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10.6 Seborrheic Dermatitis (SD) 165
Fig. 10.7 Tinea corporis on
the back of the trunk
– Please see Chap. 6 on ‘Common Cutaneous Infections’ for details on clinical
presentation, diagnosis and management of tinea corporis, scabies and other
infections mentioned above.
10.6 Seborrheic Dermatitis (SD)
– The exact etiology is multifactorial.
– Malasseizia, the normal body yeast is the likely the cause of seborrheic dermatitis.
– SD is considered as an inflammatory response to Malassezia species (Borda et al.
2019
).
It manifests as erythematous plaques with greasy-looking scales that involves the
–
seborrheic areas such as front of the chest (Fig.
10.8).
– Not always all the seborrheic areas are involved. However, examination of all the
seborrheic areas needs to be done anytime seborrheic dermatitis is suspected on
the trunk.
– Please see Chap. 5, ‘Eczema’ for more details on its clinical presentation,
diagnosis and management.
166 10 Trunk
Fig. 10.8 Seborrheic
dermatitis
10.7 Contact Dermatitis
–
Nickel allergy and allergy to textile products are among others that can cause
contact dermatitis on the trunk.
– Nickel allergy is very common. Among many others, nickel is an ingredient in
the jean buttons and bra hooks. Therefore, any rashes that are in the vicinity of
bra hooks and jean buttons (Fig.
–
Please see Chap. 5, ‘Eczema’, for more details on clinical presentation, diagnosis
10.9) need to be ruled out for nickel allergy.
and management of contact dermatitis.
Fig. 10.9 Contact dermatitis to jean button. Likely due to nickel allergy
10.8 Subacute Cutaneous Lupus Erythematosus (SCLE) 167
10.8 Subacute Cutaneous Lupus Erythematosus (SCLE)
– The eruption appears in a photodistributed fashion. Scaly lesions or annular or
polycyclic lesions appear in the sun-exposed areas such as V of the chest and
upper back (Figs.
aspects of upper extremities.
– Management: Management includes photoprotection, topical potent corticos-
teroids, topical calcineurin inhibitors and/or systemic glucocorticoids depending
on the extent of involvement and subset of disease. Recommend patients of SCLE
can be referred to either a dermatologist and/or rheumatologist to rule out systemic
Fig. 10.10 Subacute
cutaneous lupus
erythematosus involving V
area of the chest
10.10 and 10.11). Similar lesions can also be seen on extensor
Fig. 10.11 Subacute
cutaneous lupus
erythematosus involving the
upper back of the trunk that
is usually exposed to sun
168 10 Trunk
lupus erythematosus (SLE) and the need for hydroxychloroquine for long time
management.
– Please see Chap. 3, ‘Papulosquamous Disorders’, for more details on clinical
presentation, diagnosis and management of SCLE.
Bibliography
Borda LJ, Perper M, Keri JE. Treatment of seborrheic dermatitis: a comprehensive review. J
Dermatol Treatment. 2019;30(2):158–69.
Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet.
2021;397(10281):1301–15.
.Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options.
Exp Opin Pharmacother. 2014;15(12):1707–13.
pityriasis-versicolor-an-update-on-pharmacological-treatment-options/?from_term=%234+
AND+%233&from_sort=&from_pos=4&from_exact_term=%28malassezia+furfur%29+
AND+%28Pityriasis+versicolor%29
Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet 2012;379(9813):361–72. https://
www.sciencedirect.com/science/article/pii/S0140673611603218
Yee G, Al Aboud AM. Tinea corporis. In: StatPearls. Treasure Island (FL). StatPearls Publishing;
2024.
https://www.ncbi.nlm.nih.gov/books/NBK544360/
https://www.ncbi.nlm.nih.gov/pubmed/29737895
https://pubmed.ncbi.nlm.nih.gov/24991691-
Chapter 11
Upper Extremity Including Hands
Abstract This chapter provides an overview of the common dermatological condi-
tions such as keratosis pilaris, actinic purpura, Actinic keratosis, Granuloma annulare
that can involve the upper extremity. The chapter discusses mainly from their clinical
perspective. It provides details about the clinical presentation of these conditions and
ways to diagnose them; where appropriate it provides clinical information regarding
how to diagnose them clinically. It also discusses their treatment options and where
appropriate the circumstances as to when the patients need to be referred to the
dermatologist.
Keywords Keratosis pilaris · Senile purpura · Actinic keratosis · Atopic
dermatitis
Palmoplantar psoriasis · Pompholyx/dyshyrotic eczema · Hand eczema
· Nummular eczema · Psoriasis · Lichen planus · Granuloma annulare ·
Upper Extremity
•
Keratosis pilaris.
•
Acne.
•
Senile purpura.
•
Actinic keratosis.
•
Eczema.
– Atopic dermatitis.
– Nummular eczema
•
Psoriasis.
•
Lichen planus.
