O. 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