Dermatologija Atlas U Boji

Chapter 1:
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Histological reminder of the structure of human skin
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page: 1
Skin from the axillary region

The three constituents are, from top to bottom, the epidermis (coloured in red), the dermis (coloured in blue) and the hypodermis (or subcutaneous adipocytic tissue) packed with sudoriparous glands which are either small (eccrine glands) or large (apocrine glands). Hairs and small sebaceous glands are identifiable in the dermis (coloration : Masson blue trichromatic; enlargement : x 25).
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page: 2
Skin from the forehead region

It nicely illustrates the regional varieties of the integument, compared to the axillary skin. The three constituents are clearly recognisable from top to bottom : the epidermis (thin red border), the dermis (coloured in orange) and the subcutaneous adipocytic tissue. The fine hairs and the sebaceous glands are very numerous in the dermis, but one finds only a small number of sudoriparous glands (coloration : haemalun-eosinesafran; enlargement : x 25).
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page: 3
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All the signs of physiological lightageing are present : disorganised epidermis, elastic transformation of the collagen fibres of the dermis. Under a thin strip of normal subepidermal collagen tissue (coloured in yellow) there appear large degenerated elastic collagen fibres (coloured in red), (coloration : haemalun-eosine-safran; enlargement : x 100).
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Skin from the face of an elderly subject
alphabetical
page: 4
Structure of the epidermis

Close-up of the epidermis. This includes three cell types : the keratinocytes, the melanocytes and the cells of Langerhans. Two are recognisable on this photo : the keratinocytes very coherent among one another, and in the basal stratum several melanocytes surrounded by a light halo (coloration : haemalun-eosinesafran; enlargement : x 250).
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page: 5

continued
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basic lesion
Close-up of the epidermis. Melanin coloured by the Fontana method. The melanocytes appear like crazed, dendritic cells in the basal stratum of the epidermis. They transfer the melanin to the keratinocytes, which are diffusely tattooed with it (enlargement: x 250).
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page: 6

continued
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Close-up of the epidermis. Highlighting of the cells of Langerhans, which appear like dendritic cells covering all of the living epidermis. These cells belong to the line of histiocytic cells and play the immunological role of antigen-presenting cells (immunomarking OKT6 in peroxidase; enlargement : x 250).
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page: 7
Chapter 2:
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Basic lesions
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page: 8
2.1
Macules
Erythematous macule
A macule is a non-infiltrated mark which differs in colour from adjacent skin. The skin coloration varies from pale pink to dark red and disappears on vitropression. It is the result of more or less intense vasodilation (e.g. blushing from modesty).
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Basic lesions
Macules
page: 9
Vascular macule
These permanent marks, which disappear partially or completely on vitropression, result from the presence of an abundant network of dilated vessels in the superficial dermis (e.g. telangiectasia).
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Basic lesions
Macules
page: 10
Purpuric macule
The red macules do not disappear on vitropression. They are the result of extravasation of blood into the dermis (e.g. Bateman's purpura). Their colour changes in time from red to ochre.
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Basic lesions
Macules
page: 11
Pigmentary macules
varying in size, their colour ranging from ochre to dark brown, corresponding to melanin hyperpigmentation in the epidermis (e.g. freckles).
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Pigmented macules
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Basic lesions
Macules
page: 12
Pigmentary macules
Blueish-grey macules
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are the result of melanin deposits extending more or less deeply into the dermis. (e.g. paresthetic notalgia)
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Basic lesions
Macules
page: 13
Pigmentary macules
Achromic macules
continued
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are white marks, varying in shape and size, which result from a decrease in the melanin content of the epidermis (e.g. vitiligo).
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Basic lesions
Macules
page: 14
2.2
Papules
Papules are more or less well demarcated elevations of varying size. There are 3 papule types.
Epidermal papules
These correspond to global thickening of the epidermis (e.g. plane warts).
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Papules
page: 15
Dermal papules
These correspond to oedematous, inflammatory, or proliferative thickening of the dermis (e.g. the weal of urticaria).
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Papules
page: 16
Dermo-epidermal papules
These correspond to a mixed thickening of the epidermis and dermis. (e.g. lichen planus)
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Basic lesions
Papules
page: 17
2.3
Nodules
Nodules are hemispherical elevations caused by inflammatory and oedematous infiltrations of the deep dermis and subcutis (e.g. rheumatoid nodule).
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Basic lesions
Nodules
page: 18
2.4
Tubercles
Tubercles are solid, prominent, circumscribed formations, superficially encased in the dermis. They sometimes ulcerate in the course of their development (e.g. lupus vulgaris [tuberculosis]).
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Basic lesions
Tubercles
page: 19
2.5
Vegetations
Vegetations are filiform or lobulate excrescences, generally of soft consistency (e.g. condylomata acuminata).
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Basic lesions
Vegetations
page: 20
2.6
Warts
Warts are vegetations covered with a more or less thick horny layer (e.g. common wart).
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Basic lesions
Warts
page: 21
2.7
Keratoses
Keratoses consist of epidermal lesions characterized by a localized accumulation of keratin (e.g. cutaneous horn).
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Basic lesions
Keratoses
page: 22
2.8
Vesicles
Vesicles are small cutaneous protuberances with a central cavity containing clear liquid. They are often hemispherical and their centre can be depressed (e.g. varicella).
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Basic lesions
Vesicles
page: 23
2.9
Bullae
Bullae are more voluminous elevations with a central cavity containing a clear, cloudy, or haemorrhagic liquid. They vary in dimensions and in tension: flaccid of firm bullae (e.g. bulla of a thermal burn).
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Basic lesions
Bullae
page: 24
2.10
Pustules
Pustules are protuberances which vary in size and have a central cavity containing a purulent liquid. They occur as primary lesions or develop from vesicles or bullae (e.g. palmoplantar pustulosis).
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Basic lesions
Pustules
page: 25
2.11
Scales
Scales are aggregates of more or less dry horny cells formed by the superficial layers of the epidermis. They detach in fragments of varying size (e.g. ichthyosis).
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Basic lesions
Scales
page: 26
2.12
Crusts
Crusts are concretions of fairly hard consistency which result when exudative, haemorrhagic, or purulent lesions dry out (e.g. impetigo).
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Basic lesions
Crusts
page: 27
2.13
Excoriations (or ulcerations)

Excoriations are very superficial wounds. The dermis is exposed (e.g. excoriations caused by scratching).
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page: 28
2.14
Fissures
Fissures are linear ulcers, with or without marginal hyperkeratosis, which break through the superficial dermis (e.g. athlete's foot).
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Basic lesions
Fissures
page: 29
2.15
Ulcers
Ulcers are more serious losses of substance, which penetrate deep into the dermis (e.g. slough).
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Ulcers
page: 30
2.16
Gangrene
Gangrene is tissue necrosis associated with loss of arterial or arteriolar blood supply (e.g. frostbite).
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Basic lesions
Gangrene
page: 31
2.17
Atrophy
Atrophy consists of a reduction in skin thickness with loss of its firmness and elasticity (e.g. senile atrophy).
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Atrophy
page: 32
2.18
Scars
Scars are due to modifications of the dermis or epidermis and are a sign of a variable degree of fibrosis. They are the evidence of repair of a wound or of a loss of substance (e.g. scar after a burn).
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Scars
page: 33
2.19
Sclerosis
Sclerosis means induration of the skin, which loses its normal suppleness. It is associated with coalescence of fibres in the dermis (e.g. morphoea).
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Basic lesions
Sclerosis
page: 34
Chapter 3:
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Eczemas
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page: 35
3.1
Allergic contact dermatitis and irritation dermatitis

Acute exudative contact dermatitis
Acute exudative allergic contact dermatitis of the flexor surfaces of the forearms and arms after repeated application of an antiseptic lotion. Allergic reaction to hexamidine. Countless small translucent vesicles on a background of congestive erythema, rupturing and exuding a clear serous liquid.
Basic Lesions:
Erythematous Macule; Vesicles
Causes: search contents print
Chemical Agents last screen viewed back next
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Eczemas
page: 36
Basic Lesions:
Erythematous Macule; Keratoses; Scales; Fissures Chemical Agents last screen viewed back next
basic lesion
cause
Slightly keratotic, cracked, and infected scaly erythematous lesions of the back of the fingers in a mason. Allergic reactions to chromium salts present in cements.
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Chronic occupational contact dermatitis
alphabetical
Eczemas
page: 37
Vesicular contact dermatitis

Acute erythematous papulovesicular allergic contact dermatitis of the backs of the hands in a physiotherapist. Allergic reaction to the lanolin contained in a massage cream. The right hand is more severely affected than the left.
Basic Lesions:
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Eczemas
page: 38

continued
Basic Lesions:
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The diffuse erythema, with an unsharp and fragmented margin, is covered with small translucent vesicles.
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Eczemas
page: 39
Bullous contact dermatitis

Acute allergic contact dermatitis of the dorsal surface of the forefoot and toes. Allergic reaction to chromium salts used to tan shoe leather.
Basic Lesions:
Erythematous Macule; Vesicles; Bullae Chemical Agents last screen viewed back next
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cause
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alphabetical
Eczemas
page: 40

continued
Bullae are formed on an erythematous vesicular background.
Basic Lesions:
Erythematous Macule; Vesicles; Bullae Chemical Agents last screen viewed back next
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cause
picture
alphabetical
Eczemas
page: 41
Crusted eczema
Allergic contact dermatitis to the nickel in a jeans stud. At the point of contact there is a crusty greyish patch, partly eroded by excoriations caused by scratching.
Basic Lesions:
Erythematous Macule; Dermoepidermal Papules; Vesicles; Crusts; Excoriations (or Ulcerations) Chemical Agents last screen viewed back next
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cause
picture
alphabetical
Eczemas
page: 42
Crusted eczema
continued
At the edges an erythematous papulovesicular eczema extends to an unclear margin.
Basic Lesions:
Erythematous Macule; Dermoepidermal Papules; Vesicles; Crusts; Excoriations (or Ulcerations) Chemical Agents last screen viewed back next
basic lesion
cause
picture
alphabetical
Eczemas
page: 43
Allergic contact dermatitis of the eyelids caused by the use of an antiwrinkle cream. Allergic reaction to Kathon CG, the cream's preservative. Diffused demarcated and itchy erythematous patches of eczema with fine scales.
Basic Lesions:
Erythematous Macule; Scales
basic lesion
cause
picture
Scaly dry erythematous contact dermatitis
alphabetical
Eczemas
page: 44
Acute irritant dermatitis

Acute irritant dermatitis of the back of the hand and fingers, caused by contact with detergents. Diffuse itchy erythema. The margins of the erythema are distinct, corresponding to the zone of contact with the irritants.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Eczemas
page: 45
Basic Lesions:
Erythematous Macule; Keratoses; Scales; Fissures Chemical Agents last screen viewed back next
basic lesion
cause
Chronic irritant dermatitis of the back of the hand and fingers caused by contact with detergents. Scaly keratotic and chapped erythema causing pruritus and pain.
picture
Cumulative insult dermatitis or chronic irritant dermatitis
alphabetical
Eczemas
page: 46
Basic Lesions:
Keratoses; Fissures
Mechanical Factors; Chemical Agents last screen viewed back next
basic lesion
cause
Thick greyish or blackish keratotic patches, which are fissured and chapped. The clinical picture results from the combination of physical (friction, microtraumata) and chemical factors.
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Chronic palmar irritant dermatitis
alphabetical
Eczemas
page: 47
3.2
Constitutional eczema or atopic dermatitis

Atopic dermatitis of the face in an infant
Bright red oedematous patches of eczema with weeping vesicles. The margins are poorly defined. The lesions predominate on the convex areas of the face: forehead, cheeks, chin.
Basic Lesions:
None specic last screen viewed back next
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picture
alphabetical
Eczemas
page: 48
Itchy exudative erythematous lesions of the retro-auricular groove, centred on a fissure at the base of the fold. Yellowish crusts are the sign of a microbial infection. These lesions, classical in childhood, can persist into adulthood.
Basic Lesions:
Erythematous Macule; Crusts; Fissures None specic last screen viewed back next
basic lesion
cause
picture
Infected retro-auricular dermatitis
alphabetical
Eczemas
page: 49
Very itchy exudative eczematous lesions of the eyelids and atopic angular cheilitis.
Basic Lesions:
Erythematous Macule; Fissures
basic lesion
cause
picture
Atopic dermatitis of childhood
alphabetical
Eczemas
page: 50
Lichenified and very itchy patches in the knee flexures, transversed by scratch lines. In the present case similar lesions are present in other folds (e.g. of elbows, behind the ears, under the buttocks). The lesions can persist into adulthood.
Basic Lesions:
Excoriations (or Ulcerations)
basic lesion
cause
picture
Atopic dermatitis of the folds in a child
alphabetical
Eczemas
page: 51
Eczema of the nipples picture

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Sign of atopic dermatitis in adulthood Acute exudative eczematous lesions of the nipple, the areola, and the periareolar region. The lesion margins are indefinite, the pruritus intense, and the course chronic. This is a classical sign of atopy in adulthood.
Basic Lesions:
Erythematous Macule; Dermoepidermal Papules; Vesicles None specic last screen viewed back
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cause
alphabetical
Eczemas
page: 52
Atopic cheilitis
Atopic cheilitis affects the upper and lower lips and extends over the perioral region. Dry eczematous lesions causing chronic desquamation.
Basic Lesions:
Scales; Fissures
basic lesion
cause
picture
alphabetical
Eczemas
page: 53
Basic Lesions:
Dermo-epidermal Papules; Excoriations (or Ulcerations) Mechanical Factors last screen viewed back next
basic lesion
Very particular polymorphism of the lesions: skin dry and rough (xerosis), lichenified patches. There are also papules of various sizes, very strongly infiltrated, hard in consistency and often excoriated. These are prurigo papules (which used to be called "Besnier's prurigo").
cause
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Atopic dermatitis in the adult: xerosis, lichenication and prurigo
alphabetical
Eczemas
page: 54
Atopic conjunctivitis
Atopic conjunctivitis associated with blepharitis. This inflammation of the conjunctiva is embarrassing, sometimes painful, and often distressingly chronic. It is not unusual in the atopic adult.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Eczemas
page: 55
Basic Lesions:
Erythematous Macule; Scales; Fissures None specic last screen viewed back next
basic lesion
Chronic scaly erythematous eczema of the back of the hands. One quite characteristic feature is the irregular distribution (patchy pattern) of the lesions. Some fingers are affected, whereas others are not. The back of the hands is irregularly affected. This "disordered" topography of the lesions is frequently found in atopic dermatitis.
cause
picture
Atopic dermatitis of the hands in the adult
alphabetical
Eczemas
page: 56
Pityriasis alba
Rounded patch of dry scaly erythematous eczema on the cheek of a child. Spontaneous healing with a tendency to transient residual depigmentation, whence the name pityriasis alba. It occurs more frequently in atopic patients.
Basic Lesions:
Erythematous Macule; Achromic macules; Scales None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Eczemas
page: 57
Juvenile plantar dermatosis

This condition, the site of which is generally the anterior third of the sole, always bilateral, and often symmetrical, is characterized by the triad of erythema, hyperkeratosis, and fissures.
Basic Lesions:
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picture
alphabetical
Eczemas
page: 58

continued
Basic Lesions:
basic lesion
cause
The skin often has a shiny collodion-like appearance. It often becomes worse in winter and is perhaps more common in atopic patients ("atopic winter feet").
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alphabetical
Eczemas
page: 59
3.3
Nummular dermatitis (discoid eczema)

Exudative variety Round erythematous plaque (nummulus = coin) covered with numerous weeping vesicles which develop into small crusts.
Basic Lesions:
Erythematous Macule; Vesicles; Crusts None specic last screen viewed back next
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cause
picture
alphabetical
Eczemas
page: 60
continued
Dry variety of nummular dermatitis Several round or oval erythematous plaques, well demarcated and isolated from each other. Their diameter varies from one to several centimetres and they are covered in fine dry scales.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Eczemas
page: 61
3.4
Gravitational eczema
Patches of itchy erythematous dry eczema, often accompanied by scratches. The lesions are sometimes situated along the course of varicose vessels.
Basic Lesions:
basic lesion
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picture
alphabetical
Eczemas
page: 62
3.5
Seborrhoeic dermatitis
Seborrhoeic dermatitis of the trunk
Red circinate plaques in the presternal and/or interscapular region, covered in slightly itchy greasy scales. Very slight depigmentation occurs in the centre of the lesion.
Basic Lesions:
Erythematous Macule; Achromic macules; Scales None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Eczemas
page: 63
Basic Lesions:
basic lesion
On the scalp it is characterized by diffuse itchy erythema covered in greasy scales. The lesions sometimes spread to the forehead, as in the present case, where they form what is commonly known as the corona seborrhoeica: erythematous patches dotted with steatoid scales, which, following the hairline, show scalloped and arched margins.
cause
picture
Seborrhoeic dermatitis of the hairline
alphabetical
Eczemas
page: 64
Basic Lesions:
basic lesion
cause
The scaly erythematous lesions are well demarcated and have characteristic sites: hairline, nasolabial folds, vertical mediofrontal fold, and the free edges of the lower eyelids.
picture
Seborrhoeic dermatitis of the face
alphabetical
Eczemas
page: 65
3.6
Pompholyx
Pompholyx of the ngers
The vesicles of pompholyx are arranged in groups on the lateral sides of the fingers. They are hard to the touch, encased in the epidermis, translucent, and classically compared to grains of sago or to cooked tapioca. They are accompanied by intense itching.
Basic Lesions:
Vesicles
basic lesion
cause
picture
alphabetical
Eczemas
Pompholyx
page: 66
Basic Lesions:
Vesicles; Bullae
basic lesion
cause
The vesicles encased in the palmar epidermis coalesce to form true bullae, which are sometimes haemorrhagic.
picture
Bullous pompholyx of the palms (cheiro-pompholyx)
alphabetical
Eczemas
Pompholyx
page: 67
Eczematous pompholyx represents an association of pompholyx vesicles with scaly erythematous patches with diffuse margins. The itching is fierce and the course is characterized by successive, even subintrant episodes.
Basic Lesions:
Erythematous Macule; Vesicles; Scales None specic last screen viewed back next
basic lesion
cause
picture
Eczematous pompholyx of the palms
alphabetical
Eczemas
Pompholyx
page: 68
3.7
Asteatotic eczema
(or winter eczema, eczma craquel, or erythema craquel) Dry eczema with imprecise margins reminiscent of crazy paving. The cracks in the "paving" correspond to fissures of variable depth, with pinpoint bleeding. The name "erythema craquel" is nowadays preferred to "eczma craquel".
Basic Lesions:
Erythematous Macule; Fissures
basic lesion
cause
picture
alphabetical
Eczemas
Asteatotic eczema
page: 69
Chapter 4:
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Urticarias
alphabetical
page: 70
4.1
Contact urticarias
Latex contact urticaria
Urticarial weals occurring within minutes of putting on surgical latex gloves. These weals can spread beyond the actual site of contact because this is an immunoallergic urticaria (specific IgE are sometimes present). Generalized urticaria with systemic symptoms can therefore occur: allergic rhinitis, conjunctivitis, asthma-like attacks, anaphylactic shock, etc.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Urticarias
Contact urticarias
page: 71
Prick test with latex

