Contents GraySection:IntroductionandDiagnosis ..................................................................................... 1 IntroductiontoSkinBiology (cid:1) 1 2 DermatologicDiagnosis (cid:1) 16 3 OtherDiagnosticMethods (cid:1) 39 BlueSection:DermatologicDiseases ..................................................................................... 4 ViralDiseases (cid:1) 53 5 BacterialDiseases (cid:1) 73 6 FungalDiseases (cid:1) 106 7 OtherInfectiousDiseases (cid:1) 122 8 SexuallyTransmittedDiseases (cid:1) 134 9 HIVInfectionandAIDS (cid:1) 155 10 AllergicDiseases (cid:1) 166 11 DrugReactions (cid:1) 179 12 Dermatitis (cid:1) 190 13 Collagen–VascularDisorders (cid:1) 203 14 AutoimmuneBullousDiseases (cid:1) 229 15 PurpuraandVasculitis (cid:1) 245 16 PapulosquamousDisorders (cid:1) 262 17 GranulomatousandNecrobioticDisorders (cid:1) 290 18 DermatosesCausedbyPhysicalandChemicalAgents (cid:1) 295 19 MetabolicDiseases (cid:1) 310 20 PruritusandPrurigo (cid:1) 328 21 Genodermatoses (cid:1) 332 22 DisordersofPigmentation (cid:1) 371 23 MelanocyticTumors (cid:1) 384 24 CystsandEpidermalTumors (cid:1) 407 25 AdnexalTumors (cid:1) 424 26 SoftTissueTumors (cid:1) 438 27 OtherCutaneousTumors (cid:1) 465 28 CutaneousLymphomasandLeukemia (cid:1) 471 29 ParaneoplasticDisorders (cid:1) 485 30 DiseasesoftheLipsandOralMucosa (cid:1) 489 31 DiseasesoftheHairsandScalp (cid:1) 495 32 DiseasesoftheNails (cid:1) 518 33 DisordersofSweatGlands (cid:1) 528 34 DiseasesofSebaceousGlands (cid:1) 530 35 DiseasesofSubcutaneousFat (cid:1) 538 36 AnogenitalDiseases (cid:1) 543 37 Phlebology (cid:1) 552 38 OccupationalDermatoses (cid:1) 565 39 SkinDiseasesinDifferentAgeGroups (cid:1) 569 40 Psychodermatology (cid:1) 579 RedSection:Therapy ..................................................................................... 41 TopicalTherapy (cid:1) 583 42 SystemicTherapy (cid:1) 615 43 RadiationTherapy (cid:1) 644 44 TherapyDuringPregnancyandNursing (cid:1) 647 45 OperativeDermatology (cid:1) 651 46 WoundHealing (cid:1) 671 47 DermatologicEmergencies (cid:1) 673 PurpleSection ..................................................................................... AppendixI CommonSystemicMedications (cid:1) 681 AppendixII FavoriteCompoundingRecipes (cid:1) 689 GreenSection ..................................................................................... AppendixIIIDermatologicDifferentialDiagnosis (cid:1) 702 Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. Checklisten der aktuellen Medizin ............................................... BegründetvonF.Largiadèr,A.Sturm,O.Wicki Thiseditionhasbeensupportedby Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. Thieme Clinical Companions Dermatology ............................................... WolframSterry,M.D. ProfessorandChairman DepartmentofDermatology, Venereology,andAllergy CharitéUniversityHospital Berlin,Germany RalfPaus,M.D. Professor DepartmentofDermatologyandVenereology UniversityHospitalSchleswig-Holstein Luebeck,Germany WalterBurgdorf,M.D. ClinicalLecturer DepartmentofDermatology LudwigMaximilianUniversity Munich,Germany Withcontributionsby