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 Manual of
Dermatological
Differential Diagnosis

i
 Manual of
Dermatological
Differential Diagnosis

Debabrata Bandyopadhyay MD
Professor and Head
Department of Dermatology
Venereology, and Leprosy
Medical College
Kolkata, India

CBS Publishers & Distributors Pvt Ltd

New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai

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 Disclaimer
Science and technology are constantly changing
fields. New research and experience broaden the
scope of information and knowledge. The author has
tried his best in giving information available to him while
preparing the material for this book. Although, all
efforts have been made to ensure optimum accuracy
of the material, yet it is quite possible some errors might
have been left uncorrected. The publisher, printer and
the author will not be held responsible for any
inadvertent errors or inaccuracies.

ISBN: 978-81-239-2942-2

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First Edition: 2016

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 to

my students
who are a constant source of
inspiration for me
 Preface

D ermatology deals with an organ that is fully visible to the naked eye.
Any deviation from the normal appearance being immediately
apparent, each change has been given a descriptive name. Thus, among all
specialties, dermatology has the largest number of named diseases. However,
in the vast majority of clinical encounters, a correct diagnosis can be made by
history and physical examination alone. This is usually accomplished by the
traditional morphological approach to diagnosis. However, each
morphological pattern can occur in a large number of diseases and the
establishment of a precise differential diagnosis for a given skin problem is a
challenging pursuit. In a short period of time, the clinician has to consider a
large number of possible diagnoses for the condition and to narrow down the
possibilities to a single entity or a handful of differential diagnoses by a
process of elimination.
I hope to provide the readers with some assistance in carrying out this
challenging and intellectually satisfying task. The goal of this manual is to
provide a single and rapid source of information for answering the question
‘what else could it be?” when encountering a cutaneous problem.
This manual of differential diagnosis of skin lesions is intended for the use
of practising dermatologists, other physicians dealing with skin problems,
and particularly the dermatology residents who are often asked to provide
a list of differential diagnosis of a particular skin lesion while on the rounds
or in their examination papers.
Dr Abanti Saha has provided valuable help in the preparation of the
chapter on cutaneous signs and drugs causing different dermatoses. Dr Vivek
Mishra has prepared the primary draft of the drug lists. I am much indebted
to them. I also take this opportunity to express my gratitude to Mr SK Jain,
Managing Director, and Mr Krishnendu Bandhu, Sales and Marketing
Executive, CBS Publishers & Distributors, for their constant help and
inspiration during the preparation of this book.
I welcome any criticism or suggestions that would improve the text for
future editions.

Debabrata Bandyopadhyay
dr.dban@gmail.com
 Contents
Preface vii
Introduction xix

1. Morphology and Arrangement 1

Acneiform Lesions 1 Lesions in Scar 22

Annular Lesions 1 Lesions with Halos 22
Atrophic Lesions 2 Livedo Reticularis 22
Blaschkoid Lesions 3 Lymphedema 23
Blue Lesions 4 Macules, Brown 23
Blueberry Muffin Lesions 5 Macules, Hypomelanotic 24
Bromhidrosis 5 Melanoma Look-alikes 25
Café au Lait Macules 6 Migratory Eruption 25
Cerebriform Lesions 6 Milia 26
Chromhidrosis 7 Morbilliform Eruptions 26
Collodion Baby 7 Necrotic Lesions 27
Cutaneous Cysts 7 Nodules 27
Cutaneous Horn 8 Nodules, Congenital 28
Desquamation (Exfoliation) 9 Painful Tumors 29
Dyschromatosis 9 Panniculitis 29
Eczematous Reaction 10 Papules, Crusted 30
Erosion/Excoriation 11 Papules, Flat-topped 31
Erythroderma 11 Papules, Flesh-colored 31
Erythroderma in Infants 12 Papules, Follicular 32
Eschars 13 Papules, Hyperkeratotic 32
Figurate Erythemas 13 Papules, Linearly Arranged 33
Flagellate Lesions 14 Papules, Vascular 33
Flushing 14 Papulonecrotic Lesions 34
Follicular Lesions 14 Papulosquamous Lesions 34
Gangrenous Lesions 15 Peau d’orange Appearance 35
Grouped Lesions 16 Pedunculated Lesions 35
Guttate Leukoderma 16 Perforating Dermatoses 36
Herpetiform Lesions 16 Plaques, Erythematous 36
Hyperhidrosis 17 Poikilodermas 37
Hyperpigmentation, Diffuse 18 Pruritic Nevi/Tumors 37
Hypertrichosis 18 Pruritus, Generalized,
Hypohidrosis/Anhidrosis 19 without Skin Lesions 38
Hypopigmentation/Depigmentation, Purpura, Non-palpable 38
Generalized 20 Purpura, Palpable 39
Hypopigmentation, Linear 20 Pustules 39
Ichthyosis, Acquired 21 Rash with Abdominal Pain 40
Ichthyosis, Congenital/ Rash with Arthritis 41
Hereditary 21 Rash with Fever 41
 x Manual of Dermatological Differential Diagnosis