Diagnosis of latex contact urticaria: the prick test is performed with a lancet, using incubation liquid from the suspected latex gloves.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Urticarias
Contact urticarias
page: 72
Basic Lesions:
Erythematous Macule; Dermal Papules Chemical Agents last screen viewed back next
basic lesion
In cases of doubt (prick test difficult to interpret), a provocation test can be performed, if necessary with the suspected glove. This will always be done initially with a finger-stall, which is slipped onto a moistened finger for 10 min. The provocation test must always be done in a hospital environment.
cause
picture
Provocative use test with latex gloves
alphabetical
Urticarias
Contact urticarias
page: 73
4.2
Physical urticarias
Dermographism
Drawing on the skin with a blunt tip produces a linear erythema with an oedematous component. The dermographism appears 5 to 10 min after the rubbing. It can be isolated or associated with chronic idiopathic urticaria.
Basic Lesions:
Erythematous Macule; Dermal Papules Mechanical Factors last screen viewed back next
basic lesion
cause
picture
alphabetical
Urticarias
Physical urticarias
page: 74
Pressure urticaria
Very itchy deep oedema occurring several hours (6 to 12 hours) after strong pressure on a precise area, e.g. on palmar side. Feet can be affected after walking, as can buttocks after prolonged sitting.
Basic Lesions:
Dermal Papules
Mechanical Factors last screen viewed back next
basic lesion
cause
picture
alphabetical
Urticarias
Physical urticarias
page: 75
Cold urticaria
Eruption triggered by cold: the application of an ice-cube for 3 to 10 min systematically reproduces an urticarial weal. Nevertheless, in the present case it would be appropriate to perform a second test to eliminate aquagenic urticaria (with immersion of one hand in water at ambient temperature).
Basic Lesions:
Erythematous Macule; Dermal Papules Cold last screen viewed back next
basic lesion
cause
picture
alphabetical
Urticarias
Physical urticarias
page: 76
Solar urticaria
This very rare variant of urticaria occurs within minutes on exposure to sunlight. The eruption can persist for three to four hours. Photobiological investigation very easily confirms the diagnosis (photosensitivity test positive with UVA and/or UVB).
Basic Lesions:
Dermal Papules
Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
picture
alphabetical
Urticarias
Physical urticarias
page: 77
4.3
Common urticarias (medicines, food, idiopathic)

Urticated weals
Eruption of oedematous urticated weals which can coalesce into broad patches. Itching is constant and can prevent sleep. This urticaria can be the first sign of anaphylactic shock.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Urticarias
page: 78
Papular urticaria
Urticarial weals spread symmetrically over the body, most often blamed on medicines. Specific foods can sometimes trigger this type of urticaria (acute urticaria). Strawberries, shellfish, fish, certain cereals, milk, eggs, and some particular food additives are most frequently the cause. The diagnosis is based mainly on provocation tests (withdrawal and reintroduction of the suspected medicine or food).
Basic Lesions:
basic lesion
cause
picture
alphabetical
Urticarias
page: 79
Figured urticaria
The urticarial papules describe curlicues or geographical shapes. In this case, the cause would most often be a drug (aspirin, codeine, penicillin, etc.). Again, a withdrawal test with reintroduction, if appropriate, makes it possible to reach an exact diagnosis.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Urticarias
page: 80
Hereditary angio-oedema
Not particularly itchy, deep urticaria mainly affecting the face (particularly eyelids and lips), the glottis, and even the larynx. This is an emergency which requires rapid therapeutic intervention (adrenaline and corticosteroids in particular). Iatrogenic causes are not uncommon.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Urticarias
page: 81
Urticarial vasculitis
Combination of urticaria with lesions of leucocytoclastic vasculitis. The urticarial lesions are more fixed than in classical urticaria. They last for 2 to 3 days and are frequently accompanied by joint pains and by fever. Reduced complement levels in blood are observed.
Basic Lesions:
Erythematous Macule; Dermal Papules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Urticarias
page: 82
Chapter 5:
Infectious viral diseases
search
contents
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basic lesion
cause
picture
alphabetical
page: 83
5.1
Herpes virus group

Type I herpes
Multiple vesicles arranged in a cluster on an erythematous background. The lesions are usually painful and in most cases preceded by a burning or itching sensation. The vesicles rupture spontaneously after a few days and drying occurs later. Recurrences are typical (recurrent herpes), usually at the same site.
Basic Lesions:
Infection last screen viewed back next
basic lesion
cause
picture
Herpes of the face
alphabetical
Herpes virus group
page: 84
Type II herpes (genital)

There are lesions which correspond to two stages of development: vesicles on an erythematous base on the prepuce (recent attack) and black crusts on the shaft (old attack). The lesions are itching and painful. The diagnosis is confirmed with liquid from a vesicle: smear for immunological diagnostics with the aid of monoclonal antibodies and culture.
Basic Lesions:
Erythematous Macule; Vesicles; Crusts Infection last screen viewed back next
basic lesion
cause
picture
Herpes of the penis
alphabetical
Herpes virus group
page: 85
Varicella
Varicella and herpes zoster are associated with infection by the virus Herpes varicellae. Vesicles on a background of healthy skin or surrounded by an erythematous ring, distinctly separated from each other, whose contents become cloudy secondarily.
Basic Lesions:
Erythematous Macule; Vesicles; Crusts Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Herpes virus group
page: 86
Varicella
continued
Basic Lesions:
Scars
basic lesion
cause
The central umbilication is classical. They develop to form an adhesive crust which sometimes leaves a depressed scar when it detaches.
picture
alphabetical
Herpes virus group
page: 87
Zoster of the trunk

Herpes zoster is associated with infection by the virus Herpes varicellae. Vesiculobullous dermatosis preceded and very often accompanied by considerable pain (especially in old people). The lesions are strictly unilateral and correspond to the tract of a nerve root. In the present case an intercostal nerve is involved ("fiery half-girdle").
Basic Lesions:
Erythematous Macule; Vesicles; Bullae Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Herpes virus group
page: 88
Ophthalmic nerve zoster

In the present case the topography of the lesions makes it possible to say that two branches are affected by the infectious process: the ophthalmic branch and the superior maxillary branch. The third branch, the inferior maxillary, is spared. The presence of vesicles on the nostril shows that the nasociliary nerve is involved.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Herpes virus group
page: 89
5.2
Papillomavirus group
The papillomaviruses are responsible for the occurrence of various types of benign tumour, viral warts.
Common warts
Small greyish keratotic tumours, rough to the touch, on the backs of the fingers. Common warts are contagious and autoinoculable.
Basic Lesions:
Epidermal Papules; Warts; Keratoses Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
page: 90
Plane warts
These warts are mainly located on the face and on the back of the hands or fingers. They are orange very slightly raised papules.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
page: 91
Plane warts
continued
The linear disposition is typical (Koebner's phenomenon caused by autoinoculation along scratch lines).
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
page: 92
Condylomata acuminata
Fleshy reddish formations on the genital organs. Condylomata acuminata are contagious (sexually transmitted disease) and can spread rapidly. The maceration is sometimes considerable.
Basic Lesions:
Vegetations
basic lesion
cause
picture
alphabetical
page: 93
Plantar wart
Distinctly demarcated keratotic formation which is often deeply embedded in the skin of the sole. The disappearance of dermatoglyphics all over the surface of plantar warts is typical and makes it possible to distinguish this lesion from a corn. A single plantar wart is classically known as myrmecia.
Basic Lesions:
Keratoses
basic lesion
cause
picture
alphabetical
page: 94
Mosaic warts
Juxtaposition of numerous plantar warts forming a hyperkeratotic patch by spreading by degrees. These mosaic plantar warts are often painful (sensitivity to pressure during walking).
Basic Lesions:
Warts
basic lesion
cause
picture
alphabetical
page: 95
Horny liform wart

Small pedunculate papilloma mainly affecting the face (nose, side of the neck, and cheeks). Horny filiform warts are typically found in men (shaving, especially with a razor rather than an electric shaver, contributes to dissemination).
Basic Lesions:
Warts
basic lesion
cause
picture
alphabetical
page: 96
5.3
Epstein-Barr virus
Hairy leucoplakia
Appearance of fine whitish striations on the sides of the tongue. Oral hairy leucoplakia is most often encountered in homosexual men suffering from AIDS. The term "hairy" is purely descriptive. The hairy appearance is associated with linear hyperplasia.
Basic Lesions:
Epidermal Papules
basic lesion
cause
picture
alphabetical
Epstein-Barr virus
page: 97
5.4
Pox and parapox virus groups

Molluscum contagiosum
Small round papule with a smooth surface, often shiny, a few millimetres in diameter. There is often a small central depression (crater, often filled with creamy whitish material). These lesion most frequently affect children and can be secondarily accompanied by eczema around the lesion. Molluscum contagiosum is caused by a poxvirus.
Basic Lesions:
Epidermal Papules
basic lesion
cause
picture
alphabetical
page: 98
Multiple mollusca contagiosa

Illustration of the phase of dissemination of the lesions. The topographical predilection for the axilla is characteristic. In some cases the mollusca contagiosa can become inflamed and there can be a superimposed infection. In adults molluscum contagiosum is often found in the genital area. An immunological status check is indispensable in the case of very numerous lesions (especially if found on the face).
Basic Lesions:
Epidermal Papules
basic lesion
cause
picture
alphabetical
page: 99
ORF
Red to violet pseudovesicular papule appearing on the dorsal face of a finger. The incubation period varies from three days to two weeks after contact with a sick animal (usually sheep). Regression without complications in about two weeks. A superimposed bacterial infection is not uncommon. ORF is caused by a parapoxvirus.
Basic Lesions:
Dermo-epidermal Papules
basic lesion
cause
picture
alphabetical
page: 100
5.5
Other viruses
Erythema infectiosum
Maculopapular "butterfly-wing" eruption of the face giving a puffy appearance, like "butterfly wings". The biphasic development of the lesions on the face is typical.
Basic Lesions:
Erythematous Macule; Dermal Papules Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Other viruses
page: 101
continued
Basic Lesions:
basic lesion
cause
After the second bout there are often numerous pink polycyclic or circinate maculopapules, describing curlicues on the limbs. The eruption disappears in about ten days and is caused by Parvovirus B19.
picture
alphabetical
Other viruses
page: 102
Measles
Maculopapular eruption, very pronounced on the face. Enanthema is also present. Some healthy skin areas can always be seen. There is often a superimposed ENT bacterial infection and injection of the conjuctivae. Measles is caused by a paramyxovirus.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other viruses
page: 103
Hand-foot-and-mouth-disease
Intraoral enanthema of the anterior part of the mouth, with small greyish vesicles which rupture very rapidly. The pain caused can make it difficult to eat.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other viruses
page: 104
continued
Basic Lesions:
basic lesion
cause
Appearance of small oval vesicles about 3 to 4 millimetres in diameter on the hands and feet. The vesicles are greyish-white and surrounded by an erythematous halo.
picture
alphabetical
Other viruses
page: 105
continued
Basic Lesions:
basic lesion
There is a vaguely painful sensation. Disappearance is rapid; disseminated lymphadenopathy can be present. Similar lesions are sometimes found on the buttocks. The condition is generally caused by the Coxsackie A16 virus. Other coxsackie viruses may also be responsible.
cause
picture
alphabetical
Other viruses
page: 106
Rubella
Relatively modest erythematous macular eruption accompanied by suboccipital lymphadenopathy with considerable swelling. The pale pink colour and the unobtrusive effect on general health are other features to be borne in mind. In adults and adolescents the symptoms are often more prominent (fever and more pronounced rash). The pathogen is a togavirus.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Other viruses
page: 107
5.6
Signs of AIDS on skin and mucosa

Necrotic herpes zoster
Multiple ulcers developing from necrotic patches. These ulcerated lesions have spread considerably.
Basic Lesions:
Gangrene; Ulcers
basic lesion
cause
picture
alphabetical
page: 108
continued
After several weeks, the ulcerated lesions have left slightly atrophic cicatrized patches.
Basic Lesions:
Scars
basic lesion
cause
picture
alphabetical
page: 109
Seborrhoeic dermatitis, often severe and resistant to conventional treatments, can be seen in the course of an HIV infection. In the present case the involvement of the whole nasal pyramid was the first sign of HIV infection.
Basic Lesions:
basic lesion
cause
picture
alphabetical
page: 110
Prurigo
In quite a number of cases prurigolike lesions (excoriated nodules) accompanied (or caused) by diffuse pruritus are observed. The involvement of the trunk is relatively typical.
Basic Lesions:
Nodules; Excoriations (or Ulcerations) Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
page: 111
Gingivitis
The dentogingival junction is the site of a purulent erythema (presence of fusiform and spiral bacteria). This periodontitis is painful and shows no tendency to regress spontaneously.
Basic Lesions:
Erythematous Macule; Ulcers
basic lesion
cause
picture
alphabetical
page: 112
Very numerous mollusca on the face, sometimes with a few lesions which are haemorrhagic in appearance, can be seen in AIDS. The mollusca are generally very deeply embedded in the skin. Curettage is relatively difficult. The mollusca show a marked tendency to multiply.
Basic Lesions:
Epidermal Papules
basic lesion
cause
picture
alphabetical
page: 113
Kaposi's sarcoma
Purplish angiomatous papular lesion. The preferred involvement of the face is typical in AIDS patients. In the present case Kaposi's nodules are observed side by side with mollusca contagiosa.
Basic Lesions:
Dermal Papules; Nodules
basic lesion
cause
picture
alphabetical
page: 114
Kaposi's sarcoma
continued
Basic Lesions:
basic lesion
cause
Kaposi's nodules can occur in large numbers all over the skin. These nodules keep distinct margins with angular edges. Here again the violet colour is characteristic. The nodules are generally completely painless.
picture
alphabetical
page: 115
Abnormally large or rapid spread of condylomata acuminata must always lead to a suspicion that the patient is seropositive for HIV. In the present case the condylomata spread all over the vulva and into the vaginal canal.
Basic Lesions:
Vegetations
basic lesion
cause
picture
alphabetical
page: 116
Chapter 6:
Bacterial infections diseases
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contents
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basic lesion
cause
picture
alphabetical
page: 117
6.1
Impetigo
Bullous impetigo
Bullae with cloudy contents, often surrounded by an erythematous halo. These bullae rupture easily and are rapidly replaced by extensive crusty patches. Bullous impetigo is classically caused by Staphylococcus aureus .
Basic Lesions:
Bullae; Crusts
basic lesion
cause
picture
alphabetical
Impetigo
page: 118
Non-bullous impetigo
Erythematous patches covered by a yellowish crust. Lesions are most frequently around the mouth. Lesions around the nose are very characteristic and require prolonged treatment. -Haemolytic streptococcus is most frequently found in this type of impetigo.
Basic Lesions:
Erythematous Macule; Crusts
basic lesion
cause
picture
alphabetical
Impetigo
page: 119
6.2
Ecthyma
Slow and gradually deepening ulceration surmounted by a thick crust. The usual site of ecthyma are the legs. After healing there is a permanent scar. The pathogen is often a streptococcus. Ecthyma is very common in tropical countries.
Basic Lesions:
Crusts; Ulcers
basic lesion
cause
picture
alphabetical
Ecthyma
page: 120
6.3
Folliculitis
Inflammatory papule with a follicular pustule at its centre. The pathogen is usually a staphylococcus. Folliculitis is frequently multiple and classically located on the buttocks, thighs, or the face.
Basic Lesions:
Erythematous Macule; Dermal Papules; Pustules Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Folliculitis
page: 121
6.4
Furuncle (BOIL)
Acute deep folliculitis starting with a painful erythematous papule with the appearance of a central pustule. After spontaneous or induced evacuation of the pus, the furuncle often leaves a permanent scar. The pathogen is Staphylococcus aureus .
Basic Lesions:
Dermal Papules; Pustules
basic lesion
cause
picture
alphabetical
Furuncle (BOIL)
page: 122
6.5
Carbuncle
By definition, carbuncles result from the coalescence of several juxtaposed furuncles. A large painful lump is strewn with small pustules which emerge on the skin surface.
Basic Lesions:
Nodules; Pustules
basic lesion
cause
picture
alphabetical
Carbuncle
page: 123
6.6
Erysipelas
Hot, painful, oedematous erythematous patches, accompanied by fever and malaise, typically caused by a streptococcus. Erysipelas can affect the face, and in this case the border against healthy skin is very distinct and raised: the "step" sign.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Erysipelas
page: 124
Erysipelas
continued
Basic Lesions:
Erythematous Macule
basic lesion
On the leg one observes extensive wide patches identical with those on the face but having a less accentuated margin. Again, the general health is affected, and there is always fever. A mixed infection is found in most cases (gram positive and/or gram negative bacteria). There is often a portal of entry, e.g. a lesion between the toes or a wound caused by trauma.
cause
picture
alphabetical
Erysipelas
page: 125
6.7
Orbital cellulitis
Deep retro-orbital infection manifests itself on the skin with periorbital oedema accompanied by malaise and fever. This is evidently a serious condition, given the possibility of spreading towards the cavernous sinus.
Basic Lesions:
Nodules; Crusts
basic lesion
cause
picture
alphabetical
Orbital cellulitis
page: 126
6.8
Septic emboli
Small erythematous pustular lesions occurring simultaneously in a number of places. The general context depends on the starting point of these septic emboli (cardiac involvement in rheumatic fever, gonorrhoea in the process of dissemination, etc.).
Basic Lesions:
Erythematous Macule; Pustules
basic lesion
cause
picture
alphabetical
Septic emboli
page: 127
6.9
Borrelia infections
Erythema chronicum migrans or lyme disease
Broad erythematous patch spreading outwards with a false appearance of healing at the centre.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Borrelia infections
page: 128
continued
Basic Lesions:
Erythematous Macule
basic lesion
cause
Sometimes a small scar is found in the middle (trace of a tick bite). Erythema chronicum migrans is caused by Borrelia infection.
picture
Erythema chronicum migrans or lyme disease
alphabetical
Borrelia infections
page: 129
Borrelia pseudolymphoma
In some cases the Borrelia infection is clinically recognized by the presence of one or more pasty nodules, mainly on uncovered parts of the body, most typically on earlobes. This type of "pseudolymphoma" is also one of the Borrelia diseases. One can include this lesion among the forms of the old "lymphocytoma benigna cutis".
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Borrelia infections
page: 130
6.10
Proteus infection
In rare cases, if untreated contused lesions are present, a gram-negative microorganism such as Proteus or Pseudomonas can cause necrosis of the distal extremity of a finger.
Basic Lesions:
Gangrene
basic lesion
cause
picture
alphabetical
Proteus infection
page: 131
6.11
Cat-scratch disease
More or less fluctuant nodules with ulceration and central crust, accompanied by lymphadenopathy with considerable swelling.
Basic Lesions:
Nodules; Crusts
Infection; Mechanical Factors last screen viewed back next
basic lesion
cause
picture
alphabetical
Cat-scratch disease
page: 132
Cat-scratch disease
continued
The young patient was scratched by his cat a few weeks previously.
Basic Lesions:
Nodules; Crusts; Ulcers
basic lesion
cause
picture
alphabetical
Cat-scratch disease
page: 133
6.12
Intertrigo
Glazed erythematous patches with the appearance of "pages of a book", centred on the base of a large fold. Maceration and infection with common microorganisms are typical.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Intertrigo
page: 134
6.13
Cutaneous tuberculosis
Lupus vulgaris
Large reddish-yellow lesion affecting the face and the earlobe. False appearance of healing at the centre.
Basic Lesions:
Tubercles; Scars
basic lesion
cause
picture
alphabetical
page: 135
Lupus vulgaris
continued
Basic Lesions:
Tubercles
basic lesion
cause
Vitropression reveals characteristic orange-red coloration, which dermatologists at the beginning of the century compared to "barley sugar", a delicacy which has now gone out of fashion.
picture
alphabetical
page: 136
Scofuloderma
Chronic tuberculous cervical lymphadenopathy with skin ulceration.
Basic Lesions:
Ulcers; Scars
basic lesion
cause
picture
alphabetical
page: 137
Basic Lesions:
Nodules
basic lesion
cause
Non-specific abscess formation after BCG vaccination. This complication of BCG vaccination is generally the result of an injection made too deeply.
picture
Complication of BCG vaccination
alphabetical
page: 138
6.14
Atypical mycobacterial infections

