(c) 2015 Wolters Kluwer. All Rights Reserved. C2 V-2 C2 V-3 Left side: Relaxed skin tension lines. Right side: Dermatome chart—sensory root fields. Note: The illustrations on the inside covers and facing front cover, dermatome charts and relaxed skin tension lines (RSTLs), represent approximations, since there is much overlap and individual variation. Denervation of one posterior root will not produce complete anesthesia within the corresponding dermatome. The direction of the RSTLs should always be assessed before making an ellipsoidal incision parallel to, or a punch biopsy with skin stretched perpendicular to, these lines (see Fig. 48-1, p. 370). In areas of flexion creases, flex and note the direction of the majority of “wrinkle” lines, that is, the direction of the RSTL. In nonflexion areas, the RSTL is determined by picking up skin folds between the thumb and index finger and pinching, proceeding in a clockwise direction, until it is clear in which direction wrinkle lines are most numerous, straight, and parallel to one another. In certain areas it is difficult or impossible to find the RSTL. In that situation, make a small circular incision or “punch” to see in which direction the ellipse forms. (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 1 13/12/13 6:41 PM MANUAL OF DERMATOLOGIC THERAPEUTICS Eighth Edition Kenneth A. Arndt, MD Ashish C. Bhatia, MD, FAAD President Assistant Professor of Clinical Dermatology SkinCare Physicians Department of Dermatology Chestnut Hill, Massachusetts Northwestern University - Feinberg School Clinical Professor of Dermatology, Emeritus of Medicine Harvard Medical School Chicago, Illinois Boston, Massachusetts Medical Director for Dermatologic Adjunct Professor Research Department of Surgery Department of Clinical Research, The Geisel School of Medicine at Dartmouth Co-Director of Dermatologic, Laser and Hanover, New Hampshire Cosmetic Surgery Adjunct Professor of Dermatology The Dermatology Institute Brown University DuPage Medical Group Providence, Rhode Island Naperville, Illinois Jeffrey T.S. Hsu, MD Suneel Chilukuri, MD Co-Director of Dermatologic Director of Mohs and Dermatological Laser and Cosmetic Surgery Surgery The Dermatology Institute Bellaire Dermatology Associates DuPage Medical Group Associate Clinical Professor Naperville, Illinois Baylor College of Medicine Adjunct Assistant Professor Chief of Dermatology and Dermatologic Department of Surgery Surgery The Geisel School of Medicine at Dartmouth Memorial Hermann Family Practice Hanover, New Hampshire Residency Program Houston, Texas Murad Alam, MD Associate Clinical Professor Professor of Dermatology, Otolaryngology, Columbia University College of and Surgery Surgeons & Physicians Chief, Section of Cutaneous and New York, New York Aesthetic Surgery Department of Dermatology Feinberg School of Medicine Northwestern University Chicago, Illinois (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 3 13/12/13 6:41 PM Executive Editor: Rebecca Gaertner Product Development Editor: Kristina Oberle Developmental Editor: Rebeca Baroso Production Project Manager: Alicia Jackson Senior Manufacturing Manager: Beth Welsh Marketing Manager: Stephanie Manzo Designer: Terry Mallon Production Services: Integra Software Services Pvt. Ltd. © 2014 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business 2001 Market Street Philadelphia, PA 19106 USA LWW.com 7th edition, © 2007 Lippincott Williams & Wilkins 6th edition, © 2002 Lippincott Williams & Wilkins 5th edition, © 1995 Lippincott Williams & Wilkins 4th edition, © 1988 Lippincott Williams & Wilkins 3rd edition, © 1983 Little Brown and Company 2nd edition, © 1978 Little Brown and Company 1st edition, © 1974 Little Brown and Company All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Manual of dermatologic therapeutics / [edited by] Kenneth A. Arndt, Jeffrey T.S. Hsu, Murad Alam, Ashish Bhatia, Suneel Chilikuri. — Eighth edition. p. ; cm. Preceded by Manual of dermatologic therapeutics / Kenneth A. Arndt, Jeffrey T.S. Hsu. 7th ed. c2007. Includes bibliographical references and index. ISBN 978-1-4511-7634-6 I. Arndt, Kenneth A., 1936- editor of compilation. II. Hsu, Jeffrey T. S., editor of compilation. III. Alam, Murad, editor of compilation. IV. Bhatia, Ashish, editor of compilation. V. Chilikuri, Suneel, editor of compilation. VI. Arndt, Kenneth A., 1936- Manual of dermatologic therapeutics. Preceded by (work): [DNLM: 1. Skin Diseases—therapy—Handbooks. 