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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5220_Библиотеки_им_академика_М_И_Перельмана.pdf
xii Contents
6.11.7 Management of Dermatophytes ................... 93
6.12 Cutaneous Candidiasis ................................... 93
6.12.1 Diagnosis ..................................... 94
6.12.2 Management ................................... 94
6.13 Scabies ................................................ 95
6.13.1 Diagnosis ..................................... 95
6.13.2 Treatment ..................................... 96
Bibliography .................................................. 96
7 Cutaneous Malignancy ........................................ 99
7.1 Basal Cell Carcinoma (BCC) ............................. 99
7.1.1 Nodular BCC (Fig. 7.1) ......................... 100
7.1.2 Pigmented BCC (Fig. 7.3) ....................... 101
7.1.3 Superficial BCC ................................ 102
7.1.4 Morpheaform/Infiltrative BCC .................... 103
7.1.5 BCC Metastasis ................................ 103
7.1.6 BCC Diagnosis ................................. 104
7.1.7 BCC Management .............................. 104
7.2 Squamous Cell Cancer (SCC) (Figs. 7.7 and 7.8) ............ 106
7.2.1 Keratoacanthoma (KA) .......................... 107
7.2.2 Bowen’s Disease ............................... 108
7.2.3 SCC Diagnosis ................................. 109
7.2.4 SCC Management .............................. 109
7.3 Melanoma ............................................. 110
7.3.1 Superficial Spreading Melanoma (Fig. 7.10) ........ 111
7.3.2 Nodular Melanoma (Fig. 7.11) ................... 112
7.3.3 Lentigo Maligna Melanoma (LMM) ............... 112
7.3.4 Acral Lentiginous Melanoma ..................... 114
7.3.5 Amelanotic Melanoma .......................... 114
7.3.6 Melanoma—Metastasis .......................... 115
7.3.7 Melanoma Diagnosis ............................ 115
7.3.8 Treatment of Melanoma ......................... 115
7.4 Diagnosis of Skin Cancer ................................. 115
7.4.1 Skin Examination Tips .......................... 115
7.4.2 Dermoscopy ................................... 116
7.4.3 Skin Biopsy/Histopathological Examination ........ 116
7.5 Management of Skin Cancer—Prevention & Treatment ....... 116
7.6 Skin Cancer and Color of the Skin ......................... 117
Bibliography .................................................. 117
8 Scalp ......................................................... 121
8.1 Androgenetic Alopecia (AGA) ............................ 122
8.1.1 Diagnosis ..................................... 123
8.1.2 Management ................................... 124
Contents xiii
8.2 Alopecia Areata (AA) ................................... 125
8.2.1 Clinical Features ............................... 125
8.2.2 Diagnosis ..................................... 126
8.2.3 Management ................................... 126
8.3 Telogen Effluvium ....................................... 127
8.3.1 Diagnosis ..................................... 127
8.3.2 Management ................................... 128
8.4 Trichotillomania ........................................ 128
8.4.1 Diagnosis ..................................... 128
8.4.2 Management ................................... 129
8.5 Seborrheic Dermatitis (Fig. 8.3) (SD) ...................... 129
8.6 Psoriasis Scalp .......................................... 130
8.6.1 Management ................................... 131
8.7 Actinic Keratoses ....................................... 132
8.7.1 Diagnosis ..................................... 133
8.7.2 Management ................................... 133
8.8 Contact Dermatitis ...................................... 134
8.8.1 Management ................................... 135
8.9 Acne Keloidalis Nuchae (Folliculitis Keloidalis Nuchae) ...... 135
8.9.1 Management ................................... 136
Bibliography .................................................. 137
9 Face ......................................................... 139
9.1 Acne Vulgaris .......................................... 139
9.1.1 Diagnosis ..................................... 141
9.1.2 Treatment of Acne .............................. 141
9.2 Rosacea ................................................ 145
9.2.1 Diagnosis ..................................... 146
9.2.2 Management ................................... 147
9.3 Perioral Dermatitis ...................................... 147
9.3.1 Diagnosis ..................................... 148
9.3.2 Management ................................... 148
9.4 Atopic Dermatitis (AD) (Fig. 9.8) ......................... 149
9.5 Contact Dermatitis (Fig. 9.9) .............................. 150
9.5.1 Management ................................... 151
9.6 Actinic Keratosis ........................................ 151
9.6.1 Management ................................... 152
9.7 Phtosensitivity Rash ..................................... 152
9.8 Cutaneous Infections .................................... 153
9.9 Pseudofolliculitis Barbae ................................. 154
9.9.1 Management ................................... 154
9.10 Seborrheic Dermatitis .................................... 154
9.11 Discoid Lupus Erythematosus (DLE) (Fig. 9.12) ............. 154
xiv Contents
9.12 Melasma (Fig. 9.13) ..................................... 155
9.12.1 Management ................................... 156
Bibliography .................................................. 156
10 Trunk ........................................................ 159