Infection with mycobacterium marinum
This condition is found mainly in fish fanciers (fish-tank disease) and classically appears in the form of a chain of nodules spaced like rosary beads, extending along the line of lymphatic drainage. These are more or less keratotic papulonodular lesions and/or ulcers. There is generally little pain. Deep biopsy with culture in a suitable medium very easily reveals the mycobacterium.
Basic Lesions:
Nodules; Ulcers
basic lesion
cause
picture
alphabetical
page: 139
continued
Basic Lesions:
Nodules; Ulcers
basic lesion
cause
The papulonodules can be single or multiple. The latter form of the mycobacterial infection is sometimes known as sporotrichoid.
picture
alphabetical
page: 140
Abscess and violet nodules occurring a few weeks after repeated injections as part of mesotherapy (in the treatment of "cellulitis").
Basic Lesions:
Nodules; Ulcers
basic lesion
cause
picture
Infection with mycobacterium fortuitum or chelonae
alphabetical
page: 141
6.15
Corynebacterium infections
Erythrasma
Broad and distinctly demarcated brownish or buff macule, with rounded margins, usually symmetrical and affecting either the groins or the axillae. These lesions are homogeneous and finely squamous. The pathogen is Corynebacterium minutissimum . Examination in Wood's light reveals coral-red fluorescence.
Basic Lesions:
Pigmented Macules; Scales
basic lesion
cause
picture
alphabetical
page: 142
Trichomycosis axillaris
This is a bacterial infection caused by corynebacteria. The axillary hairs are surrounded by small yellowish nodules corresponding to colonies of bacteria. There is little in the way of subjective symptoms. The sweat sometimes becomes yellowish.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
page: 143
Pitted keratolysis
Small serpiginous erosions of the horny layer with a punched-out appearance, mainly found on weight-bearing areas of the soles and causing an interruption in footprints. An associated plantar hyperhidrosis is often present. The erosions correspond to areas of desquamation in a block of the horny layer invaded by corynebacteria.
Basic Lesions:
basic lesion
cause
picture
alphabetical
page: 144
Chapter 7:
search
contents
print
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basic lesion
Treponematoses and other sexually transmitted diseases
cause
picture
alphabetical
page: 145
7.1
Syphilis
Syphilitic chancre (primary sore)
Ulceration with erosion situated on the glans penis or sheath. Distinctly palpable induration. Considerable swelling of inguinal lymph nodes, usually unilateral.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Syphilis
page: 146
continued
Basic Lesions:
basic lesion
cause
The characteristics of female chancre are identical with those in the male. In women the chancre is often accompanied by considerable oedema of the labia majora.
picture
alphabetical
Syphilis
page: 147
Occurring about six weeks after the start of the chancre, secondary syphilis appears in the form of pink oval macules with little or no scaling and no itching. These macules are located mainly on the trunk.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
Secondary syphilis (macular syphilid)
alphabetical
Syphilis
page: 148
Late secondary syphilis

Dull red, sometimes brownish, very distinctly indurated papules, which are not itchy, located on the trunk and on the proximal regions of the limbs.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Syphilis
page: 149
Papular syphilids
Slightly reddish macules with peripheral desquamative collarette (Biett's collarette). These papular syphilids occur four to twelve months after the chancre.
Basic Lesions:
Erythematous Macule; Dermal Papules; Scales Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Syphilis
page: 150
Genital gonorrhoea
Diffuse redness of the glans, purulent urethral discharge, considerable dysuria, pollakiuria. Presence of two mollusca contagiosa, equally sexually transmitted.
Basic Lesions:
Erythematous Macule; Epidermal Papules Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Syphilis
page: 151
Chapter 8:
search
contents
print
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basic lesion
cause
picture
Mycoses
alphabetical
page: 152
8.1
Dermatophytoses
Tinea corporis
Round or oval lesion, as in the present case, with a distinctly raised margin, sometimes with fine vesicles, sometimes very scaly. There is often a false appearance of healing at the centre. These round lesions are generally slightly scaly. Pruritus is not always present as a subjective symptom. The lesions can be single.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 153
Tinea corporis
continued
The lesions can be multiple. The pathogen is generally Microsporum canis, or Trichophyton rubrum.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 154
Tinea faciei
The dermatophytosis has the same appearance as on glabrous skin, but can assume an impressive clinical picture owing to it's spread.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 155
Tinea faciei
continued
Basic Lesions:
basic lesion
cause
The dermatophytosis can also assume a more or less atypical clinical picture owing to late diagnosis or unsuitable topical therapy with corticosteroids.
picture
alphabetical
Mycoses
Dermatophytoses
page: 156
Tinea cruris
Dermatophytosis of the inguinal fold (also called dhobi itch and Hebra's eczema marginatum). This dermatophytosis affects men more frequently than women. A very distinct vesicular border circumscribes a central red, sometimes brownish, central region, which is always scaly. The lesion typically spreads towards the inner thigh.
Basic Lesions:
Erythematous Macule; Vesicles; Scales Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 157
Tinea manuum
This condition affects the palms, most frequently on one hand. There is no substantial hyperkeratosis. An active margin may be noticeable at the wrist. Association with athlete's foot or eczema marginatum is typical, and it is a good idea to persevere in looking for this. Scraping with a curette generally yields plenty of horny, brittle, powdery material.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 158
Tinea manuum
continued
It is characterized by diffuse redness and dryness with floury accentuation of flexural creases of the palms.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 159
Tinea pedum (athlete's foot)

Fissured and scaly intertrigo of the space between the fourth and the fifth toes. There is often a small painful crack running along the base of the fold.
Basic Lesions:
Erythematous Macule; Scales; Fissures Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 160

continued
Sometimes the whole area is eroded, which is a sign of microbial infection.
Basic Lesions:
Erythematous Macule; Scales; Fissures Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 161

continued
The dermatophytosis can extend to the sole, which it affects more or less extensively. In some cases in which tinea manuum is associated with tinea pedis, three of the four limbs are affected (e.g. one hand and two feet).
Basic Lesions:
Scales
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 162
Tinea capitis or ringworm

The scalp is attacked by a dermatophyte. Children are affected most often. Large plaque of alopecia, presence of numerous short broken hairs, on a greyish and scaly base. The pathogen is most frequently Microsporum canis. Ringworm is characteristic of the prepubescent period: it is distinguished from alopecia or pseudo-alopecia by its floury appearance.
Basic Lesions:
Scales
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 163
Kerion
Crusty and well demarcated suppurative patch sometimes tumour-like. Most typical site is the scalp in the child.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 164
Kerion
continued
Another most typical site is the beard in the adult.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 165
Kerion
continued
The lesion evolves into a definitive scar. The pathogen is Trichophyton mentagrophytes or Trichophyton verrucosum.
Basic Lesions:
Scars
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 166
Basic Lesions:
None specic
basic lesion
cause
Thickened and opaque nail, distal onycholysis. The nail becomes brittle. There is no associated paronychia.
picture
Onychomycosis due to dermatophytes
alphabetical
Mycoses
Dermatophytoses
page: 167
continued
More rarely, dermatophytic onychomycosis involves the superficial layer of the nail plate and appears in the form of small opaque whitish patches which are well demarcated (appearance of leuconychia). The surface becomes more brittle as a result.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Mycoses
Dermatophytoses
page: 168
8.2
Candidiasis
Thrush
Thrush is the classical form of intraoral candidiasis, characterized by a whitish coating of creamy consistency covering bright red areas of erosion. Scraping with the curette removes the coating and exposes the erosion patches. The inner cheek surface and the tongue are affected. The surrounding mucosa is inflamed and there is a considerable burning sensation. The pathogen is Candida albicans.
Basic Lesions:
Achromic macules; Excoriations (or Ulcerations) Infection last screen viewed back next
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 169
Angular cheilitis
Fissures, which are most frequently symmetrical, localized at the corners of the lips and surrounded by small impetigo-like crusts. Edentulous patients or patients with badly fitting dentures are most frequently affected. A superimposed bacterial infection is very common.
Basic Lesions:
Fissures
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 170
Candidal intertrigo
More or less symmetrical exudative erythematous axillary patches with small satellite lesions. A peripheral desquamative collarette is often present.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 171
Candidal intertrigo
continued
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 172
Candidal vulvovaginitis
Symmetrical involvement of the external genitals with peripheral desquamative collarette and small punctiform erythematous satellite lesions which are sometimes somewhat pustular. Itching is generally severe. There is frequently an associated whitish leucorrhoea.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 173
Candidal balanitis
Glazed erythema surrounded by a fine whitish border, affecting the glans and the neck of the penis. Relatively intense burning. Recurrences are common.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 174
Basic Lesions:
Pustules
basic lesion
Thickened, brittle, and yellowish nail, accompanied by an inflamed nail fold which discharges a purulent exudate on pressure. Pain is typical. Some cases of candidal paronychia are preceded by irritant dermatitis, most frequently to vegetable or animal proteins (protein contact dermatitis).
cause
picture
Candidal paronychia and subungual infection
alphabetical
Mycoses
Candidiasis
page: 175
Napkin candidiasis (infant)

Wide glazed erythematous patch over the whole area of genitals and buttocks with satellite lesions. The condition classically starts at the base of the folds (inguinal folds, cleft of the buttocks or anal region).
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Mycoses
Candidiasis
page: 176
8.3
Pityriasis versicolor
Small, well-demarcated buff or brownish patches located mainly on the trunk or the neck. Pruritus is moderate or absent.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
page: 177
continued
Scraping with a curette reveals a scale becoming detached from a mass of scales: chip sign. The depigmented form can either be scaly from the beginning and thus contagious, or residual after exposure of pigmented pityriasis versicolor to the sun.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
page: 178
continued
Basic Lesions:
Achromic macules
basic lesion
In this case it is not contagious and represents only the aftermath of an old pityriasis versicolor after treatment. In cases of doubt, mycological examination reveals the presence of short mycelial filaments accompanied by colonies of small round spores (Malassezia furfur). Wood's light examination reveals the presence of a yellowish fluorescence.
cause
picture
alphabetical
Mycoses
page: 179
8.4
Deep fungal infections

Sporotrichosis
Multiple violet papulonodular lesions developing along the lines of lymphatic drainage, associated with infection with Sporothrix schenkii. The limbs are most frequently affected.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Mycoses
page: 180
Mycetoma (Madura foot)

Severe inflammatory swelling located most frequently on the foot, exuding a purulent material containing grains through fine breaks. The pathogens can be either eumycetes or actinomycetes.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Mycoses
page: 181
Chapter 9:
Parasitic diseases arthropods
search
contents
print
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basic lesion
cause
picture
alphabetical
page: 182
9.1
Human scabies
Parasitic disease caused by Sarcoptes scabiei. Blackish burrows from 5 to 15 mm in length, ending in a vesicle at one end ("mite hill"). The sides of the fingers and the anterior surfaces of the wrist are sites of predilection. Numerous marks of excoriation, sometimes accompanied by fine more or less translucent vesicles spread all over the skin.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Human scabies
page: 183
Human scabies
continued
These excoriations are mainly the sign of very severe itching in the evening and at night.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Human scabies
page: 184
Human scabies
continued
Basic Lesions:
Nodules
basic lesion
cause
Scabies nodules: very distinctly infiltrated, extremely itchy reddish nodules in the axillae, on the scrotum, and on the penis, persisting even after successful treatment.
picture
alphabetical
Human scabies
page: 185
Human scabies
continued
In children the lesions usually affect the feet: numerous extremely itchy excoriated papules.
Basic Lesions:
Epidermal Papules; Pustules
basic lesion
cause
picture
alphabetical
Human scabies
page: 186
9.2
Animal scabies
Numerous small itchy papules spread all over the skin, which regress spontaneously. There are no burrows. The patient's pet (cat or dog) is typically found to be infested.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Animal scabies
page: 187
9.3
Pediculosis (head lice)

Wide impetigo-like patch at the nape of the neck caused by scratching, associated with very severe undiagnosed infestation.
Basic Lesions:
Crusts
basic lesion
cause
picture
alphabetical
page: 188
continued
Area of attachment of a nit to a hair.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
page: 189
9.4
Crab lice (pubic lice)

Excoriations and presence of louse eggs firmly attached to the pubic hairs. There are also crab lice (Phthirius pubis) grasping the public hairs. On the body, relatively discrete bluish grey macules (maculae caerulae) can sometimes be found.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
page: 190
continued
These blue-grey macules correspond to the release of toxins by the crab louse in the course of successive bites.
Basic Lesions:
Blueish-grey Macules
basic lesion
cause
picture
alphabetical
page: 191
9.5
Insect bites
Trombiculiasis
Immunological reactions to bites by harvest mites (larvae of Trombiculidae which feed on blood). Small itchy lesions, sometimes in a line, located anywhere on the skin, with predilection for constricted areas. The lesions sometimes rise to a point in the centre.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Insect bites
page: 192
Trombiculiasis
continued
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Insect bites
page: 193
Basic Lesions:
Dermal Papules; Vesicles
basic lesion
Occurring mainly in children, this type of papular urticaria occurs in the form of numerous small erythematous papules, sometimes with fine vesicles. The lesions are found mainly on the legs, are extremely itchy, and very likely to be excoriated. Sometimes a linear disposition is seen, which makes the diagnosis much more obvious. Infantile papular urticaria is caused by an ectoparasite with a cat or dog host.
cause
picture
Infantile papular urticaria (strophulus)
alphabetical
Insect bites
page: 194
Flea bites
Large inflammatory papules in a linear disposition. There is a distinct central acumination. Infestation is usually via a pet (cat or dog), which acts as the carrier.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Insect bites
page: 195
Flea bites
continued
In some cases the lesions become frankly bullous and even haemorrhagic.
Basic Lesions:
Bullae
basic lesion
cause
picture
alphabetical
Insect bites
page: 196
9.6
Leishmaniasis
Large encrusted papular lesion surrounded by an inflammatory rim. There is no associated pain or lymphadenopathy. The course is chronic and the lesion is resistant to conventional antiseptic treatments.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Leishmaniasis
page: 197
Leishmaniasis
continued
Basic Lesions:
basic lesion
cause
It is a protozoan infection caused by a species of Leishmania. The carrier is a Phlebotomus fly, which explains why in most cases the lesions of leishmaniasis are found on uncovered areas (especially the face).
picture
alphabetical
Leishmaniasis
page: 198
Leishmaniasis
continued
After a few months the lesion subsides, leaving a scar of variable visibility.
Basic Lesions:
Scars
basic lesion
cause
picture
alphabetical
Leishmaniasis
page: 199
9.7
Larva migrans (creeping eruption)

Inflammatory serpiginous line ending in a small, extremely itchy papule. Larva migrans is caused by a larva of an Ancylostoma species (hookworm) which migrates about 1 cm per day, thus extending the line of inflammation. In humans contact usually occurs on the beach (soil polluted with animal excreta). Cutaneous larva migrans is found mainly on the feet and the buttocks.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
page: 200
continued
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
page: 201
9.8
Tungiasis (chigger)
Itchy inflammatory nodule with a small blackish opening at the centre, found in the periungual region of a toe. Secondary superinfection (abscess formation) may be present. Tungiasis is caused by a flea which lives on blood: Tunga penetrans.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Tungiasis (chigger)
page: 202
Tungiasis (chigger)
continued
Infestation typically occurs on the feet (walking barefoot in areas where it is endemic, especially Africa and Central America).
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Tungiasis (chigger)
page: 203
Chapter 10:
search
contents
print
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basic lesion
cause
picture
Psoriasis
alphabetical
page: 204
10.1
Clinical aspects
Psoriasis vulgaris
Very extensive psoriasis. Large confluent patches, mainly erythematous, covered in fine scales.
Basic Lesions:
basic lesion
cause
picture
Erythematous form
alphabetical
Psoriasis
Clinical aspects
page: 205
Psoriasis vulgaris
Scaly erythematous form
continued
Basic Lesions:
basic lesion
cause
Psoriasis on the knees. Well demarcated scaly erythematous patches. Thick white scales with a shiny micaceous appearance.
picture
alphabetical
Psoriasis
Clinical aspects
page: 206
Psoriasis vulgaris
Plaster-like psoriasis
continued
Basic Lesions:
basic lesion
Extended psoriatic lesions on the trunk and the arms. In the present case the scales, which are thick and adherent, mask the erythema which appears here and there like a thin border at the edge of the lesions. The appearance of the scales is such that they are often referred to as cretaceous psoriasis or, more picturesquely "plaster-like scales".
cause
picture
alphabetical
Psoriasis
Clinical aspects
page: 207
Psoriasis vulgaris
continued
Patches resemble candle wax.
Basic Lesions:
basic lesion
cause
picture
Characteristic clinical symptoms
alphabetical
Psoriasis
Clinical aspects
page: 208
Psoriasis vulgaris
continued
Patches are bleeding after curettage.
Basic Lesions:
basic lesion
cause
picture
Characteristic clinical symptoms
alphabetical
Psoriasis
Clinical aspects
page: 209
Psoriasis vulgaris
Guttate psoriasis
continued
Basic Lesions:
basic lesion
cause
Guttate psoriasis consists of innumerable small scaly erythematous patches, a few millimetres across, which in the present case are distributed all over the skin.
picture
alphabetical
Psoriasis
Clinical aspects
page: 210
Psoriasis vulgaris
Guttate psoriasis
continued
In many cases it is an eruptive psoriasis of childhood or adolescence.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
Clinical aspects
page: 211
Psoriasis vulgaris
Koebner's phenomenon (isomorphic reaction)
continued
Psoriatic lesions appear around a surgical scar.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
Clinical aspects
page: 212
Psoriasis vulgaris
Pustular psoriasis of the flexor surface of the forearm. Large erythematous patch with distinct margins, strewn with a scatter of flattened yellowish-white pustules arranged in confluent clusters.
Basic Lesions:
Erythematous Macule; Pustules
basic lesion
cause
picture
Body
alphabetical
Psoriasis
Clinical aspects
page: 213
Pustular psoriasis
Feet
continued
Basic Lesions:
Erythematous Macule; Pustules; Scales None specic last screen viewed back next
basic lesion
cause
Plantar pustular psoriasis. Isolated pustules appear on a scaly erythematous base with distinct borders.
picture
alphabetical
Psoriasis
Clinical aspects
page: 214
Pustular psoriasis
Feet
continued
Basic Lesions:
Erythematous Macule; Pustules; Scales None specic last screen viewed back next
basic lesion
cause
The most recent yellowish-white pustules are slightly raised, whereas the older pustules are brown and embedded in the horny layer of the epidermis.
picture
alphabetical
Psoriasis
Clinical aspects
page: 215
Psoriatic erythroderma
The erythrodermic psoriasis has spread all over the body.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
Clinical aspects
page: 216
Psoriatic erythroderma continued