HeikeAudring,UlrikeBlume-Peytavi,GuidoBruning,PetervondenDriesch, JorgeFrank,MarkusFriedrich,ChristophGarcia-Bartels,SylkeGellrich, InaHadshiew,MichaelHertl,WolfgangKimmig,StefanPeker, AndreasPlettenberg,BertoldRzany,PeterSchulze,WolfgangSchulze, UteSiemann-Harms,HansSperl,EggertStockfleth,Hans-JuergenTietz, ClassUlrich,ChristianeVoit,GerdWolf,MargittaWorm,TorstenZuberbier 345illustrations GeorgThiemeVerlag Stuttgart·NewYork Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. LibraryofCongressCataloging-in-PublicationData SterryWolfram. [ChecklisteDermatologie.English] Dermatology / Wolfram Sterry, Ralf Paus, Walter Burgdorf ; with contributions by Heike Audring...[etal.]. p.;cm.--(Thiemeclinicalcompanions) ISBN1-58890-258-7(alk.paper)--ISBN3-13-135911-0(alk.paper) 1.Dermatology--Handbooks,manuals,etc.2.Skin--Diseases--Handbooks,manuals,etc. [DNLM:1.SkinDiseases--therapy--Handbooks.2.Dermatology--Handbooks.3.SexuallyTransmitted Disease--therapy--Handbooks.4.SkinNeoplasms--Handbooks.WR39S838c2006a]I.Paus,Ralf.II. Burgdorf,WalterH.C.III.Title.IV.Series. RL74.S815132006 616.5--dc22 2006000851 1stGermanedition1987 4thGermanedition2000 2ndGermanedition1992 5thGermanedition2005 3rdGermanedition1999 Illustrator:HelmutHoltermann,Dannenberg,Germany Importantnote:Medicineisanever-changingscienceundergoingcontinualdevelopment.Research andclinicalexperiencearecontinuallyexpandingourknowledge,inparticularourknowledgeofproper treatmentanddrugtherapy.Insofarasthisbookmentionsanydosageorapplication,readersmayrest assuredthattheauthors,editors,andpublishershavemadeeveryefforttoensurethatsuchreferences areinaccordancewiththestateofknowledgeatthetimeofproductionofthebook. Nevertheless,thisdoesnotinvolve,imply,orexpressanyguaranteeorresponsibilityonthepartofthe publishersinrespecttoanydosageinstructionsandformsofapplicationsstatedinthebook.Everyuser isrequestedtoexaminecarefullythemanufacturersleafletsaccompanyingeachdrugandtocheck,if necessaryinconsultationwithaphysicianorspecialist,whetherthedosageschedulesmentioned thereinorthecontraindicationsstatedbythemanufacturersdifferfromthestatementsmadeinthe presentbook.Suchexaminationisparticularlyimportantwithdrugsthatareeitherrarelyusedorhave beennewlyreleasedonthemarket.Everydosagescheduleoreveryformofapplicationusedisentirely attheusersownriskandresponsibility.Theauthorsandpublishersrequesteveryusertoreporttothe publishersanydiscrepanciesorinaccuraciesnoticed.Iferrorsinthisworkarefoundafterpublication, erratawillbepostedatwww.thieme.comontheproductdescriptionpage. Someoftheproductnames,patents,andregistereddesignsreferredtointhisbookareinfactregistered trademarksorproprietarynameseventhoughspecificreferencetothisfactisnotalwaysmadeinthe text.Therefore,theappearanceofanamewithoutdesignationasproprietaryisnottobeconstruedasa representationbythepublisherthatitisinthepublicdomain. Thisbook,includingallpartsthereof,islegallyprotectedbycopyright.Anyuse,exploitation,orcom- mercializationoutsidethenarrowlimitssetbycopyrightlegislation,withoutthepublishersconsent,is illegalandliabletoprosecution.Thisappliesinparticulartophotostatreproduction,copying,mimeo- graphing,preparationofmicrofilms,andelectronicdataprocessingandstorage. (cid:1)2006GeorgThiemeVerlagKG, Rüdigerstraße14,D-70469Stuttgart Germany http://www.thieme.de ThiemeNewYork,333SeventhAvenue, NewYork,NY10001,USA http://www.thieme.com