10.1 Acne Vulgaris .......................................... 160
10.2 Psoriasis ............................................... 161
10.3 Pityriasis Rosea (PR) .................................... 162
10.4 Pityriasis Versicolor (Figs. 10.4 and 10.5) ................... 162
10.5 Cutaneous Infections .................................... 163
10.5.1 Tinea Corporis ................................. 164
10.6 Seborrheic Dermatitis (SD) ............................... 165
10.7 Contact Dermatitis ...................................... 166
10.8 Subacute Cutaneous Lupus Erythematosus (SCLE) .......... 167
Bibliography .................................................. 168
11 Upper Extremity Including Hands .............................. 169
11.1 Keratosis Pilaris (KP) .................................... 170
11.1.1 Diagnosis ..................................... 171
11.1.2 Management ................................... 171
11.2 Actinic Purpura or Senile Purpura (Bateman Purpura) ........ 171
11.2.1 Diagnosis ..................................... 172
11.2.2 Management ................................... 172
11.3 Actinic Keratoses (AK) .................................. 173
11.4 Acne Vulgaris .......................................... 174
11.5 Atopic Dermatitis (AD) .................................. 174
11.6 Nummular Eczema or Nummular Dermatitis or Discoid
Eczema ................................................ 175
11.6.1 Management ................................... 176
11.7 Psoriasis Vulgaris ....................................... 176
11.8 Lichen Planus (LP) ...................................... 177
11.9 Granuloma Annulare (GA) ............................... 178
11.9.1 Diagnosis ..................................... 180
11.9.2 Management ................................... 180
11.10 Pompholyx (Dyshydrotic Eczema) ......................... 180
11.10.1 Management ................................... 182
11.11 Hand Eczema (Figs. 11.10 and 11.11) ...................... 182
11.12 Palmoplantar Psoriasis (Figs. 11.12 and 11.13) .............. 184
11.12.1 Diagnosis ..................................... 186
11.12.2 Management ................................... 187
11.13 Cutaneous Infections .................................... 187
11.13.1 Tinea Manuum ................................. 187
11.13.2 Acute Staphylococcal Paronychia ................. 188
Bibliography .................................................. 189
Contents xv
12 Axilla ........................................................ 191
12.1 Contact Dermatitis ...................................... 191
12.2 Cutaneous Infections .................................... 193
12.2.1 Tinea Axillaris (Fig. 12.3) ....................... 193
12.2.2 Candidiasis .................................... 194
12.2.3 Erythrasma (Fig. 12.5) .......................... 195
12.3 Hidradenitis Suppurativa (HS) ............................ 196
12.3.1 Management ................................... 196
Bibliography .................................................. 199
13 Genitals and Groin ............................................ 201
13.1 Tinea Cruris ............................................ 201
13.1.1 Diagnosis ..................................... 202
13.1.2 Management ................................... 202
13.2 Erythrasma ............................................. 203
13.2.1 Management ................................... 203
13.3 Candidiasis ............................................. 204
13.3.1 Management ................................... 205
13.4 Contact Dermatitis ...................................... 205
13.4.1 Diagnosis ..................................... 205
13.4.2 Management ................................... 205
13.5 Inverse or Flexural Psoriasis .............................. 206
13.5.1 Diagnosis ..................................... 207
13.5.2 Management ................................... 207
13.6 Lichen Sclerosus et Atrophicus ............................ 207
13.6.1 Diagnosis ..................................... 208
13.6.2 Management ................................... 208
13.7 Pearly Penile Papules .................................... 208
13.7.1 Management ................................... 209
13.8 Genital Warts (Fig. 13.6) ................................. 209
13.8.1 Management ................................... 210
13.9 Herpes ................................................. 210
13.10 Syphilis ................................................ 210
13.10.1 Diagnosis ..................................... 210
13.10.2 Management ................................... 211
13.11 Erythroplasia of Queyrat ................................. 212
13.11.1 Management ................................... 212
Bibliography .................................................. 212
14 Legs ......................................................... 215
14.1 Cutaneous Small Vessel Vasculitis (CSVV) ................. 215
14.1.1 Management ................................... 216
14.2 Stasis Dermatitis (Fig. 14.2) .............................. 216
14.2.1 Management ................................... 217
xvi Contents
14.3 Erythema Nodosum (EN) (Fig. 14.3) ....................... 218
14.3.1 Clinical Features ............................... 219
14.3.2 Management ................................... 219
14.4 Lichen Simplex Chronicus (LSC) (Fig. 14.4) ................ 219
14.4.1 Management ................................... 220
14.5 Nummular Eczema (Nummular Dermatitis) (Discoid
Eczema) ............................................... 220
14.5.1 Management ................................... 221