The erythrodermic psoriasis has spread all over the body without intervals of healthy skin.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
Clinical aspects
page: 217
10.2
Particular local forms

Palmoplantar psoriasis
Palmar psoriasis. Scaly erythematous patches with distinctly rounded contours. The covering scales are thick and nacreous.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
page: 218
Flexural psoriasis
Inverse psoriasis of an axilla. The psoriatic eruption consists of a continuous plaque which is bright red, shiny, smooth, and not very scaly, with a well-circumscribed margin.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
page: 219
Psoriasis of the nails

The picture, which is very complete, includes distal onycholysis with yellow coloration, cup-shaped depressions in the central area, and advanced disintegration of the nail plate in the proximal area. In addition, classical psoriatic lesions have invaded the whole of the nail fold.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
page: 220
Psoriasis of the scalp

The round, scaly erythematous patches spread beyond the hairline to invade the cervical region.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Psoriasis
page: 221
Basic Lesions:
basic lesion
cause
Psoriasis of the face is rare and is usually found predominantly in the seborrhoeic regions: wings of the nose, area between the eyebrows, hairline. It is often called "seborrhoeic psoriasis".
picture
Psoriasis of the face (seborrhoeic psoriasis)
alphabetical
Psoriasis
page: 222
Mucosal psoriasis
Erythematous and slightly glazed plaques with distinct margins, scattered over the upper surface of the tongue. The picture is quite similar to that described by the term geographical tongue (or benign migratory glossitis or lingual erythema migrans).
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
1. Psoriasis of the tongue
alphabetical
Psoriasis
page: 223
Mucosal psoriasis
continued
Large red and well-circumscribed plaques, neither infiltrated nor scaly, with a chronic course. They present problems of differential diagnosis, as they have to be distinguished from balanitis of other origins.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
2. Psoriasis of the glans penis
alphabetical
Psoriasis
page: 224
Chapter 11:
search
contents
print
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basic lesion
cause
picture
Other skin diseases
alphabetical
page: 225
11.1
Pityriasis rosea
The eruption consists of pink oval patches measuring 1 to 3 cm in diameter, with fine scaling in a peripheral collarette. The initial lesion, looking like an oval medallion, can usually be recognized by its larger size (diameter 5 to 6 cm) and its accentuated margin.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
Pityriasis rosea
page: 226
Pityriasis rosea
continued
Its oblique orientation on the trunk is characteristic.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
Pityriasis rosea
page: 227
11.2
Parapsoriasis
Pityriasis lichenoides ("guttate parapsoriasis")
The polymorphic eruption is spread over the trunk and the limbs. It consists of red or brownish and more or less scaly maculopapular lesions. The characteristic feature is a brownish macule covered with an adherent scale, which detaches in one piece.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
Parapsoriasis
page: 228
Varioloid parapsoriasis
The eruption affects the trunk and the limbs, it is polymorphic: papulopustular lesions, necrotic, often haemorrhagic lesions, crusts, varioloid scars.
Basic Lesions:
Dermal Papules; Pustules; Crusts; Scars None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Parapsoriasis
page: 229
continued
Basic Lesions:
Dermal Papules; Pustules; Crusts; Scars None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Parapsoriasis
page: 230
The lesions are oval, 2 to 5 cm in diameter, well-circumscribed, flat and yellowish pink with fine scaling. These patches are disposed in lines, the position of which is fairly stereotyped: slanting along the ribs on the trunk, longitudinal on the limbs.
Basic Lesions:
basic lesion
cause
picture
Chronic supercial scaly dermatitis (digitate dermatosis)
alphabetical
Other skin diseases
Parapsoriasis
page: 231
The lesions consist of wide plaques (10 to 20 cm in diameter) located on the trunk and the base of the limbs. Their appearance is polymorphic: sepia-coloured scaly erythematous plaques, atrophic or even poikilodermal lesions.
Basic Lesions:
basic lesion
cause
picture
Premycotic or prereticulotic eruption with large plaques
alphabetical
Other skin diseases
Parapsoriasis
page: 232
11.3
Lichen planus
Simple cutaneous lichen planus
The basic lesion is a firm reddishviolet polygon. The surface, which has a sheen in oblique illumination, is covered with fine greyish striations known as Wickham's striae.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen planus
page: 233
One of the preferred sites is the flexor surface of the forearm.
Basic Lesions:
basic lesion
cause
picture
Simple cutaneous lichen planus continued
alphabetical
Other skin diseases
Lichen planus
page: 234
Papules may appear along the excoriations caused by scratching (Koebner's phenomenon).
Basic Lesions:
basic lesion
cause
picture
Simple cutaneous lichen planus continued
alphabetical
Other skin diseases
Lichen planus
page: 235
Oral lichen planus

The lesions are white and reticulated. Their preferred site is the tongue and the lower posterior part of the cheeks ("fern-leaf" appearance).
Basic Lesions:
Achromic macules
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen planus
page: 236
Oral lichen planus
continued
Basic Lesions:
Achromic macules; Ulcers
basic lesion
cause
A rare form is erosive lichen planus: painful red ulcerations with no tendency towards spontaneous healing. The ulcers are surrounded by a lichen-like whitish border.
picture
alphabetical
Other skin diseases
Lichen planus
page: 237
Hypertrophic lichen planus

The lesions are oval or coalescent, infiltrated, and pink or violet in colour. Their surface is hyperkeratotic. The skin disease classically affects the front of the legs.
Basic Lesions:
Warts
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen planus
page: 238

continued
Basic Lesions:
Warts
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen planus
page: 239
Lichen planus of the nails

Dorsal pterygium and flaps of nail at the sites.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen planus
page: 240
11.4
Graft versus host disease (GVHD)

In the subacute stage the graft's reaction against the host can appear as a lichenoid eruption. The lesions are spread all over the skin.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 241
The lesions are spread all over the skin and can involve the mucosa.
Basic Lesions:
Achromic macules; Dermoepidermal Papules None specic last screen viewed back next
basic lesion
cause
picture
Graft versus host disease (GVHD) continued
alphabetical
Other skin diseases
page: 242
11.5
Lichenication
Well-demarcated thick itchy hyperkeratotic patch on the ankle, forming a grid of scratch lines. The term neurodermatitis is sometimes used to describe this phenomenon.
Basic Lesions:
Keratoses; Excoriations (or Ulcerations) Mechanical Factors last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichenification
page: 243
11.6
Subacute prurigo
The excoriated papules are disposed symmetrically on the extensor surfaces of the limbs, the upper back, and sometimes on the face and the scalp.
Basic Lesions:
Dermo-epidermal Papules; Excoriations (or Ulcerations) None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Subacute prurigo
page: 244
Subacute prurigo
continued
Basic Lesions:
Dermo-epidermal Papules; Excoriations (or Ulcerations) None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Subacute prurigo
page: 245
11.7
Lupus erythematosus
Discoid lupus erythematosus
The eruption consists of erythematous patches covered with an adherent hyperkeratotic layer, predominantly at the hair follicles. It resolves into cicatricial atrophy.
Basic Lesions:
Erythematous Macule; Keratoses
basic lesion
cause
picture
1. Face
alphabetical
Other skin diseases
Lupus erythematosus
page: 246

continued
1. Face The erythema is associated with severe oedema, producing one or more swollen patches with distinct margins, a smooth surface, and an oedematous consistency. A rare form is lupus erythematosus tumidus.
Basic Lesions:
Erythematous Macule; Keratoses
basic lesion
cause
picture
alphabetical
Other skin diseases
Lupus erythematosus
page: 247

continued
2. Scalp This consists of erythematous and somewhat atrophic alopecic plaques which heal with scarring.
Basic Lesions:
Erythematous Macule; Atrophy; Scars Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Lupus erythematosus
page: 248
Subacute lupus erythematosus

The eruption corresponds to a profuse form consisting of erythematous and somewhat scaly polycyclic annular plaques which resolve to leave depigmentation and telangiectasia.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
Lupus erythematosus
page: 249
Systemic lupus erythematosus

The eruption is in the form of slightly oedematous erythematous sheets, without atrophy or follicular hyperkeratosis. The lesions are often symmetrical and located on areas exposed to the sun ("butterfly" appearance).
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
1. Face
alphabetical
Other skin diseases
Lupus erythematosus
page: 250

continued
2. Fingers The site of the lesions on the fingers is usually around the nails. The lesions are usually erythematous and telangiectatic, sometimes violet (chilblain-like in appearance).
Basic Lesions:
Erythematous Macule
Cold last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Lupus erythematosus
page: 251
11.8
Jessner and Kanof disease

The eruption consists of more or less tumid smooth erythematous papules with a flat surface and no scaling. These lesions tend to be located on the face, neck, and the upper trunk.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 252
11.9
Dermatomyositis
1. Face Diffuse oedematous and telangiectatic erythema of the face. The lesions are usually found predominantly on the eyelids.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Other skin diseases
Dermatomyositis
page: 253
Dermatomyositis
2. Hands and ngers
continued
Basic Lesions:
Erythematous Macule
basic lesion
cause
Lesions or purplish erythema predominantly on the dorsal surface of the hand and finger joints, mainly in the supraarticular regions.
picture
alphabetical
Other skin diseases
Dermatomyositis
page: 254
11.10 Scleroderma
Localized morphoea
The condition consists of one or more indurated nacreous white plaques which have a sheen in oblique light. They are bordered by a mauve band (lilac ring) which disappears as the lesions develop.
Basic Lesions:
Erythematous Macule; Achromic macules; Sclerosis None specic last screen viewed back next
basic lesion
cause
picture
1. Plaque lesions
alphabetical
Other skin diseases
Scleroderma
page: 255
Localized morphoea
2. Bands
continued
Basic Lesions:
Atrophy; Scars; Sclerosis
basic lesion
cause
This variant of morphoea is characterized by a paramedian band of sclerosis and atrophy. In some cases actual facial hemiatrophy develops.
picture
alphabetical
Other skin diseases
Scleroderma
page: 256
Systemic sclerosis
Systemic sclerosis is found mainly on the face and on the extremities. The facial expression seems fixed. The tapering of the nose and narrowing of the mouth, surrounded by radial furrows, aggravate the lack of expression.
Basic Lesions:
Sclerosis
basic lesion
cause
picture
alphabetical
Other skin diseases
Scleroderma
page: 257
Systemic sclerosis
continued
The sclerodactyly is characterized by tapering of the fingers, which become fixed in flexion. There are painful ulcerations on the pulps.
Basic Lesions:
Sclerosis
basic lesion
cause
picture
alphabetical
Other skin diseases
Scleroderma
page: 258
11.11 Lichen sclerosus

Skin (glabrous skin) Well-circumscribed shiny white papules resembling mother-ofpearl, with a slight depression at the centre, sometimes clustered in plaques with fragmented margins.
Basic Lesions:
Dermo-epidermal Papules; Sclerosis
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen sclerosus
page: 259
Lichen sclerosus
Vulva
continued
Basic Lesions:
Purpuric Macule; Achromic macules; Sclerosis None specic last screen viewed back next
basic lesion
cause
The vulval mucosa assumes a nacreous white shiny appearance. There are sometimes areas of bruising.
picture
alphabetical
Other skin diseases
Lichen sclerosus
page: 260
Lichen sclerosus
Glans penis
continued
Porcelain-white patches which are either disseminated or, more often, located around the meatus.
Basic Lesions:
Achromic macules; Sclerosis
basic lesion
cause
picture
alphabetical
Other skin diseases
Lichen sclerosus
page: 261
11.12 Sarcoidosis
Papular form Small, round, well-circumscribed elevations, either isolated or multiple, measuring 1 to 3 mm in diameter. Their colour is red, violet, or sepia. They appear yellowish on vitropression.
Basic Lesions:
Nodules; Tubercles
basic lesion
cause
picture
alphabetical
Other skin diseases
Sarcoidosis
page: 262
Sarcoidosis
Nodular form
continued
Basic Lesions:
Nodules
basic lesion
cause
Larger lesions (diameter 5 to 10 mm). These are smooth, firm, violet or brownish red, and have the same appearance of yellowish lupoid infiltration on vitropression.
picture
alphabetical
Other skin diseases
Sarcoidosis
page: 263
Sarcoidosis
Angiolupoid form
continued
Basic Lesions:
Nodules
basic lesion
cause
This very rare clinical variant consists of a tumid, round or oval, reddish violet infiltration appearing on the nose.
picture
alphabetical
Other skin diseases
Sarcoidosis
page: 264
Sarcoidosis
Scar sarcoidosis
continued
Development of sarcoid nodules around foreign matter contained in a scar. These nodules sometimes appear in the context of active systemic sarcoidosis. Sometimes, however, they represent a simple local granulomatous reaction.
Basic Lesions:
Blueish-grey Macules; Nodules; Tubercles Mechanical Factors last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Sarcoidosis
page: 265
11.13 Granuloma annulare

Small, firm, well-circumscribed nodules with a smooth surface, which are normal or pink in colour and show little inflammation. They are clustered in rings which spread outwards from the centre. The ring does not generally exceed a diameter of 1 to 2 cm. Giant annular granulomas (several centimetres in diameter) are much more rare.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Other skin diseases
Granuloma annulare
page: 266
11.14 Necrobiosis lipoidica

Large sclerotic and atrophic pretibial plaque with distinct margins, red and telangiectatic. Its surface is shiny, which explains the "hot spot" on the photograph.
Basic Lesions:
Erythematous Macule; Atrophy; Scars; Sclerosis None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Necrobiosis lipoidica
page: 267
continued
The centre of the plaque is smooth, with a cicatricial appearance which is often yellowish owing to an excess of fat.
Basic Lesions:
Erythematous Macule; Atrophy; Scars; Sclerosis None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 268
11.15 Vasculitis
The term vasculitis is used collectively for diseases associated with inflammation of the walls of blood vessels in the skin and other organs. The classification of vasculitis is usually based on two features: the calibre of the affected vessels and the type of inflammatory reaction. Urticarial vasculitis is included in the section on urticaria.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Other skin diseases
Vasculitis
page: 269
Histologically, cutaneous vasculitis is characterized by infiltration of polymorphonuclear neutrophils, which are often pyknotic, into and around the vessel walls, hence the often-used term leucocytoclastic vasculitis. It occurs in two main welldefined forms: purpuric and necrotic.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
Cutaneous vasculitis (allergic vasculitis)
alphabetical
Other skin diseases
Vasculitis
page: 270
continued
Purpuric form In this form the lesions essentially correspond to infiltrated purpuric papules, which affect mainly the legs and which can extend over other skin areas.
Basic Lesions:
Purpuric Macule; Dermal Papules
basic lesion
cause
picture
alphabetical
Other skin diseases
Vasculitis
page: 271
continued
Necrotic form Purpuric papules coexist with vesiculobullous, pustular, or necrotic lesions, hence the old name used in the French literature: "Gougerot's triad".
Basic Lesions:
Purpuric Macule; Dermal Papules; Gangrene None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Vasculitis
page: 272
Basic Lesions:
Purpuric Macule; Gangrene
basic lesion
cause
Picture of chronic vasculitis of the ankle regions, characterized by purpura which necroses rapidly, leaving very small painful ulcerations bordered by a violet ring.
picture
Atrophie blanche (livedo vasculitis)
alphabetical
Other skin diseases
Vasculitis
page: 273
continued
Basic Lesions:
Purpuric Macule; Gangrene
basic lesion
cause
picture
Atrophie blanche (livedo vasculitis)
alphabetical
Other skin diseases
Vasculitis
page: 274
Polyarteritis nodosa
The clinical appearance is generally polymorphic, combining cutaneous nodules, livedo, infiltrated purpura, and necrotic ulcerations. These cutaneous signs are part of general systemic illness (weight loss, fever, aching all over the body).
Basic Lesions:
Purpuric Macule; Nodules
basic lesion
cause
picture
alphabetical
Other skin diseases
Vasculitis
page: 275
Erythema elevatum diutinum

Very rare vasculitis characterized by the appearance of red or violet papules, plaques, and nodules distributed symmetrically over the extensor surfaces of the limbs. The course is chronic and successive episodes are accompanied by fever.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
Vasculitis
page: 276
11.16 Erythema nodosum

The eruption Painful red nodules found mainly on the extensor surfaces of the legs, usually accompanied by fever and pains in the joints.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Other skin diseases
Erythema nodosum
page: 277
Erythema nodosum
Regression
continued
The nodules resolve in about ten days and turn blue and yellow, like bruises.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Other skin diseases
Erythema nodosum
page: 278
11.17 Nodular vasculitis (panniculitis)

Firm cyanotic nodules with little inflammation, located on the lower third of the legs. They occur in women, usually overweight women suffering from chronic venous insufficiency.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Other skin diseases
Nodular vasculitis (panniculitis)
page: 279
11.18 Pyoderma gangrenosum

Superficial ulceration with circular margins, bordered by a firm inflammatory swelling, which is undermined by deep-seated purulent lesions. The condition can be idiopathic or associated with various internal diseases, in particular, diseases of the digestive tract such as Crohn's disease or ulcerative colitis. The illustrations correspond to two stages of development of the same lesion in a leg.
Basic Lesions:
Pustules; Ulcers
basic lesion
cause
picture
alphabetical
Other skin diseases
Pyoderma gangrenosum
page: 280
continued
Basic Lesions:
Pustules; Ulcers
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 281
11.19 Erythema multiforme

Erythema multiforme is a syndrome of the skin and mucosa associated with various aetiological circumstances, among which herpes infections occupy an important place. Non-bullous "target" form Dull red, round, symmetrical maculopapules on the backs of the hands. The characteristic configuration is like a target or butterfly.
Basic Lesions:
Erythematous Macule; Dermoepidermal Papules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Erythema multiforme
page: 282
Erythema multiforme
Non-bullous "target" form
continued
Basic Lesions:
Erythematous Macule; Dermoepidermal Papules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Erythema multiforme
page: 283
Erythema multiforme
Bullous form
continued
Basic Lesions:
Erythematous Macule; Dermoepidermal Papules; Bullae None specic last screen viewed back next
basic lesion
cause
The maculopapules in a butterfly configuration are bullous in the centre and can follow a necrotic course. The mucous membranes are sometimes affected.
picture
alphabetical
Other skin diseases
Erythema multiforme
page: 284
Erythema multiforme
Stevens-Johnson syndrome
continued
This is the most severe form of erythema multiforme. In addition to the cutaneous symptoms there are severe erosive mucosal lesions affecting the lips, buccal cavity, and sometimes the genital organs. The clinical picture is severe, with fever and alterations of the general condition.
Basic Lesions:
Ulcers
basic lesion
cause
picture
alphabetical
Other skin diseases
Erythema multiforme
page: 285
11.20 Sweet's syndrome (acute febrile neutrophilic dermatosis)

