Disorders Index

Abscesses, 350 Cellulitis, 336

Acanthosis nigricans, 990 Cement dermatitis and burns, 142
Acne, 218 Chancroid, 406
Acne keloidalis, 957 Chapped fissured feet, 113
Acne rosacea, 256 Cherry angioma, 914
Acral lentiginous melanoma, 878 Chickenpox, 468
Acrochordon (skin tags), 792 Cholinergic urticaria, 193
Actinic cheilitis, 826 Chondrodermatitis nodularis, 803
Actinic (senile) comedones, 252 Chronic cutaneous (discoid) lupus erythematosus, 684,
Actinic keratosis, 819 951
Adenoma sebaceum, 999 Chronic pruritus, 215
Allergic contact dermatitis, 129 Cicatricial pemphigoid, 660
Alopecia areata, 942 Cold urticaria, 194
Androgenetic alopecia (female), 934 Compound nevi, 856
Androgenetic alopecia (male), 932 Condyloma acuminata, 419
Angioedema, 196 Congenital nevi, 858
Angiokeratoma, 914 Congenital syphilis, 396
Angular cheilitis, 529 Contact dermatitis, 126
Animal bites, 614 Contact urticaria syndrome, 202
Ants, 625 Corns, 454
Aquagenic pruritus, 195 Cowden disease, 1002
Aquagenic urticaria, 195 Crab lice, 589
Arsenical keratoses, 829 Cradle cap, 302
Arterial leg ulcers, 123 Creeping eruption, 624
Asteatotic eczema, 110 CREST syndrome, 706
Atopic dermatitis, 152 Cutaneous larva migrans, 624
Atypical mole syndrome, 865 Cutaneous T-cell lymphoma, 837
Baboon syndrome, 140 Cystic acne, 231
Bacillary angiomatosis, 613 Delusions of parasitosis, 119
Basal cell carcinoma, 809 Dermal nevi, 856
Bathing trunk nevus, 860 Dermatitis herpetiformis, 641
Beau’s lines, 542, 979 Dermatofibroma, 795
Becker’s nevus, 862 Dermatomyositis, 694
Bee stings, 618 Dermatophytid reaction, 109, 492
Benign familial chronic pemphigus, 668 Dermographism, 191, 194
Benign juvenile melanoma (Spitz nevus), 864 Dermatosis papulosa nigra 794
Berloque dermatitis, 768 Digital mucous cyst, 982
Bite wounds, 614 Discoid lupus erythematosus (chronic cutaneous), 684,
Birt-Hogg-Dubé syndrome, 1006 951
Black heel, 455 Dissecting cellulitis (folliculitis), 956
Black widow spider bites, 592 Distal nail splitting, 977
Blepharitis (seborrheic dermatitis), 303 Dog bites, 614
Blistering distal dactylitis, 355 Drug eruptions, 560, 562
Blue nevus, 864 Dyshidrosis (pompholyx), 109
Bowenoid papulosis, 426 Dysplastic nevi (atypical nevi), 865
Bowen’s disease, 828 Dystrophic epidermolysis bullosa, 670
Brown recluse spider bites, 595 Ecthyma gangrenosum, 364
Bullous impetigo, 330 Eczema craquelé, 110
Bullous pemphigoid, 655 Eczema herpeticum, 466
Buschke-Löwenstein, giant condylomata of, 836 Eczematous dermatitis, 90
Café-au-lait spots, 782, 994 En coup de sabre, 712
Candidiasis (moniliasis), 516 Epidermal cyst, 804
Capillary hemangioma (lobular), 916 Epidermal nevus, 800
Carbuncles, 350 Epidermolysis bullosa, 666
Cat bites, 614 Epidermolysis bullosa acquisita, 663
Cat-scratch disease, 612 Erosive pustular dermatosis, 959
Cavernous hemangiomas, 906 Eruptive xanthomas, 994
Disorders Index
Erysipelas, 336 Keratolysis exfoliativa, 104
Erysipeloid, 353 Keratolysis pitted, 494
Erythema ab igne, 783 Keratosis pilaris, 163, 347
Erythema elevatum diutinum, 741 Labial melanocytic macule, 864
Erythema infectiosum (fifth disease), 544 Leishmaniasis, 630
Erythema multiforme, 569, 713 Lentigo (liver spots), 778
Erythema nodosum, 723 Lentigo maligna melanoma, 876
Erythema toxicum neonatorum, 671 Leukocytoclastic vasculitis, 732
Erythrasma, 497 Leukonychia, 977
Erythrodermic psoriasis, 268 Leukoplakia, 835
Erythroplasia of Queyrat, 829 Lice, 587
Exanthem subitum (roseola infantum), 547 Lichen planopilaris, 952
Exercise-induced anaphylaxis, 194 Lichen planus, 310
Exfoliative erythroderma, 574 Lichen sclerosus, 321
External otitis, 360 Lichen simplex chronicus, 114
Extramammary Paget’s disease, 851 Lupus erythematosus, 680
Fifth disease (erythema infectiosum), 544 Lyme disease, 598
Fire ant stings, 625 Lymphangioma circumscriptum, 915
Fixed drug eruption, 572 Male-pattern baldness, 932
Folliculitis, 345 Malignant melanoma, 868
Folliculitis decalvans, 955 Mastocytosis, 208
Furuncles (boils), 350 Measles, 535
Gardner’s syndrome, 1005 Melasma, 779
Genital warts, 418 Meningococcemia, 365
German measles, 543 Merkel cell carcinoma, 852
Gonorrhea, 411 Methotrexate, 287
Granuloma annulare, 988 Milia, 252
Granuloma inguinale (donovanosis), 408 Moles, 856
Grover’s disease, 328 Molluscum contagiosum, 426, 458
Guttate psoriasis, 265 Morphea, 709
Hairy leukoplakia, 445 Mucha-Habermann disease (PLEVA), 326
Halo nevi, 863 Muir-Torre syndrome, 1004
Hand eczema, 99 Mycobacterium marinum, 375
Hand-foot-and-mouth disease, 538 Mycosis fungoides, 837
Hemangioma of infancy, 902 Myiasis, 621
Henoch-Schönlein purpura, 735 Necrobiosis lipoidica, 986
Hereditary hemorrhagic telangiectasia, 920 Neurofibromatosis, 995
Herpes simplex, 429, 460 Neurotic excoriations, 118
Herpes zoster, 473 Nevi 855
Herpetic whitlow, 968 Nevoid basal cell carcinoma syndrome, 815
Hidradenitis suppurativa, 260 Nevus anemicus, 776
Hirsutism, 936 Nevus flammeus (port-wine stains), 908
Hydroa aestivale, 758 Nevus sebaceous, 802
Hydroa vacciniforme, 758 Nodular melanoma, 874
Hypersensitivity vasculitis, 732 Nummular eczema, 104, 111
Ichthyosis vulgaris, 162 Onycholysis, 975
Idiopathic guttate hypomelanosis, 776 Onychomycosis (nail fungal infections), 969
Impetigo, 329 Otitis externa, 360
Intertrigo, 496, 525 Paget’s disease of the breast, 850
Irritant contact dermatitis, 128 Paronychia, 966
Isotretinoin, 245 Pearly penile papules, 422
Junction nevus, 856 Pediculosis, 587
Kaposi’s sarcoma, 917 Pemphigoid, 655
Kawasaki disease, 552 Pemphigus, 647
Keloids, 796 Perioral dermatitis, 82, 254
Keratoacanthoma, 797 Perlèche, 529
Keratoderma blennorhagicum, 271 Pilar cyst (wen), 806
Continued
Disorders Index
Pitted keratolysis, 494 Stucco keratosis, 792
Pityriasis alba, 165 Sturge-Weber syndrome, 912
Pityriasis lichenoides, 326 Sunburn, 752
Pityriasis rosea, 307 Superficial basal cell carcinoma, 814
Pityriasis rubra pilaris, 299 Superficial spreading melanoma, 871
Plantar warts, 453 Sweet’s syndrome, 739
PLEVA (Mucha-Habermann disease), 326 Swimmer’s itch, 627
Poikiloderma, 842 Swimming pool granuloma, 375
Poison ivy, 133 Sycosis barbae, 348
Polymorphous light eruptions, 756 Syphilis, 392
Pompholyx (dyshidrosis), 109 Syringoma, 808
Porphyria cutanea tarda, 760 Systemic lupus erythematosus, 688
Postherpetic neuralgia, 480 T-cell lymphoma (cutaneous), 837
Pressure urticaria, 192 Telangiectasia macularis eruptiva perstans, 211
Prurigo nodularis, 117 Telangiectasia, 920
Pruritis, 215, 1007 Telogen effluvium, 930
Pseudofolliculitis barbae, 346 Terry’s nails, 981
Pseudomonas folliculitis, 358 Tick bite paralysis, 611
Pseudopelade, 954 Tinea amiantacea, 303
Pseudoporphyria, 765 Tinea barbae, 512
Psoriasis, 263 Tinea capitis, 505
PUPPP, 203 Tinea corporis, 499
Pustular psoriasis, 268 Tinea cruris, 495
Pyoderma gangrenosum, 743 Tinea gladiatorum, 500
Pyogenic granuloma, 916, 983 Tinea incognito, 87, 504
Rocky Mountain spotted fever, 607 Tinea pedis, 490
Rosacea, 256 Tinea versicolor, 530
Roseola infantum (exanthem subitum), 547 Toxic epidermal necrolysis, 569, 720
Rubella, 543 Toxic shock syndrome, 558
Scabies, 577 Transient neonatal pustular melanosis, 672
Scarlet fever, 540 Trichomonas vaginalis, 385
Schamberg’s disease, 745 Trichomycosis axillaris, 959
Scleroderma, 702 Trichotillomania, 948
Seabather’s eruption, 628 Tuberous sclerosis, 999
Sebaceous hyperplasia, 807 Tufted folliculitis, 958
Seborrheic dermatitis, 302 Unilateral nevoid telangiectasia syndrome, 922
Seborrheic keratosis, 784 Urethritis, 384, 409
Senile comedones, 252 Urticaria pigmentosa, 209
Serum sickness, 207 Urticaria, 178
Sézary syndrome, 846 Urticarial vasculitis, 206
Shingles (herpes zoster), 473 Vaginal lichen planus, 316
Skin tags (acrochordon), 792 Vaginosis, bacterial, 385, 318
Small-vessel vasculitis, 731 Varicella, 468
Speckled lentiginous nevus, 861 Vasculitis, 725
Spider angioma, 920 Venous lake, 915
Spider bites, 592 Venous ulcers, 122
Spitz nevus, 864 Verrucous carcinoma, 836
Squamous cell carcinoma, 830 Viral exanthems, 549
Staphylococcal scalded skin syndrome, 355 Vitiligo, 770
Stasis dermatitis, 120 von Recklinghausen’s neurofibromatosis, 995
Stasis (venous) ulcers, 122 Warts, 448
Steroid acne, 82, 249 Warts (genital), 419
Steroid atrophy, 84 White superficial onychomycosis, 971
Steroid rosacea, 82, 249 Xanthelasma, 993
Stevens-Johnson syndrome, 568, 718 Xanthomas, 992
Stinging insects, 618 Xerosis, 162
Striae, 87 Yellow nail syndrome, 979
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QUICK REFERENCE FORMULARY
(Topical steroids are listed on the inside back cover.)

