appear.
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Connective tissue tumours
cause
Benign skin tumours
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Vascular Macule
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Angioma
alphabetical
page: 413
continued
Tuberous angioma
basic lesion
Bright red, distinctly demarcated, raised angioma in infants, projecting above the surrounding normal skin. Its growth is rapid, and it can bleed and ulcerate. Most of these angiomas disappear spontaneously in childhood, leaving no trace.
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Connective tissue tumours
cause
Benign skin tumours
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Vascular Macule; Nodules
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Angioma
alphabetical
page: 414
continued
Subcutaneous angioma
basic lesion
Tumour protruding under skin which is either normal, bluish, or telangiectatic. This lesion does not undergo spontaneous involution.
picture
Connective tissue tumours
cause
Benign skin tumours
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Vascular Macule; Nodules
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Angioma
alphabetical
page: 415
continued
Angiokeratoma
basic lesion
Papular telangiectasia with a hyperkeratotic surface. Angiokeratomas of the scrotum and vulva are the most common. They are usually benign. Nevertheless, if they have disseminated over the buttocks, one must investigate for Fabry's disease.
picture
Connective tissue tumours
cause
Benign skin tumours
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Dermal Papules; Keratoses
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Angioma
alphabetical
page: 416
continued
Glomus tumour
basic lesion
Small, bluish intradermal tumour, remarkable for its painfulness. Its site is most likely to be peripheral, on the hands and feet, more rarely on the forearms and buttocks. A common and characteristic site is the subungual region.
picture
Connective tissue tumours
cause
Benign skin tumours
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Nodules
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Connective tissue tumours
page: 417
Angioma
alphabetical
Benign skin tumours
continued
basic lesion
cause
picture
Glomus tumour
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Nodules
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Connective tissue tumours
page: 418
Angioma
alphabetical
Benign skin tumours
continued
picture
Pyogenic granuloma
basic lesion
cause
Fleshy vascular pimple secondary to minimal or unnoticed trauma. Its eroded surface bleeds easily. Pyogenic granuloma may be "nipped" at its base by a characteristic groove which separates it from neighbouring skin.
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Nodules
Mechanical Factors last screen viewed
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Angioma
alphabetical
page: 419
continued
Senile angioma (cherry angioma)
B
Small bright red patches, flat or slightly tumid. Extremely common in old people, usually multiple and found on the trunk (A). In many cases they coexist with seborrhoeic warts (keratoses) (B).
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Connective tissue tumours
cause
Benign skin tumours
basic lesion
A
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Vascular Macule; Warts; Keratoses None specific last screen viewed
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Connective tissue tumours
page: 420
alphabetical
Benign skin tumours
B
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Vesicles
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cause basic lesion
A
Pseudovesicular elevations 1 to 5 mm in diameter, arranged in clusters or irregular plaques, translucent and taut but readily depressible. The lesions can occur anywhere on the body, but are more commonly found on the trunk and the base of the limbs. Lymphangioma (A) is very often found concomitantly with hemangionma (B).
picture
Lymphangioma
alphabetical
page: 421
Chondrodermatitis nodularis helicis (painful nodule in the ear)
basic lesion
Inflammatory nodule of the helix, which is painful or tender. Its centre is keratotic or crater-like. It is nowadays regarded as a chondrodermatitis, but its aetiology has not been clarified.
picture
Connective tissue tumours
cause
Benign skin tumours
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Basic Lesions:
Nodules; Keratoses
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Connective tissue tumours
page: 422
alphabetical
Benign skin tumours
cause basic lesion
Small, firm, flesh-coloured translucent nodule, occurring on the backs of the fingers near the distal interphalangeal joints and often causing a characteristic nail deformation with longitudinal grooves. It is the result of the accumulation of a mucoid substance in the dermis.
picture
Mucoid pseudocyst
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Nodules
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13.5
Melanocytic naevi
page: 423
alphabetical
Benign skin tumours
Melanocytic naevi
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Pigmented Macules
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cause basic lesion
Small (1 to 3 mm) brown or black hyperpigmented macules which can be distributed all over the skin and/or mucous membranes. Lentigines are often isolated. Sometimes they are generalized (lentiginosis) and form part of complex syndromes involving several internal organs. They represent epidermal hypermelanocytosis.
picture
Lentigo
Melanocytic naevi
page: 424
alphabetical
Benign skin tumours
cause basic lesion
Bluish grey macules varying in size from a few millimetres to tens of centimetres and occurring most frequently on the loins and buttocks. They are especially common in Orientals. These spots represent dermal hypermelanocytosis.
picture
Mongolian spot
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Pigmented Macules
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page: 425
Melanocytic naevi (naevocytic naevi)
basic lesion
Melanocytic naevi are wellcircumscribed lesions which show a wide variety of colour, shape, thickness, consistency, and size, their diameter ranging from a few millimetres to a few centimetres.
picture
Melanocytic naevi
cause
Benign skin tumours
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Pigmented Macules; Dermoepidermal Papules None specific last screen viewed
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Melanocytic naevi (naevocytic naevi)
alphabetical
page: 426
continued
basic lesion
They can be flat or raised, lenticular or discoid, and vary in colour from pale yellow to black-brown. The domed forms may be without pigmentation.
picture
Melanocytic naevi
cause
Benign skin tumours
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Pigmented Macules; Dermoepidermal Papules; Nodules None specific last screen viewed
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Melanocytic naevi
page: 427
alphabetical
Benign skin tumours
picture
Hairy melanocytic naevus
basic lesion
cause
Some melanocytic naevi become covered in hairs at puberty.
