Appendix A: Table of Primary Lesions and Related Disorders

BullaeErysipelas [Part III]Erythema multiforme [Part III]Fixed drug eruption [Part III]Impetigo [Part VI]Tinea (large, multiloculated) [Part III]Urticaria (bullae as secondary lesions) [Part III]

MaculesActinic keratosis (erythematous) [Part V]Atypical nevi [Part V]Common benign nevi (pigmented) [Part V]Ephelides [Part V]Erysipelas (erythematous) [Part III]Erythema multiforme (erythematous) [Part III]Erythrasma [Part III]Fixed drug eruption [Part III]Halo nevi [Part V]Impetigo (deep red) [Part VI]Lentigines [Part V]Malignant melanoma [Part V]

NodulesAcne [Part VI]Basal cell carcinoma (translucent, dome-shaped) [Part V]Keratoacanthoma (dome-shaped) [Part V]Malignant melanoma [Part V]Molluscum (dome-shaped umbilicated) [Part II]Rosacea (red) [Part VI]Squamous cell carcinoma (indurated) [Part V]Verruca vulgaris [Part II]

PapulesAcne (with or without comedones) [Part VI]Atopic dermatitis [Part IV]Atypical nevi [Part V]Basal cell carcinoma (translucent, dome-shaped) [Part V]Developed dermal nevi (sharply defined) [Part V]DLE (sharply defined, raised, smooth, shiny) [Part IV]Early compound nevi (dome-shaped) [Part V]Erythema multiforme (erythematous) [Part III]

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From: Current Clinical Practice: Dermatology Skills for Primary Care: An Illustrated GuideD.J. Trozak, D.J. Tennenhouse, and J.J. Russell © Humana Press, Totowa, NJ

370 Appendices

Halo nevi [Part V]Keratoacanthoma (dome-shaped) [Part V]Lichen planus (flat-topped, angular, polygonal) [Part II]Malignant melanoma [Part V]Mature compound nevi (sharply defined) [Part V]Mature dermal nevi (pedunculated) [Part V]Miliaria (small, erythematous) [Part II]Molluscum (dome-shaped umbilicated) [Part II]Pityriasis rosea (rosy red) [Part II]Psoriasis (erythematous, scaling) [Part II]Rosacea (red) [Part VI]Scabies (papulovesicle at end of burrow) [Part II]Seborrheic dermatitis (red-brown, follicular) [Part II]Seborrheic keratosis [Part V]SLE (sharply defined, may coalesce) [Part IV]Squamous cell carcinoma (indurated) [Part V]Striae distensae (yellow papules as secondary lesions) [Part IV]Tinea (follicular) [Part III]Verruca vulgaris [Part II]

PatchesActinic keratosis (erythematous) [Part V]Asteatosis [Part IV]Atopic dermatitis [Part IV]Erythrasma [Part III]Malignant melanoma [Part V]Rosacea (erythematous) [Part VI]Seborrheic keratosis [Part V]Senile purpura (purple) [Part IV]Striae distensae (linear) [Part IV]Tinea [Part III]Toxicodendron dermatitis (linear) [Part IV]

PlaquesActinic keratosis (thin) [Part V]Atypical nevi [Part V]Basal cell carcinoma [Part V]Congenital melanocytic nevi (pigmented) [Part V]Developed compound nevi [Part V]DLE (sharply defined, raised, smooth, shiny) [Part IV]Erysipelas (erythematous) [Part III]Erythema multiforme (erythematous) [Part III]Fixed drug eruption [Part III]Herpes simplex (erythematous) [Part VI]Herpes zoster (erythematous) [Part VI]Impetigo (red) [Part VI]Lichen planus (coalescing papules) [Part II]

Appendices 371

Malignant melanoma [Part V]Molluscum (tightly-grouped papules) [Part II]Pityriasis rosea (rosy red) [Part II]Psoriasis [Part II]SCLE (sharply defined) [Part IV]Seborrheic keratosis [Part V]SLE (edematous) [Part IV]Squamous cell carcinoma (indurated) [Part V]Tinea (indurated) [Part III]Toxicodendron dermatitis (linear) [Part IV]Urticaria (edematous) [Part III]

PustulesAcne [Part VI]Herpes simplex (late) [Part VI]Herpes zoster (late) [Part VI]Miliaria (as secondary lesions) [Part II]Rosacea (dome-shaped) [Part VI]Tinea (follicular) [Part III]

VesiclesAtopic dermatitis [Part IV]Erysipelas [Part III]Erythema multiforme [Part III]Fixed drug eruption [Part III]Herpes simplex [Part VI]Herpes zoster [Part VI]Impetigo (small, transient) [Part VI]Miliaria (crystalline, intra-dermal) [Part II]Scabies (papulovesicle at end of burrow) [Part II]Tinea (intra-dermal, small, grouped) [Part III]Toxicodendron dermatitis (linear) [Part IV]

Appendix B: Table of Secondary Lesions and Related Disorders

AtrophyDLE (epidermal and dermal) [Part IV]Lichen planus [Part II]SCLE (epidermal) [Part IV]Senile purpura (epidermal) [Part IV]SLE (epidermal and dermal) [Part IV]

CalcinosisSLE [Part IV]

CrustingAcne (hemorrhagic) [Part VI]Atopic dermatitis [Part IV]Atypical nevi (malignant change) [Part V]Basal cell carcinoma [Part V]Herpes simplex [Part VI]Herpes zoster [Part VI]Impetigo [Part VI]Malignant melanoma (very late) [Part V]Molluscum (on involuting lesions) [Part II]Scabies [Part II]Toxicodendron dermatitis [Part IV]

Cutaneous hornActinic keratosis [Part V]Squamous cell carcinoma [Part V]

ErosionsActinic keratosis [Part V]Atypical nevi (malignant change) [Part V]Basal cell carcinoma [Part V]Congenital melanocytic nevi [Part V]Erysipelas [Part III]Erythema multiforme [Part III]Fixed drug eruption [Part III]Herpes simplex [Part VI]Herpes zoster [Part VI]Lichen planus [Part II]Malignant melanoma (very late) [Part V]Squamous cell carcinoma [Part V]

EscharAcne [Part VI]Basal cell carcinoma (late) [Part V]

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374 Appendices

ExcoriationsAtopic dermatitis [Part IV]Congenital melanocytic nevi [Part V]Molluscum [Part II]Scabies [Part II]Toxicodendron dermatitis [Part IV]

FissuresAsteatosis [Part IV]Atopic dermatitis [Part IV]Psoriasis (intertriginous areas) [Part II]Seborrheic dermatitis (intertriginous areas) [Part II]Squamous cell carcinoma [Part V]Tinea (intertriginous areas) [Part III]

GangreneErysipelas [Part III]Herpes zoster [Part VI]SLE [Part IV]

HyperpigmentationAcne [Part VI]DLE [Part IV]Erythrasma [Part III]Fixed drug eruption [Part III]Herpes zoster [Part VI]Impetigo [Part VI]Lichen planus [Part II]Psoriasis [Part II]Senile purpura [Part IV]SLE [Part IV]Tinea [Part III]

HypopigmentationDLE [Part IV]Halo nevi (macular) [Part V]Impetigo [Part VI]Malignant melanoma [Part V]Pityriasis rosea (transient) [Part II]Psoriasis [Part II]SCLE [Part IV]SLE [Part IV]Tinea [Part III]

HypertrichosisCommon benign nevi [Part V]Congenital melanocytic nevi [Part V]

ImpetiginizationAsteatosis [Part IV]Erythema multiforme [Part III]

Appendices 375

Miliaria [Part II]Scabies [Part II]Tinea [Part III]Toxicodendron dermatitis [Part IV]

LichenificationScabies [Part II]Erythrasma [Part III]Atopic dermatitis [Part IV]

NecrosisErythema multiforme [Part III]Herpes zoster [Part VI]SLE [Part IV]

PapillomatosisCompound nevi [Part V]Squamous cell carcinoma [Part V]

PurpuraErysipelas [Part III]Erythema multiforme [Part III]Urticaria [Part III]

ScaleActinic keratosis (adherent scale) [Part V]Asteatosis (white scale) [Part IV]Atopic dermatitis (loose, white scale) [Part IV]Atypical nevi (malignant change) [Part V]Compound nevi (hyperkeratotic) [Part V]DLE (white adherent scale) [Part IV]Erythrasma (dry, velvety) [Part III]Impetigo (loose, white scale) [Part VI]Lichen planus [Part II]Malignant melanoma [Part V]Pityriasis rosea [Part II]Psoriasis (loose and silvery) [Part II]SCLE [Part IV]Seborrheic dermatitis (loose scale) [Part II]SLE (white adherent scale) [Part IV]Squamous cell carcinoma (adherent scale) [Part V]Tinea [Part III]Toxicodendron dermatitis [Part IV]

ScarringAcne [Part VI]Atypical nevi (malignant change) [Part V]Basal cell carcinoma [Part V]DLE [Part IV]Herpes zoster [Part VI]Keratoacanthoma [Part V]

376 Appendices

Lichen planus [Part II]Molluscum (mild scarring) [Part II]Senile purpura (stellate) [Part IV]SLE [Part IV]Tinea [Part III]

SclerosisBasal cell carcinoma [Part V]SLE [Part IV]

TelangectasiaDLE [Part IV]Rosacea [Part VI]SCLE [Part IV]SLE [Part IV]

UlcerationActinic keratosis [Part V]Atypical nevi (malignant change) [Part V]Basal cell carcinoma (central) [Part V]Congenital melanocytic nevi (benign or malignant change) [Part V]Erysipelas [Part III]Malignant melanoma (very late) [Part V]Squamous cell carcinoma [Part V]

VegetationKeratoacanthoma [Part V]

Part I: Color Photographs

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PHOTO 1Ephelides (freckles), macules of melanin with pigmentin the lower epidermis and basal cell layer. Note thelack of distortion of the skin lines.