Well-circumscribed infiltrated erythematous plaques, depressed at the centre, appearing on the limbs. Raised temperature, aching joints, abdominal pain, and neutrophilia accompany the skin symptoms.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Other skin diseases
Sweet's syndrome (acute febrile neutrophilic dermatosis)
page: 286
11.21 Bullous pemphigoid

Early stage Large urticaria-like polycyclic patches, bordered by a few firm bullae of varying size and containing a clear liquid.
Basic Lesions:
Dermal Papules; Bullae
basic lesion
cause
picture
alphabetical
Other skin diseases
Bullous pemphigoid
page: 287
Bullous pemphigoid
Further development
continued
Basic Lesions:
Bullae
basic lesion
cause
Presence of very numerous firm bullae of varying size, some of which are haemorrhagic. Some bullae rupture, leaving extensive skin erosions.
picture
alphabetical
Other skin diseases
Bullous pemphigoid
page: 288
11.22 Autoimmune forms of pemphigus

Two forms of autoimmune pemphigus are distinguished, according to the preferred site of separation of epidermal cells from each other: "deep" pemphigus (pemphigus vulgaris and pemphigus vegetans) on the one hand and "superficial" pemphigus (pemphigus erythematosus) on the other.
Pemphigus vulgaris
Skin Presence of superficial flaccid bullae, which rupture easily to expose extensive erosions.
Basic Lesions: Bullae; Ulcers
basic lesion
cause
picture
alphabetical
Other skin diseases
Autoimmune forms of pemphigus
page: 289
Pemphigus vulgaris
Oral
continued
Dragging painful erosions of the buccal mucosa of the inside of the cheeks, the palate, and the dental cuffs, exposing a bright red surface without a fibrinous coating. Similar erosions can occur in other bullous diseases, but in pemphigus they are more constant and more characteristic.
Basic Lesions:
Ulcers
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 290
Pemphigus erythematosus
Crusty, scaly, erythematous plaques of the seborrhoeic regions on the face and the trunk, which are sometimes itchy. These lesions represent the development of superficial bullae.
Basic Lesions:
Erythematous Macule; Bullae; Scales; Crusts Chemical Agents last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 291
continued
This variant is also characteristic of drug-induced pemphigus (d-penicillamine).
Basic Lesions:
Erythematous Macule; Bullae; Scales; Crusts Chemical Agents last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 292
11.23 Benign familial chronic pemphigus (Hailey-Hailey disease)

Erosive vesiculobullous lesions which become covered with small yellowish crusts. The lesions are clustered in well-defined plaques traversed by very characteristic parallel fissures. The preferred sites of these lesions are the sides of the neck, the axillae, and the inguinogenital region.
Basic Lesions:
Vesicles; Bullae; Fissures
basic lesion
cause
picture
alphabetical
Other skin diseases
Benign familial chronic pemphigus (Hailey-Hailey disease)
page: 293
11.24 Dermatitis herpetiformis

Urticaria -like erythematous or papular lesions surmounted by vesicles and bullae, clustered in a herpetiform ring. The symmetry of the lesions, the constant pruritus, and the association with a glutensensitive enteric disease are the other peculiarities of this rare skin disease.
Basic Lesions:
Dermal Papules; Vesicles; Bullae
basic lesion
cause
picture
alphabetical
Other skin diseases
Dermatitis herpetiformis
page: 294
continued
Basic Lesions:
Dermal Papules; Vesicles; Bullae
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 295
11.25 Linear IgA bullous disease

Large firm bullae containing a clear liquid, occurring on normal or erythematous skin. The usual sites are the lower part of the trunk, buttocks, perineum, and the thighs. This chronic bullous skin disease of children and adults is characterized by linear deposits of IgA in direct immunofluorescence.
Basic Lesions:
Bullae; Ulcers
basic lesion
cause
picture
alphabetical
Other skin diseases
Linear IgA bullous disease
page: 296
11.26 Epidermolysis bullosa

Simple epidermolysis bullosa (non-dystrophic)
Clear bullae of various sizes, triggered by trauma and by persistent friction, which heal without leaving a trace. The usual sites are the hands, feet, elbows, and knees in the adult and the bottom in the infant.
Basic Lesions:
Bullae
basic lesion
cause
picture
alphabetical
Other skin diseases
Epidermolysis bullosa
page: 297
Basic Lesions:
Bullae
basic lesion
cause
There is no abnormality of the teeth or the nails. The condition is transmitted in the autosomal dominant mode.
picture
Simple epidermolysis bullosa (non-dystrophic) continued
alphabetical
Other skin diseases
page: 298
Basic Lesions:
Bullae; Crusts; Ulcers
basic lesion
cause
In dystrophic forms of epidermolysis bullosa, of which there are a number of variants, the traumatic bullae leave atrophic scars and milia when they heal. Some joints can be fixed in flexion.
picture
Dystrophic forms of epidermolysis bullosa
alphabetical
Other skin diseases
page: 299
continued
Basic Lesions:
Bullae
basic lesion
cause
Certain abnormalities of the teeth or the nails are sometimes associated. The mode of transmission varies according to the form of the disease.
picture
alphabetical
Other skin diseases
page: 300
11.27 Diabetic bullae

Translucent bullae of various sizes, haemorrhagic in rare cases, without inflammatory areola, which are usually multiple, found especially on the extremities, particularly on the feet. The condition tends to occur in complicated cases of diabetes of all types.
Basic Lesions:
Bullae
basic lesion
cause
picture
alphabetical
Other skin diseases
Diabetic bullae
page: 301
11.28 Porphyria cutanea tarda

The preferred sites of porphyria cutanea tarda lesions are areas exposed to light, such as the backs of the hands and the face. On the backs of the hands the condition is characterized by several symptoms associated with increased skin fragility: serous or haemorrhagic bullae, erosions after various traumas, milia.
Basic Lesions:
Bullae; Ulcers
Mechanical Factors; Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Porphyria cutanea tarda
page: 302

continued
Basic Lesions:
Scars
Mechanical Factors; Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
On the face the condition is characterized mainly by hypertrichosis of the malar regions and a diffuse brownish pigmentation.
picture
alphabetical
Other skin diseases
page: 303
Basic Lesions:
Vesicles; Bullae
Sunlight, Ultraviolet Radiation; Chemical Agents last screen viewed back next
basic lesion
cause
Erythematous vesicular or bullous eruption reproducing the pattern of a grass or leaf. Sun, humidity, and contact with the plant are the three prerequisites for the appearance of the skin condition.
picture
Bullous phytophotodermatitis (Meadow dermatitis)
alphabetical
Other skin diseases
page: 304
11.29 Acne and rosacea

Acne vulgaris
Acne vulgaris (adolescent acne) essentially includes three types of lesion: comedones, papules and pustules. To these can be added nodules and cysts.
Basic Lesions:
Dermal Papules; Nodules; Keratoses; Pustules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 305
Acne vulgaris
Papulopustular acne
continued
Basic Lesions:
basic lesion
cause
Papulopustular acne essentially comprises isolated or confluent papules and very inflamed papulopustules. It is often associated with seborrhoea. Comedones are never absent.
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 306
Acne vulgaris
Comedo acne
continued
Comedo acne is characterized by a distinct preponderance of comedones over the lesions of adolescent acne. The comedones are either open (blackheads) or closed (whiteheads). Blackheads are the prominent lesions in this illustration. Cosmetic acne often takes the form of this variant.
Basic Lesions:
Keratoses
basic lesion
cause
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 307
Acne vulgaris
Nodular and cystic acne
continued
Basic Lesions:
Nodules; Scars
basic lesion
In addition to the basic lesions just mentioned (comedones, papules and pustules), this form of acne presents epidermal cysts of follicular origin and inflamed nodules resulting from the rupture of these cysts. The nodules can develop into abscesses, which leave indurated, pitted, or retractile scars when they dry out.
cause
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 308
Acne conglobata
The lesions are polymorphic and numerous: multiple comedones, follicular cysts, pustules, nodules, and abscesses developing to form fistulae, haemorrhagic ulcers, then pitted scars and adhesions bridging the scars.
Basic Lesions:
Nodules; Pustules; Ulcers; Scars
basic lesion
cause
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 309
Acne conglobata
continued
This form of acne classically affects the face and trunk, but it can also spread to the arms and the buttocks.
Basic Lesions:
Nodules; Pustules; Ulcers; Scars
basic lesion
cause
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 310
Basic Lesions:
Dermal Papules; Keratoses; Pustules
basic lesion
This variant of acne, of indeterminate origin, appears in infants aged between 3 and 6 months. It is usually severe, but in most cases fades in 1 to 2 years. It is characterized by the presence of comedones, papules, and pustules, found mainly on the cheeks. It should be distinguished from a much more rare variety of acne: neonatal acne (acne neonatorum).
cause
picture
Infantile acne (acne infantum)
alphabetical
Other skin diseases
Acne and rosacea
page: 311
Rosacea
The blotchy form comprises erythema and telangiectasia affecting the nose, cheeks and sometimes the forehead and chin. Flushes appear in various circumstances: in the presence of stress or a change in ambient temperature, after the consumption of alcohol, hot drinks, or hot food.
Basic Lesions:
Erythematous Macule
Heat last screen viewed back next
basic lesion
cause
picture
Blotchy form
alphabetical
Other skin diseases
Acne and rosacea
page: 312
Rosacea
Papulopustular form
continued
Basic Lesions:
Erythematous Macule; Dermal Papules; Pustules Heat last screen viewed back next
basic lesion
cause
Inflamed papules and aseptic pustules appear on a background of telangiectatic erythema, but never comedones (which necessarily leads to rejection of the term "acne rosacea").
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 313
Perioral dermatitis
This is characterized by the appearance of micropapules and micropustules on a base of erythema and oedema, mainly around the mouth, separated from the lips by a border of healthy skin. The lesions can sometimes spread to the nasolabial folds.
Basic Lesions:
Erythematous Macule; Dermal Papules; Pustules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Acne and rosacea
page: 314
11.30 Drug-induced eruptions

Fixed pigmented erythema
Well-circumscribed pigmented erythematous patch occurring 48 h after the ingestion of a drug, in this case phenacetin. The lesion resolves into a residual pigmentation which disappears gradually. Reintroduction of the drug causes a recurrence, invariably at the same site. In some cases the centre of the lesion can be bullous (fixed bullous toxic dermatitis).
Basic Lesions:
Erythematous Macule; Pigmented Macules; Bullae Chemical Agents last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
Drug-induced eruptions
page: 315
Eruption characterized by dull red congestive patches on the skin. These vary in size and run together into sheets. Two prominent characteristics are the usual symmetry of the lesions and their itchiness. The present case is an ampicillin rash.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
Maculopapular exanthema (morbilliform eruption)
alphabetical
Other skin diseases
page: 316
Basic Lesions:
Bullae; Ulcers
basic lesion
Detachment of large pieces of epidermis, leaving extensive areas of erosion. The eruption usually spreads all over the skin. All mucous membranes are involved in the necrolytic process. The situation is similar to that of major burns. The drug responsible in this particular case was sulfonamide.
cause
picture
Lyell's syndrome (toxic epidermal necrolysis)
alphabetical
Other skin diseases
page: 317
Lichenoid eruptions
Drug-induced lichenoid eruption caused by methyldopa. The clinical picture is quite similar to that of lichen planus, but the lesions are often more red and scaly.
Basic Lesions:
Dermo-epidermal Papules; Scales
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 318
Lichenoid eruptions
continued
The distribution of the lesions is symmetrical and more diffuse than in most forms of lichen planus.
Basic Lesions:
Dermo-epidermal Papules; Scales
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 319
Drug-induced phototoxic eruption associated with the ingestion of a tetracycline. Erythematous oedematous lesions whose pattern corresponds strictly to the skin areas exposed to sunlight. The borders of the lesions are as if "cut with a knife".
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
Drug-induced phototoxic eruption
alphabetical
Other skin diseases
page: 320
Basic Lesions:
Erythematous Macule; Dermal Papules; Vesicles Sunlight, Ultraviolet Radiation; Chemical Agents last screen viewed back next
basic lesion
Drug-induced photoallergic reaction associated with the ingestion of a phenothiazine. The symptoms comprise erythema, confluent papules, and plaques of weeping vesicular eczema. The lesions, which are accompanied by severe itching, spread beyond the areas exposed to the sun, in contrast to the phototoxic reactions.
cause
picture
Drug-induced photoallergic eruption
alphabetical
Other skin diseases
page: 321
Acneiform facial eruption

This drug-induced eruption is associated in the present case with intramuscular injections of vitamin B12. It is clinically monomorphic, i.e. it is characterized by the presence of papules and pustules and by the absence of comedones.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 322
Psoriatiform eruption
Psoriatiform eruption associated with the ingestion of a -blocker. In certain cases this is an aggravation of existing psoriasis. The lesions are not usually very scaly. They can be itchy. There is an increasingly large number of suspected groups of drugs.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 323
Drug-induced lupus
Induced lupus usually assumes the appearance of subacute or systemic lupus. It is reversible when the treatment is stopped and recurs if the treatment is reintroduced. In this case the suspected drug is an anticonvulsant.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 324
Cortisone atrophy
Prolonged systemic use of corticosteroids leads to a reduction in collagen tissue, culminating in atrophy of the skin. This occurs particularly on the extensor surfaces of the forearms. The atrophy is accompanied by purpura, ecchymoses, and also by these three unusual star-shaped false scars resulting from an internal tear in the dermal tissue (without a wound).
Basic Lesions:
Purpuric Macule; Atrophy; Scars
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 325
Basic Lesions:
Nodules; Pustules; Crusts
basic lesion
Very rare reactions to the use of drugs containing bromide or iodine. Bromide and iodide eruptions appear as plaques and lumps with infiltration and vegetation, which are sometimes covered in pustules and crusts. The illustration is of a bromide eruption caused by bromazepam.
cause
picture
Bromide and iodide eruptions (Halide eruptions)
alphabetical
Other skin diseases
page: 326
Gingival hyperplasia
Gingival hyperplasias are often provoked by a drug. The drugs most frequently blamed are anticonvulsants (phenytoin, sodium valproate) and cyclosporin, as in the present case.
Basic Lesions:
Vegetations
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 327
Melasma (chloasma)
A specifically female skin disease, melasma is hyperpigmentation appearing on the upper part of the face (temples and forehead), but sparing the hairline. It is generally bilateral, but never perfectly symmetrical. Its colour varies from light to dark brown. Melasma occurs in pregnancy or during treatment with hormonal contraceptives. It becomes more pronounced in summer and the aggravating influence of exposure to solar ultraviolet is evident.
Basic Lesions: Pigmented Macules
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 328
11.31 Skin disorders caused by physical agents

Benign summer photodermatitis
Small acuminate erythematous papules, a few millimetres in diameter, and papulovesicles clustered on the extensor surface of the arms (as in the present case), legs, and exposed areas of the neck and the chest. The eruption usually spares the face. It occurs a few hours after sunbathing.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Other skin diseases
Skin disorders caused by physical agents
page: 329
Polymorphic light eruption

Small erythematous papules or oedematous plaques appearing on exposed parts of the body, especially the face (forehead, nose, cheekbones), behind the ears, the exposed area of neck and chest, and the extensor surfaces of the limbs. In more than 70% of the cases the eruption appears in spring. The patient does not have to be unaccustomed to the sun. The condition appears in the course of everyday life, whether the sky is clear or cloudy.
Basic Lesions: Erythematous Macule; Dermal Papules Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 330
Chilblains
Erythematous and cyanotic infiltrations of the toes which may become covered with clear or haemorrhagic bullae, ulcerations, or small crusts. Chilblains are purple and painful in the cold, but become red and itchy when the sufferer enters a heated room. Chilblains are most common in young women, but they are seen at all ages in both sexes. Other sites include the heels, ankles, knees, ears, etc.
Basic Lesions:
Erythematous Macule
Heat; Cold last screen viewed back next
basic lesion
cause
picture
alphabetical
Other skin diseases
page: 331
Chapter 12:
Topographical dermatology
search
contents
print
last screen viewed
back
next
basic lesion
cause
picture
alphabetical
page: 332
12.1
Alopecia
Alopecia areata
Alopecia areata of the scalp is characterized by the appearance of round or oval, smooth, shiny patches of alopecia which gradually increase in size. The patches are usually homogeneously glabrous and are bordered by a peripheral scatter of short brokenoff hairs known as exclamationmark hairs.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Alopecia
page: 333
Alopecia areata
continued
Alopecia areata of the occipital region, known as ophiasis, is more resistant to regrowth. Other hair regions can also be affected: eyebrows, eyelashes, beard, and the axillary and pubic regions. In some cases the alopecia can be generalized: this is known as alopecia totalis (scalp) and alopecia universalis (whole body).
Basic Lesions:
basic lesion
cause
picture
alphabetical
Alopecia
page: 334
Pseudopelade
Pseudopelade consists of circumscribed alopecia which varies in shape and in size, with more or less distinct limits. The skin is atrophic and adheres to the underlying tissue layers. This unusual cicatricial clinical appearance can be symptomatic of various other conditions: lupus erythematosus, lichen planus, folliculitis decalvans. Some cases are idiopathic and these are known as pseudopelade.
Basic Lesions:
Atrophy; Scars
basic lesion
cause
picture
alphabetical
Alopecia
page: 335
Trichotillomania
Plucking of the hair on a large scale. In trichotillomania the alopecia has irregular, "geographic" margins which may be distinct or indefinite. The area of alopecia can be entirely glabrous or dotted with clumps of broken hairs of very different lengths, and either smooth or covered irregularly with small excoriations or crusts caused by scratching. Similar lesions can appear on the nails (onychotillomania).
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Alopecia
page: 336
Androgenetic alopecia
This alopecia, known generally as baldness, occurs in adulthood both in men, where it affects the temporal regions (photo) and/or the crown, and in women, where it is confined to the central area of the scalp, in a longitudinal band which extends from the forehead to the crown. In females alopecia always leaves a large number of healthy hairs which are scattered irregularly over the alopecic area.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Alopecia
page: 337
12.2
Mucosal diseases
Aphtae, aphthosis, Behet's disease
Small "punched-out" ulcerations of the buccal mucosa, characterized by a yellowish base resembling the colour of fresh butter and by an erythematous inflammatory halo. Often very painful, aphthae are accompanied by lymphadenopathy.
Basic Lesions:
Ulcers
basic lesion
cause
picture
alphabetical
Mucosal diseases
page: 338
Aphthae can occur on the genital mucosa (bipolar aphthosis).
Basic Lesions:
Ulcers
basic lesion
cause
picture
Aphtae, aphthosis, Behet's disease continued
alphabetical
Mucosal diseases
page: 339
Basic Lesions:
Pustules
basic lesion
cause
Behet's disease is a severe condition with the additional characteristics of aphthae on the skin and an isomorphic reaction to injections.
picture
Aphtae, aphthosis, Behet's disease continued
alphabetical
Mucosal diseases
page: 340
Black hairy tongue

Black hairy tongue comprises hypertrophy of the villi on the upper surface of the tongue. These are loaded with oxidized keratin, which explains the brown or black colour of the lesion. It can occur after the use of certain drugs, such as antibiotics or metronidazole, for example.
Basic Lesions:
Vegetations
basic lesion
cause
picture
alphabetical
Mucosal diseases
page: 341
Scrotal / ssured tongue