Raynaud’s Phenomenon 42 Targetoid Lesions 49

Reticulated Lesions 42 Telangiectasia 50
Scarring Lesions 43 Ulcers 50
Sclerodermoid Skin 44 Ulcer with Lymphadenitis 51
Sclerosis (Diffuse and Umbilicated Lesions 52
Localized) 44 Verrucous Lesions 52
Segmental/Zosteriform
Vesicle and Bullae 53
Lesions 45
Vesicles/Bullae, Hemorrhagic 54
Serpiginous Lesions 46
Vesicles/Bullae in Newborn 55
Sinus Tracts 47
Sporotrichoid Lesions 48 Violaceous (Purplish) Lesions 55
Striae Distensae 48 Woolly Hair 56
Subcutaneous Nodules 49 Yellow Lesions 56

2. Regional Dermatology 57

Acral Necrosis 57 Oral Papules/Nodules 81

Alopecia, Acquired, Oral Pigmentation 82
Non-scarring 57 Oral Ulcers 83
Alopecia, Acquired, Scarring 58 Oral White Lesions 83
Alopecia, Congenital 59 Palate 84
Atrophic Glossitis 59 Palm and Sole 84
Axilla 60 Palmar Erythema 85
Balanoposthitis 61 Palmar Pitting/Keratoses 85
Bathing-trunk Distribution 61 Palmar/Plantar Nodules 86
Blepharitis 61 Palmoplantar Keratodermas,
Breast 62 Acquired 86
Cysts on Neck 62 Palmoplantar Keratoderma,
Diaper Dermatitis 62 Hereditary 87
Elbow 63 Penile Annular Lesions 88
External Ear 63 Penile Ulcers 88
Facial Nodules 64 Perianal Ulcers 89
Flexural Dermatoses 65 Periorbital Lesions 89
Gingiva 65 Poliosis 90
Gingivitis, Desquamative 66 Pruritus Ani 90
Hand and Finger 66 Pruritus Vulvae 91
Hirsutism 68 Pseudoainhum 91
Inframammary Region 68 Retroauricular Lesions 92
Inguinal Lymphadenopathy 68 Saddle-nose Deformity 92
Interdigital Web Spaces 69 Scalp 92
Knuckles, Papules/Nodules 69 Scaly Scalp 93
Leonine Facies 70 Scrotal Nodules 93
Lip 70 Seborrheic Areas 94
Macroglossia 71 Shin 94
Madarosis 72 Tongue 95
Malar Area 72 Umbilicus 95
Nail Disorders 73 Vulva 96
Nasal Enlargement 80 Xerostomia 97
Oral Mucosa/Lips, Cobblestone
Appearance 80
 Contents xi