TypesettingbyGötz,Ludwigsburg PrintedinGermanybyGötz,Ludwigsburg 10-ISBN:3-13-135911-0(GTV) 13-ISBN:978-3-13-135911-7(GTV) 10-ISBN:1-58890-258-7(TNY) 13-ISBN:978-1-58890-258-0(TNY) 123456 Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. Preface .... Preface e c a ef WearehappytopresentyouwithournewbookDermatologyintheThiemeClinical Pr Companionsseries.AsimilartexthasappearedinfiveGermaneditionssince1987 andbeenhighlysuccessful.Thegoalofthisbookistopresenteverythingoneneedsto diagnoseandtreatmostcutaneousdiseasesinacompact,“one-stop”resource,care- fullyeditedbythreeexperienceddermatologists.Thetherapeuticoptionsrepresent bestpracticeinternationallyandreflectthediversifiedexperienceofthreedermato- logists,oneofwhomtrainedandworkedintheUSAfor20years. Thecontentshavebeenextensivelyreviewedwiththehelpofanumberofcolleagues listedonthetitlepage.SomeofthemhaveprovidedadditionalinputfortheEnglish version,includingDrs.PetervondenDriesch,BertoldRzany,ChristianeVoit,and MargittaWorm.Inaddition,Dr.MajaHoffmannhelpedwiththedifferentialdiagnos- ticconsiderationsinthelastchapter.WewouldespeciallyliketothankDr.GerdWolf, whoprovidedconstructivecriticismanddetailedinformationontopicaltherapy. Mr.StephanKonnryatThiemeInternationalguidedthewritingandproductionof thistext.HewashelpedbyDr.CliffBergmanandDr.ChristianeBrill-Schmid.We thankallthreeindividualsfortheircooperativespiritandvaluableinput. WehopethatyouwillenjoyreadingthisClinicalCompanionasanintroductionto dermatologyand,moreover,thatyoufindithelpful,ifnotindispensable,inyour clinicaltrainingandpractice.Weareeagertohearfromyou,withcomplaints,con- structivesuggestions,orevenpraise. WolframSterry,M.D. RalfPaus,M.D. WalterBurgdorf,M.D. V ... Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. .... Contributors s Contributors r o t u rib HeikeAudring,M.D. MichaelHertl,M.D. nt Prof.UlrikeBlume-Peytavi,M.D. ProfessorandChairman o MarkusFriedrich,M.D. DepartmentofDermatologyand C ChristophGarcia-Bartels,M.D. Allergy SylkeGellrich,M.D. PhillipsUniversity Prof.BertoldRzany,M.D. Marburg,Germany PeterSchulze,M.D. StefanPeker,M.D. HansSperl,M.D. PrivateDermatologyPractice Prof.EggertStockfleth,M.D. BadSegeberg,Germany Prof.Hans-JuergenTietz,M.D. ClassUlrich GuidoBruning,M.D. Prof.ChristianeVoit,M.D. TabeaHospitalHamburg Prof.MargittaWorm,M.D. Hamburg,Germany Prof.TorstenZuberbier,M.D. PetervondenDriesch,M.D. ClinicandPolyclinicforDermatology, Professor Venereology,andAllergy BadCanstattHospital Berlin,Germany ClinicforDermatology InaHadshiew,M.D. Stuttgart,Germany UteSiemann-Harms,M.D. AndreasPlettenberg,M.D. WolfgangKimmig,M.D. Professor Prof.WolfgangSchulze,M.D. InstituteofInterdisciplinary HeadandSkinCenter InfectiologyandImmunology ClinicandPolyclinicforDermatology (ifi-MedizinGmbH) andVenereology Hamburg,Germany UniversityHospital Hamburg-Eppendorf GerdWolf,M.D. Hamburg,Germany Pharmacist Robert-KochPharmacy JorgeFrank,M.D. Grafschaft-Ringen,Germany Professor AfdelingDermatologie AcademischZiekenhuisMaastricht Maastricht,TheNetherlands ... VI Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents .... Contents s t n e GraySection:IntroductionandDiagnosis nt ..................................................................................... o C 1 IntroductiontoSkinBiology (cid:1) 