In the practice of medicine, virtually every clinician encounters patients with skin disease. Physicians of all specialties face the daily task of determining the nature and clinical implication of dermatologic disease. In patients with skin eruptions and rashes, the physician must confront the question of whether the cutaneous process is confined to the skin, representing a pure dermatologic event, or whether it is a manifestation of internal disease relating to the patient's overall medical condition. Evaluation and accurate diagnosis of skin lesions are also critical given the marked rise in both melanoma and nonmelanoma skin cancer. Dermatologic conditions can be classified and categorized in many different ways, and in this Atlas, a selected group of inflammatory skin eruptions and neoplastic conditions are grouped in the following manner: (A) common skin diseases and lesions, (B) nonmelanoma skin cancer, (C) melanoma and pigmented lesions, (D) infectious disease and the skin, (E) immunologically mediated skin disease, and (F) skin manifestations of internal disease.
(Figs. e16-1, e16-2, e16-3, e16-4, e16-5, e16-6, e16-7, e16-8, e16-9, e16-10, e16-11, e16-12, e16-13, e16-14, e16-15, e16-16, e16-17, e16-18, and e16-19) In this section, several common inflammatory skin diseases and benign neoplastic and reactive lesions are presented. While most of these dermatoses usually present as a predominantly dermatologic process, underlying systemic associations may be made in some settings. Atopic dermatitis is often present in patients with an atopic diathesis, including asthma and sinusitis. Psoriasis ranges from limited patches on the elbows and knees to severe erythrodermic involvement and associated psoriatic arthritis. Some patients with alopecia areata may have an underlying thyroid abnormality requiring screening. Finally, even acne vulgaris, one of the most common inflammatory dermatoses, can be associated with a systemic process such as polycystic ovarian syndrome.
Acne vulgaris with inflammatory papules, pustules, and comedones. (Courtesy of Kalman Watsky, MD; with permission.)
Acne rosacea with prominent facial erythema, telangiectasias, scattered papules, and small pustules. (Courtesy of Robert Swerlick, MD; with permission.)
Psoriasis is characterized by small and large erythematous plaques with adherent silvery scale.
Atopic dermatitis with hyperpigmentation, lichenification, and scaling in the antecubital fossae. (Courtesy of Robert Swerlick, MD; with permission.)
Dyshidrotic eczema, characterized by deep-seated vesicles and scaling on palms and lateral fingers, is often associated with an atopic diathesis.
Seborrheic dermatitis showing erythema and scale in the nasolabial fold (Courtesy of Robert A. Swerlick, MD; with permission.)
Stasis dermatitis showing erythematous, scaly, and oozing patches over the lower leg. Several stasis ulcers are also seen in this patient.
A. Allergic contact dermatitis, acute phase, with sharply demarcated, weeping, eczematous plaques in a perioral distribution. B. Allergic contact dermatitis to nickel, chronic phase demonstrating an erythematous, lichenified, weeping plaque on skin chronically exposed to a metal snap. (B, Courtesy of Robert Swerlick, MD; with permission.)
Lichen planus showing multiple flat-topped, violaceous papules and plaques. Nail dystrophy as seen in this patient's thumbnail may also be a feature. (Courtesy of Robert Swerlick, MD; with permission.)
Seborrheic keratoses are seen as “stuck on,” waxy, verrucous papules and plaques with a variety of colors ranging from light tan to black.
Vitiligo in a typical acral distribution demonstrating striking cutaneous depigmentation, as a result of loss of melanocytes.
Alopecia areata characterized by a sharply demarcated circular patch of scalp completely devoid of hairs. Follicular orifices are preserved, indicating a nonscarring alopecia. (Courtesy of Robert Swerlick, MD; with permission.)
Pityriasis rosea. Multiple round to oval erythematous patches with fine central scale are distributed along the skin tension lines on the trunk.
A. Urticaria showing characteristic discrete and confluent, edematous, erythematous papules and plaques. B. Dermatographism. Erythema and whealing that developed after firm stroking of the skin. (B, Courtesy of Robert Swerlick, MD; with permission.)
Epidermoid cysts. Several inflamed and noninflamed firm, cystic nodules are seen in this patient. Often a patulous follicular punctum is observed on the overlying epidermal surface.
Keloids resulting from ear piercing, with firm exophytic flesh-colored to erythematous nodules of scar tissue.
Cherry hemangiomas are ...
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