PHOTO 2A blue 3 mm macule caused by a deposit of graphitein the dermis following a pencil jab. Note the lack ofdistortion of the skin lines.

PHOTO 3A “coast of Maine” spot, a patch of melanin pigment inthe lower epidermis and basal cell layer. Note the lackof distortion of the skin lines.

PHOTO 4A patch of increased melanin in the upper dermis, theend result of a fixed drug reaction. Note the lack ofdistortion of the skin lines.

PHOTO 5A papular wart of the upper lip. The elevation consistsof proliferating epidermis. Note the normal skin linesare missing.

PHOTO 6A papule of the upper lid margin that is caused by abenign cyst in the dermis. Note the shiny surface andeffacement of the epidermis.

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PHOTO 7A nodular keratoacanthoma. The nodule consists ofproliferating epidermal cells and the surface lines areeffaced by the keratin debris in the central pit.

PHOTO 8A nodule of erythema induratum on the shin. Thislesion is caused by inflammation in the dermis andsubcutis. Note although it is easily palpated, there isminimal visible elevation.

PHOTO 9A plaque of mycosis fungoides caused by a malignantT-cell infiltrate in the dermis.

PHOTO 10Scaling pebbly plaques of metastatic breast carci-noma formed by a confluence of papules.

PHOTO 11Pinpoint vesicles on the left evolving to tense bullaeseveral centimeters in size in the center.

PHOTO 12Flat intra-epidermal pustules on the heel in a case ofpustular psoriasis.

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PHOTO 13Adnexal pustules occur within adnexal skin structures.In acne the terminal hair follicle is affected.

PHOTO 14Adherent white scale in lichen planus.

PHOTO 15Adherent brown scale in ichthyosis vulgaris.

PHOTO 16Silvery white, loosely adherent scale of psoriasis.

PHOTO 17Greasy, yellow, loosely adherent scale of seborrheicdermatitis.

PHOTO 18Moist eroded lesion of erythema multiforme.

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PHOTO 19Crusted lesions of nonbullous impetigo.

PHOTO 20A moist impetiginized lesion of nummular eczema.

PHOTO 21Sclerosis of the upper back in a case of scleredema.The sclerosis is due to an accumulation ofmucopolysaccharide and edema fluid. Note the“orange-peel” surface and the accentuation of the oldscar. The skin cannot be pinched.

PHOTO 22Excoriations on the wrist in atopic dermatitis. Notethe accentuated skin markings: a change referred to aslichenification.

PHOTO 23Linear canal-like fissures on the extremely dry skin ofan elderly patient.

PHOTO 24A large seborrheic keratosis with a papillomatous sur-face of epidermal origin.

PHOTO 25Lichen amyloidosis. Infiltrates of amyloid substance inthe dermis push up and produce papillomatosis.

PHOTO 26Acanthosis nigricans in the axilla. The surface projec-tions of epidermis and dermis produce soft smoothvegetations in this condition.

PHOTO 27An eschar composed of scale, secretion and necrotictissue on the central surface of a basal cell carcinoma.

PHOTO 28Dermal atrophy in malignant atrophic papulosis.The early papular lesions (left) evolve leaving der-mal atrophy. At edge is a rim of normal dermis.

PHOTO 29Atrophy of the subcutaneous fat allows visualization ofa sizable vein at the base of this depressed lesion ofpanatrophy. Epidermal and dermal atrophy are alsopresent.

PHOTO 30Ulcerations of the epidermis and upper dermis in apatient with a necrotizing vasculitis.

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PHOTO 31An elderly diabetic with wet streptococcal gangrene.

PHOTO 32Dry gangrenous infarcts in a case of severe necrotiz-ing vasculitis.

PHOTO 33Hyperpigmentation from increased basal cell melaninin a lesion known as a Becker’s nevus. The focalchange in hair growth is called hypertrichosis.

PHOTO 34Hyperpigmentation, in this instance hemosiderin pig-ment free in the upper dermis from trauma on the toeof a jogger.

PHOTO 35A patch of pityriasis alba. Surrounding the inflamma-tory center is a circular zone of partial pigment loss.

PHOTO 36Segmental vitiligo on the posterior neck would showabsent melanin with special stains.

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PHOTO 37Poikiloderma atrophicans vasculare associated with anunderlying lymphoma.

PHOTO 38Annular tinea corporis, note the similarity to a solitaryherald patch of pityriasis rosea.

PHOTO 39Arciform lesions of tinea faciale.

PHOTO 40Polycyclic lesions in a patient with erythema gyratumrepens.

PHOTO 41An iris lesion in a case of milker’s nodules (paravacciniavirus infection).

PHOTO 42Serpiginous-shaped lesion of elastosis perforans ser-piginosum.

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PHOTO 43A linear birthmark on the preauricular skin.

PHOTO 44Herpes zoster of the right mid cervical and upper tho-racic dermatome segments. Note the midline cutoff.

PHOTO 45Two groupings of herpetic vesicles on the buttock skin.

PHOTO 46Netlike pigment deposition in erythema ab igne.Color fails to blanch with diascopy indicating pig-ment within tissue as opposed to blood in a vessel.

PHOTO 47A corymbiform plantar wart.

PHOTO 48Pyogenic granuloma on the neck simulating amelanoma. Note the difference on the right afterapplication of gentle pressure.

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PHOTO 49Wood’s lamp exam: Pink urine of porphyria cutaneatarda, left; normal urine right.

PHOTO 50KOH slide showing the long branching hyphae of adermatophyte fungal infection.

PHOTO 51KOH slide showing the short club-shaped hyphae andclusters of spores in tinea versicolor.

PHOTO 52Segmented pseudohyphae and round chlamydosporesof Candida albicans are occasionally seen in KOHpreparations.

PHOTO 53Tzanck smear from the base of a herpetic vesicle. Notethe large multinucleated giant cells and epidermal cellswith enlarged (ballooned) nuclei.

PHOTO 54Scabies prep. shows a mature itch mite with a matur-ing ovum. These are easily identified under lowpower.

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Part II: Color Photographs

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PHOTO 1Grouped dome-shaped lesions of molluscum. Note thewhite central core.

PHOTO 2Grouped molluscum lesions on the buttocks of achild. Several lesions show a dimple and peripheralridge. Mature lesion on the right shows distinct scale.

PHOTO 3Dusky molluscum lesion which is starting to involute.Note the halo of inflammation at its base.

PHOTO 4Typical grouping of molluscum lesions on an innerthigh.

PHOTO 5Molluscum smear, expressed contents of lesion float-ing in physiologic saline. Low and high power.

PHOTO 6Early wart on the palmar surface of the finger inter-rupts skin lines.

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PHOTO 7Pedunculated wart on forehead composed of filiformpapules.

PHOTO 8Plantar wart shows dome-shaped papules which inter-rupt skin lines. Note the fine scale and black ends ofthe thrombosed vessels.

PHOTO 9Large filiform wart on the penile shaft.

PHOTO 10Corymbiform plantar wart.

PHOTO 11Warts on the hand and periungual tissue.

PHOTO 12Clustered partially treated warts on the knee.

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PHOTO 13Verrucae of the beard area in a young adult man.

PHOTO 14Dull red patches of seborrheic dermatitis along thescalp margin.

PHOTO 15Yellow greasy scale at the scalp edge.

PHOTO 16White loose scale in the scalp.

PHOTO 17Petaloid patches of seborrhea on the mid back.

PHOTO 18Early rosy-red papules of pityriasis rosea.

PHOTO 19Rosy-red plaques of pityriasis rosea.

PHOTO 20Scale with free edge turned toward the center of thelesion.

PHOTO 21Oval lesions in linear configuration, long axes followskin tension lines.

PHOTO 22Early papules of psoriasis with loose silvery scale.

PHOTO 23Plaques formed by centrifugal extension and conflu-ence.

PHOTO 24Plaques. Some show white mica-like scale.

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PHOTO 25Macular hyperpigmentation at the sites of resolvedplaques.

PHOTO 26Positive Auspitz’s sign. Bleeding points where scalehas been removed.

PHOTO 27Guttate (small drop-like) lesions of psoriasis. Somehave merged into plaques and others are becomingconfluent.

PHOTO 28Nummular or coin-sized psoriasis lesions in a child.

PHOTO 29Annular, polycyclic psoriasis lesions.

PHOTO 30Linear nail pits strongly support a diagnosis of psori-asis.

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PHOTO 31Violaceous, angular, flat-topped primary papules oflichen planus.

PHOTO 32Wickham’s stria in a mucosal lesion of lichen planus.Note the erosion on the right.

PHOTO 33Hypertrophic lichen planus shows plaques with thickadherent white scale.

PHOTO 34Plaques of lichen planus formed by coalescence ofpapules. Note the satellite papules at the periphery.

PHOTO 35Mucosal lichen planus. Note the deep violaceous color,Wickham’s stria, and the erosion on the top.

PHOTO 36Lacy pattern of oral lichen planus. Note the erosionsat the extreme upper and lower edges of the photo.

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PHOTO 37Permanent scarring due to lichen planus of the nailmatrix.

PHOTO 38Tiny crystalline vesicles of early miliaria.

PHOTO 39Red papules of miliaria rubra.

PHOTO 40Early pustular lesions of miliaria rubra profunda.

PHOTO 41Track of scabies at the base of the forefinger. Note thevesicle.

PHOTO 42Linear scabies track at the base of the digit.

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PHOTO 43Linear scabies track. Note the point of entry at the bot-tom of the photo.

PHOTO 44Secondary papular scabies lesions with excoriations,eczematization, and secondary infection.

PHOTO 45Ectoparasite prep., shows mature eight-legged itchmite with ova. Ova alone may also be seen.

Part III: Color Photographs

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PHOTO 1Erythrasma showing brown macules and patches in theinguinal crease area. Scale and early lichenificationpresent.