Acne Medications—Retinoids
Base Concentration Packaging
Retin-A (tretinoin) Cream 0.025%, 0.05%, 0.1% 20, 45 gm
Gel 0.01%, 0.025% 15, 45 gm
Retin-A Micro (tretinoin) Gel 0.1%, 0.04% 20, 45, 50 gm pump
Tazorac (tazarotene) Gel 0.1%, 0.05% 30, 100 gm
Cream 0.1%, 0.5% 30, 60 gm
Fabior (tazarotene) Foam 0.1% 50 gm can, 100 gm can
Differin (adapalene) Gel 0.1%, 0.3% 45 gm. 0.3% also in 45 gm pump
Cream 0.1% 45 gm
Lotion 0.1% 59 ml pump
Epiduo Gel 0.1% adapalene 1 2.5% benzoyl peroxide 45 gm
Veltin, Ziana Gel 1.2% clindamycin phosphate/0.025% tretinoin 30 gm, 60 gm

Acne Medications—Topical Antibiotics

Product Antibiotics Packaging
Aczone 5% dapsone 30, 60 gm; 90 gm gel
Benzaclin 1% clindamycin, 5% benzoyl peroxide 25, 50 gm gel; 35, 50 gm pump
Benzamycin 3% erythromycin, 5% benzoyl peroxide 23.3, 46.6 gm gel
Cleocin T 1% clindamycin 30, 60 ml liquid; 30, 60 gm gel; 60 ml lotion
Duac gel 1% clindamycin, 5% benzoyl peroxide 45 gm gel
Klaron 10% 10% sodium sulfacetamide 4 oz bottle
Clenia 5% sulfur, 10% sodium sulfacetamide 1 oz emollient cream
Sulfacet-R lotion 5% sulfur, 10% sodium sulfacetamide 25 ml, larger in generic
AVAR cleanser 5% sulfur, 10% sodium sulfacetamide 8 oz pump
Ovace wash 10% sodium sulfacetamide 12 oz

Acne Medications—Benzoyl Peroxide Cleansers

(Numerous generics, many different concentrations)
Product Formulation Packaging
Brevoxyl Creamy Wash Liquid 4% 6 oz tube
Brevoxyl Creamy Wash Liquid 8% 6 oz tube
PanOxyl 5 bar (OTC) Bar 5% 4 oz bar
PanOxyl 10 bar (OTC) Bar 10% 4 oz bar

Acne Medications—Benzoyl Peroxide Gels

(Numerous generics, many different concentrations: 2.5%, 5%, 10%)
Acne Medications: Oral Antibiotics

Generic Preparation Adult dosage (mg unless noted)