2. Skin Diseases—diagnosis—Handbooks. 3. Skin Diseases—physiopathology—Handbooks. WR 39] RL74 616.5—dc23 2013043802 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health-care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. 10 9 8 7 6 5 4 3 2 1 (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 4 13/12/13 6:41 PM To my family, with love. Kenneth A. Arndt To Mom, who teaches me to always do good. To Anita, who challenges me to always do better. Jeffrey Hsu Many thanks to all those that inspire and support me: my Mom & Dad, teachers, my loving family, my dear friends, my entire team at the office, my brilliant partners in practice—Jeff & Kelly, and my ever patient wife Tania. Ashish C. Bhatia To my parents, Rahat and Rehana; my sister, Nigar; my nephew, Ali; my niece, Noor; MP and BT, and Dr. Arndt, who always made us feel worthy and inspired us to be better. Murad Alam Thank you, Mom & Dad, for giving me the tools to succeed. Thank you Susan, Sonia, and Sage for your patience and allowing me to use these tools. With love. Suneel Chilukuri (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 5 13/12/13 6:41 PM Contributors Murad Alam, MD Ashish C. Bhatia, MD, FAAD Professor of Dermatology, Otolaryngology, Assistant Professor of Clinical and Surgery Dermatology Chief Department of Dermatology Section of Cutaneous and Aesthetic Surgery Northwestern University - Feinberg School Department of Dermatology of Medicine Feinberg School of Medicine Northwestern Chicago, Illinois University Medical Director for Dermatologic Chicago, Illinois Research Department of Clinical Research, Lauren Alberta-Wszolek, MD Co-Director of Dermatologic, Laser and Dermatology Associates of Concord Cosmetic Surgery Concord, Massachusetts The Dermatology Institute Ajay N. Amarnani, MD DuPage Medical Group Summa Health System/NEOMED Naperville, Illinois Akron, Ohio Adriane M. Boyle, MD, MA Danielle S. Applebaum, BS Resident Physician Baylor College of Medicine Division of Dermatology Houston, Texas University of California San Diego Kenneth A. Arndt, MD San Diego, California President Nathan H. Brewer, MD SkinCare Physicians Department of Dermatology Chestnut Hill, Massachusetts Yale University School of Medicine Clinical Professor of Dermatology Emeritus New Haven, Connecticut Harvard Medical School Boston, Massachusetts Kathryn Buikema, DO, MPH Adjunct Professor U.S. Navy, General Medical Officer Department of Surgery Ft. Meade, Maryland The Geisel School of Medicine at Dartmouth Christopher G. Bunick, MD, PhD Hanover, New Hampshire Instructor of Dermatology Adjunct Professor of Dermatology Department of Dermatology Brown University Yale University Providence, Rhode Island New Haven, Connecticut Yoon-Soo Cindy Bae-Harboe, MD Dermatology Resident Joanna Busquets, MD Department of Dermatology Department of Dermatology and Cutaneous Boston University Biology Boston, Massachusetts Thomas Jefferson University Hospital Philadelphia, Pennsylvania Emily Bahram-ahi, MD Candidate, B.S. Chemical Engineering Katherine L. Caretti, MD B.S. Biological Sciences Department of Dermatology Baylor College of Medicine Wayne State University Houston, Texas Detroit, Michigan vii (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 7 26/12/13 5:43 PM viii CONTRIBUTORS Gunilla Carlsson Thorn, MD Edward P. Conrad, MD Resident Physician Department of Dermatology Department of Dermatology DuPage Medical Group Northwestern University Wheaton, Illinois Chicago, Illinois Tracy Lynn Donahue, MD Chung-Yin Stanley Chan, MD Dermatology Resident Department of Dermatology Department of Dermatology The Permanente Medical Group Northwestern University Elk Grove, California Chicago, Illinois Alix J. Charles MD Kristy F. Fleming, MD The Dermatology Institute of DuPage Division of Dermatology Medical Group University of California Hinsdale, Illinois Los Angeles, California