PHOTO 2Tinea pedis and tinea manuum, so-called “two foot–one hand disease.” Note the erythema and diffusescale which is accentuated in the palmar creases. Alsotypical is the “moccasin” distribution on the lateralmargins of the feet.

PHOTO 3Inflammatory tinea of hair-bearing area. Note the par-tial alopecia, scale, broken hairs and follicular pustules.

PHOTO 4Thick, secondarily infected kerion. Cervical nodeswere enlarged. Culture grew Microsporum canis.

PHOTO 5Kerion site after 10 days of combined broad spectrumantibiotics, prednisone and systemic antifungal ther-apy. Some scarring and permanent hair loss isexpected.

PHOTO 6Chronic tinea barbae of the chin. Note the deepinflammatory character of the nodules and thescarring.

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PHOTO 7Tinea faciale with advancing scaling margin.

PHOTO 8Tinea of the neck with a very subtle advancing mar-gin. Color change is partially due to inappropriate useof a topical corticoid.

PHOTO 9Extensive tinea corporis. Note the advancing marginand concentric margins at the lower edge.

PHOTO 10Tinea corporis showing the classic concentric lesionsof ringworm.

PHOTO 11Tinea near the ankle. Note the subtle advancing mar-gin, inflammatory pustules, papules and nodules.

PHOTO 12Boggy nodular tinea on the dorsum of the hand andwrist.

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PHOTO 13Tinea cruris with advancing margin extending from theinguinal crease onto the inner thigh.

PHOTO 14Diffuse tinea of the sole. Note the margin thatextends in a moccasin-like fashion across the instep.Also note the scale and fissures at the base of the toes.

PHOTO 15Deep-seated vesicles on the instep in a case of tineapedis. KOH prep. was positive. Contact dermatitis cancause identical lesions which are KOH negative.

PHOTO 16Tinea unguium causing distal separation, dystrophyand discoloration of the nail plate.

PHOTO 17Tinea unguium showing white superficial onycho-mycosis of nail 3 and distal subungual involvement ofnail 2.

PHOTO 18Positive KOH preparation. Long, refractile, branchinghyphae.

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PHOTO 19Vesicular id reaction on the hand caused by an inflam-matory tinea pedis. These vesicles are KOH negative.

PHOTO 21Common hives showing papules and confluentplaques. Some of the more edematous lesions havewhite centers.

PHOTO 22Hives with polycyclic borders.

PHOTO 23Early fixed drug eruption in the form of an induratedplaque of the eyelid and upper cheek.

PHOTO 24Fixed drug eruption in the form of a dusky, violet-brown plaque on the dorsum of the foot. Underlyingtendons are not visible.

PHOTO 20Wheals of common urticaria. The lesions vary in size,are palpably raised and the centers show a pink orwhite color depending on the degree of edema.

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PHOTO 25Acute bullous fixed drug reaction to sulfa.

PHOTO 26Persisting hyperpigmentation after resolution of thefixed acute drug reaction in photo 25.

PHOTO 27Plaque of sharply marginated, tender erysipelas in aclassic location.

PHOTO 28Cellulitis of the shin. Ill-defined patches of tenderwarm erythema.

PHOTO 29Erysipelas which has become vesicular.

PHOTO 30Erythema multiforme showing early papular anddeveloping plaque lesions with dusky centers.

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PHOTO 31Enlarged view of erythematous plaque lesions showingearly hemorrhage in the center.

PHOTO 32Vesiculobullous erythema multiforme.

PHOTO 33Target or iris lesions of erythema multiforme on thepalmar skin.

PHOTO 34Hemorrhagic crusted lesions of the vermilion marginof the lips.

PHOTO 35Close-up of a target lesion on the palmar surface of thedigit.

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Part IV: Color Photographs

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PHOTO 1Early DLE. Photo shows a plaque with a papule above.The lesions are becoming confluent. Note the accentu-ation of the hair follicle openings, the loss of normalskin surface pattern and shiny surface.

PHOTO 2A discrete plaque of DLE near the sideburn. Earlywhite scale is evident and in the center it shows a dis-tinct follicular pattern.

PHOTO 3Developed plaque of DLE with thick adherent whitescale. Central scale has become mounded and brown-ish-yellow.

PHOTO 4DLE of forehead at hairline shows an advancingindurated margin with telangiectatic vessels. Centralarea shows hypopigmentation where activity of dis-ease has burned out.

PHOTO 5Pigmentary changes in chronic scarring DLE.

PHOTO 6Hypopigmented scar at the hairline in chronic DLE.

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PHOTO 7Punched out DLE scar. Note the typical white basewith telangiectatic blood vessels.

PHOTO 8Scarring DLE of the scalp often results in permanentalopecia.

PHOTO 9Discoid lesion in sideburn shows a margin with ery-thema and telangectasia, a white depressed center andperipheral scale.

PHOTO 10DLE lesions suggest a butterfly pattern, but are absentover the upper central face and show asymmetry onthe upper lip.

PHOTO 11DLE flare following an acute sunburn.

PHOTO 12Squamous cell carcinoma of the nasal ala arising in aburned out DLE lesion.

PHOTO 13SCLE, extensive lesions were present on other light-exposed sites (see photo 17). Note the papulosquamouscharacter and the mixture of sharply demarcatedpapules and plaques.

PHOTO 14Close-up of lesions in photo 13. Note the sharp mar-gins, mixture of papules and plaques, telangiectaticvessels and the loose central white scale.

PHOTO 15SCLE: Extensive chest lesions. Many are developingan annular configuration.

PHOTO 16Sharply demarcated papules and plaques. Lesion withbiopsy site exhibits areas of central gray-whitehypopigmentation and atrophy.

PHOTO 17SCLE onset with skin lesions showing distinct photo-accentuation. Covered skin areas were clear.

PHOTO 18Butterfly rash of lupus. In this instance the patient hasSCLE without evidence of systemic disease.

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PHOTO 19Pruritic papular eruption extensor surface of limb in apatient with SLE.

PHOTO 20Papular erythema on the dorsum of the hands. Similarchanges are seen in cases of dermatomyositis.

PHOTO 21Ragged cuticle, opaque nailbed with absence of thelunula and prominent tortuous capillaries in the proxi-mal nail fold. These changes are seen in SLE and othermajor connective tissue diseases.

PHOTO 22The results of severe peripheral vascular involvementin a case of SLE.

PHOTO 23DLE-like lesion on the foot in a patient with SLE.

PHOTO 24Linear plaques and patches of erythema typical oftoxicodendron dermatitis.

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PHOTO 25Linear streaks and patches of vesicles also typical of aplant-acquired allergic contact dermatitis.

PHOTO 26Secondary infection with honey-colored exudate, fis-suring, scale and crusting. This can occur with anyacute eczematous process.

PHOTO 27Confluent dermal edema common with secondarytransfer or airborne exposure to the antigen.

PHOTO 28Early patchy linear toxicodendron dermatitis withvesicles can simulate early Herpes zoster with mini-mal neuritis.

PHOTO 29Perioral eczema in a young woman with atopic der-matitis. Note the mild wrinkling and lichenification lat-erally; also note the reaction is limited to an areareached by the tongue.

PHOTO 30Eczema of the hands in a man with classic flexural atopicdermatitis. Note the focal lesions which began as rings ofpruritic vesicles. Also note the lichenification, excoriations,painful fissures, crusting and paronychial involvement.

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PHOTO 31Eczema of the proximal nail fold. Note the edema, lossof the cuticle and the early rippling of the nailplates ondigits 3 and 4.

PHOTO 32Scalp eczema shows erythema, white scale, excoria-tions and secondary impetiginization.

PHOTO 33Allergic shiners.

PHOTO 34Morgan-Dennie’s line of the lower eyelid.

PHOTO 35Pityriasis alba in the active phase as a scaling pinkpatch.

PHOTO 36Pityriasis alba, the erythema has resolved leaving sub-tle pigment loss.

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PHOTO 37Atopic palmar markings.

PHOTO 38Delayed white dermographism in an area of activeatopic dermatitis. Note the “A,” “T,” and partial “O.”

PHOTO 39Ichthyosis, “like fish scale” on the shin of a patientwith atopic dermatitis.

PHOTO 40Keratosis pilaris on the arm of an atopic person.

PHOTO 41Buffed nails from scratching.

PHOTO 42Early atopic dermatitis shows patches of erythema,papules and papulovesicles.

PHOTO 43Lichenified eczema of the antecubital fossa. Note theindistinct margins and excoriations.

PHOTO 44Xerotic skin is dull, scaly and shows fine wrinklingwith focal areas of erythema.

PHOTO 45More severe xerosis with fissuring erythema and earlyimpetiginization.

PHOTO 46Long canal-like fissures with exudate in the base.

PHOTO 47Craquelé or crazy-pavement pattern.

PHOTO 48Irregular patches of purpura following minor trauma.Note also the epidermal atrophy from chronic solardamage. Patchy tan pigment is left from prior episodes.

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PHOTO 49More advanced atrophy, small foci of purpura andwhite stellate scars from epidermal tears.

PHOTO 50Light transverse stria in a teen-aged weightlifter.

PHOTO 51Extensive fan-shaped stria on the lower back in apatient on long-term, high-dose systemic steroids.

PHOTO 52Dark wide stria from abuse of potent topical steroids.

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Part V: Color Photographs

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PHOTO 1Field of early 1–4 mm seborrheic keratosis. Yellow-tancolor, dull, stuck on, some show comedones on surface.

PHOTO 2Seborrheic keratosis. Typical mature, “stuck on” yel-low-tan lesion. Note multiple tiny early SKs in thefield.

PHOTO 3Developed brown-black seborrheic keratosis, stuck onwith inflammation at the base. Contrast with smaller1–3 mm yellow-tan SKs in field.

PHOTO 4Typical ephelides in a teenager of Celtic heritage.

PHOTO 5Non-solar lentigos. Individual lesions are clinicallyindistinguishable from junctional nevi.