Doxycycline 50, 75, 100, 150 mg 1 to 2 times per day
Minocycline 50, 75, 100 mg 1 to 2 times per day
Minocycline extended-release tablets (Solodyn) 55, 65, 80, 105, 115 mg 1 tablet every day (1 mg/kg/day

ii
Antineoplastic Agents—Topical
Product Packaging
Aldara cream 5% imiquimod Box of 12 packets, 24 packets
Zyclara cream 3.75% imiquimod Box of 28 packets
Zyclara cream 2.5%, 3.75% imiquimod 7.5 gm pump, 15 gm pump
Picato Ingenol mebutate gel 0.015% 3 tubes (face)
Picato Ingenol mebutate gel 0.05% 2 tubes (body)
Carac 0.5% fluorouracil 30 gm tube
Fluoroplex 1% fluorouracil 30 ml solution, 30 gm cream
Efudex 2% or 5% fluorouracil 10 ml liquid
5% fluorouracil 25 gm cream

Antipruritic Creams and Lotions

Brand name Active ingredient Packaging

Eucerin itch relief Menthol 0.15% 6.8 oz spray
Neutrogena anti-itch moisturizer Camphor 0.1%, dimethacone 0.1% 10.1 oz
PrameGel 1% pramoxine, 0.5% menthol 4 oz
Sarna original 0.5% each of camphor, menthol 7.5 oz bottle
Sarna sensitive anti-itch lotion Pramoxine HCl 7.5 oz
Sarna Ultra anti-itch cream Menthol 0.5% and pramoxine 2 oz
Zonalon 5% doxepin 45 gm

Skin Bleaches and Depigmenting Agents

Brand name Active ingredient Packaging

Generic 4% hydroquinone 1 oz, 2 oz jar
Tri-Luma 4% hydroquinone, 0.01% fluocinolone acetonide, 0.05% tretinoin 30 gm

Genital Warts
Brand name Active ingredient Packaging
Veregen Sinecatechins 15 ointment 15 gm
Condylox solution Podofilox 3.5 ml
Condylox gel Podofilox 3.5 gm
Aldara cream 5% imiquimod Box of 12 or 24 packets
Zyclara cream 3.75% imiquimod Box of 28 packets, pump

Psoriasis—Topical Vitamin D3 Analogs

Brand name Active ingredient Packaging

Dovonex cream Calcipotriene 30, 60, 100 gm tubes
Sorilux foam Calcipotriene 60 gm can, 120 gm can
Vectical ointment Calcitriol 100 gm tubes
Taclonex ointment 0.005% calcipotriene 1 0.064% betamethasone 60, 100 gm
Taclonex suspension 0.005% calcipotriene 1 0.064% betamethasone 60 gm, 100 gm bottle

iii
 Rosacea—Topical Medications
Brand name Generic name Packaging
Avar cleanser 5% sulfur, 10% sodium sulfacetamide 8 oz
Avar Green 5% sulfur, 10% sodium sulfacetamide 45 gm aqueous gel with green color masks redness
Clenia 5% sulfur, 10% sodium sulfacetamide 1 oz cream; 6, 12 oz foaming wash
Azelex 20% azelaic acid 30, 50 gm cream
Finacea 15% azelaic acid 30 gm gel
Klaron 10% 10% sodium sulfacetamide 2 oz
Generic gel, cream, lotion 0.75% Metronidazole 45 gm, 45 gm, 120 ml
Metrogel 1% gel Metronidazole 60 gm tube, 55 gm pump
Noritate Cream 1% Metronidazole 30 gm tube
Sulfacet-R lotion 5% sulfur, 10% sodium sulfacetamide 25 gm bottle
Ivermectin cream 1%
Soolantra 30 gm
Mirvaso 0.33% brimonidine tartrate gel 30 gm tube

Empirical Oral Antibiotic Regimens for Selected Patients with Methicillin-Resistant

Staphylococcus aureus (MRSA) Infections
Antibiotic Dose (adults)
Trimethoprim-sulfamethoxazole One or two double-strength doses (160 mg of trimethoprim and 800 mg of sulfamethoxazole) twice
per day
Clindamycin 300-450 mg three times per day
Doxycycline 100 mg twice per day
Minocycline 200 mg initially, followed by
100 mg every 12 hr

Antiinfectives, Topical
• Bacitracin zinc/polymyxin B sulfate
• Neomycin sulfate/polymyxin B sulfate/bacitracin zinc
• Azelaic acid
• Bacitracin
• Benzoyl peroxide
• Clindamycin
• Erythromycin
• Gentamicin
• Metronidazole
• Mupirocin (Bactroban)
• Retapamulin (Altabax)
• Sulfacetamide sodium

Isotretinoin (Branded Generics)

Accutane—first brand name medicine
10 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg

iv
 Dosing Isotretinoin by Body Weight
Body weight Total mg/day

Kilograms Pounds 0.5 mg/kg 1 mg/kg

40 88 20 40
50 110 25 50
60 132 30 60
70 154 35 70
80 176 40 80
90 198 45 90
100 220 50 100

Antiwrinkle Cream
Product Active ingredient Packaging
Renova 0.02% emollient Tretinoin 40 gm
Retin-A Tretinoin Many doses: see Acne Medications
Avage 0.1 cream Tazarotene 30 gm

Antifungal Agents, Topical

• Butenafine hydrochloride
• Ciclopirox
• Clotrimazole
• Econazole nitrate
• Efinaconazole solution (Jublia) for toenails
• Gentian Violet
• Ketoconazole
• Miconazole nitrate
• Naftifine hydrochloride
• Nystatin
• Oxiconazole nitrate
• Sertaconazole nitrate
• Sulconazole nitrate
• Terbinafine
• Tolnaftate
• Undecylenic acid and derivatives

Antifungal Agents (Oral)

Brand name Generic name Packaging
Diflucan Fluconazole 50, 100, 150, 200 mg
Grifulvin V Griseofulvin microsize 500 mg; 125 mg/5 ml in 4 oz bottle
Gris-PEG Griseofulvin ultramicrosize 125, 250 mg
Mycostatin Nystatin 500,000, 1 million unit capsules
100,000 units/ml suspension
Nizoral Ketoconazole 200 mg
Lamisil Terbinafine 250 mg
Sporanox Itraconazole 100 mg
Mycelex troches for oral Candida 10 mg troche; bottle of 70 or 140; dissolve 5/day in mouth
for 14 days

v
 Antihistamines
Initial dose Maximal dose
Drug (adult) (adult) Liquid formulation Tablet formulation
H1-Receptor Antagonists
Nonsedating
Fexofenadine (Allegra) 180 mg daily 180 mg bid — 30, 60, 180 mg
Desloratadine (Clarinex) 5 mg 10 mg — 5 mg
Loratadine (Claritin) 10 mg daily 20 mg bid 5 mg/5 ml 10 mg
Cetirizine (Zyrtec) 10 mg daily 10 mg bid 5 mg/5 ml, 1 mg/ml 5, 10 mg
Sedating
Hydroxyzine (Atarax) 10 mg qid 50 mg qid 10 mg/5 ml susp, 10, 25, 50, 100 mg
25 mg/5 ml
Diphenhydramine (Benadryl) 25 mg bid 50 mg qid Elixir 12.5 mg/5 ml; syrup 25, 50 mg;
6.25 mg/5 ml 12.5 mg chew tab
Cyproheptadine (Periactin) 4 mg qid 8 mg qid 2 mg/5 ml 4 mg