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Pigmented Macules; Dermoepidermal Papules; Nodules None specific last screen viewed
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Melanocytic naevi
page: 428
alphabetical
Benign skin tumours
cause basic lesion
Congenital pigmented naevi vary in size. Some are called giant because of their wide spread. They have an inhomogeneous surface (flat, papular, nodular, verrucous) and are most often variegated in colour, which ranges from light brown to black. They are often covered with thick hairs.
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Congenital pigmented naevus
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Pigmented Macules; Dermoepidermal Papules; Nodules None specific last screen viewed
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Melanocytic naevi
page: 429
alphabetical
Benign skin tumours
cause basic lesion
Isolated pinkish papulonodular tumour, frequently located on the face or the limbs. The histopathological appearance of this melanocytic naevus is very characteristic. In fairly exceptional cases there may be multiple Spitz naevi.
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Spitz naevus (juvenile)
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Nodules
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Melanocytic naevi
page: 430
alphabetical
Benign skin tumours
cause basic lesion
Small nodule, often less than a centimetre in diameter, blue-grey to black-blue in colour and situated especially frequently on the back of the hands and the feet, sometimes on the face. Its colour is caused by the deep dermal site of the melanocytic clusters.
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Blue naevus
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Pigmented Macules; Nodules
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Melanocytic naevi
page: 431
alphabetical
Benign skin tumours
cause basic lesion
Sutton's naevus is a melanocytic naevus surrounded by a depigmented corona. In the course of its natural development the naevus component gradually disappears and the white halo undergoes gradual repigmentation. This feature of its course is probably autoimmune.
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Halo naevus (Sutton's naevus)
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Melanocytic naevi
page: 432
alphabetical
Benign skin tumours
basic lesion
cause
continued
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Halo naevus (Sutton's naevus)
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Pigmented Macules; Achromic macules None specific last screen viewed
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Melanocytic naevi
page: 433
alphabetical
Benign skin tumours
cause basic lesion
Presence of a more or less dark brown longitudinal band in the nail plate (melanonychia), clinical evidence of the existence of a melanocytic naevus in the matrix region.
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Naevus of the nails
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Pigmented Macules
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page: 434
Chapter 14:
basic lesion
cause
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Premalignant skin tumours
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Solar keratoses (senile keratoses)
basic lesion
Raised red and well-defined plaques with a rough surface covered in scales of varying thickness. The lesions are isolated or multiple and their preferred site is on exposed regions such as the back of the hands or the face.
picture
alphabetical
page: 435
cause
Premalignant skin tumours
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Keratoses; Scales
Sunlight, Ultraviolet Radiation last screen viewed
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The lesions are isolated or multiple and their preferred site is on exposed regions such as the back of the hands or the face. Here one can observe some characteristics of skin-ageing caused by sunlight: sallow skin, accentuated wrinkles, etc. If left untreated, some cases of solar keratosis develop into squamous cell carcinoma.
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Keratoses; Scales
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continued
cause
Solar keratoses (senile keratoses)
alphabetical
page: 436
basic lesion
Premalignant skin tumours
page: 437
alphabetical
Premalignant skin tumours
cause basic lesion
Relatively well-demarcated scaly erythematous plaque, sometimes encrusted and occurring essentially on the lower lip. Under the hyperkeratotic layer the epithelium is atrophic and bleeds easily at the slightest trauma. Actinic cheilitis spreads slowly over time and can degenerate into true squamous cell carcinoma.
picture
Actinic cheilitis
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Basic Lesions:
Erythematous Macule; Scales; Crusts
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Leucoplakia – smoker's keratosis (stomatitis nicotina)
basic lesion
Well-demarcated and more or less rounded white or greyish plaques on the lower lip or the buccal mucosa. They occur more frequently in men and are probably promoted by smoking. Their natural evolution is in the direction of squamous cell carcinoma.
picture
alphabetical
page: 438
cause
Premalignant skin tumours
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Achromic macules; Warts
Chemical Agents last screen viewed
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page: 439
alphabetical
Premalignant skin tumours
cause basic lesion
Slightly raised round or oval discoid lesion with distinct borders, varying in size, red or reddish brown in colour and covered with a crust of scales or with small crusts. The current understanding of Bowen's disease is that it is an intraepidermal carcinoma (in situ).
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Bowen's disease
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page: 440
continued
basic lesion
cause
picture
Bowen's disease
alphabetical
Premalignant skin tumours
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Erythematous Macule; Scales; Crusts None specific last screen viewed
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page: 441
alphabetical
Premalignant skin tumours
cause basic lesion
Mucosal site of Bowen's disease. Red, well-demarcated, slightly protuberant plaque, with a glazed surface, on the glans penis. Similar lesions are observed on the vulval mucosa.
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Eryhtroplasia of Queyrat
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Erythematous Macule
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page: 442
alphabetical
Premalignant skin tumours
cause basic lesion
Erythematous or brownish papules on the glans and shaft of the penis, the vulva, and sometimes the perianal region. Their histopathology is similar to that of Bowen's disease. Human papillomaviruses (16, 18, 33) are the initial cause of this papulosis.