PHOTO 6Front and back view of a man with extensive solar-induced lentigines. Note the scar on the left upperanterior shoulder where an in situ melanoma wasdiscovered.

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PHOTO 7Junctional nevus, right lower corner, developed com-pound nevi right upper and left lower corners.

PHOTO 8Early compound nevi lower center, mature compoundor developed dermal nevus upper center.

PHOTO 9Mature pink-tan dermal nevi, center, contrast color andreflectance with several dull yellow and grey-tan SKsin the same field.

PHOTO 10Mature soft dermal nevus lower eyelid. Compare withpedunculated SKs on the upper lid and outer canthus.

PHOTO 11Large nevus with a mammillated cerebriform surface.

PHOTO 12Mature benign compound or dermal nevus with scale.

422

PHOTO 13Mature compound nevus with long terminal hairgrowth.

PHOTO 14Mature compound nevus. The dark spots are keratoticplugs or comedones.

PHOTO 15Halo nevus of Sutton. Note the central regressing pink-brown compound nevus with an achromic border.

PHOTO 16Depigmented macule at site of totally regressednevus. Same patient as photo 15.

PHOTO 17Primary lesion in patient with atypical mole syndrome.Irregular shape and color. Mammillated surface with anindistinct macular margin. Compare with other typicalbenign junctional moles in the same photo.

PHOTO 18Atypical nevus close-up. Note the irregular shape,color and margins.

423

PHOTO 21Medium-sized CMN. Note the mammillated surface,irregular but not truly notched border, dark terminalhair and speckling. Lesion is a uniform plaque.

PHOTO 22Medium-sized CMN. Note the speckled surface, dis-tinct but irregular margins and the central pink-tanbenign compound component.

PHOTO 23Congenital melanotic nevus, medium sized. Note theraised mammillated surface. Contrast with the 5 mmcompound nevus at the bottom of the photo.

PHOTO 24An acquired congenital pattern nevus.

PHOTO 19Atypical mole syndrome. Note the irregular and vari-able appearance of the nevi.

PHOTO 20Atypical mole syndrome. Note the irregular and vari-able appearance of the nevi.

424

PHOTO 25Giant congenital melanotic nevus (bathing trunk type).Note the speckled variable color and elevation.

PHOTO 26Superficial spreading malignant melanoma. Asym-metric, irregular border and color, size exceeds 6 mm.Note the central raised papule, a sign of invasion.

PHOTO 27Lentigo maligna. Irregular pigmentation, irregularmargins and the lesion is typically quite large. Entiresurface is still macular and lesion is still in situ.

PHOTO 28Acral lentiginous melanoma of the nail bed. Note theasymmetry and blush of lighter brown pigment at theperiphery. Skin markings are still retained.

PHOTO 29SSMM. Note the notched, pseudopod-like border.Lesion is asymmetric and size exceeds 6 mm. Contrastits highlighted surface with the dull yellow-tan SKimmediately adjacent.

PHOTO 30SSMM, shows loss of skin markings, irregular border,asymmetry and a developing central papular area.Compare with the mature dermal nevus at the bottom.

425

PHOTO 31Early SSMM. Some asymmetry, speckling, drama-tically contrasting color areas, early border notching.Size exceeds 6 mm.

PHOTO 33LMM of the nasal bridge. Note the asymmetry, size,irregular color and areas of speckling. Border is alsonotched.

PHOTO 34Nodular melanoma presenting as a deeply pigmentedrapidly growing lesion with loss of skin lines. Deepcolor correlates with depth.

PHOTO 35Nodular melanoma with irregular base.

PHOTO 36Erythematous actinic keratosis with a fine adherent yel-low scale. Note the tiny bleeding point where scale hasbeen removed. Lesion is easier to detect by palpationthan by vision.

PHOTO 32SSMM. Asymmetric, irregular notched border, colorvaries from white to pink to blue-grey to brown andbrown-black. Nodule at lower edge indicates verticalgrowth.

426

PHOTO 37Actinic keratosis of helix shows focal erythema, adher-ent white and brown scale.

PHOTO 39White actinic cheilitis of the lower lip with scale.Central area shows erosion and ulceration.

PHOTO 40Keratoacanthoma on dorsum of hand. Note the dullcentral core and dilated surface vessels. Note also theadjacent AK with white scale and the chronic actinicdamage.

PHOTO 41Keratoacanthoma of upper lip.

PHOTO 42Nodular keratoacanthoma.

PHOTO 38Cutaneous horn of antihelix. This one had a squa-mous cell carcinoma at the base. Note the thick whiteAK near the apex of the helix.

427

PHOTO 43Depression and epithelial tags at the site of a regress-ing keratoacanthoma.

PHOTO 44Translucent papular BCC of temple. Note the devel-oping central dell and compare with the yellow-tanSK above.

PHOTO 45Translucent papular BCC of nasal bridge with dilatedvessels.

PHOTO 46Nodular basal cell. Note the small erosions anddepressed areas. Also note the translucent characterand dilated surface vessels.

PHOTO 48Yellow-pink scaling depression of upper lip is actu-ally a sizable BCC.

PHOTO 47Nodular BCC with central erosion and prominent sur-face vessels.

428

PHOTO 49Subtle yellow-pink plaque with loss of skin markingsis actually a superficial BCC.

PHOTO 50BCC presenting as a white plaque.

PHOTO 51Red plaque BCC with central dell, raised thready bor-der and erosion.

PHOTO 52BCC presenting as a red plaque with loss of skinlines, surface erosions and scale.

PHOTO 53BCC with areas of regression and pigmentation.

PHOTO 54Nodular BCC with pigmented areas. Differentialwould include nodular melanoma.

429

430

PHOTO 55BCC which has ulcerated and spread peripherally.

PHOTO 57Neglected BCC covers most of the scalp and extendsinto bone. Shows erosions, ulceration, crusting, scar-ring and eschar formation.

PHOTO 58Early SCC. Note the deep indurated quality of thepapule.

PHOTO 59Large nodular ulcerating SCC.

PHOTO 56BCC with central rodent ulcer and peripheral exten-sion.

Part VI: Color Photographs

431

433

PHOTO 1Non-bullous impetigo with early small vesicles (upperphoto.) and older lesions which have ruptured,enlarged and coalesced.

PHOTO 2Ruptured vesicle leaving a moist burnished red base.

PHOTO 3Bullous impetigo shows grouped vesicles of varioussizes.

PHOTO 4Impetigo. Early blisters are clear while the older cen-tral blister is clouding as inflammatory cells accumu-late.

PHOTO 5Scaling plaque of impetigo with areas of spontaneousresolution.

PHOTO 6Lesion of bullous impetigo with a peripheral hemor-rhagic crust.

PHOTO 7Herpetic whitlow that had been recurrent for over adecade before the diagnosis was made. Multiple hospi-talizations and courses of antibiotics were given need-lessly for the accompanying viral lymphangitis.

PHOTO 8Periocular Herpes simplex.

PHOTO 9Herpes. Grouped umbilicated vesicles on an erythe-matous urticarial base.

PHOTO 10Solitary lesion of Herpes genitalis on the penile shaft.Note the two warts in the foreground.

PHOTO 11A typical location for Herpes genitalis in female vic-tims. Lesions are clouding and becoming pustular.

PHOTO 12Eroded Herpes labialis triggered by lip surgery. Todaythis complication can be prevented with prophylacticantiviral therapy.

434

PHOTO 13Tzanck smear shows multinucleated syncytial giantcells and epidermal cells with ballooned nuclei typicalof herpes virus cytopathic effect.

PHOTO 14High power view of giant cell and keratinocytes withballooned nuclei.

PHOTO 15Hemorrhagic and necrotic zoster of the ophthalmicbranch of the fifth cranial nerve. Note Hutchinson’ssign is present and there is injection of the sclera of theright eye.

PHOTO 16Ramsay-Hunt syndrome with vesicles in the conchaaccompanied by severe pain in the ear.

PHOTO 17Ramsay-Hunt syndrome (same case) demonstrating acomplete facial nerve paralysis on the same side.

PHOTO 18Sacral Herpes zoster of left segments S-2, 3, 4.

435

PHOTO 19Generalized Herpes zoster in a patient with chroniclymphocytic leukemia.

PHOTO 20Hemorrhagic zoster in a patient with advancedmyeloma. Suppression of the immune system isresponsible for the absence of the inflammatory base.

PHOTO 21Groups of vesicle traveling down a nerve segment onthe arm and forearm.

PHOTO 22Herpes zoster in the same case as photo 21 with seg-mental lesions on the palm.

PHOTO 23Segmental zoster with sharp midline cutoff.Umbilicated vesicle and pustules are present.

PHOTO 24Positive Tzanck smear shows giant cells, balloon cellsand acute inflammatory cells.

436

PHOTO 25Early grade I comedonal acne. Closed comedones andoccasional open comedones are present.

PHOTO 26More advanced grade I acne with closed cysts, andopen and closed comedones.

PHOTO 27Open and closed comedones with a single inflamedpapule in the center of the photo.

PHOTO 28Early grade II acne also shows inflammatory follicu-lar papules and pustules.

PHOTO 29Inflammatory papules and pustules that are coalescinginto nodules. Note also the appearance of ice-pick scar-ring.

PHOTO 30Nodules, cysts, and sinus tracts of grade III acne.

437

438

PHOTO 31Grade III acne. Large inflammatory papules havebecome confluent to form cysts and sinus tracts. Notealso scattered crusts and eschars.

PHOTO 32Post-acne pigmentation. The erythema componentwill fade within 3-4 months; the tan melanin compo-nent may take months or years to diminish.

PHOTO 33Acne of the upper back and shoulder causing hyper-trophic scarring.

PHOTO 34Typical facial acne, mild grade II.

PHOTO 35Moderate grade II acne of the upper back.

PHOTO 36Mild grade II acne on the central chest.