Antiperspirants
Brand name Active ingredient Packaging
CertainDri (OTC) Aluminum chloride (hexahydrate) 1, 2 oz roll-on
Pump spray (nonaerosol)
Drysol (Rx) 20% aluminum chloride 35 ml bottle with Dab-O-Matic applicator; 37.5 ml bottle
(hexahydrate) in 93% anhydrous
ethyl alcohol
Hypercare 20% aluminum chloride 37.5 ml bottle; 35 and 60 ml bottles with Dab-O-Matic applicator
(hexahydrate) in 93% anhydrous
ethyl alcohol
Lazerformalyde solution (Rx) 10% formaldehyde 3 oz roll-on
Formaldehyde-10 spray 10% formaldehyde 2 oz spray bottle
Xerac AC (Rx) 6.25% aluminum chloride 35, 60 ml bottles with Dab-O-Matic applicator
(hexahydrate) in 96% anhydrous
ethyl alcohol

Antiviral Agents (Herpes Simplex and Zoster)

Abreva (docosanol), 2 gm (OTC)
Denavir (penciclovir), 1.5 gm ointment
Famvir (famciclovir); 125, 250, 500 mg tablets
Valtrex (valacyclovir); 500 mg, 1 gm capsules
Zovirax (acyclovir); 200, 400, 800 mg capsules, 200 mg/5 ml suspension
Zovirax ointment 5%, 3 and 15 gm tubes

Masking Agents (Cosmetic Covering Agents)

Brand name Base Packaging Shades
Covermark* Cream Many products 9-10
Dermablend cover cream* Cream Many products 21

*Waterproof concealing makeup.

vi
 Hair Restoration Products
Brand name Active ingredient
Propecia Finasteride 1 mg
Generic Finasteride 5 mg (split 5 mg tablet into 4 parts); a great cost saving
Avodart Dutasteride 0.5 mg (not FDA approved)
Rogaine Minoxidil solution Solutions and foam, 2% for women and men, 5% for men

Immunomodulators (Topical)

Steroid-Free Topical Antiinflammatory Agents

Elidel cream 1% Pimecrolimus 15 g, 30 gm, 100 gm
Protopic ointment 0.1% Tacrolimus 30, 60, 100 gm
Protopic ointment 0.03% Tacrolimus 30, 60, 100 gm

Antiseborrheic Preparations
Brand name Active ingredient Packaging
Loprox gel Ciclopirox 45 gm
Nizoral cream Ketoconazole 15, 30, 60 gm
Ovace wash 10% sulfacetamide sodium 6, 12 oz
Ovace foam 10% sulfacetamide sodium 50 gm, 100 gm can
Carmol scalp treatment lotion 10% sulfacetamide sodium 90 gm
Promiseb cream Castor oil, disodium EDTA, PEG-30 30 gm

Corticosteroid and Tar Scalp Preparations

Brand name Active ingredient Base Packaging
Derma-Smoothe/FS (Rx) Fluocinolone acetonide 0.01% Peanut oil 120 ml
10% liquor carbonis detergens in Nivea oil* Liquor carbonis detergens; 8, 16 oz Nivea oil Prescribe

*Pharmacist compounded.

Tar-Containing Bath Oil Pediculocides

(or applied directly to lesions)
Brand name Generic name Packaging
Brand name Size Packaging NIX cream rinse Permethrin 2 oz
Balnetar 2.5% coal tar 240 ml Ovide 0.5% malathion 2 oz lotion
Cutar emulsion 7.5% LCD 6 oz, 1 gal RID (otc) 0.3% pyrethrins 2, 4 oz; 1 gal liquid
Doak Oil 2% tar distillate 240 ml Sklice 0.5% ivermectin 117 gm tube
Doak Oil Forte 5% tar distillate 120 ml Spinosad 0.9% spinosad 120 ml
Polytar Bath 25% polytar 240 ml
Zetar emulsion (Rx) 30% whole coal tar 177 ml (6 oz)

Scabicides
Brand name Generic name Packaging
Elimite Permethrin 5% cream: 60 gm
Kwell Lindane 1% cream: 2, 16 oz
1% lotion: 2, 16 oz
5-10% precipitated sulfur Sulfur Sulfur in petrolatum
Stromectol Ivermectin 3 mg tablets
vii
CLINICAL
DERMATOLOGY
A Color Guide to Diagnosis and Therapy
Sixth Edition

Thomas P. Habif, MD
Clinical Professor of Surgery (Dermatology Section)
Geisel School of Medicine at Dartmouth
Hanover, NH, USA

Content Strategist: Russell Gabbedy

Content Development Specialist: Joanne Scott
Publishing Services Manager: Jeffrey Patterson
Project Manager and Layout Design: Jeanne Genz
Design Direction: Julia Dummitt
Compositors: Graphic World, Inc.
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Image Processing: Graphic World, Inc.
Mark Lane
Illustrators: Graphic World, Inc.
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Project Organization: Laura McCann
Copyeditor: Beth Welch
Proofreader: Keith Robbins
Indexer: Razorsharp Communications
Printer: R. R. Donnelly China
Medical Photography: Alan N. Binnick, MD; Thomas P. Habif, MD;
Lawrence B. Meyerson, MD
Marketing Manager: Kristin Koehler
Moral Support: Dorothy, David, Tommy

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© 2016, Elsevier Inc. All rights reserved.

First edition 1984

Second edition 1990
Third edition 1996
Fourth edition 2004
Fifth edition 2010

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Library of Congress Cataloging-in-Publication Data

Habif, Thomas P., author.

Clinical dermatology: a color guide to diagnosis and therapy / Thomas
P. Habif.—Sixth edition.
p. ; cm.
Includes index.
ISBN 978-0-323-26183-8 (hardcover : alk. paper)—ISBN
978-0-323-26607-9 (eISBN)—ISBN 978-0-323-37555-9 (Inkling ISBN)
I. Title.
[DNLM: 1. Skin Diseases—Atlases. WR 17]
RL81
616.5002293—dc23
2015012441