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Bowenoid papulosis
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Epidermal Papules
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page: 443
alphabetical
Premalignant skin tumours
cause basic lesion
Cicatricial atrophy, telangiectases, and pigmentation abnormalities form the classical picture of radiodermatitis. At a further stage ulcerations can appear. Basal cell carcinoma or squamous cell carcinoma are liable to develop after several years.
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Radiodermatitis
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Ulcers; Atrophy; Scars
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page: 444
alphabetical
Premalignant skin tumours
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Pigmented Macules; Nodules; Keratoses; Atrophy Sunlight, Ultraviolet Radiation last screen viewed
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cause basic lesion
A hereditary disease with recessive autosomal transmission. The genetic basis of xeroderma pigmentosum is an enzyme deficiency resulting in disorders of DNA repair after ultraviolet irradiation. The condition is characterized by extreme photosensitivity and chronic actinic lesions including skin atrophy, freckles, and solar keratosis. Some tumours can develop early: keratoacanthoma, basal cell or squamous cell carcinoma, malignant melanoma.
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Xeroderma pigmentosum
page: 445
alphabetical
Premalignant skin tumours
Dubreuilh's melanosis
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Pigmented Macules
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basic lesion
Polychromatic pigmented macule, not raised and poorly defined. Its colour varies from pale beige to black. Dubreuilh's melanosis is observed in old people, most frequently on the face, less so on the back of the hands and on the legs. It spreads very slowly, reaching a diameter of several centimetres in about ten years.
cause
picture
(Lentigo maligna melanoma, melanosis circumscripta precancerosa of Dubreuilh)
alphabetical
page: 446
Chapter 15:
basic lesion
cause
picture
Malignant skin tumours
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15.1
Basal cell carcinomas
page: 447
alphabetical
Malignant skin tumours
Basal cell carcinomas
Basic Lesions:
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Nodules
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cause basic lesion
Globular tumour with a waxy or reddish tint, more or less translucent ("pearly" carcinoma), the smooth surface of which is streaked with fine telangiectases. The most common site is the face, but other areas can also be involved: back, limbs, genital region. Nodular basal cell carcinoma increases gradually in size and can ulcerate.
picture
Nodular basal cell carcinoma
Basal cell carcinomas
page: 448
alphabetical
Malignant skin tumours
This variant of ulcerated basal cell carcinoma is characterized by
picture
Rodent ulcer
2. considerable superficial spread 3. considerable spread in depth: the tumour "eats" into the tissue (hence "rodent ulcer") 4. the persistence of a translucent pearly and slightly telangiectatic border is very characteristic of basal cell carcinoma. Basic Lesions:
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Nodules; Ulcers
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basic lesion
cause
1. an ulcer as the primary lesion
Flat cicatricial basal cell carcinoma ("scleroderma-like" carcinoma) This variant of carcinoma appears more like a plaque than a nodule. The whole central area of the lesion is white, atrophic, sclerous, and morphoea-like, but unlike morphoea it is streaked with telangiectases. At the edge of the lesion there is usually a pearly, telangiectatic, indurated swelling, sometimes covered with small crusts.
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Nodules; Atrophy; Sclerosis
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alphabetical
page: 449
cause
Basal cell carcinomas
basic lesion
Malignant skin tumours
Basal cell carcinomas
page: 450
alphabetical
Malignant skin tumours
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Pigmented basal cell carcinoma
basic lesion
cause
A very rare variant, pigmented basal cell carcinoma is characterized by a considerable excess of melanin. It is usually nodular and is not ulcerated.
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Pagetoid basal cellular carcinoma (superficial basal cell carcinoma) The usual appearance is a pink plaque distinctly circumscribed by rounded outlines. Its limits are usually marked by a fine, pearly, filiform edge, which distinguishes it from Bowen's disease. Growth is very slow. The preferred site of this variant is on the trunk.
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Erythematous Macule; Scales
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alphabetical
page: 451
cause
Basal cell carcinomas
basic lesion
Malignant skin tumours
alphabetical
page: 452
Squamous cell carcinomas
basic lesion
The majority of squamous cell carcinomas are seen on uncovered areas: face (lower lip in particular) and the back of the hands. They develop either in apparently healthy skin, or, most frequently, over a precancerous lesion: solar keratosis, Bowen's disease, etc. They are liable to metastasize, mainly via lymph.
picture
15.2
Squamous cell carcinomas
cause
Malignant skin tumours
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Nodules
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page: 453
Squamous cell carcinoma of the face
basic lesion
Large, ulcerated, which oozes blood and forms crusts. The peripheral swelling is very indurated. The base of the whole lesion is distinctly infiltrated.
picture
Squamous cell carcinomas
cause
Malignant skin tumours
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page: 454
Squamous cell carcinoma of the lower lip
basic lesion
This sanious ulceration is surrounded by an indurated peripheral swelling. In the present case it is developing from actinic cheilitis.
picture
Squamous cell carcinomas
cause
Malignant skin tumours
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Basic Lesions:
Nodules; Scales; Crusts; Ulcers
Causes:
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page: 455
alphabetical
Squamous cell carcinomas
Squamous cell carcinoma of the penis
basic lesion
cause
Hard ulcerated vegetating tumour of the glans.
picture
Malignant skin tumours
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Paget's disease Encrusted scaly erythematous and locally erosive plaque on the nipple and the areola. Its perfectly defined border distinguishes it from an eczematous reaction (see page 52). The disappearance of the nipple's elevation must also be noted. This carcinoma is seen in 3 to 5% of breast cancers and develops mainly in postmenopausal women. Extramammary sites are rare and confined to skin areas with apocrine sweat glands (genitals, perineum, perianal region).
