Andrews' Diseases of the Skin: Clinical Dermatology

973 Pages·2005·244.48 MB·English

by  William D. James MD

ANDREWS'
DISEASES OF THE SKIN
CLINICAL
DERMATOLOGY
Commissioning Editors: Sue HodgsonIKaren Bowler
Project Development Manager: Melissa Dudlick
Project Managers: Cheryl BranWNaughton Project Management
Design Manager: Jayne Jones
Illustration Manager: Mick Ruddy
Illustrator: Richard Prime
Marketing Manager($ (UWUSA): Amy Hey/Laura Meiskey
-.
ANDREWS'
DISEASES OF THE SKIN
CLINICAL
DERMATOLOGY
T E N T H E D I T I O N
WILLIAM D JAMES, MD
Paul R Gross professor of Dermatology
Vice-Chair and Residency Program Director
University of Pennsylvan~a
Philadelphia, Pennsylvania
TIMOTHY G BERGER, MD
Professor of Clinical Dermatology
Executive Vice Chair and Residency Program Director
Chair in Dermatology Medical Student Education
University of California, San Francisco
San Francisco. California
DIRK M ELSTON, MD
Departments of Dermatology and Pathology
Geisinger Med~caCl enter
Danv~lle,P ennsylvania
SAUNDERS
ELSEVIER
An imprint of Elsevier Inc.
O 2006, Elsevier inc All rights reserved
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording or otherwise, without
l
the prior permission of the Publishers. Permissions may be sought directly from Eisevier's Health
Sciences Rights Department in Philadelphia, USA: telephone: (+I) 215 239 3804, fax: (+I) 215
239 3805; or, e-mail: healthpermissions@eIsevie~:comY~o u may also complete your request on-
line via the Elsevier homepage (http://www.elsevier.com), by selecting 'Support and contact'
and then 'Copyright and Permission'.
Main edition ISBN: 0-7216-2921- 0
EAN 97807216 29216
international edition ISBN 0-8089-2351 -X
EAN 9780808923510
9th edition O 2000, WE Saunders Company
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notice
Medical knowledge is constantly changing. Standard safety precautions must be followed,
but as new research and clinical experience broaden our knowledge, changes in treatment
and drug therapy may become necessary or appropriate. Readers are advised to check the
most current product information provided by the manufacturer of each drug to be
administered to verify the recommended dose, the method and duration of administration,
and contraindications. It is the responsibility of the practitioner, relying on experience and
knowledge of the patient, to detetmine dosages and the best treatment for each individual
patient. Neither the Publisher nor the author assumes any liability for any injury and/or
damage to persons or property arising from this publication.
The Publisher
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Working together to grow
libraries in developing countries
-
CONTENTS
Preface vii Viral Diseases
Acknowledgments viii Parasitic Infestations, Stings, and Bites 421
Contributors Chronic Blistering Dermatoses 459
Nutritional Diseases 479
Skin: Basic Structure and Function
Diseases of Subcutaneous Fat 487
Cutaneous S~gnsa nd Diagnosis
Endocrine Diseases 499
Dermatoses Resulting from Physical Factors 21
Abnormalities of Dermal Fibrous and Elastic
Pruritus and Neurocutaneous Dermatoses 51 Tissue 509
Atoplc Dermatitls, Eczema, and Errors in Metabolism 519
Nonlnfectlous lmmunodefic~encyD isorders 69
Genodermatoses and Congenital Anomalies 547
Contact Dermatitis and Drug Eruptions
Dermal and Subcutaneous Tumors 581
Erythema and Urticaria
Epidermal Nevi, Neoplasms, and Cysts 633
Melanocyiic Nevi and Neoplasms 685
Mucinoses 183
MacrophageIMonocyte Disorders 703
Seborrheic Dermatitls, Psor~aslsR, ecalcitrant
Cutaneous Lymphoid Hyperplasia,
Palmoplantar Eruptions, Pustular Dermat~tis,
Cutaneous T-cell Lymphoma, Other
and Erythroderma 191
Malignant Lymphomas, and Allied Diseases 725
Pltyriasls Rasea, Pltyr~asisR ubra Pilarls, and
Diseases of the Skin Appendages 749
Other Papulosquamous and Hyperkeratotlc
D~seases 207 Disorders of the Mucous Membranes 795
Lichen Planus and Related Cond~t~ons 217 Cutaneous Vascular Diseases 81 5
Acne Disturbances of Pigmentation 853
Bacterial Infections 25 1 Dermatologic Surgery 869
Diseases Resulting from Fungi and Yeasts 297 Laser Surgery and Cosmetic Dermatology 889
Mycobacterlal Diseases 333
Hansen's Disease index
Syphilis, Yaws, Bejei, and Pinta