439

PHOTO 37Erythematous telangiectatic rosacea; only occasionalpapules and pustules are evident. Erythema is the pre-dominant finding.

PHOTO 38Papulopustular rosacea with a component of sebor-rheic dermatitis.

PHOTO 39Severe rosacea with inflammatory nodules.

PHOTO 40Severe papulopustular rosacea with dome-shapedpustules and nodules.

PHOTO 41Rosacea. Edema causing a shiny orange-peel appear-ance to the upper cheek.

Index

441

A

Acne vulgaris, 345configuration, 348differential diagnosis, 356distinguish from rosacea, 364distribution, 348evolution of disease process, 346evolution of skin lesions, 346macrodistribution illustrations, 349onset, 345physical exam, 347primary lesions, 347provoking factors, 347secondary lesions, 348self-medication, 347supplemental history, 347supporting data, 348therapy, 348

Acne-like drug eruptionsdistinguish from acne vulgaris, 357

ACPN (acquired “congenital pattern” melanoticnevus)

Acquired ichthyosisdistinguish from asteatotic eczema, 217

Acrodermatitis enteropathicadistinguish from seborrheic dermatitis, 67

Actinic keratosis, 287differential diagnosis, 291distinguish from common skin cancers, squa-

mous cell carcinoma, 309distinguish from lentigines, 248distinguish from Seborrheic keratosis, 238distribution, 288evolution of disease process, 287evolution of skin lesions, 288macrodistribution, illustrations, 289onset, 287physical exam, 288primary lesions, 288provoking factors, 288

secondary lesions, 288self-medication, 288skin biopsy, 289supplemental history, 288supporting data, 289therapy, 290

AD, see Atopic dermatitisAdnexal pustule, illustration, 10AIDS

distinguish from pityriasis rosea, 81in relation to pityriasis rosea, 78in relation to tinea, 125

AK, see Actinic keratosisAllergic contact dermatitis

distinguish from erysipelas, 157distinguish from tinea pedis, 132

Allergic vasculitisdistinguish from erythema multiforme, 168

ALMM (acral lentiginous mucosal melanoma)Alopecia areata, distinguish from tinea capitis,

131ANA (antinuclear antibody)Anesthetics, topical therapy

basics, 44Angioneurotic edemadistinguish from erysipelas, 158

Anhidrotic ectodermal dysplasia resemblingatopic dermatitis, 211

Annular configurationbasics, 18erythema multiforme, 164illustrations, 10impetigo, 319lichen planus, 95lupus erythematosus, subacute cutaneous,

182psoriasis, 86tinea, 125urticaria, 138

ANS, see Atypical nevus syndrome

442 Index

Antihistaminessystemic therapy

basics, 45topical therapy

basics, 44Antipruritics

topical therapybasics, 45

Arciform configuration,basics, 19illustration, 19tinea, 125

Asteatotic eczema, 213configuration, 215differential diagnosis, 217distribution, 215evolution of disease process, 214evolution of skin lesions, 214macrodistribution, illustrations, 216onset, 213physical exam, 215primary lesions, 215provoking factors, 214secondary lesions, 215self-medication, 214supplemental history, 215supporting data, 215therapy, 215

Ataxia telangiectasia resembling atopic dermati-tis, 211

Atopic dermatitis, 199complications, 200configuration, 203differential diagnosis, 210distinguish from seborrheic dermatitis, 67, 74distribution, 203evolution of disease process, 200evolution of skin lesions, 201macrodistribution, illustrations, 204, 205, 206onset, 200physical exam, 203primary lesions, 203provoking factors, 202secondary lesions, 203self-medication, 202supplemental history, 203supporting data, 203therapy, 203types, 200

Atopic eczema, see atopic dermatitisAtrophy

basics, 14dermal, illustration, 15epidermal, illustration, 15subcutaneous, illustration, 15

Autoimmune diseases in relation to Lichen pla-nus, 94

B

Bacterial intertrigodistinguish from seborrheic dermatitis, 73distinguish from tinea cruris, 132distinguish from tinea pedis, 132

Bacterial paronychiadistinguish from Herpes simplex recidivans,

333Basal cell carcinoma

distinguish from keratoacanthoma, 296distinguish from melanocytic nevi, acquired,

257distinguish from molluscum contagiosum,

56distinguish from verruca vulgaris, 64

Basal cell carcinoma, see common skin cancersdistinguish from common skin cancers, squa-

mous cell carcinoma, 309Basal cell epithelioma, see common skin cancersBateman’s purpura, see senile purpuraBCC, see Basal cell carcinoma (epithelioma)Bedbug bites

distinguish from toxicodendron dermatitis,196

Biopsyelliptical incision, basics, 33elliptical incision, illustration, 34excisional, basics, 35excisional, illustration, 35incisional, basics, 31punch, illustration, 32saucerization, basics, 33saucerization, illustration, 34shave incision, basics, 32shave incision, illustration, 33skin, basics, 30

Bowen’s epitheliomabasal cell carcinoma/epithelioma, 304distinguish from common skin cancerssquamous cell carcinoma, 309

Index 443

Bullabasics, 8illustration, 10

Bullous pemphigoiddistinguish from erythema multiforme, 167distinguish from impetigo, 322

Butterfly rash, lupus erythematosus, systemicillustration, 186

C

Cafe-au-lait spotsdistinguish from melanocytic nevi, congeni-

tal, 268Caine anesthetics

topical therapy, basics, 44Calcinosis

basics, 16Cancers, common skin, see common skin can-

cersCapillary aneurysm, thrombosed

distinguish from malignant melanoma, 284Celiac disease resembling atopic dermatitis, 211Cellulitis, see erysipelasChancroid

distinguish from Herpes simplex recidivans,333

Chronic facial edema, rosacea, 361Cicatrix or scar, basics, 14Clostridial infection

distinguish from erysipelas, 158CMN, see Congenital melanotic nevusCoast of Maine spots

distinguish from melanocytic nevi, congeni-tal, 268

Cold sores, see Herpes simplex recidivansColor examination

basics, 22Common benign nevi

distinguish from melanocytic nevi, congeni-tal, 268

Common compound nevidistinguish from common skin cancers, basal

cell carcinoma/epithelioma, 304Common nevi

distinguish from melanocytic nevi, acquiredatypical, 263

Common skin cancers, 299Common skin cancers, basal cell carcinoma/

epithelioma

configuration, 302differential diagnosis, 304distribution, 302evolution of disease process, 300evolution of skin lesions, 301macrodistribution, illustrations, 302onset, 299physical exam, 301primary lesions, 301provoking factors, 301secondary lesions, 301self-medication, 301skin biopsy, 303skin phototypes, table, 299supplemental history, 301supporting data, 303therapy, 303

Common skin cancers, squamous cell carci-noma, 305

configuration, 307differential diagnosis, 308distribution, 307evolution of disease process, 305evolution of skin lesions, 305macrodistribution, illustrations, 307onset, 305physical exam, 306primary lesions, 306provoking factors, 305secondary lesions, 306self-medication, 306skin biopsy, 308supplemental history, 306supporting data, 308therapy, 308

Configurationbasics, 18recognizing 18

Congenital pattern melanocytic nevi, seemelanocytic nevi, congenital

Contact allergensdistinguish from toxicodendron dermatitis,

195Contact dermatitis

distinguish from atopic dermatitis, 210distinguish from erysipelas, 157distinguish from tinea pedis, 132

Cornu cutaneumbasics, 16

444 Index

Corymbiform configurationbasics, 22illustration, 22verruca vulgaris, 61

Creams,basics, 39vehicles, 39

Crustbasics, 11illustration, 13

Cryptococcosisdistinguish from molluscum contagiosum, 56

Cutaneous hornbasics, 16

Cutaneous T-cell lymphomadistinguish from atopic dermatitis, 211

D

Dandruff, see Seborrheic dermatitisDermal atrophy

illustration, 15Dermal lesions, 115, 173Dermatofibroma

distinguish from melanocytic nevi, acquired,257

Dermatitis herpetiformisdistinguish from erythema multiforme, 167

Dermatofibromadistinguish from malignant melanoma, 284

Dermatophyte infections in relation to lichenplanus, 94

Dermatophytosis, intertriginousdistinguish from erythrasma, 120

Dermatophytosis, see TineaDiagnostic aids

basics, 22Diagnostic data

basics, 29supporting, 29

Diascopybasics, 24

Discoid configurationLupus erythematosus, 178

Discoid lupus erythematosusdistinguish from actinic keratosis, 292

Distributionbasics, 16recognizing, 16

DLE , see lupus erythematosus, discoid

Doxepine, topical therapybasics, 44

Drug eruption, fixed, see fixed drug eruptionDrug eruptions in relation to pityriasis rosea, 78Dyshidrosis

distinguish from tinea pedis, 132

E

Ectoparasite exambasics, 30Eczemaasteatotic, 213distinguish from tinea pedis, 132nummular

distinguish from asteatotic eczema, 217distinguish from atopic dermatitis, 210distinguish from common skin cancers,

basal cell carcinoma/epithelioma,304

distinguish from pityriasis rosea, 81distinguish from psoriasis vulgaris, 90distinguish from seborrheic dermatitis, 73distinguish from tinea corporis, 132

Eczema herpeticumHerpes simplex recidivans, 327

Elliptical incision biopsybasics, 33illustration, 34

ELND (elective lymph node dissection)EM, see Erythema multiformeEmollients, topical therapy

basics, 43Enhancers, topical therapy, basics, 44Ephelides, 241

configuration, 242differential diagnosis, 242distinguish from lentigines, 248distribution, 242evolution of disease process, 241evolution of skin lesions, 241onset, 241physical exam, 241primary lesions, 241provoking factors, 241secondary lesions, 242self-medication, 241supplemental history, 241supporting data, 242therapy, 242