14.6 Asteatotic Eczema (Eczema Craquele) ..................... 222
14.6.1 Management ................................... 223
14.7 Atopic Dermatitis (AD) (Fig. 14.7) ........................ 223
14.8 Psoriasis Vulgaris (Fig. 14.8) ............................. 224
Bibliography .................................................. 225
15 Feet .......................................................... 227
15.1 Tinea Pedis (Athlete’s Foot) .............................. 227
15.1.1 Clinical Manifestations .......................... 227
15.1.2 Diagnosis ..................................... 229
15.1.3 Management ................................... 229
15.2 Psoriasis ............................................... 229
15.2.1 Diagnosis ..................................... 230
15.2.2 Management ................................... 231
15.3 Contact Dermatitis ...................................... 231
15.3.1 Management ................................... 231
15.4 Corns (Fig. 15.4) ........................................ 231
15.4.1 Diagnosis ..................................... 232
15.4.2 Management ................................... 232
15.5 Callosity (Fig. 15.5) ..................................... 232
15.5.1 Diagnosis ..................................... 233
15.5.2 Management ................................... 233
15.6 Plantar Warts (Fig. 15.6) ................................. 234
15.7 Pompholyx (Dyshidrotic Eczema) ......................... 235
15.7.1 Management ................................... 235
15.8 Erythrasma ............................................. 235
15.9 Candidal Intertrigo (Fig. 15.8) ............................ 235
15.10 Cutaneous Small Vessel Vasculitis (CSVV) (Fig. 15.9) ....... 236
Bibliography .................................................. 237
16 Common Disorders of Nails .................................... 239
16.1 Anatomy of the Nail Apparatus ........................... 239
16.2 Subungual Hyperkeratosis ................................ 240
16.3 Onycholysis ............................................ 241
16.3.1 Management ................................... 241
16.4 Nail Pitting (Fig. 16.2) ................................... 241
Contents xvii
16.5 Onychomycosis ......................................... 242
16.5.1 Clinical Features ............................... 243
16.5.2 Diagnosis ..................................... 244
16.5.3 Management ................................... 244
16.6 Nail Psoriasis ........................................... 245
16.6.1 Clinical Presentation ............................ 245
16.6.2 Diagnosis ..................................... 245
16.6.3 Management ................................... 245
16.7 Pseudomonas Infection of the Nail ......................... 246
16.7.1 Management ................................... 247
16.8 Paronychia ............................................. 247
16.8.1 Acute Paronychia ............................... 247
16.8.2 Chronic Paronychia ............................. 248
16.9 Subungual Hematoma ................................... 248
16.9.1 Management ................................... 249
16.10 Longitudinal Melanocytic Nevus (LMN) (Fig. 16.7) .......... 249
16.11 Nail Melanoma ......................................... 250
Bibliography .................................................. 250
17 Pregnancy Dermatoses ......................................... 253
17.1 Pemphigoid Gestationis (PG) or Herpes Gestationis .......... 253
17.1.1 Clinical Features ............................... 253
17.1.2 Diagnosis ..................................... 254
17.1.3 Fetal Risk (Himeles and Pomeranz 2022) .......... 254
17.1.4 Management ................................... 254
17.1.5 Prognosis ...................................... 254
17.2 Polymorphic Eruption of Pregnancy ....................... 255
17.2.1 Clinical Features ............................... 255
17.2.2 Fetal Risk ..................................... 255
17.2.3 Diagnosis ..................................... 255
17.2.4 Management ................................... 255
17.2.5 Prognosis ...................................... 256
17.3 Atopic Eruption of Pregnancy (AEP) ....................... 256
17.3.1 Clinical Features ............................... 256
17.3.2 Fetal Risk ..................................... 256
17.3.3 Diagnosis ..................................... 256
17.3.4 Management ................................... 257
17.4 Intrahepatic Cholestasis of Pregnancy (ICP) ................. 257
17.4.1 Clinical Features ............................... 257
17.4.2 Fetal Risk ..................................... 257
17.4.3 Diagnosis ..................................... 257
17.4.4 Management ................................... 258
17.4.5 Prognosis ...................................... 258
Bibliography .................................................. 258
xviii Contents
18 Skin Biopsies and Cryosurgery ................................. 259
18.1 Skin Biopsy ............................................ 259
18.1.1 Shave Biopsy .................................. 259
18.1.2 Punch Biopsy .................................. 260
18.1.3 Excisional Biopsy Using an Elliptical Excision ..... 261
18.2 Cryosurgery ............................................ 262
Bibliography .................................................. 264
Index ............................................................. 265
About the Author
Dr. D. Kishore Yellumahanthi, MD, MPH, FAAFP
Currently works as Physician for Huntsville Hospital in
Huntsville, Alabama. He practices primary care with a
strong affinity for dermatological diseases.