ISBN: 978-0-323-26183-8
eISBN: 978-0-323-26607-9
Inkling ISBN: 978-0-323-37555-9

Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
 Preface

RAPID ACCESS TO THE TEXT HOW TO USE THIS BOOK

1. Disorders Index: A list of diseases with page references Students in the classroom
is located inside the front cover.
2. Chapter 1—Regional Differential Diagnosis Atlas: This Students should learn the primary and secondary lesions
section with page references helps narrow the and look at every page in the Regional Differential Diagno-
differential diagnosis. sis Atlas at the end of Chapter 1.
3. A list of topical corticosteroids can be found on the inside
back cover.
4. A Quick Reference Formulary to the most commonly
Students in the clinic
used drugs is on pp. ii-vii. Study Chapters 20 (Benign Skin Tumors), 21 (Premalig-
5. A table of antibiotics with dosage by weight is located nant and Malignant Nonmelanoma Skin Tumors), and 22
on the back outside cover. (Nevi and Malignant Melanoma). Skin growths are com-
mon, and it is important to recognize their features.
House officers are responsible for patient manage-
ELECTRONIC VERSION ment. Read Chapter 2 carefully, and study all aspects of
the use of topical steroids. It is tempting to use these
The sixth edition is optimized for electronic delivery. I agents as a therapeutic trial and ask for a consultation
use the Disorders Index to rapidly find specific diseases. only if therapy fails. Topical steroids mask some diseases,
The images hold up quite well when enlarged. Access is make some diseases worse, and create other diseases. Do
adequate on big screen Android phones and the Apple not develop bad habits; if you do not know what a disease
iPhone. I still prefer the print version with two full pages is, do not treat it.
of information displayed but I now find myself frequently The diagnosis of skin disease is deceptively easy. Do
using the electronic version on my big phone, which I not make hasty diagnoses. Take a history, study primary
carry in my lab coat. Having a “book in a pocket” plus lesions and the distribution, and be deliberate and me-
numerous other resources is pretty nice. thodical. Ask for help. With time and experience you
will feel comfortable managing many common skin dis-
PMID numbers eases.
(PubMed identification numbers)
PMID numbers (blue letters and numbers) are used in-
The non-dermatologist provider
stead of references and are embedded in the text. Go to Look at the Regional Differential Diagnosis Atlas in Chap-
PubMed’s home page. Type in just the number in the ter 1 as a general guide. The clinical diagnosis of growths
search line and click on Go. You will be taken to the paper and pigmented lesions is complicated; study Chapters 20,
and abstract. 21, and 23.

The dermatologist
The Disorders Index on the inside front cover provides
rapid access. Examine the patient and then show the pa-
tient a picture of his or her disease. Patients see the simi-
larity and are reassured.
The book is a practical resource; I use it every day. All
current information that is practical and relevant is in-
cluded. There are numerous tables and boxes provided to
increase the efficiency of information acquisition. Rare
diseases are found in larger textbooks.

xi
xii Clinical Dermatology

PRODUCTION
Production people are listed on the title page. The layout
and design is done the “old fashioned way,” by cutting and
pasting images and strips of text by the layout artist. Page
layout design is a science and an art. Jeanne Genz (green
sweater) has done the page layout for all six editions.
Laura McCann (across from Jeanne) organizes the im-
ages and prepares them for pasting. I sit next to Jeanne.
The hard copy pasted book (Dummy) is sent to Graphic
World in St. Louis for conversion to a computer file and
typeset in Adobe Indesign software. Several stages of
checking and correction then occur. The final product is
converted to a PDF file (portable document format) and
sent to the printer in China. High-grade glossy paper re-
tains ink at the surface to enhance definition. The slow-
speed press allows ink to be laid down precisely so that
exceptional sharpness and color balance are achieved.
The entire process of writing and production takes about
2 years.

Thomas P. Habif
 Contents

Disorders Index Inside front cover Physical urticarias 191

Quick Reference Formulary ii Angioedema 196
Preface xi Contact urticaria syndrome 202
Dermatoses of pregnancy 203
1 Principles of Diagnosis and Anatomy 1 Urticarial vasculitis 206
Skin anatomy 1 Serum sickness 207
Diagnosis of skin disease 2 Mastocytosis 208
Primary skin lesions 3
Secondary skin lesions 12 7 Acne, Rosacea, and Related  218
Special skin lesions 17 Disorders
Regional differential diagnosis atlas 19 Acne 218
Acne surgery 253
2 Topical Therapy and Topical  75 Perioral dermatitis 254
Corticosteroids Rosacea (acne rosacea) 256
Topical therapy 75 Hidradenitis suppurativa 260
Topical corticosteroids 77
8 Psoriasis and Other Papulosquamous  263
3 Eczema and Hand Dermatitis 90 Diseases
Stages of eczematous inflammation 90 Psoriasis 263
Hand eczema 99 Pityriasis rubra pilaris 299
Eczema: various presentations 110 Seborrheic dermatitis 302
Chapped fissured feet 113 Pityriasis rosea 307
Self-inflicted dermatoses 114 Lichen planus 310
Psychogenic parasitosis 119 Lichen sclerosus 321
Stasis dermatitis and venous ulceration:  120 Pityriasis lichenoides 326
postphlebitic syndromes Grover’s disease 328
4 Contact Dermatitis and  126 9 Bacterial Infections 329
Patch Testing Skin infections 329
Severe occupational contact dermatitis 127 Folliculitis 345
Irritant contact dermatitis 128 Furuncles and carbuncles 350
Allergic contact dermatitis 129 Erysipeloid 353
Diagnosis of contact dermatitis 145 Blistering distal dactylitis 355
Staphylococcal scalded skin syndrome 355
5 Atopic Dermatitis 150
Pseudomonas aeruginosa infection 358
Pathogenesis and immunology 152
Meningococcemia 365
Clinical aspects 152
Nontuberculous mycobacteria 374
Associated features 162
Triggering factors 167 10 Sexually Transmitted Bacterial  377
Prevention of atopic dermatitis 169 Infections
Treatment of atopic dermatitis 169 Sexually transmitted disease presentations 377
Genital ulcers 377
6 Urticaria, Angioedema, and Pruritus 178
Syndromic management of sexually  381
Clinical aspects 178
transmitted diseases
Pathophysiology 182
Syphilis 390
Initial evaluation of all patients with urticaria 182
Rare sexually transmitted diseases 404
Acute urticaria 183
Diseases characterized by urethritis  409
Chronic urticaria 186
and cervicitis
Treatment of urticaria 189

xiii
xiv Clinical Dermatology

11 Sexually Transmitted Viral  418 Dermatomyositis and polymyositis 694

Infections Scleroderma 702
Genital warts 418
Bowenoid papulosis 426 18 Hypersensitivity Syndromes  713
Molluscum contagiosum 426 and Vasculitis
Genital herpes simplex 429 Hypersensitivity syndromes 713
Erythema multiforme 713
12 Warts, Herpes Simplex, and  448 Stevens-Johnson syndrome/toxic epidermal  717
Other Viral Infections necrolysis spectrum of disease
Warts 448 Erythema nodosum 723
Molluscum contagiosum 458 Vasculitis 725
Herpes simplex 460 Vasculitis of small vessels 731
Varicella 468 Neutrophilic dermatoses 739
Herpes zoster 473 Schamberg’s disease 745