PREFACE
-I
Andrews' remains as it was from the beginning: an authored in dermatopathologic staining and analysis, adding a chapter
text whose one volume is filled with clinical signs, symp- on cosmetic surgery, and enlarging the therapeutic recom-
toms, diagnostic tests, and therapeutic pearls. The authors mendations to include our expanded therapeutic options,
have remained general clinical dermatologists in an era of such as biologic response modifiers, and biologically-
subspecialists in academia. They are committed to keeping engineered ta~getedm edications. We have attempted to
A~~TBWasS a'n excellent tobl for anyone who needs help to define the therapeutic options in a fashion that emphasizes
diagnose a patient with a clinical conundrum or to treat a those interventions with the highest level of evidence, but
patient with a therapeutically challenging disease. also present less critically investigated therapeutic options.
Aitdrews' is primarily intended for the practicing derma- To care for our patients we need a large army of options
tologist. It is meant to be used on the desktop at- hislher and not all are fully supported by formal evidence, yet are
clinic, giving consistent, concise advice on the whole gamut helpful to individual patients. Finally, a plelhora of newly
of clinical situations faced in the course of a busy workday described conditions, infections, physical signs, and disease
Because of its relative brevity but complete coverage of our associations have been added.
field, many find the text ideal for learning dermatology Extensive revisions were necessary to add this wealth of
the first time. It has been a mainstay of the resident yearly new information. We also have selectively discarded older
curriculum for inany programs. We are hopeful that another concepts. By eliminating older, not currently useful informa-
group of trainees will learn clinical dermatology by studying tion we maintain the brief but complete one volume presen-
the clinical descriptions, disease classifications, and treat- tation that we and all previous authors have emphasized.
men1 insights that define Andrews'.We believe that students, Additionally, older references have been updated.The classic
interns, internists or other medical specialists, family early works are not cited; instead we have chosen to include
practitioners, and other health professionals who desire a only new citations and let the bibliographies of the current
comprehensive dermatology textbook will find that ours work provide the older references as you need them. Finally,
meets their needs. Long-time der~natologistsw ill hopefully a major effort in this edition was to completely reillustrate
discover Aitdrews' to be the needed update that satisfies the text with color photographs. We have looked at our
their lifelong learning desires. own collections first. These are the result of many hours of
Many major changes have been made to this edition. personal effort, the generosity of our patients, and a large
Richard Odom, who was a coauthor on the last three number of residents and faculty of the programs in which
editions, has left this revision to Bill James,llm Berger and we currently work or have worked in the past. Additionally,
our newest author, Dirk Elsion.The three of us have worked friends and colleagues from all parts of the globe have
closely to continue to improve the quality of our text. allowed us to utilize their phot.ographs.They have given their
We have tried to ensure that each entity is only discussed permission for use of these wonderful educational photos to
once, in a complete yet concise manner. In order to do this enhance your understanding of dermatology and how these
we have had to make decisions regarding the placement diseases affect our patients. We cannot thank them enough.
of disease processes in only one site. Clearly, neutrophilic The sulgical chapters continue to be coauthored by Roy
eccrine hidradenitis, for example, could be presented under Grekin. His colleague in this edition is Isaac Neuhaus, and
drug eruptions, neutrophilic reactive conditions, infection or we thank them for their efforts to expand the procedural
cancer-associated disease, or with eccrine disorders.The final portion of our textbook. Since the past edition was brought
decisions were a team effort and made in the interest of to print WB Saunders and Mosby have become part of a
eliminating redundancy.This allows us to present our unified larger enterprise, Elsevier. We are proud to be a part of this
philosophy in treating patients in one dense volume. team and have such professionals as Sue Hodgson, Karen
Medical science continues to progress with break-neck Bowler, Sam Gear and Melissa Dudlick supporting us every
speed, Our understanding of the etiology of certain condi- step of the way
tions has now led us to I-categorize well-recognized disease
states and dictated our addition of many newly described We hope you enjoy this 10th edition of Aizdrews'.
entities. Molecular investigative techniques, technologic
breakthroughs, and designer therapeutics lead the way in William D James MD
providing advances in our speciaIty.We cover the new under- Timothy G Berger MD
standing following from such innovations by discussing the Dirk M Elston MD
mechanisms at work in genetic diseases, covering the latest
m' ACKNOWLEDGMENTS
Ann, my loving wife, and my children Dan and Becca make me happy and proud. They have supported me
over the years with love and patience. I cannot thank them enough for being my companions on this
joyous ride. The faculty, residents, and patients of Walter Reed were indispensable to my development, and
those of the University of Pennsylvania continue to teach me daily.Tim Berger and Dirk Elston provide me
with examples to emulate and friendships to savor. Thank you all.
Bill D James
My wife Jessica and my daughter Olivia, "the girls," give me the joy and strength to undertake such a
task. Their patience in this process was saintly. Bill and Dirk have been profoundly professional. I have
learned all I know from other teachels, residents, and students.To them I owe an eternal debt of gmtitude.
Tim G Berger
My wife Kathy is my support, my confidant and my best friend. Her contributions are immeasurable. Our
children, Carly and Nate, are a source of joy and inspilation. Bill James andTim Berger have been
pal-tneis, friends, and mentors during this endeavor. For my worth as a clinician, I must thank the faculty,
residents, and patients at Walter Reed, Ft Eustis, the Cleveland Clinic, Brooke,Wilford Hall and Geisinger.
Thank you.
Dirk M Elston
=
CONTRIBUTORS
ROY C GREKLN, MD
Clinical Professor
Co-Director, Derrnatologic Surgery and Laser Center
University of California, San Francisco
San Francisco, California
ISAAC M NEUHAUS, MD
Clinical Instructor
Derrnatologic Surgery and Laser Center
University of California, San Francisco
San Francisco. California
MARIA L WEI, MD PHD
Assistant Professor
University of California, San Francisco
San Francisco, California