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alphabetical
page: 456
cause
15.3
Paget's disease
basic lesion
Malignant skin tumours
page: 457
alphabetical
15.4
Cutaneous metastases
Cutaneous metastases Cutaneous metastases of deep cancers can assume various clinical appearances: Carcinomatous lymphangitis
basic lesion
cause
Classically observed in cancer of the breast, characterized by an extensive inflammatory plaque, sometimes wrongly called "carcinomatous erysipelas".
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Malignant skin tumours
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page: 458
Cutaneous metastases
alphabetical
Cutaneous metastases
continued
Nodularcutaneous-subcutaneous metastases
basic lesion
cause
forming skin-embedded spherical colourless or bluish masses.
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Malignant skin tumours
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Nodules
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page: 459
Melanoma (malignant)
basic lesion
Melanoma is a tumour which develops either as a primary lesion from epidermal melanocytes or from the cells of congenital junctional and compound naevi, or much more rarely from intradermal and blue naevi. It metastasizes via lymph and/or blood. Several variants of melanoma have been described:
picture
15.5
Melanoma (malignant)
cause
Malignant skin tumours
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Pigmented Macules; Nodules
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Superficial spreading melanoma (SSM) Slightly raises melanotic spot, varying in colour from brown to black, with a margin. It undergoes a horizontal growth phase lasting several months and then finally starts its vertical phase, in which it invades the deep tissue. It occurs anywhere on the body, but more readily on the back in men and on the legs in women.
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Pigmented Macules
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alphabetical
page: 460
cause
Melanoma (malignant)
basic lesion
Malignant skin tumours
Melanoma (malignant)
page: 461
alphabetical
Malignant skin tumours
cause basic lesion
Infiltrated brown or black nodules, sometimes violet-red and more rarely achromic. The lesion, which is often dome-shaped, finally ulcerates and bleeds.
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Nodular melanoma
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Melanoma (malignant)
page: 462
alphabetical
Malignant skin tumours
picture
Melanoma developing over Dubreuilh's melanosis precancerosa
basic lesion
cause
Infiltrated nodular formations, which may or may not be pigmented, sometimes oozing blood, developing from a Dubreuilh's melanosis.
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Acral lentiginous melanoma (melanoma of the extremities) Located on the extremities (palm of the hands, sole of foot, digital extremities), it resembles superficial spreading melanoma or nodular melanoma, representing only a particular site of either of these. The illustration suggests this double categorization particularly well.
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Pigmented Macules; Nodules
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picture
alphabetical
page: 463
cause
Melanoma (malignant)
basic lesion
Malignant skin tumours
Melanoma (malignant)
page: 464
alphabetical
Malignant skin tumours
basic lesion
cause
Numerous black or bluish indurated nodules developing near a previously excised melanoma.
picture
Melanoma metastases
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Pigmented Macules; Nodules
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Large multinodular dented tumour which adheres to the skin surface without ulcerating it and infiltrates the dermis and subcutaneous tissue, often beyond the limits of palpation. The tumour develops gradually, without painful symptoms. It affects adults of both sexes with a preference for the trunk and the base of the limbs. This fibrosarcoma has local malignancy, but can metastasize in exceptional cases.
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Dermatofibrosarcoma protuberans (Darier-Ferrand fibrosarcoma)
cause
15.6
Dermatofibrosarcoma protuberans (Darier-Ferrand fibrosarcoma)page:
basic lesion
Malignant skin tumours
15.7
Kaposi's angiosarcoma
page: 466
alphabetical
Malignant skin tumours
Kaposi's angiosarcoma
basic lesion
cause
picture
Violet nodules on the ankles and feet in an elderly patient. In the present case it is not occurring in the context of acquired immune deficiency syndrome.
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Vascular Macule; Nodules
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page: 467
Malignant lymphomas – mycosis fungoides
basic lesion
Among the many malignant cutaneous lymphomas, mycosis fungoides (epidermotropic Tlymphoma) represents an unusual entity. At the eruptive stage, the clinical picture is characterized by dull coppery red infiltrated plaques distributed in arcs.
picture
15.8
Malignant lymphomas – mycosis fungoides
cause
Malignant skin tumours
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page: 468
alphabetical
Malignant lymphomas – mycosis fungoides
Malignant lymphomas – mycosis fungoides continued
basic lesion
cause
Tumours can subsequently develop, and these may ulcerate.
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Malignant skin tumours
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Ulcers
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Paraneoplastic syndromes Malignant neoplasms can be accompanied by skin diseases which themselves are not neoplastic in character, nor directly caused by the presence of the tumour (in contrast to metastases), but which develop alongside the malignant neoplasm, regressing if and when the latter is eliminated and reappearing if it recurs. These so-called paraneoplastic dermatoses can occur when the malignant neoplasm has already distinctly developed, but they can also appear as a sign revealing a small neoplasm (Bazex's sign).