13 Superficial Fungal Infections 487 19 Light-Related Diseases and  746

Dermatophyte fungal infections 487 Disorders of Pigmentation
Candidiasis (moniliasis) 516 Photobiology 746
Tinea versicolor 530 Sun-damaged skin 748
Suntan and sunburn 752
14 Exanthems and Drug Eruptions 534 Sun protection 752
Exanthems 535 Polymorphous light eruption 756
Drug eruptions: clinical patterns and most  562 Hydroa aestivale and hydroa vacciniforme 758
frequent causal drugs Porphyrias 760
Drug eruptions 568 Phototoxic reactions 766
Photoallergy 769
15 Infestations and Bites 577
Disorders of hypopigmentation 770
Scabies 577
Disorders of hyperpigmentation 777
Pediculosis 587
Spiders 592 20 Benign Skin Tumors 784
Ticks 597 Seborrheic keratoses 784
Cat-scratch and related diseases 612 Stucco keratoses 792
Animal and human bites 614 Skin tags (acrochordon) and polyps 792
Stinging insects 618 Dermatosis papulosa nigra 794
Biting insects 620 Cutaneous horn 794
Creeping eruption 624 Dermatofibroma 795
Ants 625 Hypertrophic scars and keloids 796
Dermatitis associated with swimming 627 Keratoacanthoma 797
Leishmaniasis 630 Epidermal nevus 800
Nevus sebaceous 802
16 Vesicular and Bullous Diseases 635
Chondrodermatitis nodularis helicis 803
Blisters 635
Epidermal cyst 804
Diagnosis of bullous disorders 639
Pilar cyst (wen) 806
Dermatitis herpetiformis and linear  641
Senile sebaceous hyperplasia 807
IgA bullous dermatosis
Syringoma 808
Bullae in diabetic persons 646
Pemphigus 647 21 Premalignant and Malignant  809
The pemphigoid group of diseases 655 Nonmelanoma Skin Tumors
Pemphigoid-like disease 663 Basal cell carcinoma 809
Benign familial chronic pemphigus 664 Actinic keratosis 819
Epidermolysis bullosa 666 Squamous cell carcinoma in situ 827
The newborn with blisters, pustules, erosions,  667 Bowen’s disease 828
and ulcerations Erythroplasia of Queyrat 829
Arsenical keratoses and other arsenic-related  829
17 Connective Tissue Diseases 673
skin diseases
Autoimmune diseases 673
Squamous cell carcinoma 830
Connective tissue diseases 673
Leukoplakia 835
Lupus erythematosus 680
Verrucous carcinoma 836
 Contents xv

Primary cutaneous lymphomas 837

Cutaneous T-cell lymphoma 837 Online Only Content
Paget’s disease of the breast 850
27 Dermatologic Surgical Procedures
Extramammary Paget’s disease 851
Antibiotic prophylaxis
Merkel cell carcinoma 852
Local anesthesia
Cutaneous metastasis 852
Hemostasis
22 Nevi and Malignant Melanoma 855 Wound healing
Melanocytic nevi 855 Skin biopsy
Malignant melanoma 868 Electrodesiccation and curettage
Management of melanoma 881 Curettage
Staging and prognosis 887 Blunt dissection
Dermoscopy 889 Cryosurgery
Extraction of cysts
23 Vascular Tumors and Malformations 901 Mohs’ micrographic surgery
Congenital vascular lesions 901 Chemical peels
Acquired vascular lesions 914 Dermal and subdermal fillers
Telangiectasias 920 Liposuction
Lasers
24 Hair Diseases 923 Botulinum toxin
Anatomy 923
Physiology 925
Evaluation of hair loss 927
Generalized hair loss 930
Localized hair loss 932
Trichomycosis 959

25 Nail Diseases 960

Anatomy and physiology 960
Normal variations 961
Nail disorders associated with skin disease 964
Acquired disorders 966
The nail and internal disease 979
Color and drug-induced changes 981
Congenital anomalies 981
Tumors 982

26 Cutaneous Manifestations of Internal

Disease 986
Cutaneous manifestations of diabetes mellitus 986
Necrobiosis lipoidica 986
Granuloma annulare 988
Acanthosis nigricans 990
Xanthomas and dyslipoproteinemia 992
Neurofibromatosis 995
Tuberous sclerosis 999
Internal cancer and skin disease 1002
Cutaneous paraneoplastic syndromes 1002
Familial cancer syndromes 1002
Cowden disease (mutiple hamartoma  1002
syndrome)
Muir-Torre syndrome 1004
Gardner’s syndrome 1005
Birt-Hogg-Dubé syndrome and renal 1006
carcinoma

Index I-1

Corticosteroids (topical) Inside back cover

 Skin Anatomy

Cuticle Hair shaft

Huxley’s layer Melanocyte

Hair Henle’s layer Sebaceous gland

follicle External sheath Arrector pili muscle Free nerve endings

Glassy membrane Meissner’s corpuscle Pore of sweat gland

Connective tissue
layer

Stratum corneum
Stratum lucidum

Epidermis
Stratum granulosum
Stratum spinosum
Stratum basale

Papillary layer

Dermis
Reticular layer

Subcutaneous tissue

Sweat gland
Hair matrix
Papilla of
hair follicle Hair cuticle Artery

Sensory nerve Motor (autonomic)

nerve
Elastic fibers
Vater-Pacini Vein
corpuscle

(Netter illustration from www.netterimages.com. © Elsevier Inc. All rights reserved.)

 CHAPTER 1

Principles of Diagnosis
and Anatomy

CHAP T E R CONTE NTS

SKIN ANATOMY REGIONAL DIFFERENTIAL DIAGNOSIS ATLAS

Epidermis
Dermis
Dermal nerves and vasculature
DIAGNOSIS OF SKIN DISEASE
Primary skin lesions
Secondary skin lesions
Special skin lesions

SKIN ANATOMY Dermis

The skin is divided into three layers: the epidermis, the The dermis varies in thickness from 0.3 mm on the eyelid
dermis, and the subcutaneous tissue. The skin is thicker to 3.0 mm on the back; it is composed of three types of
on the dorsal and extensor surfaces than on the ventral connective tissue: collagen, elastic tissue, and reticular fi-
and flexor surfaces. bers. The dermis is divided into two layers: the thin upper
layer, called the papillary layer, is composed of thin, hap-
Epidermis hazardly arranged collagen fibers; the thicker lower layer,
called the reticular layer, extends from the base of the
The epidermis is the outermost part of the skin; it is papillary layer to the subcutaneous tissue and is com-
stratified squamous epithelium. The thickness of the posed of thick collagen fibers that are arranged parallel to
epidermis ranges from 0.05 mm on the eyelids to 1.5 the surface of the skin. Histiocytes are wandering macro-
mm on the palms and soles. The microscopic anatomy phages that accumulate hemosiderin, melanin, and debris
of the epidermal-dermal junction is complex; it is dis- created by inflammation. Mast cells, located primarily
cussed in detail in Chapter 16. The innermost layer of around blood vessels, manufacture and release histamine
the epidermis consists of a single row of columnar cells and heparin.
called basal cells. Basal cells divide to form keratino-
cytes, which comprise the spinous layer. The cells of the Dermal Nerves and Vasculature
spinous layer are connected to each other by intercellu-
lar bridges or spines, which appear histologically as lines The sensations of touch and pressure are received by
between cells. The keratinocytes synthesize insoluble Meissner’s and Vater-Pacini corpuscles. The sensations of
protein, which remains in the cell and eventually be- pain, itch, and temperature are received by unmyelinated
comes a major component of the outer layer (the stra- nerve endings in the papillary dermis. A low intensity of
tum and corneum). The cells continue to flatten, and stimulation created by inflammation causes itching,
their cytoplasm appears granular (stratum granulosum); whereas a high intensity of stimulation created by inflam-
they finally die as they reach the surface to form the mation causes pain. Therefore scratching converts the
stratum corneum. There are three types of branched intolerable sensation of itching to the more tolerable sen-
cells in the epidermis: the melanocyte, which synthe- sation of pain and eliminates pruritus.
sizes pigment (melanin); the Langerhans cell, which The autonomic system supplies the motor innervation
serves as a frontline element in immune reactions of the of the skin. Adrenergic fibers innervate the blood vessels
skin; and the Merkel cell, the function of which is not (vasoconstriction), hair erector muscles, and apocrine
clearly defined. glands. Autonomic fibers to eccrine sweat glands are

