Table Of ContentO. BRAUN-FALCO· G. PLEWIG
H.H. WOLFF· W.H.C. BURGDORF
Dermatology
Springer
Berlin
Heidelberg
New York
Barcelona
Hong Kong
London
Milano
Paris
Singapore
Tokyo
O. BRAUN-FALCO • G. PLEWIG
H.H. WOLFF • W.H.C. BURGDORF
DERMATOLOGY
Second, Completely Revised Edition
With 1038 Color Figures
and 281 Tables
Springer
Prof. Dr. med. Dr. h.c.mult. OTTO BRAUN-FALCO Prof. Dr. med. HELMUT H. WOLFF
Emeritus Professor and Chairman Professor and Chairman
Department of Dermatology Department of Dermatology
and Allergology and Venerology
Ludwig Maximilians University University of Lubeck
FrauenlobstraBe 9 -11 Ratzeburger Allee 160
D-80337 Munich, Germany D-23562 Lubeck, Germany
Prof. Dr. med. GERD PLEWIG WALTER H.C. BURGDORF, M.D.
Professor and Chairman Clinical Lecturer
Department of Dermatology Department of Dermatology
and Allergology and Allergology
Ludwig Maximilians University Ludwig Maximilians University
FrauenlobstraBe 9 -11 FrauenlobstraBe 9 -11
D-80337 Munich, Germany D-80337 Munich, Germany
Based on: O. Braun-Falco, G. Plewig, H. H. Wolff: Dermatologie und Venerologie,
4th revised edition. © Springer-Verlag Berlin Heidelberg 1996
Library of Congress Cataloging-in-Publication Data
Dermatologie und Venerologie. English, Dermatology / O. Braun-Falco ... [et al.l. - 2nd, completely rev. ed. p. ; cm. Includes
bibliographical references and index.
ISBN-13: 978-3-642-97933-0 e-ISBN-13: 978-3-642-97931-6
DOI:IO.1007/ 978-3-642-97931-6
1. Skin - Diseases - Diagnosis. 2. Sexually transmitted diseases - Diagnosis. I. Braun-Falco, Otto. II. Title.
[DNLM: 1. Skin Diseases. 2. Sexually Transmitted Diseases. WR 140 04354 2000al RL105 .45413 2000
This work is subject to copyright. All rights are reserved, whether the whole part of ilie material is concerned, specifically ilie
rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any oilier way,
and storage in data banks. Duplication of iliis publication or parts iliereof is permitted only under ilie provision of ilie German
Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Viola
tions are liable for prosecution under ilie German Copyright Law.
Springer-Verlag Berlin Heidelberg New York
a member of BertelsmannSpringer Science+ Business Media GmbH
© Springer-Verlag Berlin Heidelberg 2000
Softcover reprint of ilie hardcover 2nd edition 2000
The use of general descriptive names, registered names, trademarks, etc. in iliis publication does not imply, even in ilie absence
of a specific statement, iliat such names are exempt from ilie relevant protective laws and regulations and ilierefore free for gen
eral use.
Product liability: The publishers guarantee ilie accuracy of any information about dosage and application contained in iliis book.
In every individual case ilie user must check such information by consulting ilie relevant literatur.
Production editor: W. Bischoff, Heidelberg
Cover design: de'blik Konzept & Gestaltung, Berlin
Illustrations: R. Darroll, Hamburg
Reproduction of figures: Schneider Repro, Heidelberg
Data conversion: Fotosatz-Service Kohler GmbH, Wiirzburg
22/3111 -5 4 3 2 1 Printed on acid-free paper
Preface
This text book has a long history. The first two German editions of Dermatologie und Vene
rologie were written by Egon Keining and Otto Braun-Falco and appeared in 1961 and 1969.
Otto Braun-Falco invited two of his proteges, Gerd Plewig and Helmut H. Wolff, to assist him
in writing the third German edition, which was published in 1984. These authors, along with
Richard K. Winkelmann, joined together, in 1991, to create the first English edition. The
fourth German edition appeared in 1996 and now the second English edition is ready.
This second English edition is quite different from both the fourth German edition and
the first English edition. The fourth German edition was used as the framework for an entire
ly new translation; this work is not based on the first English edition. Many new topics have
been introduced and much of the material has been reorganized. Two new chapters, on
diseases of black skin and operative dermatology, have been added. Every chapter has been
checked by at least two of the German authors; most have been revised several times.
This book is designed for a wide variety of readers. Dermatology residents will find it
valuable both in their daily work and when reviewing for specialty board examinations.
Experienced dermatologists should be able to update their knowledge, as well as refer to the
chapters on specific diseases for therapeutic options. Ambitious medical students may want
to use our book as an introduction to dermatology, for it will stand them in good stead as
they pursue training in other specialties. Finally, for the increasing number of primary care
physicians, be they family doctors, pediatricians, internists, gynecologists or emergency
room physicians, caring for patients with skin diseases, we hope that this book will be a help
ful source of information that can be used in daily practice.