The upper surface of the tongue is criss-crossed by deep grooves running in various directions. The lingual papillae are often hypertrophic and inflamed. On discovery of this anatomical peculiarity the subjects often complain of a painful sensation (glossodynia).
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Mucosal diseases
page: 342
Basic Lesions:
Ulcers
basic lesion
Well-defined patches denuded of papillae, surrounded by an unobtrusive whitish border. The spread of these areas is eccentric and their appearance changes from one day to the next. This could be a variant of lingual psoriasis. Association with scrotal tongue is common.
cause
picture
Geographic tongue (benign migratory glossitis)
alphabetical
Mucosal diseases
page: 343
12.3
Cheilitis
Allergic contact cheilitis
Allergic contact dermatitis connected with the application of a lipstick containing balsam of Peru. The eczematous condition extends far beyond the limits of the vermilion zone of the lips, to spread out over the surrounding skin.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Cheilitis
page: 344
Cheilitis caused by ingestion of isotretinoin. This is a fissured, scaly, erythematous cheilitis which is dependent on the isotretinoin dose administered. There are sometimes associated episodes of epistaxis.
Basic Lesions:
Erythematous Macule; Scales; Fissures Chemical Agents last screen viewed back next
basic lesion
cause
picture
Cheilitis caused by systemic use of isotretinoin
alphabetical
Cheilitis
page: 345
12.4
Miscellaneous
Darier's disease
Hereditary skin disease with a characteristic topography (sides of the face, trunk). Multiple small greyish-brown papules are observed, keratotic, dry, and very adherent. These papules can run together to form extensive brownish plaques. The lesions have a very distinct tendency to increase during the months of sunshine.
Basic Lesions:
Epidermal Papules; Keratoses
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 346
Darier's disease
continued
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 347
Ichthyosis vulgaris
Condition transmitted by a dominant gene, sometimes associated with atopic dermatitis. The whole of the skin is affected, sprinkled with small dry scales, which vary in number. Improvement during the months of sunshine is typical. Acquired ichthyosis must always make one think of a paraneoplastic syndrome (e.g. underlying Hodgkin's disease).
Basic Lesions:
Scales
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 348
Basic Lesions:
Scales
basic lesion
cause
Also called ichthyosis nigricans, this variant of ichthyosis is found only in boys, does not spare the major skin folds, and presents in the form of wide, adherent, blackish scales.
picture
Sex-linked (recessive) ichthyosis
alphabetical
Miscellaneous
page: 349
continued
Basic Lesions:
Scales
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 350
Basic Lesions:
Keratoses
Appearing very early in life (between the 4th and 8th week), this palmoplantar keratoderma represents the model of a disease with autosomal dominant transmission. There are extensive yellowish keratotic plaques, accompanied by large cracks in flexural creases of the palms. This keratoderma is distinctly demarcated and does not extend to the wrist. The keratotic lesions are accentuated by an inflammatory border. There is sometimes associated hyperhidrosis.
basic lesion
cause
picture
Hereditary palmoplantar keratoderma (Thost-Unna syndrome)
alphabetical
Miscellaneous
page: 351
Pityriasis rubra pilaris

Association of diffuse orangeyellow palmoplantar keratoderma with a scoring of small fissures and horny follicular papules producing a grid on the skin. On palpation it feels abrasive (like emery paper). The pinkish papules are pointed at the top and surmounted by a small horny follicular plug. The course is usually chronic. Episodes of erythroderma may be seen as time goes on.
Basic Lesions:
Keratoses
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 352
continued
Basic Lesions:
Keratoses
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 353
Keratosis pilaris
Extremely common skin disease surrounded by a fine erythematous border, characterized by slight hyperkeratosis of the hair follicle orifices. This "condition" is transmitted by an autosomal dominant gene and is usually seen on the cheeks and the temples.
Basic Lesions:
Keratoses
basic lesion
cause
picture
alphabetical
Miscellaneous
page: 354
Keratosis pilaris
continued
Basic Lesions:
Keratoses
basic lesion
cause
In adults the exterior surfaces of the arms and anterior surfaces of the thigh are most frequently affected. The affected areas feel abrasive on palpation. Exposure to sunlight attenuates the condition.
picture
alphabetical
Miscellaneous
page: 355
Basic Lesions:
Erythematous Macule
Extensive annular lesions of the arms with the appearance of healing at the centre. The distinctly infiltrated erythematous margins spread slowly outwards. Having appeared suddenly, this condition has become chronic, each ring developing over several weeks at a rate of 2 to 3 mm per week. It should be noted that when two rings join together they never overlap. There is no pruritus. It is always important to check for a possible underlying cause, though in a number of cases erythema annulare centrifugum remains idiopathic.
basic lesion
cause
picture
Erythema annulare centrifugum (Darier's)
alphabetical
Miscellaneous
page: 356
continued
Basic Lesions:
Erythematous Macule
basic lesion
Among the potential causes the following should be remembered: remote infectious foci, viral diseases, Hodgkin's disease, visceral cancer, autoimmune thyroiditis, lupus erythematosus, liver disease, etc. In the present case it was viral hepatitis B which, after an acute episode, subsequently developed into chronic active hepatitis.
cause
picture
Erythema annulare centrifugum (Darier's)
alphabetical
Miscellaneous
page: 357
12.5
Leg ulcers
Venous leg ulcer
Extensive ulceration with pliant borders and outlines which vary from one case to the next. The base of the ulcer is granular in some places and sanious and necrotic in others. Surrounding trophic disorders are evident: gravitational purpura, atrophie blanche.
Basic Lesions:
Ulcers; Atrophy
basic lesion
cause
picture
alphabetical
Leg ulcers
page: 358
Venous leg ulcer
continued
This type of ulcer can be the result of a varicose disorder or a postphlebitic syndrome. It represents more than 80% of leg ulcer cases. It affects women most frequently and there is an evident hereditary factor. The pains vary individually in intensity and are improved by lying down.
Basic Lesions:
Ulcers
basic lesion
cause
picture
alphabetical
Leg ulcers
page: 359
Ischaemic (arterial) leg ulcer

Punched-out ulceration which is most often unilateral. Its site is near the ankle. There is no associated trophic disorder. The pulse in the foot can be felt only with difficulty. Ischaemic ulcers develop rapidly and cause intense pain which is often aggravated by lying down. They are much less common than venous ulcers and can be found in diabetes, arteriosclerosis, or Buerger's disease.
Basic Lesions:
Crusts; Ulcers
basic lesion
cause
picture
alphabetical
Leg ulcers
page: 360
Ulcer caused by capillaritis

Slow and relatively superficial ulceration with jagged and irregular margins. There is surrounding pigmentary and purpuric angiodermatitis, sometimes associated with small patches of atrophie blanche. The pains are often intense and persistent, and are not influenced by lying down. Diabetes and arteriosclerosis promote this condition.
Basic Lesions:
Purpuric Macule; Crusts; Ulcers; Atrophy None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Leg ulcers
page: 361
Basic Lesions:
Ulcers
basic lesion
Deep circular, punched-out ulcer found at the bearing surface of the metatarsal joint. The base is necrotic. There is no tendency towards spontaneous cicatrization. There is virtually no pain. In the present case it is caused by diabetes with a major neuropathological component. Other neurological conditions can be responsible (e.g. syringomyelia).
cause
picture
Neurotrophic leg ulcer (perforating ulcer)
alphabetical
Leg ulcers
page: 362
continued
Basic Lesions:
Ulcers
basic lesion
cause
picture
Neurotrophic leg ulcer (perforating ulcer)
alphabetical
Leg ulcers
page: 363
12.6
Pathomimicry
Skin self-mutilation simulated disease
Extensive escharotic ulceration of the back of the hand, caused intentionally with caustic soda. The margins are distinct, the angular edges and the configuration "surprising". The appearance of the lesion was very rapid and recurrences at the same site are typical.
Basic Lesions:
Crusts; Ulcers; Scars
basic lesion
cause
picture
alphabetical
Pathomimicry
page: 364
continued
The course is usually capricious, spontaneous healing retarded, and persistence indefinite. In the present case the patient acted voluntarily with intent to deceive, for her own advantage (extension of sick leave from work).
Basic Lesions:
Crusts; Ulcers; Scars
basic lesion
cause
picture
alphabetical
Pathomimicry
page: 365
Basic Lesions:
Crusts; Ulcers
basic lesion
Ulceration of exogenous origin on the face, with distinct margins and "aberrant" configuration. This particular topography is rarely found in cases of disease simulation. True pathomimicry is caused by the patient who is "unconscious" of it or shows "dual consciousness".
cause
picture
Self-mutilation, pathomimicry
alphabetical
Pathomimicry
page: 366
continued
Basic Lesions:
Crusts; Ulcers
basic lesion
cause
Major psychological disturbances are present. There is no evident intention to take financial advantage of the condition.
picture
alphabetical
Pathomimicry
page: 367
Chapter 13:
Benign skin tumours
search
contents
print
last screen viewed
back
next
basic lesion
cause
picture
alphabetical
page: 368
13.1
Epidermal tumours
Seborrhoeic keratosis / wart
Excrescences of varying size, covered with a greasy, scaly keratotic layer which is not very adherent. They can have various colours: yellow, sepia, grey, dark brown, or pure black. Each lesion seems to be "placed" on the skin surface, is well-circumscribed, has no underlying infiltration.
Basic Lesions:
Warts; Keratoses
basic lesion
cause
picture
alphabetical
Benign skin tumours
Epidermal tumours
page: 369

continued
Basic Lesions:
Warts; Keratoses
basic lesion
cause
picture
alphabetical
Benign skin tumours
Epidermal tumours
page: 370
Verrucous epidermal naevus

The epidermal naevus appears in the form of raised papuloverrucous lesions, rough to the touch and sometimes fragmented. It is usually disposed in continuous linear bands following the Blaschko's classical lines, to be interrupted over the midline.
Basic Lesions:
Warts; Keratoses
basic lesion
cause
picture
alphabetical
Benign skin tumours
Epidermal tumours
page: 371

continued
The colour is that of normal skin, sometimes greyish or brownish.
Basic Lesions:
Warts; Keratoses
basic lesion
cause
picture
alphabetical
Benign skin tumours
Epidermal tumours
page: 372
ILVEN appears in the form of psoriatiform scaly erythematous patches, which are sometimes lichenoid or verrucous, disposed in linear bands following Blaschko's lines (like the lesions of verrucous epidermal naevus).
Basic Lesions:
Erythematous Macule; Warts; Pustules; Scales; Gangrene None specic last screen viewed back next
basic lesion
cause
picture
Inammatory linear verrucous epidermal naevus (ILVEN)
alphabetical
Benign skin tumours
Epidermal tumours
page: 373
continued
Inflammatory episodes can occur, causing exacerbation of pruritus, more or less severe excoriations, secondary eczematization, and even areas of necrosis.
Basic Lesions:
Erythematous Macule; Warts; Pustules; Scales; Gangrene None specic last screen viewed back next
basic lesion
cause
picture
Inflammatory linear verrucous epidermal naevus (ILVEN)
alphabetical
Benign skin tumours
Epidermal tumours
page: 374
Basic Lesions:
Pigmented Macules
basic lesion
Hyperpigmented unilateral plaque, the preferred site of which is the chest or the shoulder, sometimes covered in hairs. It appears most often in young adults after exposure to the sun. It corresponds to a late epithelial (epidermal and follicular) naevus with secondary epidermal melanin hyperpigmentation.
cause
picture
Becker's naevus (pigmented and hairy epidermal naevus)
alphabetical
Benign skin tumours
Epidermal tumours
page: 375
Clear cell acanthoma

Small, round and domed firm tumour, which is generally isolated, pink in colour, usually with a moist surface. The diagnosis of this lesion is essentially histopathological.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Epidermal tumours
page: 376
Kerato-acanthoma
Very well defined nodule surmounted by a central horny plug. Its growth is rapid, the maximum size of the lesion being reached in a few weeks. The lesion usually regresses spontaneously in a few months.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Epidermal tumours
page: 377
Basic Lesions:
Nodules; Fissures
basic lesion
cause
Well-circumscribed, slightly pink retro-auricular papulonodule, 1-2 cm in diameter, surrounded by an inflammatory halo. The lesion is divided in two by a groove (fold).
picture
Spectacle frame acanthoma (ssured acanthoma)
alphabetical
Benign skin tumours
Epidermal tumours
page: 378
Acanthoma occurs in the weeks or months after the patient starts wearing a new spectacle frame.
Basic Lesions:
Nodules; Fissures
basic lesion
cause
picture
Spectacle frame acanthoma (fissured acanthoma) continued
alphabetical
Benign skin tumours
Epidermal tumours
page: 379
13.2
Follicular and sebaceous tumours

Epidermoid cyst
Inflammatory subcutaneous nodule, often with a punctiform opening at its centre, through which malodorous whitish or yellowish material can be expressed. It is a single or multiple lesion which occurs especially in seborrhoeic areas, within the context of acne vulgaris or nodulocystic acne. Epidermoid cysts are sometimes wrongly called "sebaceous cysts".
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 380
Trichilemmal cyst (pilar cyst)

Generally located on the scalp, it appears in the form of a subcutaneous nodule covered with non-adherent pink and glabrous skin. The cysts are sometimes multiple. They range from pea-size to egg-size and are colloquially known as wens.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 381
Milia
Milia are very superficial small white elevations which occur in various circumstances. In newborn babies they appear as innumerable small white dots on the face, as illustrated in the photograph, caused by transient retention of sebum. They disappear spontaneously in a few weeks. In adolescents and adults they are commonly seen on the cheeks, the eyelids, and the nose, and are due to clogging of follicles.
Basic Lesions: Dermal Papules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 382
Trichoepithelioma
Translucent, flattened or globular papular formations, 2 to 5 mm in diameter, pink or white in colour and sometimes surmounted by fine telangiectasias. Their preferred site is the face (nose, nasolabial folds, cheeks, forehead, chin). These are generally multiple and hereditary lesions, appearing from childhood or in adolescence.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 383
Senile sebaceous adenoma

These adenomas correspond to senile adenomatous hyperplasia of the sebaceous glands.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 384
continued

continued
Basic Lesions:
Dermal Papules
basic lesion
cause
Small yellowish umbilicate formations, 3 to 6 mm in diameter, occurring on seborrhoeic areas of the face (forehead, temples, cheeks) in both sexes after the age of fifty.
picture
alphabetical
Benign skin tumours
page: 385
Jadassohn's sebaceous naevus

This is a tumour on the scalp or the face, which is often congenital. Its appearance changes with age. During childhood there is an oval or pink and slightly raised alopecic plaque. Starting from puberty the surface becomes mamillated and warty, and assumes the characteristic orange-yellow colour. In adulthood it can, in exceptional cases, give rise to a basal-cell carcinoma.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 386
13.3
Sweat gland tumours

Syringoma
Small, always multiple lesions measuring 1 to 3 mm in diameter and forming smooth, fleshcoloured papules generally occurring on the face (especially the eyelids), chest, neck, and axillae.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Sweat gland tumours
page: 387
Eccrine poroma
Solitary benign congestive tumour bleeding in pinpoint haemorrhages, the wide base of which is encircled by a keratin collar. Its preferred site is the area of the sole around the heel.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Sweat gland tumours
page: 388
Eccrine poroma
continued
In differential diagnostics it must be distinguished from pyogenic granuloma and achromic malignant melanoma.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Sweat gland tumours
page: 389
Cylindroma
Multiple benign tumours, often familiar, appearing on the scalp, which becomes mamillated and embossed (turban-like tumours). The surface of these tumours is smooth, glabrous, normal or pink in colour, with telangiectasias. There is no adherence to deep layers.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Sweat gland tumours
page: 390
13.4
Connective tissue tumours

Dermatobroma
Nodular intradermal tumour 5 to 6 mm in diameter, firm to the touch, generally located on the legs. Its surface is pigmented to varying degree and often slightly keratotic. A dermatofibroma can sometimes be caused by an insect bite.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 391
Dermatofibroma
continued
Basic Lesions:
Nodules
basic lesion
cause
An unusual variant is the pastillelike fibroma, a pink shiny nodule with a smooth surface surrounded by a very fine scaly collarette separated from the tumour by a groove.
picture
alphabetical
Benign skin tumours
page: 392
Acquired digital brokeratoma

Small tumour situated on the fingers or toes, more rarely on the palms and soles. Like the pastille fibroma, it is a solitary domed lesion, sometimes elongated and pedunculate, surrounded by a fine demarcating border. The surface is slightly warty. It is perhaps caused by a trauma.
Basic Lesions:
Warts
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 393
Keloid
Red and taut fibrous tumour with a smooth surface, slightly dented and sometimes surrounded by pseudopodia-like extensions called crab legs. They are very often itchy, painful, or tender. Post-traumatic keloids secondary to wounds, burns, vaccinations, or inflammatory skin lesions (such as adolescent acne) are distinguished from spontaneous keloids, which are more common in black people.
Basic Lesions:
Scars
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 394
Small and very soft fleshy mass, on average 3 to 5 mm in diameter, implanted in the skin by a thin stalk. These lesions are often multiple and their preferred sites are the axillae or inguinal flexures, the neck, the eyelids, and the orbital area.
Basic Lesions:
None specic
basic lesion
cause
picture
Skin tag (acrochordon, molluscum pendulum)
alphabetical
Benign skin tumours
page: 395
Juvenile xanthogranuloma
Single or multiple papulonodular yellow, orange or brown lesion of soft consistency, usually appearing on the face, scalp, trunk, and the base of the limbs. It occurs most frequently in neonates and infants, but can also be seen in children and even in adults.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 396
Tuberous xanthoma
Small hemispherical papules, from a few millimetres to a centimetre in diameter, pink or orange in colour, sometimes very yellow on vitropression. The preferred sites are the elbows, knees, and buttocks.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 397
Tuberous xanthoma
continued
A rare variant (eruptive xanthoma) is found in cases of severe hypertriglyceridaemia.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 398
Xanthelasma palpebrarum
Flattened and clearly delimited yellowish or orange plaques around the eyes. This is one of the variants of xanthoma planum.
Basic Lesions:
Dermal Papules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 399
Lipoma
Single or multiple benign tumours the colour of normal skin, which develop from subcutaneous fat. They are soft in consistency and they can attain a large size.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 400
Leiomyoma
Benign tumours originating from the smooth muscles connected with hair follicles, genitals, nipples, or blood vessels. Leiomyomas are single or multiple, contractile, nodular tumours, which are red, pink, or brownish in colour.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 401
Cutaneous mastocytosis
The term mastocytosis covers all lesions caused by the proliferation of mast cells in skin. Urticaria pigmentosa This is the most common form, encountered in all age groups. It produces a fairly monomorphic eruption of smooth violet or brown itchy macules or maculopapules. The reactivity of the lesions to certain stimuli, such as rubbing, is very characteristic (Darier's sign).
Basic Lesions: Erythematous Macule; Pigmented Macules; Dermal Papules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 402
continued
Mastocytoma Single firm tumour, orange in colour, occurring only in children.
Basic Lesions:
Erythematous Macule; Pigmented Macules; Dermal Papules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 403
Neural crest diseases