Sumul A. Gandhi, MD Pamela Chayavichitsilp, MD Resident Assistant Clinical Professor John H. Stroger, Jr. Hospital of Cook County Division of Dermatology Chicago, Illinois University of California San Diego San Diego, California Jessica M. Gjede, MD Resident in Dermatology Michael C. Chen, PhD Department of Dermatology Medical Sciences Boston University Medical Center Galderma Laboratories, L.P. Boston, Massachusetts Fort Worth, Texas Allison L. Goddard, MD Suneel Chilukuri, MD Fellow, Cutaneous Oncology Director of Mohs & Dermatological Surgery Department of Dermatology Bellaire Dermatology Associates Brigham and Women’s Hospital and Associate Clinical Professor Dana-Farber Cancer Institute Baylor College of Medicine Boston, Massachusetts Chief of Dermatology & Dermatologic Jacqueline A. Guidry, MD Surgery Memorial Hermann Family Practice Baylor College of Medicine Residency Program Houston, Texas Houston, Texas Nilanthi Gunawardane, MD Associate Clinical Professor Resident Physician Columbia University College of Surgeons Department of Dermatology & Physicians Northwestern University New York, New York Chicago, Illinois Michelle T. Chevalier, MD, PGY-4 Elena Hadjicharalambous, BS Division of Dermatology Department of Dermatology John H. Stroger, Jr. Hospital of Cook County Wayne State School of Medicine Chicago, Illinois Detroit, Michigan (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 8 13/12/13 6:41 PM CONTRIBUTORS ix Sarah J. Harvey, MD Maria Kashat, BS University of Minnesota Biological Science, Medical Student, Minneapolis, Minnesota Dermatology Wayne State University School of Medicine James J. Herrmann, MD Detroit, Michigan Associate Clinical Professor of Dermatology Northwestern University of Medical School Julia M. Kasprzak MD Chicago, Illinois Division of Dermatology Partner of DuPage Medical Group John H. Stroger Jr. Hospital of Cook County Wheaton, Illinois Chicago, Illinois Paul M. Hoesly, BS Leonard Yale Kerwin, MD Senior Medical Student Department of Dermatology Department of Dermatology Wayne State University Northwestern University Dearborn, Michigan Chicago, Illinois Dominic C. Kim, MS, 2d Lt, Jeffrey T.S. Hsu, MD USAF, MSC Co-Director of Dermatologic Uniformed Services University Laser and Cosmetic Surgery School of Medicine The Dermatology Institute of DuPage Class of 2015 Medical Group Bethesda, Maryland Naperville, Illinois Jessica S. Kim, MD Adjunct Assistant Professor Division of Dermatology Department of Medicine University of California The Geisel School of Medicine at San Diego Health System Dartmouth San Diego, California Hanover, New Hampshire Silvia Soohyun Kim, BA Abel D. Jarell, MD Medical Student Assistant Professor of Dermatology and Division of Dermatology Dermatopathology University of California San Diego Department of Dermatology La Jolla, California Uniformed Services University Walter Reed National Military Medical Lacey L. Kruse, MD Center Pediatric Dermatology Fellow Bethesda, Maryland Ann & Robert H. Lurie Children’s Hospital of Chicago Shang I Brian Jiang, MD Chicago, Illinois Clinical Professor of Dermatology/ Medicine Chao Li, MD University of California San Diego Resident, Division of Dermatology San Diego, California University of California San Diego San Diego, California Jessica Ann Kado, MD Assistant Professor Jeffrey M. Melancon, MD, PhD Department of Dermatology Division of Dermatology Wayne State University School of Medicine University of California San Diego Detroit, Michigan San Diego, California (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 9 13/12/13 6:41 PM x CONTRIBUTORS Laurel M. Morton, MD Nazanin Saedi, MD Resident Physician Assistant Professor, Director, Laser Surgery Department of Dermatology and Cosmetic Dermatology Skin care Physicians Thomas Jefferson University Chestnut Hill, Massachusetts Philadelphia, Pennsylvania Emily Newsom, MD Kevin Shih, BA Department of Dermatology Medical Student, Research Assistant Wayne State University School of Department of Dermatology Medicine Northwestern University Feinberg School of Detroit, Michigan Medicine Chicago, Illinois Quynh-Giao Ly Nguyen, ScB Vidya D.M. Shivakumar, MD Medical