Dermatology remains a highly visual specialty, and in this respect the major strengths of
this book are unchanged. We have concentrated on providing detailed clinical and morpho
logical descriptions and excellent clinical photographs. Many new photographs have been
added or have replaced older ones. To be more representative, we have also included photo
graphs of black and Hispanic patients. In addition, all of the illustrations in the book have
been redrawn. While a correlation between the clinical findings and the histology remains a
cornerstone of dermatologic diagnosis, we have once again not included photomicrographs.
Instead, the histological descriptions are designed to orient the reader and not to be exhaus
tive. Many excellent dermatopathology books are available; some are almost as long as this
book. We refer the reader to these sources for more detailed information.
The changes since the last English edition have been immense. The pathogenesis of many
diseases is better understood because of advances in immunology, molecular biology and
molecular genetics. We have tried to distill these advances into a form understandable to the
student, resident or practicing physician. In the process, we have undoubtedly oversimpli
fied and introduced mistakes, for which we apologize in advance. Finally, the HIVI AIDS epi
demic has once again made the sexually transmitted diseases and other infectious diseases
such as syphilis and tuberculosis critically important, so we have retained the extensive sec
tions on these disorders.
Many friends and colleagues helped with this book. Several colleagues took complete re
sponsibility for a chapter: Roselyn E. Epps and John A. Kenney, Jr., (Chapter 66 Diseases of
Black Skin), Hans Wolff and Wolf-Bernhard Schill (Chapter 68 Andrology) and Rainer Rom
pel (Ch<l;pter 72 Operative Dermatology). Other colleagues provided particular input into
either new sections or ones that received extensive revision: Wybo Bruinsma (drug reac
tions), Rudolf Happle (genetics and epidermal nevi), Axel Hauschild (malignant mela-
VI Preface
noma), Ulrich Hohenleutner (stump dermatoses), Thomas Jansen (acne and rosacea),
Michael Landthaler (lasers), Gerald Messer (bullous and connective tissue diseases), Maja
Mockenhaupt (severe skin reactions), Bernhard Ortel (phototherapy equipment), Martin
R6cken (immunology), Franziska Rueff (allergy), Christian Sander (malignant lymphoma),
Martin Schaller (infectious diseases), Eva-Regina Thoma-Greber (AIDS) and Franz Trautin
ger (phototherapy). Elke Bornh6vd attempted to identify as many original reference cita
tions as possible and helped extensively with checking of other references and responding
to copy editing queries. Anette Bonowitz and Tilmann Oppel helped with the index. Other
colleagues provided figures, including Ju rg Hafner, Rebat M. Halder, Michael Landthaler,
Juan J. Ochoa, Johannes Ring, Thomas Ruzicka, Robert H. Schosser and Robert Swerlick.
Once again many co-workers from the Department of Dermatology, Ludwig Maximilian
University, Munich, reviewed chapters and helped with references. They include: Hans Peter
Bertsch, Ursula B6hmer, Susanne Breit, Elke Bornh6vd, Rene Chatelain, Klaus Degitz,
Michael Flaig, Kamran Ghoreschi, Marc Heckmann, Thomas Herzinger, Thomas Jansen,
Peter Kaudewitz, Gerold Kick, Hans Christian Korting, Christian Kunte, Dagmar Ludolph
Hauser, Gerald Messer, Silke Michelsen, Uwe Neubert, Bettina Prinz, J6rg Prinz, Martin
R6cken, Ricardo Romiti, Franziska Rueff, Rudolf Rupee, Arne Sakrauski, Christian Sander,
Martin Schaller, Monika -Hildegard Schmid -Wendtner, Kathrin Schuhmann, Eva-Regina
Thoma-Greber, Peter Thomas, Beata Trautner, Sabine Werfel, Ralf Wienecke, Hans Wolff,
Andreas Wollenberg and Sabine Zenker.
Finally, the following colleagues helped with the fourth German edition, and thus some of
their work has been carried over into this translation. Their titles and addresses are given in
the German text. They include: Dietrich Abeck, Ulrich Amon, Thomas Bergner, Thomas Bie
ber, Leena Bruckner-Tuderman, Friedemann Enders, Peter Frosch, Gunter Goerz (t), Wolf
gang Hartschuh, Conrad Hauser, Stefan H6dl, Erhard H6lzle, Heiko Iven, Thomas Jansen,
Peter Kaudewitz, Martina Kerscher, Peter Kind, Peter Karl Kohl, Hans Christian Korting,
Jurgen Kreusch, Thomas Krieg, Wolfgang Kuster, Michael Landthaler, Bodo Melnik,
Michael Meurer, Helmut Naher, Uwe Neubert, J6rg Prinz, Bernhard Przybilla, Johannes Ring,
Martin R6cken, Thomas Ruzicka, Christian Sander, Martin Schaller, Rudiger Scharf, Wolf
Bernhard Schill, Carl-Georg Schirren, Wilfried Schmeller, Eva-Regina Thoma-Greber and
Michael Tronnier.