1
2 Clinical Dermatology

cholinergic. The sebaceous gland is regulated by the endo- sections and carefully study each section. For example,
crine system and is not innervated by autonomic fibers. when studying the face, examine the area around each
The anatomy of the hair follicle is described in Chapter 24. eye, the nose, the mouth, the cheeks, and the temples.
During an examination, patients may show small areas
of their skin, tell the physician that the rest of the erup-
DIAGNOSIS OF SKIN DISEASE tion looks the same, and expect an immediate diagnosis.
The remainder of the eruption may or may not look the
What could be easier than the diagnosis of skin disease? same. Patients with rashes should receive a complete skin
The pathology is before your eyes! Why then do nonder- examination to determine the distribution and confirm
matologists have such difficulty interpreting what they the diagnosis. Decisions about quantities of medication to
see? dispense require visualization of the big picture. Many
There are three reasons. First, there are literally hun- dermatologists now advocate a complete skin examina-
dreds of cutaneous diseases. Second, a single entity can tion for all of their patients. Because of an awareness that
vary in its appearance. A common seborrheic keratosis, some patients are uncomfortable undressing completely
for example, may have a smooth, rough, or eroded surface when they have a specific request such as treatment of a
and a border that is either uniform or as irregular as a plantar wart, other dermatologists advocate a case-by-
melanoma. Third, skin diseases are dynamic and change case approach.
in morphology. Many diseases undergo an evolutionary
process: herpes simplex may begin as a red papule, evolve Primary Lesions and Surface Characteristics. Lesions
into a blister, and then become an erosion that heals with should be examined carefully. Standing back and viewing
scarring. If hundreds of entities can individually vary in a disease process provides valuable information about the
appearance and evolve through several stages, then it is distribution. Close examination with a magnifying device
necessary to recognize thousands of permutations to di- provides much more information. Often the primary
agnose cutaneous entities confidently. What at first glance lesion is identified and the diagnosis is confirmed at this
appeared to be simple to diagnose may later appear to be step. The physician should learn the surface characteristics
simply impossible. of all the common entities and gain experience by
Dermatology is a morphologically oriented specialty. examining known entities. A flesh-colored papule might
As in other specialties, the medical history is important; be a wart, sebaceous hyperplasia, or a basal cell carcinoma.
however, the ability to interpret what is observed is even The surface characteristics of many lesions are illustrated
more important. The diagnosis of skin disease must be throughout this book.
approached in an orderly and logical manner. The temp-
tation to make rapid judgments after hasty observation Approach to Treatment
must be controlled.
Most skin diseases can be managed successfully with the
numerous agents and techniques available. If a diagnosis
A Methodical Approach has not been established, medications should not be pre-
The recommended approach to the patient with skin dis- scribed; this applies particularly to prescription of topical
ease is as follows: steroids. Some physicians are tempted to experiment with
• History. Obtain a brief history, noting duration, rate various medications and, if the treatment fails, to refer the
of onset, location, symptoms, family history, allergies, patient to a specialist. This is not a logical or efficient way
occupation, and previous treatment. to practice medicine.
• Distribution. Determine the extent of the eruption by
having the patient disrobe completely. Primary Lesions
• Primary lesion. Determine the primary lesion. Exam-
ine the lesions carefully; a hand lens is a valuable aid Most skin diseases begin with a basic lesion that is re-
for studying skin lesions. Determine the nature of any ferred to as a primary lesion. Identification of the primary
secondary or special lesions. lesion is the key to accurate interpretation and descrip-
• Differential diagnosis. Formulate a differential diag- tion of cutaneous disease. Its presence provides the initial
nosis. orientation and allows the formulation of a differential
• Tests. Obtain a biopsy and perform laboratory tests, diagnosis. Definitions of the primary lesions and their
such as skin biopsy, potassium hydroxide examination differential diagnoses are listed and illustrated on pp. 3
for fungi, skin scrapings for scabies, Gram stain, fungal to 11.
and bacterial cultures, cytology (Tzanck test), Wood’s
light examination, patch tests, dark field examination,
and blood tests.
Secondary Lesions
Secondary lesions develop during the evolutionary pro-
Examination Technique cess of skin disease or are created by scratching or infec-
tion. They may be the only type of lesion present, in
Distribution. The skin should be examined methodi- which case the primary disease process must be inferred.
cally. A visual scan over wide areas is inefficient. It is most The differential diagnoses of secondary lesions are listed
productive to mentally divide the skin surface into several and illustrated on pp. 12 to 16.
 1 Principles of Diagnosis and Anatomy 3

PRIMARY SKIN LESIONS—MACULES

PRIMARY SKIN LESIONS

MACULE
A circumscribed, flat discoloration that may be brown, blue, red, or hypopigmented

MACULES
Hypopigmented Junction nevus (p. 856)
Idiopathic guttate hypomelanosis Lentigo (p. 778)
(p. 776) Lentigo maligna (p. 876)
Nevus anemicus (p. 776) Melasma (p. 779)
Piebaldism Photoallergic drug eruption (p. 769)
Postinflammatory psoriasis Phototoxic drug eruption (p. 766)
Radiation dermatitis Stasis dermatitis (p. 120)
Tinea versicolor (p. 530) Tinea nigra palmaris
Tuberous sclerosis (p. 999) Blue
Vitiligo (p. 770)
Ink (tattoo) Red
Brown Maculae ceruleae (lice) Drug eruptions (pp. 560, 562)
Becker’s nevus (p. 862) Mongolian spot Juvenile rheumatoid arthritis (Still’s
Café-au-lait spot (pp. 782, 995) Ochronosis disease)
Erythrasma (p. 497) Rheumatic fever
Fixed drug eruption (p. 572) Secondary syphilis (p. 392)
Freckles (p. 777) Viral exanthems (p. 549)