Index 445

Epidermal atrophyillustration, 15

Epidermal lesions, 115, 173Epithelial nevi

distinguish from melanocytic nevi, congeni-tal,, 268

Equipment list for examination, basics, 25Erosion

basics, 11illustration, 13

Erysipelas, 153configuration, 155differential diagnosis, 157distribution, 155evolution of disease process, 153evolution of skin lesions, 154macrodistribution, illustrations, 156onset, 153physical exam, 154primary lesions, 154provoking factors, 154secondary lesions, 155self-medication, 154supplemental history, 154supporting data, 155therapy, 155

Erysipeloiddistinguish from erysipelas, 157

Erysipelothrix insidiosa infectiondistinguish from erysipelas, 157

Erythema multiforme, 161configuration, 164differential diagnosis, 167direct immunofluorescence, 164distribution, 164evolution of disease process, 162evolution of skin lesions, 162Herpes simplex recidivans, 327macrodistribution, illustration, 165onset, 161physical exam, 163primary lesions, 163provoking factors, 163secondary lesions, 163self-medication, 163skin biopsy, 164supplemental history, 163supporting data, 164therapy, 164

Erythrasma, 117configuration, 118differential diagnosis, 119distinguish from tinea pedis, 132distribution, 118evolution of disease process, 117evolution of skin lesions, 117intertriginous

distinguish from tinea cruris, 132macrodistribiution, illustrations, 119onset, 117physical exam, 118primary lesions, 118provoking factors, 117secondary lesions, 118self-medication, 117supplemental history, 118supporting data, 118

Escharbasics, 13illustration, 15

Examination equipmentbasics, 25list for, 25

Excisional biopsybasics, 35illustration, 35

Excoriationsbasics, 12

F

FDE, see Fixed drug eruptionFever blisters, see Herpes simplex recidivansFissures

basics, 12illustration, 13

Fixed drug eruption, 147configuration, 149distribution, 149drugs causing, table, 148evolution of disease process, 147evolution of skin lesions, 147foods causing, table, 148macrodistribution, illustrations, 150onset, 147physical exam, 149primary lesions, 149provoking factors, 148secondary lesions, 149

446 Index

self-medication, 148supplemental history, 148supporting data, 149therapy, 149

Foamsbasics, 40vehicles, 40

Follicular configurationseborrheic dermatitis, 69

Freckles, see EphelidesFungus infection

deepdistinguish from molluscum contagiosum,

56in relation to lichen planus, 94intertriginous

distinguish from erythrasma, 120superficial, see Tinea

G

Gangrenebasics, 14

Gelsbasics, 39vehicles, 39

Graft versus host reactions in relation to lichenplanus, 94

Gram-negative folliculitisdistinguish from acne vulgaris, 357distinguish from tinea barbae, 131

Gram-negative toe web infectiondistinguish from tinea pedis, 132

Grouped configurationactinic keratosis, 289basics, 21Herpes simplex recidivans, 329illustration, 22impetigo, 319lichen planus, 95miliaria rubra, 102molluscum contagiosum, 53rosacea, 362verruca vulgaris, 61

H

Halo melanomadistinguish from melanocytic nevi, acquired,

halo nevi, 258Hand, foot, and mouth disease

distinguish from erythema multiforme, 167

Herpes genitalis, see Herpes simplex recidivansHerpes labialis

distinguish from impetigo, 322see Herpes simplex recidivans

Herpes simplex recidivans, 325complement fixation tests, 329complications, 327configuration, 329differential diagnosis, 332distinguish from Herpes zoster, 343distribution, 329evolution of disease process, 326evolution of skin lesions, 328onset, 326physical exam, 328primary lesions, 328provoking factors, 328rapid immunofluorescent tests for Herpes, 330secondary lesions, 328self-medication, 328skin biopsy, 329supplemental history, 328supporting data, 329therapy, 330Tzanck smear, 329

Herpes zoster, 335complement fixation tests, 339complications, 337configuration, 339differential diagnosis, 343distinguish from toxicodendron dermatitis, 196distribution, 339divisions of trigeminal nerve, illustrations, 337evolution of disease process, 335evolution of skin lesions, 338onset, 335physical exam, 338postherpetic neuralgia treatment, 342primary lesions, 338provoking factors, 338rapid immunofluorescence test, 340secondary lesions, 339self-medication, 338skin biopsy, 339supplemental history, 338supporting data, 339therapy, 340Tzanck smear, 339viral culture, 339

Index 447

Heterozygous cystic fibrosis resembling atopicdermatitis, 211

History-taking basicsevolution of disease process, 3evolution of skin lesions, 4onset, 3provoking factors, 4self-medication, 4supplemental review from general history, 4

HIV (human immunodeficiency virus)Hives, see UrticariaHSV (Herpes simplex virus)HSV-1 (Herpes simplex virus, Type 1)HSV-2 (Herpes simplex virus, Type 2)HTLV type-1 associated infective dermatitis

resembling atopic dermatitis, 211Hurler’s syndrome resembling atopic dermatitis,

211Hyperpigmentation

basics, 14illustration, 15

Hypertrichosis, basics, 12Hypopigmentation

basics, 14illustration, 16

Hypotrichosisbasics, 12

HZV (Herpes zoster virus)

I

Ichthyosisdistinguish from asteatotic eczema, 217

Immunodeficienciesdistinguish from seborrheic dermatitis, 67primary, 67

Immunosuppression, in molluscumcontagiosum, 52

Impetiginizationbasics, 11

Impetigo, 317configuration, 319differential diagnosis, 322distinguish from Herpes simplex recidivans,

332distribution, 319evolution of disease process, 317evolution of skin lesions, 318macrodistribution, illustrations, 320, 321nonbullous, distinguish from atopic dermatitis,

210

of scalp, distinguish from tinea capitis, 131onset, 317physical exam, 319primary lesions, 319provoking factors, 318secondary lesions, 319self-medication, 319supplemental history, 319supporting data, 319therapy, 321

Incisional biopsybasics, 31

Indicated supporting diagnostic databasics, 29

Infantile seborrheic dermatitisonset, 67

Intra-epidermal pustuleillustration, 10

Intralesional steroid therapybasics, 45

Iris configurationbasics, 19erythema multiforme, 164illustration, 20melanocytic nevi, acquired halo nevi, 258

J

Junctional nevidistinguish from lentigines, 247

Jung’s disease resembling atopic dermatitis, 211

K

KA, see KeratoacanthomaKeratoacanthoma, 293

configuration, 295differential diagnosis, 296distinguish from common skin cancers, squa-

mous cell carcinoma, 309distinguish from molluscum contagiosum, 56distinguish from verruca vulgaris, 64distribution, 295evolution of disease process, 293evolution of skin lesions, 294macrodistribution, illustrations, 295onset, 293physical exam, 294primary lesions, 294provoking factors, 294secondary lesions, 294

448 Index

self-medication, 294skin biopsy, 296supplemental history, 294supporting data, 296therapy, 296

KOH exambasics, 29

L

Langerhan’s cell histiocytosisdistinguish from seborrheic dermatitis, 67

LCMN (Large congenital melanotic nevus)LE, see Lupus erythematosisLentigines, 245

configuration, 246differential diagnosis, 247distinguish from ephelides, 242distribution, 246evolution of disease process, 245evolution of skin lesions, 245macrodistribution, illustrations, 247onset, 245physical exam, 246primary lesions, 246provoking factors, 246secondary lesions, 246self-medication, 246supplemental history, 246supporting data, 246therapy, 246

Lentigo malignadistinguish from lentigines, 248

Leukodermabasics, 16illustration, 16

Lichen planus, 93configuration, 95differential diagnosis, 98direct immunofluorescence, 96distribution, 95evolution of disease process, 93evolution of skin lesions, 94general laboratory testing, 97macrodistribution, illustrations, 96onset, 93physical exam, 94primary lesions, 94provoking factors, 94secondary lesions, 95

self-medication, 94skin biopsy, 96supplemental history, 94supporting data, 96therapy, 97

Lichen planus-like drug eruptionsdistinguish from lichen planus, 98in relation to lichen planus, 94

Lichen simplex chronicusdistinguish from atopic dermatitis, 210distinguish from seborrheic dermatitis, 74

Lichenificationbasics, 12

Lightingbasics, 23examination, 23

Linear configurationbasics, 19illustrations, 20lichen planus, 95molluscum contagiosum, 53striae distensae, 226toxicodendron dermatitis, 193

Liver disease in relation to lichen planus, 94Liver spots, 235LM, see Lentigo malignaLMM (lentigo maligna melanoma)LN2 (liquid nitrogen)Lotions

basics, 39vehicles, 39

LP, see Lichen planusLupus erythematosis

differential diagnosis, 187discoid and systemic

distinguish from rosacea, 364distinguish from lichen planus, 99distinguish from psoriasis vulgaris, 89distinguish from tinea faciale, 131serologic testing, 178

Lupus erythematosus, discoidantinuclear antibody, 178configuration, 178direct immunofluorescence, 178distribution, 178evolution of disease process, 176evolution of skin lesions, 176onset, 176physical exam, 177primary lesions, 177

Index 449

provoking factors, 176secondary lesions, 177self-medication, 176skin biopsy, 178supplemental history, 176supporting data, 178therapy, 179

Lupus erythematosus, subacute cutaneousantinuclear antibody, 183configuration, 182direct immunofluorescence, 183distribution, 182evolution of disease process, 181evolution of skin lesions, 181macrodistribution, illustration, 183onset , 181physical exam, 182primary lesions, 182provoking factors, 181secondary lesions, 182self-medication, 182skin biopsy, 183supplemental history, 182supporting data, 183therapy, 183

Lupus erythematosus, systemicbutterfly rash

illustration, 186configuration, 186direct immunofluorescence, 186distribution, 185evolution of disease process, 184evolution of skin lesions, 184onset, 184physical exam, 185primary lesions, 185provoking factors, 184secondary lesions, 185self-medication, 185skin biopsy, 186supplemental history, 185supporting data, 186therapy, 187