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alphabetical
page: 469
cause
15.9
Paraneoplastic syndromes
basic lesion
Malignant skin tumours
Bazex's paraneoplastic acrokeratosis Paraneoplastic skin diseases are, amongst others, malignant acanthosis nigricans, Gammel's erythema gyratum repens, and Bazex's paraneoplastic keratosis, hypertrichosis lanuginosa. Both last diseases have been selected to illustrate paraneoplastic syndromes.
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Warts; Keratoses
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alphabetical
page: 470
cause
Paraneoplastic syndromes
basic lesion
Malignant skin tumours
Paraneoplastic syndromes
page: 471
alphabetical
Malignant skin tumours
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This occurs suddenly (within a few weeks), in the form of a down of long, white, silky, fine, and extremely numerous lanuginous hairs extending all over the glabrous skin and especially on the face. The rate of growth is accelerated and the hair (of the head) becomes more luxuriant. The papillae on the lingual mucosa are hypertropic and glazed. There is a distinct change in the sense of taste.
picture
Hypertrichosis lanuginosa
Paraneoplastic syndromes
page: 472
alphabetical
Malignant skin tumours
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The appearance of such a picture must lead one to suspect the presence of an associated neoplasm. In the present case a neoplasm was detected in the breast. Radical treatment of the cancer leads to the disappearance of the acquired lanuginous hypertrophy. The recurrence of the neoplasm is accompanied by reappearance of the hypertrichosis (paraneoplastic dermatosis in the strict sense).
basic lesion
continued
picture
Hypertrichosis lanuginosa
alphabetical
page: 473
Chapter 16:
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basic lesion
cause
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Algorithmic approach to a dermatological diagnosis
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Urticaria
Physical Urticaria?
No
Yes
Provoked by direct contact with a substance?
No
Yes
Genetic origin?
No
Yes
Systemic origin?
No
Yes
Medicamentouse or food allergy?
No
Yes
Infectious origin?
No
Yes
To conclude this pictorial presentation of the most common skin diseases for the general practitioner, we thought it would be interesting to include the modern diagnostic procedure in dermatology applied to an everyday problem: urticaria.
If duration is longer than 6 weeks: Chronic idiopathic urticaria
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alphabetical
page: 474
basic lesion
16.1
Urticaria
cause
Algorithmic approach to a dermatological diagnosis
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alphabetical
Urticaria
Physical urticaria
Simple or retarded dermographism
Aquagenic urticaria
Click
Vibratory angio-oedema
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Solar urticaria
Click
Cholinergic urticaria
Delayed pressure urticaria
Click
Cold urticaria
No Physical urticaria
Click
Heat urticaria
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Click
Click
Click
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Click
basic lesion
Click
picture
Algorithmic approach to a dermatological diagnosis
page: 476
Physical urticaria Simple or retarded dermographism Rub with a blunt tip.
alphabetical
Urticaria
picture
Algorithmic approach to a dermatological diagnosis
basic lesion
Continue
cause
other disease
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Urticaria
page: 477
Physical urticaria
alphabetical
Algorithmic approach to a dermatological diagnosis
Photosensitivity test.
picture
Solar urticaria
other disease
basic lesion
cause
Continue
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Urticaria
page: 478
Physical urticaria
alphabetical
Algorithmic approach to a dermatological diagnosis
Small papules induced by heat, physical effort, stress.
picture
Cholinergic urticaria
basic lesion
Continue
cause
other disease
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Urticaria
page: 479
Physical urticaria
alphabetical
Algorithmic approach to a dermatological diagnosis
Test with ice cube sheathed in plastic.
picture
Cold urticaria
basic lesion
Continue
cause
other disease
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Urticaria
page: 480
Physical urticaria
alphabetical
Algorithmic approach to a dermatological diagnosis
Aquagenic urticaria Immersion test: hand in water at ambient temperature.
cause
Test with test-tube of hot water.
picture
Heat urticaria
Professional circumstances ( particularly pneumatic hammer). other disease
Continue
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Vibratory angio-oedema
Urticaria
page: 481
Physical urticaria
alphabetical
Algorithmic approach to a dermatological diagnosis
Test by pressure with a weight strapped on to the body.
picture
Delayed pressure urticaria
basic lesion
Continue
cause
other disease
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Urticaria
page: 482
Provoked by direct contact with a substance
alphabetical
Algorithmic approach to a dermatological diagnosis
Rapid result patch test, prick test or scratch test.
picture
Contact urticaria
basic lesion
Continue
cause
other origin
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Genetic origin Hereditary angioneurotic oedema Investigate for deficiency of C1 esterase inhibitor. other origin
basic lesion
Continue
alphabetical
page: 483
picture
Urticaria
cause
Algorithmic approach to a dermatological diagnosis
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Systemic origin Lesions persisting at the same place for more than 24h, not very itchy, accompanied by joint pains and myalgias; histopathological appearance that of vasculitis.
alphabetical
Urticaria
picture
Algorithmic approach to a dermatological diagnosis
2
-
acute lupus erythematosus (1-3) Still’s disease macroglobulinaemia blood disease hyperthhyroidism urticarial vasculitis (4)
other origin 4
3
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1
cause
Investigate for:
Medicamentous or food allergy Painstaking history with regard to drugs and food - Drugs Especially acetylsalicylic acid (see photos) - Food Especially preservatives and colourings
alphabetical
page: 485
picture
Urticaria
cause
Algorithmic approach to a dermatological diagnosis
other origin
Continue
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basic lesion
Do provocation tests.