ment of Family Medicine, University of Alabama
at Birmingham (UAB), Huntsville Regional Medical
Campus, Alabama and Adjunct Assistant Professor
of Dermatology at Vanderbilt University of School
of Medicine, Nashville, Tennessee. He also serves as
Adjunct Faculty in the Department of Family Medicine
at University of South Alabama, Mobile, Alabama.
unique in that he has expertise and formal training
in both Dermatology and Family Medicine. He has
completed Residency in Family Medicine at the University of Alabama, Tuscaloosa, Alabama. Prior to that, he
had also completed postgraduate training in MD Dermatology (Equivalent to Residency in Dermatology) in
India and worked as Consultant Dermatologist for few
years.
nals and presented his scientific work at several
national and international conferences including American Academy of Dermatology (AAD) Annual Meetings. His research work has won several accolades
including the ‘Best Scientific Paper’ (Southern Surgical
Association Annual Meeting, Palm Beach, Florida), and
‘Outstanding Research Award’ (Residency, University
of Alabama, Tuscaloosa, Alabama).
He is a Clinical Associate Professor at the Depart-
Dr. Yellumahanthi’s educational background is
Dr. Yellumahanthi has published in reputed jour-
xix
xx About the Author
Dr. Yellumahanthi enjoys sharing his knowledge and
expertise with primary care providers, trainees and the
community through guest lectures.
He was invited as guest speaker at various levels
including the American Academy of Family Physicians
(AAFP) Scientific Assembly.
Dr. Yellumahanthi is a distinguished Fellow of Amer-
ican Academy of Family Physicians and American
Contact Dermatitis Society. He is a member of International Dermoscopy Society and National Psoriasis
Foundtion.
Chapter 1
Morphology of Skin Lesions
Abstract In order to be able to diagnose dermatological diseases, knowing the
descriptive terminology is useful. Also, being able to precisely describe skin lesions
helps in communication among healthcare providers. Included in this chapter are
description of the morphology of the skin lesions that are commonly encountered.
Keywords Macule · Patch · Atrophy · Purpura · Excoriation · Erosion · Crust ·
Lichenification · Plaque · Blister · Ve s ic le · Bulla · Papule
Macule: A circumscribed discoloration of the skin of size less than 1 cm that is even
with the surface level of the surrounding skin (Fig.
Patch: A circumscribed discoloration of the skin of size equal to or greater than 1 cm
that is even with the surface level of the surrounding skin (Fig.
1.1).
1.2).
Papule: A circumscribed elevated solid skin lesion that is less than 1.0 cm in size
1.3).
(Fig.
Plaque: A plaque is usually formed by coalescence of papules. It is a raised solid
plateau like skin lesion, that has a diameter of 1 cm or more (Fig.
Vesicles and Bullae: Vesicle is a visible fluid filled skin lesion that is less than 1 cm
in diameter (Fig.
or equal to 1 cm.
See tense bulla in Fig. 1.6 and flaccid bulla in Fig. 1.7.
Pustule: A pustule is a circumscribed raised skin lesion containing visible pus
1.8).
(Fig.
Nodule: A solid or cystic mass in the skin which can either be palpated or found as
an elevation during inspection of the skin. It is more than 1 cm in diameter (Fig.
Ulcer of the skin: A loss of epidermis and at least a part of the underlying dermis
1.10).
(Fig.
© 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_1
1.5). Bullae are similar to vesicles except that size is greater than
1.4).
1.9).
1