Lymphoma, cutaneous T-celldistinguish from atopic dermatitis, 211

M

Macroanatomic distributionbasics, 17

Maculebasics, 8illustration, 9

Magnificationbasics, 23examination, 23

Malignant lesions, 233Malignant melanoma, 271

AJCC revised melanoma staging systempartial, table, 276

Breslow breakpoints, table, 275Clark’s levels of melanoma, table, 274configuration, 279current recommended excision margins,

table, 281differential diagnosis, 284distinguish from seborrheic keratosis, 239distribution, 278evolution of disease process, 274evolution of skin lesions, 276favored sites for melanoma, illustrations,

279, 280follow-up, table, 283melanoma size, illustration, 278nodular, growth phases, illustration, 273onset, 271pathology report, 281physical exam, 277primary lesions, 278provoking factors, 276secondary lesions, 278self-medication, 276skin biopsy, 279superficial spreading, growth phases, illustra-

tion, 272supplemental history, 276supporting data, 279therapy, 281traditional three-stage melanoma staging

system, table, 275MC, see Molluscum contagiosumMCMN (medium congenital melanotic nevus)Melanocytic nevi, 251Melanocytic nevi, acquired atypical

configuration, 261differential diagnosis, 263distribution, 261evolution of disease process, 259evolution of skin lesions, 260

450 Index

onset, 259physical exam, 261primary lesions, 261provoking factors, 260secondary lesions, 261self-medication, 260skin biopsy, 261supplemental history, 260supporting data, 261therapy, 261

Melanocytic nevi, acquired halo neviconfiguration, 258differential diagnosis, 258distribution, 258evolution of disease process, 257evolution of skin lesions, 258onset, 257physical exam, 258primary lesions, 258provoking factors, 258secondary lesions, 258self-medication, 258supplemental history, 258supporting data, 258therapy, 258

Melanocytic nevi, acquiredconfiguration, 254differential diagnosis, 256distribution, 254evolution of disease process, 252evolution of skin lesions, 252onset, 251physical exam, 253primary lesions, 253provoking factors, 253secondary lesions, 254self-medication, 253skin biopsy, 254supplemental history, 253supporting data, 254therapy, 255

Melanocytic nevi, congenitalconfiguration, 266differential diagnosis, 268distribution, 266evolution of disease process, 264evolution of skin lesions, 265onset, 264physical exam, 265

primary lesions, 265provoking factors, 265secondary lesions, 266self-medication, 265skin biopsy, 266supplemental history, 265supporting data, 266therapy, 267

Melanoma, nodulardistinguish from common skin cancers, squa-

mous cell carcinoma, 309Melanoma, see malignant melanomaMicroanatomic distribution

basics, 16Miliaria ,rubra, 101

configuration, 102differential diagnosis, 103distribution, 102evolution of disease process, 101evolution of skin lesions, 101macrodistribution, illustration, 103onset, 101physical exam, 102primary lesions, 102provoking factors, 102secondary lesions, 102self-medication, 102supplemental history, 102supporting data, 102therapy, 102

MM, see Malignant melanomaMoles, see Melanocytic neviMolluscum contagiosum, 51

biopsy, 53configuration, 53diagnostic data, 53differential diagnosis, 56distinguish from common skin cancers, basal

cell carcinoma/epithelioma, 304distinguish from common skin cancers, squa-

mous cell carcinoma, 308distinguish from keratoacanthoma, 296distribution, 53evolution of disease process, 51evolution of skin lesions, 52immunosuppression, 52macrodistribution, illustrations, 54, 55, 56onset, 51physical exam, 52

Index 451

primary lesions, 52provoking factors, 52secondary lesions, 53Self-medication, 52smear, 53supplemental history, 52therapy, 53

Mongolian spotdistinguish from melanocytic nevi, congeni-

tal, 268Monilia, intertriginous

distinguish from erythrasma, 120seborrheic dermatitis, 73tinea cruris, 132

Moniliasisdistinguish from tinea pedis, 132

Morpheadistinguish from common skin cancers, basal

cell carcinoma/epithelioma, 304

N

Nail bed carcinomadistinguish from verruca vulgaris, 64

Nail bed hemorrhagedistinguish from malignant melanoma, 284

Nail lichen planusdistinguish from tinea unguium, 132

Nail moniliadistinguish from tinea unguium, 132

Nail psoriasisdistinguish from tinea unguium, 132

Necrosisbasics, 11

Necrotizing fasciitisdistinguish from erysipelas, 158

Nephrotic syndrome resembling atopic dermati-tis, 211

Netherton’s syndrome resembling atopic derma-titis, 211

Nevi, commondistinguish from melanocytic nevi, acquired

atypical, 263Nevi, common benign

distinguish from melanocytic nevi, congenital,268

Nevi, common compounddistinguish from common skin cancers, basal

cell carcinoma/epithelioma, 304Nevi, melanocytic, 251

Nevus of Itodistinguish from melanocytic nevi, congeni-

tal, 268Nevus of Ota

distinguish from melanocytic nevi, congeni-tal, 268

NM (nodular melanoma)Nodular melanoma

distinguish from common skin cancers, basalcell carcinoma/epithelioma, 304

distinguish from common skin cancers, squa-mous cell carcinoma, 309

Nodulebasics, 8illustration, 9

Nonbullous impetigodistinguish from atopic dermatitis, 210

Nonsolar lentigodistinguish from melanocytic nev, acquired,

256NSAID (nonsteroidal anti-inflammatory drugs)Nummular eczema

distinguish from asteatotic eczema, 217distinguish from atopic dermatitis, 210distinguish from common skin cancers, basal

cell carcinoma/epithelioma, 304distinguish from pityriasis rosea, 81distinguish from psoriasis vulgaris, 90distinguish from seborrheic dermatitis, 73distinguish from tinea corporis, 132

O

Occlusive therapybasics, 40

Ocular Herpes simplex, Herpes simplexrecidivans, 327

Ocular rosacea, rosacea, 360Ointments

basics, 39vehicles, 39

Old age spots, 235

P

Papillomatosisbasics, 12illustration, 13

Papular lesions, 49Papule

basics, 8illustration, 9

452 Index

Papulo-pustular lesions, 315Papulo-squamous lesions, 49Papulo-vesicular lesions, 49Paronychia, bacterial

distinguish from Herpes simplex recidivans,333

Parvovirus B19 infectiondistinguish from lupus erythematosus, 187

Patchbasics, 8illustration, 9

PCR (polymerase chain reaction)Pediculosis capitisdistinguish from seborrheic dermatitis, 74Pemphigoid, bullous

distinguish from erythema multiforme, 167distinguish from impetigo, 322

Percutaneous absorptionbasics, 38

Perioral dermatitisdistinguish from acne vulgaris, 356distinguish from rosacea, 364

Petaloid configuration, seborrheic dermatitis,69\

Phenylketonuria resembling atopic dermatitis,211

PHN (postherpetic neuralgia)Physical examination

basics, 7primary lesions, 8

Phytophotodermatitisdistinguish from toxicodendron dermatitis,

195Pigmented basal cell carcinoma

distinguish from malignant melanoma, 284distinguish from seborrheic keratosis, 239

Pigmented lesions, 233Pityriasis alba

distinguish from tinea corporis, 132Pityriasis rosea, like drug eruptions

distinguish from pityriasis rosea, 80Pityriasis rosea, 77

configuration, 80differential diagnosis, 80distinguish from lupus erythematosus, 187distinguish from psoriasis vulgaris, 89distinguish from seborrheic dermatitis, 73distinguish from tinea corporis, 132distribution, 79

evolution of disease process, 77evolution of skin lesions, 78macrodistribution, illustrations, 79onset, 77physical exam, 78primary lesions, 78provoking factors, 78secondary lesions, 79self-medication, 78supplemental history, 78supporting data, 80therapy, 80

Pityriasis versicolordistinguish from erythrasma, 119distinguish from seborrheic dermatitis, 73

Planar wartsdistinguish from seborrheic keratosis, 238

Plant dermatitisdistinguish from toxicodendron dermatitis,

195Plantar calluses

distinguish from verruca vulgaris, 64Plaque

basics, 8illustration, 10

Poikilodermabasics, 16

Poison ivy, see Toxicodendron dermatitisPoison oak, see Toxicodendron dermatitisPoison sumac, see Toxicodendron dermatitisPolycyclic configuration

basics, 19erythema multiforme, 164illustration, 19impetigo, 319lupus erythematosus, subacute cutaneous,

182psoriasis, 86tinea, 125urticaria, 138

Postherpetic neuralgia, Herpes zoster, 337Potassium hydroxide exam

basics, 29Potency of topical steroids, table, 42PR, see Pityriasis roseaPramoxine, topical therapy

basics, 44Pre-malignant lesions, 233Prickly heat, see Miliaria rubra

Index 453

Primary lesionsbasics, 8recognizing, 8

Pseudofolliculitis barbaedistinguish from acne vulgaris, 357

Pseudomelanomadistinguish from malignant melanoma, 284

Psoriasis vulgaris, 83configuration, 86differential diagnosis, 89distinguish from common skin cancers, basal

cell carcinoma/epithelioma, 304distinguish from lupus erythematosus, 187distinguish from pityriasis rosea, 81distinguish from seborrheic dermatitis, 73distinguish from tinea capitis, 131distinguish from tinea corporis, 132distribution, 85evolution of disease process, 83evolution of skin lesions, 84macrodistribution, illustration, 86onset, 83physical examination, 85primary lesions, 85provoking factors, 84secondary lesions, 85self-medication, 85supplemental history, 85therapy, 87