•
Cutaneous infections.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
D. K. Yellumahanthi, Manual of Primary Care Dermatology,
https://doi.org/10.1007/978-3-031-68406-7_11
169
170 11 Upper Extremity Including Hands
11.1 Keratosis Pilaris (KP)
– KP is a common and chronic skin disorder that manifests as keratotic follicular
papules (Fig.
– There could be perifollicular erythema.
– It is common in children.
– Commonly affects the extensor surfaces of arms, buttocks and upper legs (Hosking
2018).
et al.
– It’s exact etiology is unknown (Hosking et al. 2018).
Fig. 11.1 Keratosis pilaris
11.1).
11.2 Actinic Purpura or Senile Purpura (Bateman Purpura) 171
11.1.1 Diagnosis
– Diagnosis is usually obvious based on clinical examination.
11.1.2 Management
– It has a tendency to improve over the years (Pennycook and McCready
2023). Patients or parents should be made aware of it.
– Emolients and keratolytic preparations containing urea, lactic acid or salicyclic
acid can help soften the lesions (Cohen et al.
– Topical retinoids such as 0.01% tazarotene can also be tried (Gerbig 2002).
– Topical low potent steroids for a brief time can help in relieving the symptoms of
itch but do not help in improving the lesions (Bruckner
2020).
2019).
11.2 Actinic Purpura or Senile Purpura (Bateman
Purpura)
– Acinic purpura commonly manifests in elderly as purpura on the sun exposed
areas of the body such as extensor aspects of forearm (Fig.
– It is as a result of chronic sun exposure and age related skin thinning. Both these
factors make the cutaneous microvasculature fragile to the extent that even minor
trauma can lead to extravasation of the blood (Fenske and Lober
Drugs such as aspirin and other blood thinners can exacerbate senile purpura
–
).
(Kerns et al.
– Purpura is usually resolved within about 2–3 weeks and often postinflammatory
hyperpigmentation may result (Cho et al.
2019a
2019b
).
11.2).
1986).
172 11 Upper Extremity Including Hands
Fig. 11.2 Actinic purpura
11.2.1 Diagnosis
– In typical cases diagnosis is obvious from history and physical examination.
Complete blood count may be done if patient is seen with initial episode to
make sure there is no thrombocytopenia. If patient gives history of recurrent
episodes that are suggestive of repeated episodes of actinic purpura, then no lab
testing is needed.
11.2.2 Management
–
Assurance and education about the benign nature of the condition is often
adequate.
11.3 Actinic Keratoses (AK) 173
11.3 Actinic Keratoses (AK)
– Actinic keratoses are neoplasms of keratinocyte occurring on skin that has been
chronically exposed to ultraviolet radiation such as face, ears, balding scalp, dorsal
hands and forearms (Eisen et al. 2021; Marks et al. 1986; Leonard 2010; Salasche
2000).
– Classically manifests as a rough scaly papule on an erythematous base (Fig. 11.3).
– There are clinical variants such as hypertrophic, atrophic and pigmented. Some
of them can develop cutaneous horns.
– The lesions usually measure between 3 mm to 1 cm in diameter, most being less
than 6 mm.
– AKs can regress on their own or, can evolve into keratinocyte carcinoma if left
untreated (Marks et al.
Czarnecki et al.
Fig. 11.3 Actinic keratosis
2002;Glogau 2000; Mittelbronn et al. 1998).
1988,Elmetsetal. 2010; Berman and Cockerell 2013;
174 11 Upper Extremity Including Hands
– The estimated risk of progression of AK to SCC vary from less than 0.1% to 20%
(Marks et al.
1988; Criscione et al. 2009; Werner et al. 2013).
–
Please see Chap. 8
and management of AK.
, ‘Scalp’ for more details on clinical presentation, diagnosis
11.4 Acne Vulgaris
–
Papules, pustules, cysts and comedones can be seen, while the latter ones are
the characteristic lesions. Comedones can be closed (white heads) or open (black
heads).
–
They are variably distributed and treatment is based on the lesions that are seen.
– Common areas are Face, V area of the chest, back of the trunk and upper arms.
Examining all these areas could aid in the diagnosis.
– Please see Chap. 9
management.
, ‘Face’ for more details on its clinical presentation and
11.5 Atopic Dermatitis (AD)
Atopic dermatitis is an inflammatory skin disease that is characterized by
–
recurrent, pruritic, localized eczema, often associated with seasonal fluctuations.
– The disorder can be associated with asthma, allergic rhino conjunctivitis, food
allergies and other immediate hypersensitivity allergies.
– It usually develops in childhood and may persist into adulthood; less commonly,
it can start in midlife or late life.
– The clinical presentation can vary depending on age, disease stage, race or ethnic
group and geographic location.
When AD manifests on upper extremity, it usually involves flexors such as
cubital fossa and ventral aspect of the wrists (Ständer
This type of presentation is more common in children above 2years and in
adults.
– Please s ee Chap. 5
management.
, ‘Eczema’ for more details on its clinical presentation and
2021b) (Fig. 11.4).