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Manual ofPrimary
Care Dermatology
D.KishoreYellumahanthi
123
Manual of Primary Care Dermatology
D. Kishore Yellumahanthi
Manual of Primary Care
Dermatology
D. Kishore Yellumahanthi
Physician
Huntsville Hospital
Huntsville, Alabama, USA
Clinical Associate Professor
Department of Family Medicine
University of Alabama at Birmingham
Huntsville Regional Medical Campus
Huntsville, Alabama, USA
Adjunct Assistant Professor
of Dermatology
Department of Dermatology
Vanderbilt University School of Medicine
Nashville, Tennessee, USA
Adjunct Faculty
Department of Family Medicine
University of South Alabama
Mobile, Alabama, USA
ISBN 978-3-031-68405-0 ISBN 978-3-031-68406-7 (eBook)
https://doi.org/10.1007/978-3-031-68406-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse
of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
Disclaimer: Theauthor of this book cannot accept responsibility for any incorrect or misleading statements.
It needs to be understood that the management of a given patient remains the direct responsibility of the
individual healthcare provider.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
Preface
This book comprises mainly common dermatological cases that can be managed in
primary care. In order to tailor the book specifically to the needs of the practicing
primary care provider, only clinically relevant aspects of the diseases are discussed
in the book. The objective of the book is to aid primary care providers in making
sure the diagnosis of the common dermatological conditions seen and that can be
managed in primary care are not missed.
The differential diagnosis is mainly discussed based on the body part that is
affected with skin ailment. This type of compilation makes it easy for readers in
aiding in knowing the diagnosis of their patient’s skin condition as what all they
need to do is just to refer to that part of the book that discusses the relevant part of
the body, for instance, scalp, face or upper extremity.
v
vi Preface
I hope the book meets its objective and you will enjoy reading this book.
D. Kishore Yellumahanthi, MD, MPH
Physician, Huntsville Hospital
Huntsville, Alabama, USA
Clinical Associate Professor
Department of Family Medicine
University of Alabama at Birmingham
Huntsville Regional Medical Campus
Huntsville, Alabama, USA
Adjunct Assistant Professor of Dermatology
Department of Dermatology
Vanderbilt University School of Medicine
Nashville, Tennessee, USA
Adjunct Faculty
Department of Family Medicine
University of South Alabama
Mobile, Alabama, USA
Acknowledgements
First and foremost, I thank all my patients who had given me their consent to be
photographed and to be a part of this book. If not for them, this book would have
been incomplete.
My sincere thanks to my colleagues and staff at Family Medicine of Huntsville
and at Huntsville Hospital Physician Care, Airport Road, Huntsville, Alabama, USA,
for their continued cooperation.
My sincere appreciation to Mr. Grant Weston and other Springer Nature’s team
for making sure ‘my idea’ is transformed into print and electronic media and reached
the intended readers globally.
Last but not least, I am thankful to my wife, Lata and my children Shushruth and
Prithvi for their support during this time to make sure I have time to produce this
book.
vii
Contents
1 Morphology of Skin Lesions .................................... 1
Bibliography .................................................. 11
2 Topical Corticosteroids ........................................ 13
2.1 Topical Corticosteroids ................................... 13
2.1.1 The Common Factors That Determine
the Usage of Appropriate Topical Steroid .......... 13
2.1.2 Ointments, Creams and Lotions ................... 15
2.1.3 Adverse Effects of Topical Steroids ............... 15
Bibliography .................................................. 16
3 Papulosquamous Disorders (Skin Disorders with Scales) .......... 17
3.1 Psoriasis ............................................... 18
3.1.1 Psoriasis Vulgaris ............................... 18
3.1.2 Guttate Psoriasis ................................ 21
3.1.3 Variants of Psoriasis Based on the Site
of Involvement ................................. 22
3.2 Lichen Planus (LP) ...................................... 23
3.2.1 Diagnosis ..................................... 25
3.2.2 Management ................................... 25
3.3 Pityriasis Rosea ......................................... 26
3.3.1 Diagnosis ..................................... 27
3.3.2 Management ................................... 27
3.4 Cutaneous Lupus Erythematosus (CLE) .................... 28
3.4.1 Acute Cutaneous LE ............................ 28
3.4.2 Subacute Cutaneous LE ......................... 28
3.4.3 Chronic Cutaneous LE .......................... 30
3.4.4 Diagnosis of CLE .............................. 31
3.4.5 Management of CLE ............................ 32
3.5 Pityriasis Versicolor (Tinea Versicolor) ..................... 32
3.5.1 Diagnosis ..................................... 34
3.5.2 Management ................................... 34
ix
x Contents
3.6 Seborrheic Dermatitis .................................... 34