1 1.1 Overview (cid:1) 1 1.2 FunctionalAnatomy (cid:1) 1 1.3 Epidermis (cid:1) 5 1.4 Hair (cid:1) 7 1.5 BasementMembraneZone (cid:1) 8 1.6 Dermis (cid:1) 9 1.7 Subcutis (cid:1) 10 1.8 Neuroendocrine-immuneNetworking (cid:1) 11 1.9 Outlook (cid:1) 12 2 DermatologicDiagnosis (cid:1) 16 2.1 ComponentsoftheDermatologicEvaluation (cid:1) 16 2.2 DescriptionofSkinFindings (cid:1) 16 2.3 PrimaryandSecondaryLesions (cid:1) 17 2.4 AdditionalDescriptiveTerms (cid:1) 18 2.5 ToolsoftheTrade (cid:1) 22 2.6 History (cid:1) 24 2.7 HistologicDiagnosis (cid:1) 25 2.8 MolecularDiagnostics (cid:1) 32 2.9 MycologicDiagnosis (cid:1) 33 2.10 DiagnosisofHairDisorders (cid:1) 34 3 OtherDiagnosticMethods (cid:1) 39 3.1 PhlebologicDiagnosis (cid:1) 39 3.2 AllergyTesting (cid:1) 43 3.3 LightTesting (cid:1) 49 3.4 Ultrasonography (cid:1) 51 BlueSection:DermatologicDiseases ..................................................................................... 4 ViralDiseases (cid:1) 53 4.1 Overview(Table4.1) (cid:1) 53 4.2 PoxvirusInfections (cid:1) 54 4.3 HerpesvirusInfections (cid:1) 57 4.4 PicornavirusInfections (cid:1) 65 4.5 CutaneousManifestationsofHepatitisVirusInfections (cid:1) 66 4.6 HumanPapillomaviruses (cid:1) 67 5 BacterialDiseases (cid:1) 73 5.1 Introduction (cid:1) 73 5.2 Gram-positiveBacteria:Staphylococci (cid:1) 74 5.3 Gram-positiveBacteria:Streptococci (cid:1) 77 5.4 Gram-positiveBacteria:Corynebacteria (cid:1) 83 5.5 Gram-negativeBacterialInfections (cid:1) 85 5.6 MiscellaneousBacterialInfections (cid:1) 88 VII ... Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license. .... Contents s 5.7 ZoonoticInfections (cid:1) 89 t n 5.8 Borreliosis (cid:1) 92 e t 5.9 MycobacterialInfections:Tuberculosis (cid:1) 96 n o 5.10 MycobacterialInfections:Leprosy (cid:1) 101 C 5.11 AtypicalMycobacterialInfections (cid:1) 103 5.12 Actinomycosis (cid:1) 104 5.13 Nocardiosis (cid:1) 105 6 FungalDiseases (cid:1) 106 6.1 Nomenclature (cid:1) 106 6.2 Dermatophytes (cid:1) 106 6.3 Yeasts (cid:1) 112 6.4 SubcutaneousMycoses (cid:1) 117 6.5 SystemicMycoses (cid:1) 118 7 OtherInfectiousDiseases (cid:1) 122 7.1 Leishmaniasis (cid:1) 122 7.2 OtherProtozoanInfections (cid:1) 125 7.3 Pediculosis (cid:1) 126 7.4 Scabies (cid:1) 127 7.5 OtherEpizoonoses (cid:1) 130 7.6 Worms (cid:1) 131 8 SexuallyTransmittedDiseases (cid:1) 134 8.1 Overview (cid:1) 134 8.2 Syphilis (cid:1) 135 8.3 EndemicTreponematoses (cid:1) 145 8.4 Gonorrhea (cid:1) 146 8.5 OtherSexuallyTransmittedDiseases (cid:1) 149 9 HIVInfectionandAIDS (cid:1) 155 9.1 Overview (cid:1) 155 9.2 CutaneousManifestations (cid:1) 157 9.3 ExtracutaneousManifestations (cid:1) 161 10 AllergicDiseases (cid:1) 166 10.1 BasicMechanisms (cid:1) 166 10.2 Urticaria (cid:1) 167 10.3 Angioedema (cid:1) 173 10.4 FoodAllergies (cid:1) 174 10.5 OtherAllergicDiseases (cid:1) 176 10.6 Hyposensitization (cid:1) 176 11 DrugReactions (cid:1) 179 11.1 Overview (cid:1) 179 11.2 CommonReactions (cid:1) 182 11.3 SevereSkinReactions (cid:1) 184 11.4 UncommonReactions (cid:1) 186 11.5 DrugPseudoallergies (cid:1) 188 12 Dermatitis (cid:1) 190 12.1 AtopicDermatitis (cid:1) 190 12.2 SyndromesAssociatedwithAtopicDermatitis (cid:1) 194 ... VIII Sterry, Dermatology © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license.