3. Cutaneous Signs 98

4. Dermatoses and Drugs 112

Acanthosis Nigricans 112 Hypertrichosis 121

Acne 112 Hypopigmentation 121
Acquired Ichthyosis 112 Ichthyosiform Eruption 122
Acrocyanosis 113 Keratoderma 122
Acute Generalized Exanthematous Leukotrichia 122
Pustulosis 113 Lichenoid Eruption 122
Alopecia 113 Linear IgA Bullous Dermatosis 123
Anaphylaxis 114 Lipoatrophy 123
Angioedema 114 Livedo Reticularis 123
Anhidrosis 114 Longitudinal Melanonychia 123
Asteatotic Eczema 114 Lymphocytoma Cutis (Cutaneous
Atrophic Glossitis 114 Lymphoid Hyperplasia) 123
Azure Lunulae 115 Melasma 124
Baboon Syndrome 115 Morphea 124
Beau’s Lines 115 Ochronosis, Exogenous 124
Black Hairy Tongue 115 Onycholysis 124
Bullous Pemphigoid 115 Pellagra-like Rash 124
Calcinosis Cutis 116 Pemphigus Vulgaris 125
Candidiasis 116 Photoallergic Drug Eruption 125
Chemotherapy-induced Acral Photo-onycholysis 125
Erythema 116 Photo-Recall Reaction 126
Cicatricial Pemphigoid 116 Phototoxic Drug Eruption 126
Dermatomyositis 116 Pigmented Purpuric Dermatosis 126
DRESS (Drug Eruption with Pityriasis Rosea 127
Eosinophilia and Systemic Porphyria Cutanea Tarda 127
Symptoms) 117 Pruritus 127
Dry Lips 117 Pseudolymphoma 128
Eczematous Eruption 117 Pseudoporphyria 128
Elastosis Perforans Serpiginosa 117 Purpura 128
Eosinophilia Myalgia Syndrome 117 Raynaud’s Phenomenon 129
Epidermolysis Bullosa Acquisita 117 Rosacea 129
Erythema Annulare Centrifugum 118 Scleroderma-like Change 129
Erythema Multiforme 118 Seborrheic Dermatitis 130
Erythema Nodosum 118 Serum Sickness-like Disease 130
Erythroderma 119 SJS-TEN 130
Erythromelalgia 119 SLE 131
Exanthematous Reactions 119 Stomatitis 131
Fixed Drug Eruption 120 Subacute Cutaneous LE 132
Flushing 120 Sweet’s Syndrome 132
Folliculitis 120 Urticaria 132
Hair Discoloration 120 Vasculitis 133
Hirsutism 121 Xerostomia 134
Hyperpigmentation 121
 xii Manual of Dermatological Differential Diagnosis

5. Diagnostic Features of Dermatoses 135

Acanthoma Fissuratum 135 Angiolymphoid Hyperplasia with

Acanthosis Nigricans 135 Eosinophilia 145
Achenbach Syndrome 136 Angioma Serpiginosum 146
Acne Conglobata 136 Angiosarcoma 146
Acne Keloidalis Nuchae 136 Angular Cheilitis 146
Acne Vulgaris 136 Annular Erythema of Infancy 147
Acquired Digital Fibrokeratoma 137 Anthrax 147
Acroangiodermatitis of Mali 137 Antiphospholipid Antibody
Acrochordon 137 Syndrome 147
Acrocyanosis 138 APACHE Syndrome 148
Acrodermatitis Chronica Aphthous Stomatitis 148
Atrophicans 138 Aplasia Cutis Congenita 148
Acrodermatitis Continua of Aquagenic Pruritus 148
Hallopeau 138 Arsenicosis, Chronic 149
Acrodermatitis Enteropathica 138 Arteriovenous Malformation 149
Acrokeratoelastoidosis 138 Ashy Dermatosis 149
Acrokeratosis Verruciformis of Hopf Aspergillosis 149
138 Asteatotic Dermatitis 149
Acropigmentation of Dohi 138 Ataxia Telangiectasia 149
Actinic Cheilitis 138 Atopic Dermatitis 149
Actinic Granuloma 139 Atrophoderma of Pasini and Pierini
Actinic Keratosis 139 150
Actinic Prurigo 139 Atrophoderma Vermiculata 150
Actinic Reticuloid 139 Atypical Fibroxanthoma 150
Actinomycosis 139 Baboon Syndrome 150
Acute Generalized Bacillary Angiomatosis 150
Balanitis Xerotica Obliterans 151
Exanthematous Pustulosis 139 Bannayan–Riley–Rivulcaba
Acute hemorrhagic Edema of Syndrome 151
Infancy 140 Bartonellosis 151
Acute Necrotizing Gingivitis 140 Basal Cell Carcinoma 151
Adams-Oliver Syndrome 140 Basaloid Follicular Hamartoma 152
Addison’s Disease 140 Bazex Syndrome 152
Adiposis Dolorosa 140 Becker’s Nevus 152
Beckwith-Wiedemann Syndrome
Ainhum 141
153
Albinism 141 Behcet’s Disease 153
Alezzandrini Syndrome 141 Bejel 153
Alopecia Areata 141 Benign Cephalic Histiocytosis 154
Alopecia Mucinosa (Follicular Berloque Dermatitis 154
Mucinosis) 142 Birt-Hogg-Dube Syndrome 154
Amalgam Tattoo 142 Black Hairy Tongue 154
Amebiasis, Cutaneous 142 Blastomycosis 154
Blastomycosis-like Pyoderma 155
Amyloidosis 142
Blau Syndrome 155
Anagen Effluvium 143 Blistering Distal Dactylitis 155
Androgenetic Alopecia 143 Bloom Syndrome 155
Anetoderma 143 Blue Nevus 155
Angioedema 143 Blue Rubber Bleb Nevus
Angiofibromas 144 Syndrome 155
Angiokeratomas 145 Botryomycosis 156
 Contents xiii