- Hepatitis A (photo) Exceptional case of figured urticaria revealing hepatitis A in its initial phase. The yellowish colour of the central oedematous (urticated zone) is caused by accumulation of bilirubin in the oedema fluid. -
Hepatitis B or C Infectious mononucleosis Parasitosis Focus of bacterial infection Focus of mycotic infection other origin
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Infectious origin
picture
page: 486
cause
Urticaria
basic lesion
Algorithmic approach to a dermatological diagnosis
alphabetical
page: 487
basic lesion
cause
picture
Picture Index
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alphabetical
page: 488
Skin from the forehead region
Skin from the face of an elderly subject
Structure of the epidermis
Structure of the epidermis
Structure of the epidermis
basic lesion
Skin from the axillary region
cause
picture
Picture Index
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picture
alphabetical
page: 489
Vascular macule
Purpuric macule
Pigmentary macules
Pigmentary macules
Pigmentary macules
basic lesion
cause
Erythematous macule
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picture
alphabetical
page: 490
Dermal papules
Dermo-epidermal papules
Nodules
Tubercles
Vegetations
basic lesion
cause
Epidermal papules
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picture
alphabetical
page: 491
Keratoses
Vesicles
Bullae
Pustules
Scales
basic lesion
cause
Warts
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picture
alphabetical
page: 492
Excoriations (or ulcerations)
Fissures
Ulcers
Gangrene
Atrophy
basic lesion
cause
Crusts
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Sclerosis
Acute exudative contact dermatitis
Chronic occupational contact dermatitis
Vesicular contact dermatitis
Vesicular contact dermatitis
basic lesion
Scars
cause
picture
alphabetical
page: 493
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picture
alphabetical
page: 494
Bullous contact dermatitis
Crusted eczema
Crusted eczema
Scaly dry erythematous contact dermatitis
Acute irritant dermatitis
basic lesion
cause
Bullous contact dermatitis
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Chronic palmar irritant dermatitis
Atopic dermatitis of the face in an infant
Infected retro-auricular dermatitis
Atopic dermatitis of childhood
Atopic dermatitis of the folds in a child
basic lesion
Cumulative insult dermatitis
cause
picture
alphabetical
page: 495
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Atopic cheilitis
Atopic dermatitis in the adult
Atopic conjunctivitis
Atopic dermatitis of the hands in the adult
Pityriasis alba
basic lesion
Eczema of the nipples
cause
picture
alphabetical
page: 496
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picture
alphabetical
page: 497
Juvenile plantar dermatosis
Nummular dermatitis
Nummular dermatitis
Gravitational eczema
Seborrhoeic dermatitis of the trunk
basic lesion
cause
Juvenile plantar dermatosis
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alphabetical
page: 498
Seborrhoeic dermatitis of the face
Pompholyx of the fingers
Bullous pompholyx of the palms
Eczematous pompholyx of the palms
Asteatotic eczema
basic lesion
cause
Seborrhoeic dermatitis of the hairline
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Prick test with latex
Provocative use test with latex gloves
Dermographism
Pressure urticaria
Cold urticaria
basic lesion
Latex contact urticaria
cause
picture
alphabetical
page: 499
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picture
alphabetical
page: 500
Urticated weals
Papular urticaria
Figured urticaria
Hereditary angio-oedema
Urticarial vasculitis
basic lesion
cause
Solar urticaria
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picture
alphabetical
page: 501
Herpes, type II (genital)
Varicella
Varicella
Zoster of the trunk
Ophthalmic nerve zoster
basic lesion
cause
Herpes, type I
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alphabetical
page: 502
Plane warts
Plane warts
Condylomata acuminata
Plantar wart
Mosaic warts
basic lesion
cause
Common warts
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alphabetical
page: 503
Hairy leucoplakia
Molluscum contagiosum
Multiple mollusca contagiosa
ORF
Erythema infectiosum
basic lesion
cause
Horny filiform wart
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page: 504
Measles
Hand-foot-and-mouth-disease
Hand-foot-and-mouth-disease
Hand-foot-and-mouth-disease
Rubella
basic lesion
cause
Erythema infectiosum
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page: 505
Necrotic herpes zoster
Seborrhoeic dermatitis
Prurigo
Gingivitis
Molluscum contagiosum
basic lesion
cause
Necrotic herpes zoster
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page: 506
Kaposi's sarcoma
Condylomata acuminata
Bullous impetigo
Non-bullous impetigo
Ecthyma
basic lesion
cause
Kaposi's sarcoma
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page: 507
Furuncle (BOIL)
Carbuncle
Erysipelas
Erysipelas
Orbital cellulitis
basic lesion
cause
Folliculitis
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page: 508
Erythema chronicum migrans
Erythema chronicum migrans
Borrelia pseudolymphoma
Proteus infection
Cat-scratch disease
basic lesion
cause
Septic emboli
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page: 509
Intertrigo
Lupus vulgaris
Lupus vulgaris
Scofuloderma
Complication of BCG vaccination
basic lesion
cause
Cat-scratch disease
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Infection with mycobacterium marinum
Infection with mycobacterium fortuitum or chelonae
Erythrasma
Trichomycosis axillaris
Pitted keratolysis
basic lesion
Infection with mycobacterium marinum
cause
picture
alphabetical
page: 510
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picture