Becker’s nevus Erythrasma Lentigo

Idiopathic guttate hypomelanosis Phototoxic drug eruption Tuberous sclerosis

 4 Clinical Dermatology

PRIMARY SKIN LESIONS—PAPULES

PRIMARY SKIN LESIONS

PAPULE
An elevated solid lesion up to 0.5 cm in diameter; color varies; papules may become
PAPULES

confluent and form plaques

Flesh colored, yellow, or white Brown
Acrochordon (skin tag) (p. 792) Dermatofibroma (p. 795)
Adenoma sebaceum (p. 999) Melanoma (p. 868)
Basal cell carcinoma (p. 809) Nevi (p. 855)
Closed comedone (acne) (p. 220) Seborrheic keratosis (p. 784)
Flat warts (p. 452) Urticaria pigmentosa (p. 209)
Granuloma annulare (p. 988) Warts (p. 448)
Lichen nitidus
Lichen sclerosus (p. 321) Red
Milia (p. 252) Acne (p. 218)
Molluscum contagiosum (pp. 426, 458) Atopic dermatitis (p. 152) Pyogenic granuloma (pp. 916, 983)
Neurofibroma (p. 996) Cat-scratch disease (p. 612) Scabies (p. 577)
Nevi (dermal) (p. 855) Cherry angioma (p. 914) Urticaria (p. 178)
Pearly penile papules (p. 422) Cholinergic urticaria (p. 193) Blue or Violaceous
Pseudoxanthoma elasticum Chondrodermatitis nodularis (p. 803)
Senile sebaceous hyperplasia (p. 807) Eczema (p. 90) Angiokeratoma (p. 914)
Skin tags (acrochordons) (p. 792) Folliculitis (p. 345) Blue nevus (p. 864)
Syringoma (p. 808) Insect bites Kaposi’s sarcoma (p. 917)
Keratosis pilaris (pp. 163, 347) Lichen planus (p. 310)
Leukocytoclastic vasculitis (p. 732) Lymphoma
Miliaria Melanoma (p. 868)
Polymorphous light eruption (p. 756) Mycosis fungoides (p. 837)
Psoriasis (p. 263) Venous lake (p. 915)

Sebaceous hyperplasia

Basal cell carcinoma Wart (cylindrical projections) Wart (mosaic surface)

Nevi (dermal) Lichen planus Lichen sclerosus

 1 Principles of Diagnosis and Anatomy 5

PRIMARY SKIN LESIONS—PAPULES—cont’d

PRIMARY SKIN LESIONS

PAPULES
Seborrheic keratosis Seborrheic keratosis Seborrheic keratosis

Melanoma Granuloma annulare Dermatofibroma

Flat warts Molluscum contagiosum Chondrodermatitis nodularis

Venous lake Cherry angioma Pyogenic granuloma

 6 Clinical Dermatology

PRIMARY SKIN LESIONS—PLAQUES

PRIMARY SKIN LESIONS

PLAQUE
A circumscribed, elevated, superficial, solid lesion more than 0.5 cm in diameter,
PLAQUES

often formed by the confluence of papules

Chronic cutaneous (discoid) lupus Pityriasis rosea (p. 307)

erythematosus (pp. 684, 951) Psoriasis (p. 263)
Cutaneous T-cell lymphoma (p. 837) Seborrheic dermatitis (p. 302)
Eczema (p. 90) Sweet’s syndrome (p. 739)
Lichen planus (p. 310) Syphilis (secondary) (p. 394)
Paget’s disease (p. 850) Tinea corporis (p. 499)
Papulosquamous (papular and scaling) Tinea pedis (p. 490)
lesions (p. 263) Tinea versicolor (p. 530)

Pityriasis rosea Eczema Seborrheic dermatitis

Pityriasis rosea Syphilis (secondary) Psoriasis

 1 Principles of Diagnosis and Anatomy 7

PRIMARY SKIN LESIONS—PLAQUES—cont’d

PRIMARY SKIN LESIONS

PLAQUES
Lichen planus Discoid lupus erythematosus Cutaneous T-cell lymphoma

Tinea corporis Tinea pedis Tinea versicolor

Psoriasis Paget’s disease Sweet’s syndrome

 8 Clinical Dermatology

PRIMARY SKIN LESIONS—NODULES

PRIMARY SKIN LESIONS

NODULE
A circumscribed, elevated, solid lesion more than 0.5 cm in diameter; a large nod-
NODULES

ule is referred to as a tumor

Basal cell carcinoma (p. 809) Melanoma (p. 868)

Cutaneous T-cell lymphoma (p. 837) Metastatic carcinoma (p. 854)
Erythema nodosum (p. 723) Neurofibromatosis (p. 995)
Furuncle (p. 350) Prurigo nodularis (p. 117)
Hemangioma (p. 902) Sporotrichosis
Kaposi’s sarcoma (p. 917) Squamous cell carcinoma (p. 830)
Keratoacanthoma (p. 797) Warts (p. 448)
Lipoma Xanthoma (p. 992)
Lymphoma (p. 837)

Basal cell carcinoma Squamous cell carcinoma Keratoacanthoma

Melanoma Hemangioma Kaposi’s sarcoma

Cutaneous T-cell lymphoma Prurigo nodularis Neurofibromatosis

 1 Principles of Diagnosis and Anatomy 9

PRIMARY SKIN LESIONS—PUSTULES

PRIMARY SKIN LESIONS

PUSTULE
A circumscribed collection of leukocytes and free fluid that varies in size

PUSTULES
Acne (p. 218) Hidradenitis suppurativa (p. 260)
Candidiasis (p. 516) Impetigo (p. 329)
Chickenpox (p. 468) Keratosis pilaris (pp. 163, 347)
Dermatophyte infection (p. 487) Pseudomonas folliculitis (p. 358)
Dyshidrosis (pompholyx) (p. 109) Psoriasis (p. 263)
Folliculitis (p. 345) Pyoderma gangrenosum (p. 743)
Gonorrhea (disseminated) (p. 415) Rosacea (p. 256)
Herpes simplex (pp. 429, 460) Scabies (p. 577)
Herpes zoster (p. 473) Varicella (p. 468)

Chickenpox Folliculitis Gonorrhea (disseminated)

Impetigo Keratosis pilaris Herpes simplex

Pseudomonas folliculitis Dyshidrosis (pompholyx) Acne

 10 Clinical Dermatology

PRIMARY SKIN LESIONS—VESICLES AND BULLAE

PRIMARY SKIN LESIONS
VESICLES AND BULLAE

VESICLE
A circumscribed collection of free fluid up to 0.5 cm in diameter

Benign familial chronic pemphigus Herpes simplex (pp. 429, 460)

(p. 664) Herpes zoster (p. 473)
Cat-scratch disease (p. 612) Impetigo (p. 329)
Chickenpox (p. 468) Lichen planus (p. 310)
Dermatitis herpetiformis (p. 641) Pemphigus foliaceus (p. 647)
Eczema (acute) (p. 90) Porphyria cutanea tarda (p. 760)
Erythema multiforme (pp. 569, 713) Scabies (p. 577)

BULLA
A circumscribed collection of free fluid more than 0.5 cm in diameter

Bullae in diabetics (p. 646) Fixed drug eruption (p. 572)

Bullous pemphigoid (p. 655) Herpes gestationis (p. 662)
Cicatricial pemphigoid (p. 660) Lupus erythematosus (p. 680)
Epidermolysis bullosa acquisita (p. 663) Pemphigus (p. 647)

Eczema (acute) Chickenpox Dermatitis herpetiformis

Erythema multiforme Herpes simplex Herpes zoster