Student Dermatology Resident Baylor College of Medicine Cook County Hospital Houston, Texas Chicago, Illinois David C. Reid, MD Fareesa Shuja, MD Attending Physician Department of Dermatology Department of Dermatology Baylor College of Medicine John H. Stroger, Jr. Hospital of Cook Houston, Texas County Assistant Professor Kelly J. Stankiewicz, MD Department of Dermatology The Dermatology Institute of DuPage Rush University Medical Group Chicago, Illinois Naperville, Illinois Vicky Ren, BS Robert Stavert, MD, MBA Baylor College of Medicine Resident Houston, Texas Yale School of Medicine Department of Dermatology Kerri L. Robbins, MD New Haven, Connecticut Department of Dermatology Aimee M. Two, MD Baylor College of Medicine Post-doctoral Fellow Houston, Texas Division of Dermatology Giselle Rodriguez, BA University of California San Diego San Diego, California Research Assistant Department of Dermatology Zena W. Zoghbi, MD Northwestern University Feinberg School of Dermatology Resident Medicine Columbia University Chicago, Illinois New York-Presbyterian Hospital New York, New York Donna R. Sadowski, MD Division of Dermatology Amanda E. Zubek, MD, PhD John H. Stroger, Jr. Hospital of Cook Department of Dermatology County Yale University Chicago, Illinois New Haven, Connecticut (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 10 13/12/13 6:41 PM Preface When the first edition of the Manual was published in 1974, I could not have imag- ined how this set of guidelines to the treatment of common skin disorders would evolve into its current form. With the 2014 edition, the Manual is reframed and it is now a bigger, enhanced, and more colorful print and electronic publication. My original goal in creating the Manual was to present rational and practical therapeutic guidelines that would be useful for physicians and other health-care personnel. The original publication and the subsequent editions were greeted with enthusiasm and they became widely used in the United States and throughout the world through Spanish, Portuguese, Italian, Indonesian, French, and Chinese versions. The understanding of the causes, course, and therapy of cutaneous disorders has changed dramatically over the past four decades, as has the whole field of dermatol- ogy and the biology of skin disease. The procedural aspects of the specialty have broadened enormously as has the expertise and interest in dermatologic surgery. As knowledge about the pathophysiology of the skin and the basis of cutaneous disorders has become better understood, sophisticated and highly effective therapies for many disorders have become available, such as the biologic agents in the treatment of pso- riasis. The specialty has become bigger, broader, and better, and so has this Manual. The structure and style of this edition were conceptualized together with my col- leagues and coeditors Murad Alam, Ashish Bhatia, Suneel Chilikuri, and Jeffrey T.S. Hsu. Jeff Hsu assumed the yeoman task of pulling this all together and has been the driving force behind the successful completion of this edition. The book has been enlarged and enhanced with discussion of all common and many less common disor- ders affecting the skin. Each chapter has been edited, rewritten, or newly written by authors from around the country, particularly from the Departments of Dermatology at the University of Chicago, Northwestern, Baylor, and Yale Universities, and was then reviewed by several of the coeditors, Dr. Hsu and myself. For each entity, the Background is first discussed, followed by sections on the Clinical Presentation, Workup, Treatment, References, and Suggested Readings. Included are tables list- ing treatment choices and differential diagnosis and numerous color illustrations. As in previous editions, there are sections on Operative Procedures, Diagnostic and Therapeutic Techniques, and Treatment Principles. We hope that the eighth edition of the Manual is as helpful and educational a guide to rational therapeutics and disease management as the previous seven editions have been. Kenneth A. Arndt xi (c) 2015 Wolters Kluwer. All Rights Reserved. 76346_fm_pi-xviii.indd 11 13/12/13 6:41 PM