alphabetical
page: 511
Syphilitic chancre (primary sore)
Secondary syphilis
Late secondary syphilis
Papular syphilids
Genital gonorrhoea
basic lesion
cause
Syphilitic chancre (primary sore)
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page: 512
Tinea corporis
Tinea faciei
Tinea faciei
Tinea cruris
Tinea manuum
basic lesion
cause
Tinea corporis
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alphabetical
page: 513
Tinea pedum (athlete's foot)
Tinea pedum (athlete's foot)
Tinea pedum (athlete's foot)
Tinea capitis or ringworm
Kerion
basic lesion
cause
Tinea manuum
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Kerion
Onychomycosis due to dermatophytes
Onychomycosis due to dermatophytes
Thrush
Angular cheilitis
basic lesion
Kerion
cause
picture
alphabetical
page: 514
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picture
alphabetical
page: 515
Candidal intertrigo
Candidal vulvovaginitis
Candidal balanitis
Candidal paronychia and subungual infection
Napkin candidiasis (infant)
basic lesion
cause
Candidal intertrigo
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picture
alphabetical
page: 516
Pityriasis versicolor
Pityriasis versicolor
Sporotrichosis
Mycetoma (Madura foot)
Human scabies
basic lesion
cause
Pityriasis versicolor
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picture
alphabetical
page: 517
Human scabies
Human scabies
Animal scabies
Pediculosis (head lice)
Pediculosis (head lice)
basic lesion
cause
Human scabies
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picture
alphabetical
page: 518
Crab lice (pubic lice)
Trombiculiasis
Trombiculiasis
Infantile papular urticaria (strophulus)
Flea bites
basic lesion
cause
Crab lice (pubic lice)
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alphabetical
page: 519
Leishmaniasis
Leishmaniasis
Leishmaniasis
Larva migrans (creeping eruption)
Larva migrans (creeping eruption)
basic lesion
cause
Flea bites
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picture
alphabetical
page: 520
Tungiasis (chigger)
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
basic lesion
cause
Tungiasis (chigger)
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page: 521
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
Pustular psoriasis
Pustular psoriasis
basic lesion
cause
Psoriasis vulgaris
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page: 522
Psoriatic erythroderma
Psoriatic erythroderma
Palmoplantar psoriasis
Flexural psoriasis
Psoriasis of the nails
basic lesion
cause
Pustular psoriasis
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page: 523
Psoriasis of the face
Mucosal psoriasis
Mucosal psoriasis
Pityriasis rosea
Pityriasis rosea
basic lesion
cause
Psoriasis of the scalp
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page: 524
Varioloid parapsoriasis
Varioloid parapsoriasis
Chronic superficial scaly dermatitis
Premycotic
Simple cutaneous lichen planus
basic lesion
cause
Pityriasis lichenoides
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page: 525
Simple cutaneous lichen planus
Oral lichen planus
Oral lichen planus
Hypertrophic lichen planus
Hypertrophic lichen planus
basic lesion
cause
Simple cutaneous lichen planus
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page: 526
Graft versus host disease
Graft versus host disease
Lichenification
Subacute prurigo
Subacute prurigo
basic lesion
cause
Lichen planus of the nails
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page: 527
Discoid lupus erythematosus
Discoid lupus erythematosus
Subacute lupus erythematosus
Systemic lupus erythematosus
Systemic lupus erythematosus
basic lesion
cause
Discoid lupus erythematosus
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page: 528
Dermatomyositis
Dermatomyositis
Localized morphoea
Localized morphoea
Systemic sclerosis
basic lesion
cause
Jessner and Kanof disease
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page: 529
Lichen sclerosus
Lichen sclerosus
Lichen sclerosus
Sarcoidosis
Sarcoidosis
basic lesion
cause
Systemic sclerosis
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page: 530
Sarcoidosis
Granuloma annulare
Necrobiosis lipoidica
Necrobiosis lipoidica
Vasculitis
basic lesion
cause
Sarcoidosis
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page: 531
Cutaneous vasculitis
Cutaneous vasculitis
Atrophie blanche
Atrophie blanche
Polyarteritis nodosa
basic lesion
cause
Cutaneous vasculitis
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page: 532
Erythema nodosum
Erythema nodosum
Nodular vasculitis
Pyoderma gangrenosum
Pyoderma gangrenosum
basic lesion
cause
Erythema elevatum diutinum
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page: 533
Erythema multiforme
Erythema multiforme
Erythema multiforme
Sweet's syndrome
Bullous pemphigoid
basic lesion
cause
Erythema multiforme
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page: 534
Pemphigus vulgaris
Pemphigus vulgaris
Pemphigus erythematosus
Pemphigus erythematosus
Benign familial chronic pemphigus
basic lesion
cause
Bullous pemphigoid
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page: 535
Dermatitis herpetiformis
Linear IgA bullous disease
Simple epidermolysis bullosa
Simple epidermolysis bullosa
Dystrophic forms of epidermolysis bullosa
basic lesion
cause
Dermatitis herpetiformis
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page: 536
Diabetic bullae
Porphyria cutanea tarda
Porphyria cutanea tarda
Bullous phytophotodermatitis
Acne vulgaris
basic lesion
cause
Dystrophic forms of epidermolysis bullosa
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page: 537
Acne vulgaris
Acne vulgaris
Acne conglobata
Acne conglobata
Infantile acne
basic lesion
cause
Acne vulgaris
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page: 538