Punch biopsybasics, 31illustration, 32

Purpurabasics, 14illustration, 15

Pustulebasics, 8illustration, 10

PV, see Psoriasis vulgarisPyogenic granuloma

distinguish from malignant melanoma, 284

R

Recognizing configurationbasics, 18

Recognizing distributionbasics, 16

Regions of skin permeabilityillustration, 38

Reticulated configuration, lichen planus, 95Retiform configuration

basics, 22illustration, 22

Rhinophyma, rosacea, 360Rhus dermatitis, see Toxicodendron dermatitisRIF (rapid immunofluorescence test)Ringworm, see tineaRosacea lymphedema, rosacea, 361Rosacea, 359

complications, 360configuration, 362differential diagnosis, 364distinguish from acne vulgaris, 356distinguish from lupus erythematosus, 187distribution, 362evolution of disease process, 359evolution of skin lesions, 361macrodistribution, illustration, 363onset, 359physical exam, 362primary lesions, 362provoking factors, 361secondary lesions, 362self-medication, 361supplemental history, 361supporting data, 362therapy, 362

S

Saucerization biopsybasics, 33illustration, 34

Scabies preparationbasics, 30

Scabies, 105configuration, 107differential diagnosis, 110distinguish from atopic dermatitis, 210distribution, 107evolution of disease process, 106evolution of skin lesions, 106macrodistribution, illustrations, 108, 109, 110onset, 105physical exam, 107primary lesions, 107provoking factors, 106secondary lesions, 107self-medication, 106

454 Index

supplemental history, 107supporting data, 108therapy, 108

Scalebasics, 11

Scar or Cicatrixbasics, 14

SCC (squamous cell carcinoma)SCL (subacute cutaneous lupus erythematosus)Sclerosis

basics, 12illustration, 13

SCMN (small congenital melanotic nevus)SD, see Seborrheic dermatitisSebaceous hyperplasia

distinguish from common skin cancers, basalcell carcinoma/epithelioma, 304

Seborrheic blepharitis, therapy, 72Seborrheic dermatitis, 67

and AIDS, 68configuration, 69diagnostic data, 69differential diagnosis, 73distinguish from atopic dermatitis, 210distinguish from atopic dermatitis, 210distinguish from lupus erythematosus, 187distinguish from pityriasis rosea, 81distinguish from psoriasis vulgaris, 89distinguish from tinea capitis, 131distribution, 69evolution of disease process, 67evolution of skin lesions, 68macrodistribution, illustrations, 70onset, 67physical exam, 68primary lesions, 68provoking factors, 68secondary lesions, 69self-medication, 68supplemental history, 68therapy, 71

Seborrheic keratosis, 235configuration, 236differential diagnosis, 238distinguish from actinic keratosis, 291distinguish from common skin cancers, squa-

mous cell carcinoma, 309distinguish from lentigines, 248distinguish from melanocytic nevi, acquired,

257

distribution, 236evolution of disease process, 235evolution of skin lesions, 235macrodistribution, illustrations, 237onset, 235physical exam, 236primary lesions, 236provoking factors, 236secondary lesions, 236self-medication, 236skin biopsy, 237supplemental history, 236supporting data, 237therapy, 237

Secondary lesionsbasics, 10recognizing, 10

Selective IGA deficiency resembling atopicdermatitis, 211

Senile purpura, 219configuration, 220distribution, 220evolution of disease process, 219evolution of skin lesions, 219macrodistribution, illustrations, 221onset, 219physical exam, 220primary lesions, 220provoking factors, 220secondary lesions, 220self-medication, 220supplemental history, 220supporting data, 220therapy, 220

Serologic testing for Lupus erythematosus, 178Serpiginous configuration

basics, 19illustration, 20tinea, 125urticaria, 138

Sex-linked agammaglobulinemia resemblingatopic dermatitis, 211

Shave incision biopsybasics, 32illustration, 33

Shingles, see Herpes zosterSK, see Seborrheic keratosisSkin biopsy, basics, 30Skin cancers, common, see common skin cancers

Index 455

Skin permeabilityregions of, illustration, 38

Skin phototypes, common skin cancers, basalcell carcinoma/epithelioma, table, 299

SLE, see Systemic lupus erythematosusSLNB (sentinel lymph node biopsy)Solar keratosis, see actinic keratosisSolar lentigines

distinguish from actinic keratosis, 291distinguish from melanocytic nevi, acquired,

atypical, 263distinguish from seborrheic keratosis, 238

Specific historybasics, 3

SPF (sun protection factor)Spitz’s nevus

distinguish from malignant melanoma, 284Squamous cell carcinoma, see Common skin

cancersSquamous cell carcinoma

distinguish from actinic keratosis, 292distinguish from keratoacanthoma, 296distinguish from molluscum contagiosum, 56distinguish from seborrheic keratosis, 238distinguish from verruca vulgaris, 64

SSMM (superficial spreading malignant mela-noma)

Staphylococcal folliculitisdistinguish from tinea barbae, 131

Steroid purpuradistinguish from senile purpura, 221

Steroid rosaceadistinguish from rosacea, 364

Steroid therapyintralesional, basics, 45systemic, basics, 45

Steroids, topicalbasics, 40potency of, table, 42

Stretch marks, see striae distensaeStriae distensae, 223

configuration, 226differential diagnosis, 228distribution, 225evolution of disease process, 224evolution of skin lesions, 224macrodistribution, illustrations, 225, 226,

227, 228onset, 223

physical exam, 224primary lesions, 224provoking factors, 224secondary lesions, 225self-medication, 224supplemental history, 224supporting data, 226therapy, 227

Striae gravidarum, see Striae distensaeSubacute cutaneous configuration, lupus erythe-

matosus, 182Subcutaneous atrophy

illustration, 15Superficial spreading basal cell carcinoma

distinguish from common skin cancers, squa-mous cell carcinoma, 309

Supporting diagnostic databasics, 29

Syphilis in relation to pityriasis rosea, 78Syphilis, secondary

distinguish from lichen planus, 99distinguish from pityriasis rosea, 81distinguish from psoriasis vulgaris, 89distinguish from seborrheic dermatitis, 74

Systemic steroid therapybasics, 45

T

Tactile examinationbasics, 23

Taking a basic history, see History-taking basicsTargetoid configuration, erythema multiforme,

164TB (tinea barbae)TC (tinea corporis)TCa (tinea capitis)TCr (tinea cruris)Telangectasia

basics, 16TF (tinea faciale)Therapy

basics, 37Thrombosed capillary aneurysm

distinguish from malignant melanoma, 284Tinea, 121

configuration, 125differential diagnosis, 131distribution, 125evolution of disease process, 122

456 Index

evolution of skin lesions, 123onset, 122physical exam, 125primary lesions, 125provoking factors, 124secondary lesions, 125self-medication, 124supplemental history, 125supporting data, 126therapy, 126

Tinea barbaedescription, 122differential diagnosis, 131

Tinea capitisdescription, 122differential diagnosis, 131

Tinea circinatadistinguish from impetigo, 322

Tinea corporis, 122annular

distinguish from lupus erythematosus, 187differential diagnosis, 132distinguish from atopic dermatitis, 211distinguish from pityriasis rosea, 81

Tinea crurisdescription, 122differential diagnosis, 132

Tinea faciale, 122differential diagnosis, 131distinguish from lupus erythematosus, 187

Tinea manuumdescription, 122differential diagnosis, 132

Tinea pedisdescription, 122differential diagnosis, 132

Tinea unguiumdescription, 122differential diagnosis, 132

Tinea versicolordistinguish from erythrasma, 119distinguish from seborrheic dermatitis, 73

TM, see Tinea manuumTopical steroids

basics, 40potency of, table, 42

Topical therapyanesthetics

basics, 44

antihistaminesbasics, 44

antipruriticsbasics, 45

doxepinebasics, 44

emollientsbasics, 43

enhancersbasics, 44

pramoxinebasics, 44

vehiclesbasics, 39

Toxicodendron dermatitis, 191configuration, 193differential diagnosis, 195distinguish from Herpes zoster, 343distribution, 193evolution of disease process, 192evolution of skin lesions, 192onset, 192physical exam, 193primary lesions, 193provoking factors, 193secondary lesions, 193self-medication, 193supplemental review, 193supporting data, 194therapy, 194

TP (tinea pedis)Trichotillomania

distinguish from tinea capitis, 131TU (tinea unguium)Tuberculosis

distinguish from tinea barbae, 131Tzanck preparation

basics, 30

U

Ulceration,basics, 14illustration, 15

Urticaria, 135acute, therapy, 139chronic intermittent, therapy, 141chronic

therapy, 141differential diagnosis, 142

Index 457

evolution of disease process, 135evolution of skin lesions, 136onset, 135other types, 142, 143, 144, 145physical exam, 137primary lesions, 137provoking factors, 136radiologic studies, 138secondary lesions, 137self-medication, 137skin biopsy, 138skin testing, 138supplemental history, 137supporting data, 138therapy, 139

V

Varicelladistinguish from impetigo, 322

Vegetating lesionsdistinguish from keratoacanthoma, 296

Vegetationbasics, 13illustration, 15

Vehicles, topical therapybasics, 39

Verruca vulgaris, 59configuration, 61diagnostic data, 61differential diagnosis, 64distinguish from common skin cancers, squa-

mous cell carcinoma, 309distribution, 60evolution of disease process, 59

evolution of skin lesions, 59macrodistribution, illustrations, 61, 62onset, 59physical examination, 60primary lesions, 60provoking factors, 59secondary lesions, 60self-medication, 60skin biopsy, 61supplemental history, 60therapy, 62

Verrucous carcinomadistinguish from verruca vulgaris, 64

Vesiclebasics, 8illustration, 10

Vesiculo-bullous lesions, 315Viral exanthems

distinguish from, 103VV, see Verruca vulgaris

W

Warts, see Verruca vulgarisWinter itch, see Asteatotic eczemaWiskott-Aldrich syndrome resembling atopic

dermatitis, 211Woods lamp examination

basics, 24

Z

Zosteriform configurationbasics, 19Herpes zoster, 339illustrations, 21