Table Of ContentInterdisciplinary
Approaches to Overlap
Disorders in Dermatology &
Rheumatology
Amit Garg
Joseph F. Merola
Laura Fitzpatrick
Editors
Interdisciplinary Approaches to Overlap
Disorders in Dermatology &
Rheumatology
Amit Garg • Joseph F. Merola
Laura Fitzpatrick
Editors
Interdisciplinary
Approaches to
Overlap Disorders in
Dermatology &
Rheumatology
Editors
Amit Garg Joseph F. Merola
Department of Dermatology Department of Dermatology
Donald and Barbara Zucker School of Department of Medicine
Medicine at Hofstra Northwell Division of Rheumatology
Hempstead, NY Inflammation and Immunity
USA Brigham and Women’s Hospital
Harvard Medical School
Laura Fitzpatrick Boston, MA
Department of Dermatology USA
Donald and Barbara Zucker School of
Medicine at Hofstra Northwell
Hempstead, NY
USA
ISBN 978-3-319-18445-6 ISBN 978-3-319-18446-3 (eBook)
https://doi.org/10.1007/978-3-319-18446-3
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This book was inspired by my late father, Dr. Shankar Lal
Garg, who loved rheumatology. He had the great fortune of
training with his mentor Dr. John J. Calabro. Thereafter, my
father practiced rheumatology for over 45 years in central
Massachusetts. What I appreciated most while spending time in
his office after school was that his patients adored him, even at
a time when health outcomes in rheumatology, in the absence
of truly disease modifying treatments, were modest. It was his
compassion, kindness, skills, and knowledge which drove this
sentiment. My observations in his practice and our dinner table
conversations ultimately inspired me to pursue an inter-related
focus with the specialty about which he was so passionate.
My father was the youngest of nine siblings and grew up in a
village on the outskirts of old Delhi. He was accepted into the
prestigious All India Institute of Medical Sciences and
graduated as one of their Gold Medalists. His elder brother
Baghat, the only other sibling with any sort of higher
education, sold his scooter to pay for my father’s flight to the
United States so that he could pursue their shared dream of
him practicing medicine abroad. And Boy, did he!
My father practiced rheumatology until he passed in late 2016.
One of my most beloved life moments was reacquainting with
one of his patients, someone I had first met in his office when I
was just 12 years of age. He dropped in while I was cleaning
out my father’s office to share stories about his care with my
father. I’m certain there were hundreds of patients who had the
same cherished experiences, ones I try and build with my own
patients each week as a medical dermatologist.
A quote by Nelson Mandela resonated with my father, because
it aligned with his own personal philosophy in life, and he
inspired me to live by it as well. If I can be half as inspiring to
my own kids as my father was to me, they will be just fine.
There’s no passion to be found in playing small – in settling for a life
that is less than the one you are capable of living – Nelson Mandela.
Foreword
Rheumatic skin diseases are at the core of complex medical dermatology.
Drs. Garg, Merola and Fitzpatrick have assembled a group of nationally
known dermatologists, rheumatologists and one pulmonologist to deal with
these systemic diseases with prominent cutaneous manifestations.
Cutaneous manifestations are important clues to rapid and accurate diag-
nosis. In addition, cutaneous diseases may complicate therapies directed at
control of systemic disease. The approach that is taken in this book is to first
approach diagnosis. Over a century ago, Louis A. Duhring stated that “The
power of making a correct diagnosis is the key to all success in the treatment
of skin diseases; without this faculty, the physician can never be a thorough
dermatologist, and therapeutics at once cease to hold their proper position,
and become empirical.” The first two chapters speak directly to this issue by
first laying out the findings in order to make a correct diagnosis and then
detailing the evaluation that is necessary. Subsequently the authors deal with
traditional diseases in chapters on lupus, dermatomyositis, scleroderma, pso-
riasis and psoriatic arthritis, vasculitis, and sarcoidosis before ending with
two chapters on the complications of therapy.
The editors and authors have provided the reader with information that
will improve diagnostic acumen and should result in improved patient care.