Rosacea
Perioral dermatitis
Fixed pigmented erythema
Maculoppapular exanthema
Lyell's syndrome
basic lesion
cause
Rosacea
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Lichenoid eruptions
Drug-induced phototoxic eruption
Drug-induced photoallergic eruption
Acneiform facial eruption
Psoriatiform eruption
basic lesion
Lichenoid eruptions
cause
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page: 539
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page: 540
Cortisone atrophy
Bromide and iodide eruptions
Gingival hyperplasia
Melasma
Benign summer photodermatitis
basic lesion
cause
Drug-induced lupus
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page: 541
Chilblains
Alopecia areata
Alopecia areata
Pseudopelade
Trichotillomania
basic lesion
cause
Polymorphic light eruption
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page: 542
Aphtae, aphthosis, Behçet's disease
Aphtae, aphthosis, Behçet's disease
Aphtae, aphthosis, Behçet's disease
Black hairy tongue
Scrotal / fissured tongue
basic lesion
cause
Androgenetic alopecia
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Allergic contact cheilitis
Cheilitis caused by systemic use off isotretinoin
Darier's disease
Darier's disease
Ichthyosis vulgaris
basic lesion
Geographic tongue
cause
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Sex-linked (recessive) ichthyosis
Hereditary palmoplantar keratoderma
Pityriasis rubra pilaris
Pityriasis rubra pilaris
Keratosis pilaris
basic lesion
Sex-linked (recessive) ichthyosis
cause
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page: 544
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page: 545
Erythema annulare centrifugum
Erythema annulare centrifugum
Venous leg ulcer
Venous leg ulcer
Ischaemic (arterial) leg ulcer
basic lesion
cause
Keratosis pilaris
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page: 546
Neurotrophic leg ulcer
Neurotrophic leg ulcer
Skin self-mutilation simulated disease
Skin self-mutilation simulated disease
Self-mutilation, pathomimicry
basic lesion
cause
Ulcer caused by capillaritis
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page: 547
Seborrhoeic keratosis / wart
Seborrhoeic keratosis / wart
Verrucous epidermal naevus
Verrucous epidermal naevus
Inflammatory linear verrucous epidermal naevus
basic lesion
cause
Self-mutilation, pathomimicry
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page: 548
Becker's naevus
Clear cell acanthoma
Kerato-acanthoma
Spectacle frame acanthoma
Spectacle frame acanthoma
basic lesion
cause
Inflammatory linear verrucous epidermal naevus
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page: 549
Trichilemmal cyst
Milia
Trichoepithelioma
Senile sebaceous adenoma
Senile sebaceous adenoma
basic lesion
cause
Epidermoid cyst
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page: 550
Syringoma
Eccrine poroma
Eccrine poroma
Cylindroma
Dermatofibroma
basic lesion
cause
Jadassohn's sebaceous naevus
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page: 551
Acquired digital fibrokeratoma
Keloid
Skin tag
Juvenile xanthogranuloma
Tuberous xanthoma
basic lesion
cause
Dermatofibroma
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page: 552
Xanthelasma palpebrarum
Lipoma
Leiomyoma
Cutaneous mastocytosis
Cutaneous mastocytosis
basic lesion
cause
Tuberous xanthoma
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page: 553
Neural crest diseases
Neural crest diseases
Neural crest diseases
Neural crest diseases
Neural crest diseases
basic lesion
cause
Neural crest diseases
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page: 554
Angioma
Angioma
Angioma
Angioma
Angioma
basic lesion
cause
Angioma
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page: 555
Angioma
Angioma
Angioma
Lymphangioma
Chondrodermatitis nodularis helicis
basic lesion
cause
Angioma
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page: 556
Lentigo
Mongolian spot
Melanocytic naevi
Melanocytic naevi
Hairy melanocytic naevus
basic lesion
cause
Mucoid pseudocyst
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page: 557
Spitz naevus (juvenile)
Blue naevus
Halo naevus
Halo naevus
Naevus of the nails
basic lesion
cause
Congenital pigmented naevus
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page: 558
Solar keratoses
Actinic cheilitis
Leucoplakia
Bowen's disease
Bowen's disease
basic lesion
cause
Solar keratoses
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page: 559
Bowenoid papulosis
Radiodermatitis
Xeroderma pigmentosum
Dubreuilh's melanosis
Nodular basal cell carcinoma
basic lesion
cause
Eryhtroplasia of queyrat
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page: 560
Flat cicatricial basal cell carcinoma
Pigmented basal cell carcinoma
Pagetoid basal cellular carcinoma
Squamous cell carcinomas
Squamous cell carcinoma of the face
basic lesion
cause
Rodent ulcer
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Squamous cell carcinoma of the penis
Paget's disease
Cutaneous metastases
Cutaneous metastases
Melanoma (malignant)
basic lesion
cause
Squamous cell carcinoma of the lower lip
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Nodular melanoma
Melanoma over Dubreuilh's melanosis precancerosa
Acral lentiginous melanoma
Melanoma metastases
Dermatofibrosarcoma protuberans
basic lesion
Superficial spreading melanoma
cause
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Malignant lymphomas – mycosis fungoides
Malignant lymphomas – mycosis fungoides
Paraneoplastic syndromes
Bazex's paraneoplastic acrokeratosis
Hypertrichosis lanuginosa
basic lesion
Kaposi's angiosarcoma
cause
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basic lesion
cause
Hypertrichosis lanuginosa
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