Nodules which are of normal skin colour or pink. Their firmness can vary. Their essential characteristic is that they are readily depressible.
Basic Lesions:
Nodules
basic lesion
cause
picture
Neurobroma
alphabetical
Benign skin tumours
page: 404

Von Recklinghausen neurobromatosis
continued
This is the most common form of systemic neural crest disease. It is essentially characterized by the combination of caf au lait spots, freckling", and cutaneous neurofibromas.
Basic Lesions:
Pigmented Macules; Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 405

Von Recklinghausen neurobromatosis
continued
The "principal tumour" is a neurofibroma which is very large in relation to all those surrounding it. This hereditary condition is transmitted by an autosomal dominant gene with high penetrance and variable expression.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 406
continued
a. Angiobroma Small, firm, pink or red tumid nodules covered in fine telangiectases and distributed symmetrically over the face: nasolabial folds, cheeks, perioral region.
Basic Lesions:
Nodules
basic lesion
cause
Tuberous sclerosis is a condition with autosomal dominant transmission, characterized by various isolated or associated clinical signs and symptoms.
picture
Bourneville's tuberous sclerosis (epiloia)
alphabetical
Benign skin tumours
page: 407

b. Periungual bromas (Konen's tumours)
continued
Very rare horny angiofibromas of the toes.
Basic Lesions:
Warts
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 408

c. Shagreen patch
continued
d. Achromic patches Fairly regular macules 1 to 10 cm in diameter, oval, rounded, or more characteristically in the shape of an ash leaf. They are white and do not have a hyperaemic or pigmented halo.
Basic Lesions: None specic
basic lesion
cause
Raised patch with an irregular outline and surface, covered with pale "orange-skin". Its preferred site is the lumbosacral region.
picture
alphabetical
Benign skin tumours
page: 409
Angioma
Vascular star, composed of a red central point, sometimes raised and pulsatile, and arborizations radiating outwards. The arborizations disappear on vitropression.
Basic Lesions:
Vascular Macule
basic lesion
cause
picture
Spider telangiectasis
alphabetical
Benign skin tumours
page: 410
Angioma
continued
Basic Lesions:
Vascular Macule
basic lesion
Autosomal dominant disease, characterized by telangiectases of the skin and mucous membranes, often not appearing until after puberty. The telangiectatic macules are poorly defined and the arborizations, in contrast to spider telangiectasis, are not symmetrical. They occur predominantly on the face, hands, buccal mucosa, the lips, and the tongue.
cause
picture
Hereditary haemorrhagic telangiectasia (Osler-Rendu-Weber disease)
alphabetical
Benign skin tumours
page: 411
Angioma
Angioma planum
continued
Congenital erythematous macule of varying intensity, extent, and shape. The colour varies from pale pink to dark red. Its preferred site is the face and the limbs, but it can spread to the mucosa. From the fourth decade of life the angioma thickens and superficial violet nodules can appear.
Basic Lesions:
Vascular Macule
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 412
Angioma
Tuberous angioma
continued
Bright red, distinctly demarcated, raised angioma in infants, projecting above the surrounding normal skin. Its growth is rapid, and it can bleed and ulcerate. Most of these angiomas disappear spontaneously in childhood, leaving no trace.
Basic Lesions:
Vascular Macule; Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 413
Angioma
Subcutaneous angioma
continued
Basic Lesions:
basic lesion
cause
Tumour protruding under skin which is either normal, bluish, or telangiectatic. This lesion does not undergo spontaneous involution.
picture
alphabetical
Benign skin tumours
page: 414
Angioma
Angiokeratoma
continued
Papular telangiectasia with a hyperkeratotic surface. Angiokeratomas of the scrotum and vulva are the most common. They are usually benign. Nevertheless, if they have disseminated over the buttocks, one must investigate for Fabry's disease.
Basic Lesions:
Dermal Papules; Keratoses
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 415
Angioma
Glomus tumour
continued
Small, bluish intradermal tumour, remarkable for its painfulness. Its site is most likely to be peripheral, on the hands and feet, more rarely on the forearms and buttocks. A common and characteristic site is the subungual region.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 416
Angioma
Glomus tumour
continued
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 417
Angioma
Pyogenic granuloma
continued
Fleshy vascular pimple secondary to minimal or unnoticed trauma. Its eroded surface bleeds easily. Pyogenic granuloma may be "nipped" at its base by a characteristic groove which separates it from neighbouring skin.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 418
Angioma
continued
A
basic lesion
Basic Lesions: Vascular Macule; Warts; Keratoses None specic last screen viewed back next Causes: search contents print
cause
Small bright red patches, flat or slightly tumid. Extremely common in old people, usually multiple and found on the trunk (A). In many cases they coexist with seborrhoeic warts (keratoses) (B).
picture
Senile angioma (cherry angioma)
alphabetical
Benign skin tumours
page: 419
Lymphangioma
Pseudovesicular elevations 1 to 5 mm in diameter, arranged in clusters or irregular plaques, translucent and taut but readily depressible. The lesions can occur anywhere on the body, but are more commonly found on the trunk and the base of the limbs. Lymphangioma (A) is very often found concomitantly with hemangionma (B).
A
B
Basic Lesions:
Vesicles
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 420
(painful nodule in the ear) Inflammatory nodule of the helix, which is painful or tender. Its centre is keratotic or crater-like. It is nowadays regarded as a chondrodermatitis, but its aetiology has not been clarified.
Basic Lesions:
Nodules; Keratoses
basic lesion
cause
picture
Chondrodermatitis nodularis helicis
alphabetical
Benign skin tumours
page: 421
Mucoid pseudocyst
Small, firm, flesh-coloured translucent nodule, occurring on the backs of the fingers near the distal interphalangeal joints and often causing a characteristic nail deformation with longitudinal grooves. It is the result of the accumulation of a mucoid substance in the dermis.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
page: 422
13.5
Melanocytic naevi
Lentigo
Small (1 to 3 mm) brown or black hyperpigmented macules which can be distributed all over the skin and/or mucous membranes. Lentigines are often isolated. Sometimes they are generalized (lentiginosis) and form part of complex syndromes involving several internal organs. They represent epidermal hypermelanocytosis.
Basic Lesions:
Pigmented Macules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 423
Mongolian spot
Bluish grey macules varying in size from a few millimetres to tens of centimetres and occurring most frequently on the loins and buttocks. They are especially common in Orientals. These spots represent dermal hypermelanocytosis.
Basic Lesions:
Pigmented Macules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 424
Basic Lesions:
Pigmented Macules; Dermoepidermal Papules None specic last screen viewed back next
basic lesion
cause
Melanocytic naevi are wellcircumscribed lesions which show a wide variety of colour, shape, thickness, consistency, and size, their diameter ranging from a few millimetres to a few centimetres.
picture
Melanocytic naevi (naevocytic naevi)
alphabetical
Benign skin tumours
Melanocytic naevi
page: 425
continued
Basic Lesions:
Pigmented Macules; Dermoepidermal Papules; Nodules None specic last screen viewed back next
basic lesion
cause
They can be flat or raised, lenticular or discoid, and vary in colour from pale yellow to black-brown. The domed forms may be without pigmentation.
picture
Melanocytic naevi (naevocytic naevi)
alphabetical
Benign skin tumours
Melanocytic naevi
page: 426
Hairy melanocytic naevus

Some melanocytic naevi become covered in hairs at puberty.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 427
Congenital pigmented naevus

Congenital pigmented naevi vary in size. Some are called giant because of their wide spread. They have an inhomogeneous surface (flat, papular, nodular, verrucous) and are most often variegated in colour, which ranges from light brown to black. They are often covered with thick hairs.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 428
Spitz naevus (juvenile)

Isolated pinkish papulonodular tumour, frequently located on the face or the limbs. The histopathological appearance of this melanocytic naevus is very characteristic. In fairly exceptional cases there may be multiple Spitz naevi.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 429
Blue naevus
Small nodule, often less than a centimetre in diameter, blue-grey to black-blue in colour and situated especially frequently on the back of the hands and the feet, sometimes on the face. Its colour is caused by the deep dermal site of the melanocytic clusters.
Basic Lesions:
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 430
Halo naevus (Sutton's naevus)

Sutton's naevus is a melanocytic naevus surrounded by a depigmented corona. In the course of its natural development the naevus component gradually disappears and the white halo undergoes gradual repigmentation. This feature of its course is probably autoimmune.
Basic Lesions:
Pigmented Macules; Achromic macules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 431
Halo naevus (Sutton's naevus)

continued
Basic Lesions:
Pigmented Macules; Achromic macules None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 432
Naevus of the nails

Presence of a more or less dark brown longitudinal band in the nail plate (melanonychia), clinical evidence of the existence of a melanocytic naevus in the matrix region.
Basic Lesions:
Pigmented Macules
basic lesion
cause
picture
alphabetical
Benign skin tumours
Melanocytic naevi
page: 433
Chapter 14:
Premalignant skin tumours
search
contents
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basic lesion
cause
picture
alphabetical
page: 434
Raised red and well-defined plaques with a rough surface covered in scales of varying thickness. The lesions are isolated or multiple and their preferred site is on exposed regions such as the back of the hands or the face.
Basic Lesions:
Keratoses; Scales
basic lesion
cause
picture
Solar keratoses (senile keratoses)
alphabetical
page: 435
continued
Basic Lesions:
Keratoses; Scales
basic lesion
The lesions are isolated or multiple and their preferred site is on exposed regions such as the back of the hands or the face. Here one can observe some characteristics of skin-ageing caused by sunlight: sallow skin, accentuated wrinkles, etc. If left untreated, some cases of solar keratosis develop into squamous cell carcinoma.
cause
picture
Solar keratoses (senile keratoses)
alphabetical
page: 436
Actinic cheilitis
Relatively well-demarcated scaly erythematous plaque, sometimes encrusted and occurring essentially on the lower lip. Under the hyperkeratotic layer the epithelium is atrophic and bleeds easily at the slightest trauma. Actinic cheilitis spreads slowly over time and can degenerate into true squamous cell carcinoma.
Basic Lesions:
Erythematous Macule; Scales; Crusts Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
picture
alphabetical
page: 437
Well-demarcated and more or less rounded white or greyish plaques on the lower lip or the buccal mucosa. They occur more frequently in men and are probably promoted by smoking. Their natural evolution is in the direction of squamous cell carcinoma.
Basic Lesions:
Achromic macules; Warts
basic lesion
cause
picture
Leucoplakia smoker's keratosis (stomatitis nicotina)
alphabetical
page: 438
Bowen's disease
Slightly raised round or oval discoid lesion with distinct borders, varying in size, red or reddish brown in colour and covered with a crust of scales or with small crusts. The current understanding of Bowen's disease is that it is an intraepidermal carcinoma (in situ).
Basic Lesions:
Erythematous Macule; Scales; Crusts None specic last screen viewed back next
basic lesion
cause
picture
alphabetical
page: 439
Bowen's disease
continued
Basic Lesions:
basic lesion
cause
picture
alphabetical
page: 440
Eryhtroplasia of Queyrat
Mucosal site of Bowen's disease. Red, well-demarcated, slightly protuberant plaque, with a glazed surface, on the glans penis. Similar lesions are observed on the vulval mucosa.
Basic Lesions:
Erythematous Macule
basic lesion
cause
picture
alphabetical
page: 441
Bowenoid papulosis
Erythematous or brownish papules on the glans and shaft of the penis, the vulva, and sometimes the perianal region. Their histopathology is similar to that of Bowen's disease. Human papillomaviruses (16, 18, 33) are the initial cause of this papulosis.
Basic Lesions:
Epidermal Papules
basic lesion
cause
picture
alphabetical
page: 442
Radiodermatitis
Cicatricial atrophy, telangiectases, and pigmentation abnormalities form the classical picture of radiodermatitis. At a further stage ulcerations can appear. Basal cell carcinoma or squamous cell carcinoma are liable to develop after several years.
Basic Lesions:
Ulcers; Atrophy; Scars
X-rays last screen viewed back next
basic lesion
cause
picture
alphabetical
page: 443
Xeroderma pigmentosum
A hereditary disease with recessive autosomal transmission. The genetic basis of xeroderma pigmentosum is an enzyme deficiency resulting in disorders of DNA repair after ultraviolet irradiation. The condition is characterized by extreme photosensitivity and chronic actinic lesions including skin atrophy, freckles, and solar keratosis. Some tumours can develop early: keratoacanthoma, basal cell or squamous cell carcinoma, malignant melanoma.
Basic Lesions: Pigmented Macules; Nodules; Keratoses; Atrophy Sunlight, Ultraviolet Radiation last screen viewed back next
basic lesion
cause
picture
alphabetical
page: 444
Dubreuilh's melanosis picture

next
(Lentigo maligna melanoma, melanosis circumscripta precancerosa of Dubreuilh) Polychromatic pigmented macule, not raised and poorly defined. Its colour varies from pale beige to black. Dubreuilh's melanosis is observed in old people, most frequently on the face, less so on the back of the hands and on the legs. It spreads very slowly, reaching a diameter of several centimetres in about ten years.
Basic Lesions:
Pigmented Macules
Sunlight, Ultraviolet Radiation last screen viewed back
basic lesion
cause
alphabetical
page: 445
Chapter 15:
Malignant skin tumours
search
contents
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basic lesion
cause
picture
alphabetical
page: 446
15.1
Basal cell carcinomas

Nodular basal cell carcinoma
Globular tumour with a waxy or reddish tint, more or less translucent ("pearly" carcinoma), the smooth surface of which is streaked with fine telangiectases. The most common site is the face, but other areas can also be involved: back, limbs, genital region. Nodular basal cell carcinoma increases gradually in size and can ulcerate.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
page: 447
Rodent ulcer
This variant of ulcerated basal cell carcinoma is characterized by 1. an ulcer as the primary lesion 2. considerable superficial spread 3. considerable spread in depth: the tumour "eats" into the tissue (hence "rodent ulcer") 4. the persistence of a translucent pearly and slightly telangiectatic border is very characteristic of basal cell carcinoma.
Basic Lesions: Nodules; Ulcers
basic lesion
cause
picture
alphabetical
page: 448
Basic Lesions:
Nodules; Atrophy; Sclerosis
basic lesion
This variant of carcinoma appears more like a plaque than a nodule. The whole central area of the lesion is white, atrophic, sclerous, and morphoea-like, but unlike morphoea it is streaked with telangiectases. At the edge of the lesion there is usually a pearly, telangiectatic, indurated swelling, sometimes covered with small crusts.
cause
picture
Flat cicatricial basal cell carcinoma ("scleroderma-like" carcinoma)
alphabetical
page: 449
Basic Lesions:
Nodules
basic lesion
cause
A very rare variant, pigmented basal cell carcinoma is characterized by a considerable excess of melanin. It is usually nodular and is not ulcerated.
picture
Pigmented basal cell carcinoma
alphabetical
page: 450
Basic Lesions:
basic lesion
The usual appearance is a pink plaque distinctly circumscribed by rounded outlines. Its limits are usually marked by a fine, pearly, filiform edge, which distinguishes it from Bowen's disease. Growth is very slow. The preferred site of this variant is on the trunk.
cause
picture
Pagetoid basal cellular carcinoma (supercial basal cell carcinoma)
alphabetical
page: 451
15.2
Squamous cell carcinomas

The majority of squamous cell carcinomas are seen on uncovered areas: face (lower lip in particular) and the back of the hands. They develop either in apparently healthy skin, or, most frequently, over a precancerous lesion: solar keratosis, Bowen's disease, etc. They are liable to metastasize, mainly via lymph.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
page: 452
Basic Lesions:
Nodules
basic lesion
cause
Large, ulcerated, which oozes blood and forms crusts. The peripheral swelling is very indurated. The base of the whole lesion is distinctly infiltrated.
picture
Squamous cell carcinoma of the face
alphabetical
page: 453
Basic Lesions:
Nodules; Scales; Crusts; Ulcers
basic lesion
cause
This sanious ulceration is surrounded by an indurated peripheral swelling. In the present case it is developing from actinic cheilitis.
picture
Squamous cell carcinoma of the lower lip
alphabetical
page: 454
Hard ulcerated vegetating tumour of the glans.
Basic Lesions:
Nodules
basic lesion
cause
picture
Squamous cell carcinoma of the penis
alphabetical
page: 455
15.3
Paget's disease
Encrusted scaly erythematous and locally erosive plaque on the nipple and the areola. Its perfectly defined border distinguishes it from an eczematous reaction (see page 52). The disappearance of the nipple's elevation must also be noted. This carcinoma is seen in 3 to 5% of breast cancers and develops mainly in postmenopausal women. Extramammary sites are rare and confined to skin areas with apocrine sweat glands (genitals, perineum, perianal region).
Basic Lesions:
basic lesion
cause
picture
alphabetical
Paget's disease
page: 456
15.4
Cutaneous metastases
Cutaneous metastases of deep cancers can assume various clinical appearances: Carcinomatous lymphangitis Classically observed in cancer of the breast, characterized by an extensive inflammatory plaque, sometimes wrongly called "carcinomatous erysipelas".
Basic Lesions:
Erythematous Macule; Nodules
basic lesion
cause
picture
alphabetical
page: 457
continued
forming skin-embedded spherical colourless or bluish masses.
Basic Lesions:
Nodules
basic lesion
cause
picture
Nodularcutaneous-subcutaneous metastases
alphabetical
page: 458
15.5
Melanoma (malignant)
Melanoma is a tumour which develops either as a primary lesion from epidermal melanocytes or from the cells of congenital junctional and compound naevi, or much more rarely from intradermal and blue naevi. It metastasizes via lymph and/or blood. Several variants of melanoma have been described:
Basic Lesions:
basic lesion
cause
picture
alphabetical
page: 459
Basic Lesions:
Pigmented Macules
basic lesion
Slightly raises melanotic spot, varying in colour from brown to black, with a margin. It undergoes a horizontal growth phase lasting several months and then finally starts its vertical phase, in which it invades the deep tissue. It occurs anywhere on the body, but more readily on the back in men and on the legs in women.
cause
picture
Supercial spreading melanoma (SSM)
alphabetical
page: 460
Nodular melanoma
Infiltrated brown or black nodules, sometimes violet-red and more rarely achromic. The lesion, which is often dome-shaped, finally ulcerates and bleeds.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
page: 461
Infiltrated nodular formations, which may or may not be pigmented, sometimes oozing blood, developing from a Dubreuilh's melanosis.
Basic Lesions:
basic lesion
cause
picture
Melanoma developing over Dubreuilh's melanosis precancerosa
alphabetical
page: 462
Basic Lesions:
basic lesion
Located on the extremities (palm of the hands, sole of foot, digital extremities), it resembles superficial spreading melanoma or nodular melanoma, representing only a particular site of either of these. The illustration suggests this double categorization particularly well.
cause
picture
Acral lentiginous melanoma (melanoma of the extremities)
alphabetical
page: 463
Melanoma metastases
Numerous black or bluish indurated nodules developing near a previously excised melanoma.
Basic Lesions:
basic lesion
cause
picture
alphabetical
page: 464
15.6
Dermatobrosarcoma protuberans (Darier-Ferrand brosarcoma)