Jeffrey P. Callen
Professor of Medicine (Dermatology)
Chief, Division of Dermatology
University of Louisville School of Medicine
Louisville, KY, USA
vii
Preface
To my colleagues and all learners of overlap diseases involving the
integument:
I very much hope you enjoy reading the first edition of our textbook
Interdisciplinary Approaches to Overlap Disorders in Dermatology &
Rheumatology. While there are a number of available sources on this subject
area, there are few which exist as consolidated evidence-based inter-disci-
plinary summaries. This book was in part inspired by a magnificent predeces-
sor of sorts, titled Cutaneous Manifestations of Rheumatic Diseases, by
Sontheimer and Provost, with the acknowledgment that our knowledge in this
field has evolved significantly over the past two decades. My own personal
inspiration was also drawn from experiences with my father, a rheumatolo-
gist, about whom I have written in the Dedication.
The dynamic nature of new information made it a challenge for us to stay
current, even through the initial drafting of content and the editorial process,
especially with respect to approval of new treatments (i.e., biologic therapies)
and observations of mucocutaneous reactions to novel chemotherapies, for
example. We also gave our authors the freedom to write in their own styles as
well as some flexibilities in format, with the intent of allowing the experts the
ability to relate and emphasize content which flowed naturally for the subject
area. This has resulted in some variation in the way the chapters read, some-
thing that will likely be better harmonized in a second edition.
Despite some of the challenges common to first edition textbooks, this
project was a joy to pursue. Joe and Laura were terrific partners in this
endeavor. It was a privilege to have one of my mentors and accomplished
medical dermatologist, Dr. Jeffrey Callen, write the foreword. For the con-
tent, we recruited the very best experts, many of whom are responsible for the
primary evidence described in the chapters. I want to extend my deepest grat-
itude to all of my aforementioned colleagues for skillfully engaging this
project.
Nearly all chapters provide an interdisciplinary perspective, one from der-
matology, and the other from rheumatology or another related subspecialty,
based on the topic. We felt this was a unique and critical value addition to the
resource which would facilitate an expanded scope of perspective and prac-
tice. The value to dermatologists is derived from knowledge and pearls related
to multi-system examinations, workup, and assessments. The value to rheu-
matologists and other subspecialists originates from detailed morphologic
descriptions or eruptions and dermatologic assessments that will support, and
ix
x Preface
often specify, diagnosis. We are also certain that students of medicine and
trainees across medical specialties will find value in the comprehensive multi-
disciplinary perspectives that will support disease recognition and early refer-
ral or management.
Hempstead, NY, USA Amit Garg
Contents
1 Evaluation of the Integumentary and Musculokeletal Systems:
An Approach to the Interdisciplinary Examination for
Overlap Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mital Patel-Cohen, Amit Garg, Jordan Taylor Said,
and Joseph F. Merola
2 Serologic Evaluation in the Rheumatology-D ermatology
Overlap Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Anna Helena Jonsson, Marleigh Stern, Alisa N. Femia,
and Peter H. Schur
3 Cutaneous Lupus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Lisa Pappas-Taffer, Tania C. Gonzalez-Rivera,
and Victoria P. Werth
4 Dermatomyositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Matt Lewis, Lorinda Chung, and David Fiorentino
5 Morphea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Ada Man, M. Kari Connolly, and Robert W. Simms
6 Systemic Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Ada Man, M. Kari Connolly, and Robert W. Simms
7 Psoriasis and Psoriatic Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Laura Ferris and Soumya Reddy
8 Vasculitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Robert G. Micheletti and Peter A. Merkel
9 Sarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Misha Rosenbach and Robert P. Baughman
10 Reactive Erythemas and Panniculitides in
Connective Tissue Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Daniel R. Mazori and Alisa N. Femia
11 Iatrogenic Disease and Drug Induced Toxicities Related
to Anti-Inflammatory and Immunomodulatory Agents . . . . . . . 271
Shelly Rivas and Allireza Alloo
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
xi