Many other thanks are also due. Once again Peter Bilek, our clinic photographer in
Munich, provided invaluable aid, as did his assistants Claudia Jakobec and Diana Keller
meier. Robert Darroll, a free-lance medical illustrator, executed the new drawings. Claudia
Tielkes managed the entire process of transferring material back and forth between authors,
colleagues and the publishers without a glitch. Springer-Verlag, and especially Willi Bischoff,
was very patient with the slow writing process and provided their usual excellent support in
terms of editorial advice, design and production.
We suspect this will be one of the last textbooks of this size to be typed by a single physi
cian, as WB transcribed each chapter, translating and modifying the German text. This
approach has resulted in a uniform style and hopefully kept replications and contradictions
to a minimum. Finally, we thank a most unusual helper - an aging, red Manx cat named Boris
who sat by WB's side for almost all of the computer time required to produce this text. If one
can learn by proximity, then he is a feline master of dermatology.
Munich and Lubeck, 2000 OTTO BRAUN-FALCO
GERD PLEWIG
HELMUT H. WOLFF
WALTER H.C. BURGDORF
Contents
Chapter 1
Basic Science and Principles of Dermatologic Diagnosis 1
Chapter 2
Viral Diseases 53
Chapter 3
Rickettsial Diseases 121
Chapter 4
Bacterial Diseases l27
Chapter 5
Sexually Transmitted Bacterial Diseases 245
Chapter 6
Protozoan Diseases 299
Chapter 7
Fungal Diseases 313
Chapter 8
Diseases Caused by Arthropods 359
Chapter 9
Diseases Caused by Worms
Chapter 10
Reactions to Medications
Chapter 11
Urticaria, Angioedema and Anaphylaxis 431
Chapter 12
Dermatitis 457
Chapter 13
Diseases Caused by Environmental Exposure orTrauma 521
Chapter 14
Erythemato-Papulo-Squamous Diseases 571
Chapter 15
Blistering Diseases
VIII Contents
Chapter 16
Pustular Diseases
Chapter 17
Disorders of Keratinization 709
Chapter 18
Diseases of Connective Tissue 751
Chapter 19
Malformations and Genetic Disorders
Chapter 20
Inflammatory Diseases of Cartilage 855
Chapter 21
Diseases of the Subcutaneous Fat 861
Chapter 22
Diseases of the Blood Vessels 881
Chapter 23
Disorders of Hemostasis 955
Chapter 24
Diseases of the Lymphatics
Chapter 25
Pruritus, Prurigo, Self-Induced Disease, Psychiatric Disease
and Neurologic Disease . . . . . . . . . . . . . . . . . . .
Chapter 26
Disorders of Melanin Pigmentation 1013
Chapter 27
Dyschromias 1043
Chapter 28
Diseases of the Sebaceous Glands 1051
Chapter 29
Diseases of the Apocrine Sweat Glands
Chapter 30
Diseases of the Eccrine Sweat Glands
Chapter 31
Diseases of Hair 1099
Chapter 32
Diseases of the Nails 1141
Chapter 33
Disorders of Lips and Oral Mucosa
Contents IX
Chapter 34
Diseases of the Male Genitalia 1195
Chapter 35
Diseases ofthe Female External Genitalia 1213
Chapter 36
Skin Diseases of Pregnancy 1229
Chapter 37
Disorders of Lipoprotein and Lipid Metabolism 1237
Chapter 38
The Sphingolipidoses 1253
Chapter 39
Disorders of Amino Acid Metabolism 1261
Chapter 40
Gammopathies
Chapter 41
Amyloidoses
Chapter 42
The Hyalinoses
Chapter 43
Mucinoses 1293
Chapter 44
The Porphyrias 1309
Chapter 45
Cutaneous Calcification 1327
Chapter 46
Disorders of Mineral Metabolism 1335
Chapter 47
Disorders of Purine Metabolism 1345
Chapter 48
Nutritional, Metabolic, and Endocrine Disorders 1349
Chapter 49
Vitamin Disorders
Chapter 50
Granulomatous Diseases 1379
Chapter 51
Disorders with Hypereosinophilia 1401
x
Contents
Chapter 52
Nevi 1407
Chapter 53
Cysts and Sinuses 1423
Chapter 54
Benign Epithelial Tumors 1441
Chapter 55
Premalignant Epithelial Tumors 1449
Chapter 56
Malignant Epithelial Tumors
Chapter 57
Adnexal Tumors 1491
Chapter 58
Melanocytic Lesions 1511
Chapter 59
Mesenchymal and Neural Tumors 1553
Chapter 60
Pseudolymphomas 1603
Chapter 61
Malignant Lymphomas 1611
Chapter 62
Cutaneous Aspects of Leukemia
Chapter 63
Mastocytoses
Chapter 64
Histiocytoses
Chapter 65
Para neoplastic Markers and Syndromes
Chapter 66
Diseases of Black Skin 1681
Chapter 67
Dermatologic Proctology
Chapter 68
Andrology 1701
Chapter 69
Topical Therapy 1719