Large multinodular dented tumour which adheres to the skin surface without ulcerating it and infiltrates the dermis and subcutaneous tissue, often beyond the limits of palpation. The tumour develops gradually, without painful symptoms. It affects adults of both sexes with a preference for the trunk and the base of the limbs. This fibrosarcoma has local malignancy, but can metastasize in exceptional cases.
Basic Lesions:
Nodules
basic lesion
cause
picture
alphabetical
Dermatofibrosarcoma protuberans (Darier-Ferrand fibrosarcoma)page:
15.7
Kaposi's angiosarcoma
Violet nodules on the ankles and feet in an elderly patient. In the present case it is not occurring in the context of acquired immune deficiency syndrome.
Basic Lesions:
basic lesion
cause
picture
alphabetical
page: 466
15.8
Malignant lymphomas mycosis fungoides

Among the many malignant cutaneous lymphomas, mycosis fungoides (epidermotropic Tlymphoma) represents an unusual entity. At the eruptive stage, the clinical picture is characterized by dull coppery red infiltrated plaques distributed in arcs.
Basic Lesions:
Erythematous Macule; Nodules
basic lesion
cause
picture
alphabetical
page: 467
Tumours can subsequently develop, and these may ulcerate.
Basic Lesions:
Ulcers
basic lesion
cause
picture
Malignant lymphomas mycosis fungoides continued
alphabetical
page: 468
15.9
Paraneoplastic syndromes
Malignant neoplasms can be accompanied by skin diseases which themselves are not neoplastic in character, nor directly caused by the presence of the tumour (in contrast to metastases), but which develop alongside the malignant neoplasm, regressing if and when the latter is eliminated and reappearing if it recurs. These so-called paraneoplastic dermatoses can occur when the malignant neoplasm has already distinctly developed, but they can also appear as a sign revealing a small neoplasm (Bazex's sign).
Basic Lesions: None specic
basic lesion
cause
picture
alphabetical
page: 469
Basic Lesions:
Warts; Keratoses
basic lesion
Paraneoplastic skin diseases are, amongst others, malignant acanthosis nigricans, Gammel's erythema gyratum repens, and Bazex's paraneoplastic keratosis, hypertrichosis lanuginosa. Both last diseases have been selected to illustrate paraneoplastic syndromes.
cause
picture
Bazex's paraneoplastic acrokeratosis
alphabetical
page: 470
Hypertrichosis lanuginosa
This occurs suddenly (within a few weeks), in the form of a down of long, white, silky, fine, and extremely numerous lanuginous hairs extending all over the glabrous skin and especially on the face. The rate of growth is accelerated and the hair (of the head) becomes more luxuriant. The papillae on the lingual mucosa are hypertropic and glazed. There is a distinct change in the sense of taste.
Basic Lesions:
None specic
basic lesion
cause
picture
alphabetical
page: 471
continued
Basic Lesions:
None specic
basic lesion
The appearance of such a picture must lead one to suspect the presence of an associated neoplasm. In the present case a neoplasm was detected in the breast. Radical treatment of the cancer leads to the disappearance of the acquired lanuginous hypertrophy. The recurrence of the neoplasm is accompanied by reappearance of the hypertrichosis (paraneoplastic dermatosis in the strict sense).
cause
picture
alphabetical
page: 472
Chapter 16:
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contents
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basic lesion
Algorithmic approach to a dermatological diagnosis
cause
picture
alphabetical
page: 473
16.1
Urticaria
To conclude this pictorial presentation of the most common skin diseases for the general practitioner, we thought it would be interesting to include the modern diagnostic procedure in dermatology applied to an everyday problem: urticaria.
Physical Urticaria? Provoked by direct contact with a substance? Genetic origin? Systemic origin? Medicamentouse or food allergy? Infectious origin?
No No No No No
Yes Yes Yes Yes Yes
If duration is longer than 6 weeks: Chronic idiopathic urticaria
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cause
picture
No
Yes
alphabetical
Urticaria
page: 474
Physical urticaria
Click
Vibratory angio-oedema
Click
Click
Solar urticaria Cholinergic urticaria Cold urticaria Heat urticaria Delayed pressure urticaria
Click
Click
Click
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Click
No Physical urticaria
Click
cause
picture
Simple or retarded dermographism
Aquagenic urticaria
Click
alphabetical
Urticaria
page: 475
Physical urticaria
Simple or retarded dermographism
Rub with a blunt tip. other disease
search
contents
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basic lesion
cause
Continue
picture
alphabetical
Urticaria
page: 476
Physical urticaria
Solar urticaria
Photosensitivity test. other disease
Continue
cause
search contents print last screen viewed
basic lesion
picture
alphabetical
Urticaria
page: 477
Physical urticaria
Cholinergic urticaria
Small papules induced by heat, physical effort, stress. other disease
search
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cause
Continue
picture
alphabetical
Urticaria
page: 478
Physical urticaria
Cold urticaria
Test with ice cube sheathed in plastic. other disease
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contents
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basic lesion
cause
Continue
picture
alphabetical
Urticaria
page: 479
Physical urticaria
Heat urticaria
Test with test-tube of hot water.
Aquagenic urticaria
Immersion test: hand in water at ambient temperature.
Vibratory angio-oedema basic lesion

Professional circumstances ( particularly pneumatic hammer). other disease
Continue
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contents
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cause
picture
alphabetical
Urticaria
page: 480
Physical urticaria
Delayed pressure urticaria
Test by pressure with a weight strapped on to the body. other disease
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basic lesion
cause
Continue
picture
alphabetical
Urticaria
page: 481
Provoked by direct contact with a substance

Contact urticaria
Rapid result patch test, prick test or scratch test. other origin
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basic lesion
cause
Continue
picture
alphabetical
Urticaria
page: 482
Genetic origin
Hereditary angioneurotic oedema
Investigate for deficiency of C1 esterase inhibitor. other origin
Continue
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cause
picture
alphabetical
Urticaria
page: 483
Systemic origin
Lesions persisting at the same place for more than 24h, not very itchy, accompanied by joint pains and myalgias; histopathological appearance that of vasculitis. Investigate for:
1 2
other origin
3 4
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acute lupus erythematosus (1-3) Stills disease macroglobulinaemia blood disease hyperthhyroidism urticarial vasculitis (4)
cause
picture
alphabetical
Urticaria
page: 484
Medicamentous or food allergy

Painstaking history with regard to drugs and food
- Drugs Especially acetylsalicylic acid (see photos) - Food Especially preservatives and colourings Do provocation tests. other origin
Continue
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cause
picture
alphabetical
Urticaria
page: 485
Infectious origin
- Hepatitis A (photo) Exceptional case of figured urticaria revealing hepatitis A in its initial phase. The yellowish colour of the central oedematous (urticated zone) is caused by accumulation of bilirubin in the oedema fluid. Hepatitis B or C Infectious mononucleosis Parasitosis Focus of bacterial infection Focus of mycotic infection other origin
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cause
picture
alphabetical
Urticaria
page: 486
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basic lesion
cause
picture
Picture Index
alphabetical
page: 487
Skin from the axillary region
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cause
Skin from the forehead region
Skin from the face of an elderly subject
picture
alphabetical
Picture Index
page: 488
Erythematous macule
Vascular macule
Purpuric macule
Pigmentary macules
Pigmentary macules
Pigmentary macules
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cause
picture
alphabetical
page: 489
Epidermal papules
Dermal papules
Dermo-epidermal papules
Nodules
Tubercles
Vegetations
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cause
picture
alphabetical
page: 490
Warts
Keratoses
Vesicles
Bullae
Pustules
Scales
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basic lesion
cause
picture
alphabetical
page: 491
Crusts
Fissures
Ulcers
Gangrene
Atrophy
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basic lesion
cause
picture
alphabetical
page: 492
Scars
Sclerosis
Chronic occupational contact dermatitis
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cause
Acute exudative contact dermatitis
picture
alphabetical
page: 493
Crusted eczema
Crusted eczema
Scaly dry erythematous contact dermatitis
Acute irritant dermatitis
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cause
picture
alphabetical
page: 494
Cumulative insult dermatitis
Infected retro-auricular dermatitis
Atopic dermatitis of childhood
Atopic dermatitis of the folds in a child
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basic lesion
cause
Chronic palmar irritant dermatitis
Atopic dermatitis of the face in an infant
picture
alphabetical
page: 495
Eczema of the nipples
Atopic cheilitis
Atopic conjunctivitis
Atopic dermatitis of the hands in the adult
Pityriasis alba
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basic lesion
cause
Atopic dermatitis in the adult
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alphabetical
page: 496
Nummular dermatitis
Nummular dermatitis
Seborrhoeic dermatitis of the trunk
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basic lesion
cause
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alphabetical
page: 497
Bullous pompholyx of the palms
Eczematous pompholyx of the palms
Asteatotic eczema
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basic lesion
cause
Seborrhoeic dermatitis of the hairline
Seborrhoeic dermatitis of the face
Pompholyx of the fingers
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alphabetical
page: 498
Latex contact urticaria
Prick test with latex
Dermographism
Pressure urticaria
Cold urticaria
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basic lesion
cause
Provocative use test with latex gloves
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alphabetical
page: 499
Solar urticaria
Urticated weals
Papular urticaria
Figured urticaria
Hereditary angio-oedema
Urticarial vasculitis
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basic lesion
cause
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alphabetical
page: 500
Herpes, type I
Herpes, type II (genital)
Varicella
Varicella
Zoster of the trunk
Ophthalmic nerve zoster
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cause
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alphabetical
page: 501
Common warts
Plane warts
Plane warts
Plantar wart
Mosaic warts
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cause
picture
alphabetical
page: 502
Horny filiform wart
Hairy leucoplakia
Multiple mollusca contagiosa
ORF
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basic lesion
cause
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alphabetical
page: 503
Measles
Rubella
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basic lesion
cause
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alphabetical
page: 504
Prurigo
Gingivitis
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basic lesion
cause
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alphabetical
page: 505
Kaposi's sarcoma
Kaposi's sarcoma
Bullous impetigo
Non-bullous impetigo
Ecthyma
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basic lesion
cause
picture
alphabetical
page: 506
Folliculitis
Furuncle (BOIL)
Carbuncle
Erysipelas
Erysipelas
Orbital cellulitis
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cause
picture
alphabetical
page: 507
Septic emboli
Erythema chronicum migrans
Erythema chronicum migrans
Borrelia pseudolymphoma
Proteus infection
Cat-scratch disease
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basic lesion
cause
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alphabetical
page: 508
Cat-scratch disease
Intertrigo
Lupus vulgaris
Lupus vulgaris
Scofuloderma
Complication of BCG vaccination
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basic lesion
cause
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alphabetical
page: 509
Erythrasma
Trichomycosis axillaris
Pitted keratolysis
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basic lesion
cause
Infection with mycobacterium fortuitum or chelonae
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alphabetical
page: 510
Late secondary syphilis
Papular syphilids
Genital gonorrhoea
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basic lesion
cause
Secondary syphilis
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alphabetical
page: 511
Tinea corporis
Tinea corporis
Tinea faciei
Tinea faciei
Tinea cruris
Tinea manuum
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basic lesion
cause
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alphabetical
page: 512
Tinea manuum
Tinea capitis or ringworm
Kerion
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basic lesion
cause
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alphabetical
page: 513
Kerion
Kerion
Thrush
Angular cheilitis
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cause
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page: 514
Candidal intertrigo
Candidal intertrigo
Candidal vulvovaginitis
Candidal balanitis
Candidal paronychia and subungual infection
Napkin candidiasis (infant)
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basic lesion
cause
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page: 515
Sporotrichosis
Mycetoma (Madura foot)
Human scabies
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basic lesion
cause
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alphabetical
page: 516
Human scabies
Human scabies
Human scabies
Animal scabies
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basic lesion
cause
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alphabetical
page: 517
Trombiculiasis
Trombiculiasis
Infantile papular urticaria (strophulus)
Flea bites
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basic lesion
cause
picture
alphabetical
page: 518
Flea bites
Leishmaniasis
Leishmaniasis
Leishmaniasis
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basic lesion
cause
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page: 519
Tungiasis (chigger)
Tungiasis (chigger)
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
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cause
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page: 520
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
Psoriasis vulgaris
Pustular psoriasis
Pustular psoriasis
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basic lesion
cause
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page: 521
Pustular psoriasis
Palmoplantar psoriasis
Flexural psoriasis
Psoriasis of the nails
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cause
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page: 522
Psoriasis of the scalp
Psoriasis of the face
Mucosal psoriasis
Mucosal psoriasis
Pityriasis rosea
Pityriasis rosea
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basic lesion
cause
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alphabetical
page: 523
Pityriasis lichenoides
Chronic superficial scaly dermatitis
Premycotic
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basic lesion
cause
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page: 524
Oral lichen planus
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basic lesion
cause
Oral lichen planus
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alphabetical
page: 525
Lichen planus of the nails
Graft versus host disease
Graft versus host disease
Lichenification
Subacute prurigo
Subacute prurigo
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basic lesion
cause
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alphabetical
page: 526
Subacute lupus erythematosus
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basic lesion
cause
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alphabetical
page: 527
Dermatomyositis
Dermatomyositis
Localized morphoea
Localized morphoea
Systemic sclerosis
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basic lesion
cause
picture
alphabetical
page: 528
Systemic sclerosis
Lichen sclerosus
Lichen sclerosus
Lichen sclerosus
Sarcoidosis
Sarcoidosis
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cause
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page: 529
Sarcoidosis
Sarcoidosis
Granuloma annulare
Vasculitis
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cause
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page: 530
Cutaneous vasculitis
Atrophie blanche
Atrophie blanche
Polyarteritis nodosa
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basic lesion
cause
picture
alphabetical
page: 531
Erythema elevatum diutinum
Erythema nodosum
Erythema nodosum
Nodular vasculitis
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basic lesion
cause
picture
alphabetical
page: 532
Erythema multiforme
Erythema multiforme
Erythema multiforme
Erythema multiforme
Sweet's syndrome
Bullous pemphigoid
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cause
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page: 533
Bullous pemphigoid
Pemphigus vulgaris
Pemphigus vulgaris
Benign familial chronic pemphigus
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basic lesion
cause
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alphabetical
page: 534
Linear IgA bullous disease
Simple epidermolysis bullosa
Simple epidermolysis bullosa
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basic lesion
cause
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page: 535
Bullous phytophotodermatitis
Acne vulgaris
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basic lesion
cause
Diabetic bullae
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page: 536
Acne vulgaris
Acne vulgaris
Acne vulgaris
Acne conglobata
Acne conglobata
Infantile acne
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basic lesion
cause
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page: 537
Rosacea
Rosacea
Perioral dermatitis
Fixed pigmented erythema
Maculoppapular exanthema
Lyell's syndrome
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basic lesion
cause
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page: 538
Lichenoid eruptions
Lichenoid eruptions
Drug-induced photoallergic eruption
Acneiform facial eruption
Psoriatiform eruption
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basic lesion
cause
Drug-induced phototoxic eruption
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page: 539
Drug-induced lupus
Cortisone atrophy
Bromide and iodide eruptions
Gingival hyperplasia
Melasma
Benign summer photodermatitis
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basic lesion
cause
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alphabetical
page: 540
Polymorphic light eruption
Chilblains
Alopecia areata
Alopecia areata
Pseudopelade
Trichotillomania
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basic lesion
cause
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page: 541
Androgenetic alopecia
Black hairy tongue
Scrotal / fissured tongue
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basic lesion
cause
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page: 542
Geographic tongue
Allergic contact cheilitis
Darier's disease
Darier's disease
Ichthyosis vulgaris
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basic lesion
cause
Cheilitis caused by systemic use off isotretinoin
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page: 543
Keratosis pilaris
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basic lesion
cause
Hereditary palmoplantar keratoderma
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page: 544
Keratosis pilaris
Venous leg ulcer
Venous leg ulcer
Ischaemic (arterial) leg ulcer
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cause
Erythema annulare centrifugum
Erythema annulare centrifugum
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page: 545
Ulcer caused by capillaritis
Neurotrophic leg ulcer
Neurotrophic leg ulcer
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cause
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page: 546
Inflammatory linear verrucous epidermal naevus
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basic lesion
cause
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page: 547
Kerato-acanthoma
Spectacle frame acanthoma
Spectacle frame acanthoma
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basic lesion
cause
Inflammatory linear verrucous epidermal naevus
Becker's naevus
Clear cell acanthoma
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page: 548
Epidermoid cyst
Trichilemmal cyst
Milia
Trichoepithelioma
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basic lesion
cause
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page: 549
Eccrine poroma
Cylindroma
Dermatofibroma
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basic lesion
cause
Jadassohn's sebaceous naevus
Syringoma
Eccrine poroma
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page: 550
Dermatofibroma
Skin tag
Juvenile xanthogranuloma
Tuberous xanthoma
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basic lesion
cause
Acquired digital fibrokeratoma
Keloid
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page: 551
Tuberous xanthoma
Xanthelasma palpebrarum
Lipoma
Leiomyoma
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basic lesion
cause
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page: 552
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cause
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page: 553
Angioma
Angioma
Angioma
Angioma
Angioma
Angioma
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cause
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page: 554
Angioma
Angioma
Angioma
Angioma
Lymphangioma
Chondrodermatitis nodularis helicis
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page: 555
Mucoid pseudocyst
Lentigo
Mongolian spot
Melanocytic naevi
Melanocytic naevi
Hairy melanocytic naevus
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page: 556
Halo naevus
Halo naevus
Naevus of the nails
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Congenital pigmented naevus
Spitz naevus (juvenile)
Blue naevus
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page: 557
Solar keratoses
Solar keratoses
Actinic cheilitis
Leucoplakia
Bowen's disease
Bowen's disease
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Eryhtroplasia of queyrat
Bowenoid papulosis
Radiodermatitis
Xeroderma pigmentosum
Dubreuilh's melanosis
Nodular basal cell carcinoma
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basic lesion
cause
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page: 559
Rodent ulcer
Pagetoid basal cellular carcinoma
Squamous cell carcinoma of the face
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basic lesion
cause
Flat cicatricial basal cell carcinoma
Pigmented basal cell carcinoma
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page: 560
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basic lesion
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Squamous cell carcinoma of the lower lip
Squamous cell carcinoma of the penis
Paget's disease
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page: 561
Acral lentiginous melanoma
Melanoma metastases
Dermatofibrosarcoma protuberans
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basic lesion
cause
Superficial spreading melanoma
Nodular melanoma
Melanoma over Dubreuilh's melanosis precancerosa
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page: 562
Bazex's paraneoplastic acrokeratosis
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Dermatologija Atlas U Boji

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Chapter 1:

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Histological reminder of the structure of human skin

Skin from the axillary region

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Histological reminder of the structure of human skin

Skin from the forehead region

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Histological reminder of the structure of human skin

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Skin from the face of an elderly subject

Histological reminder of the structure of human skin

Structure of the epidermis

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Histological reminder of the structure of human skin

Structure of the epidermis

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Histological reminder of the structure of human skin

Structure of the epidermis

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Histological reminder of the structure of human skin

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Excoriations (or ulcerations)

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Excoriations (or ulcerations)

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Allergic contact dermatitis and irritation dermatitis

Erythematous Macule; Vesicles

Causes: search contents print

Chemical Agents last screen viewed back next

Allergic contact dermatitis and irritation dermatitis

Causes: search contents print

Chronic occupational contact dermatitis

Allergic contact dermatitis and irritation dermatitis