3.7 Tinea Corporis .......................................... 35
Bibliography .................................................. 36
4 Vesiculo Bullous Lesions (Blistering Rashes) ..................... 39
4.1 Contact Dermatitis ...................................... 39
4.1.1 Diagnostic Tips ................................ 39
4.1.2 Management ................................... 40
4.2 Insect Bites ............................................. 41
4.2.1 Management ................................... 41
4.3 Herpes Simplex ......................................... 41
4.3.1 Management ................................... 41
4.4 Herpes Zoster ........................................... 42
4.4.1 Management ................................... 42
4.5 Bullous Impetigo ........................................ 43
4.6 Hand Foot Mouth Disease ................................ 43
4.6.1 Management ................................... 43
4.7 Bullous Pemphigoid (BP) ................................ 44
4.7.1 Clinical Features ............................... 44
4.7.2 Diagnosis ..................................... 45
4.7.3 Management ................................... 46
4.7.4 Prognosis ...................................... 46
4.8 Pemphigus Vulgaris (PV) ................................. 46
4.8.1 Etiology ....................................... 46
4.8.2 Clinical Features ............................... 47
4.8.3 Diagnosis ..................................... 47
4.8.4 Management ................................... 48
Bibliography .................................................. 49
5 Eczema ...................................................... 51
5.1 Atopic Dermatitis (AD) .................................. 52
5.1.1 Diagnosis ..................................... 52
5.1.2 Management ................................... 53
5.2 Seborrheic Dermatitis .................................... 55
5.2.1 Management ................................... 57
5.3 Pompholyx (Dyshidrotic Eczema) ......................... 58
5.3.1 Diagnosis ..................................... 59
5.3.2 Management ................................... 59
5.4 Stasis Dermatitis or Stasis Eczema ......................... 59
5.4.1 Diagnosis ..................................... 59
5.4.2 Management ................................... 59
5.5 Asteatotic Eczema (Eczema Craquele) ..................... 60
5.5.1 Management ................................... 60
5.6 Nummular Eczema (Nummular Dermatitis) (Discoid
Eczema) ............................................... 60
5.6.1 Diagnosis ..................................... 61
5.6.2 Management ................................... 61
Contents xi
5.7 Exogenous Eczema ...................................... 61
5.7.1 Contact Dermatitis .............................. 61
Bibliography .................................................. 64
6 Common Cutaneous Infections ................................. 67
6.1 Impetigo ............................................... 68
6.1.1 Diagnosis ..................................... 69
6.1.2 Management ................................... 69
6.2 Folliculitis ............................................. 70
6.2.1 Diagnosis ..................................... 70
6.2.2 Management ................................... 70
6.3 Furuncle (Boil): (Fig. 6.2) ................................ 71
6.3.1 Management ................................... 71
6.4 Carbuncle and Abscess ................................... 71
6.4.1 Carbuncle ..................................... 71
6.4.2 Abscess (Fig. 6.3) .............................. 72
6.4.3 Management ................................... 72
6.5 Cellulitis ............................................... 73
6.5.1 Diagnosis ..................................... 74
6.5.2 Management ................................... 75
6.6 Erythrasma ............................................. 75
6.6.1 Diagnosis ..................................... 76
6.6.2 Treatment ..................................... 76
6.7 Molluscum Contagiosum (MC) (Fig. 6.6) ................... 77
6.7.1 Diagnosis ..................................... 78
6.7.2 Management ................................... 78
6.8 Herpes Simplex ......................................... 78
6.8.1 Clinical Features ............................... 79
6.8.2 Diagnosis of Herpes Simplex ..................... 80
6.8.3 Management ................................... 80
6.9 Herpes Zoster (HZ) ...................................... 82
6.9.1 Diagnosis ..................................... 83
6.9.2 Management ................................... 83
6.10 Cutaneous HPV Infection (Verruca Vulgaris or Warts) ........ 84
6.10.1 Diagnosis ..................................... 86
6.10.2 Management ................................... 87
6.11 Dermatophytosis (Ring Worm) ............................ 88
6.11.1 Tinea Manuum (T. manuum) ..................... 89
6.11.2 Tinea Cruris (Jock Itch) (T. cruris) ................ 89
6.11.3 Tinea Pedis (T. pedis) ........................... 90
6.11.4 Tinea Capitis (T. capitis) (Figs. 6.15 and 6.16) ...... 91
6.11.5 Onychomycosis or Tinea Unguim or Nail
Fungus ........................................ 92
6.11.6 Diagnosis of Dermatophytic Infections ............ 92