Bowel-associated Colloid Milium 166

Dermatosis-Arthritis Syndrome 156 Condyloma Acuminatum 167
Bowen’s Disease 156 Confluent and Reticulated
Bowenoid Papulosis 156 Papillomatosis 167
Branchial Cysts 156 Congenital Non-Bullous
Bronchogenic Cyst 157 Ichthyosiform Erythroderma 167
Brucellosis 157 Connective Tissue Nevus 168
Bullosis Diabeticorum 157 Conradi-Hunermann
Bullous Congenital Ichthyosiform Syndrome 168
Erythroderma 157 Coumarin Necrosis 168
Bullous Pemphigoid 158 Cowden Disease 168
Buschke-Ollendorff Syndrome 158 Crohn’s Disease 169
Calcinosis Cutis 159 Cryoglobulinemia 169
Calciphylaxis 159 Cryptococcosis 169
Callus/Corn 159 Cushing’s Syndrome 169
Candidiasis 160 Cutaneous Ciliated Cyst 169
Carbon Baby 160 Cutaneous Endometrioma 170
Carbuncle 161 Cutaneous Larva Migrans 170
Carcinoid Syndrome 161 Cutaneous Lymphoid
Cardiofaciocutaneous Hyperplasia 170
Syndrome 161 Cutaneous Metastasis 170
Carpal Tunnel Syndrome 161 Cutaneous T cell Lymphoma 171
Cartilage Hair Hypoplasia 161 Cutis Laxa 171
Carvajal Syndrome 161 Cutis Marmorata 171
Cat-Scratch Disease 162 Cutis Verticis Gyrata 171
Cellulitis 162 Cylindroma 171
Central Centrifugal Cicatricial Cysticercosis 171
Alopecia 162 Darier Disease 172
Chancroid 162 Decubitus Ulcer 172
Chediak-Higashi Syndrome 163 Delusional Parasitosis 172
Cheilitis Glandularis 163 Demodicidosis 172
Cheilitis Granulomatosa 163 Dengue Viral Infection 172
Chemical Leukoderma 163 Dermatitis Artefacta 172
Cherry Angioma 164 Dermatitis Herpetiformis 173
Chikungunya Infection 164 Dermatofibroma 173
CHILD Syndrome 164 Dermatofibrosarcoma
CHIME Syndrome 164 Protuberans 173
Chloracne 164 Dermatographism 174
Chondrodermatitis Nodularis Helicis Dermatomyositis 174
165 Dermatopathia Pigmentosa
Chromoblastomycosis 165 Reticularis 174
Chronic Actinic Dermatitis 165 Dermatosis Papulosa Nigra 175
Chronic Granulomatous Dermoid Cyst 175
Disease 165 Desmoid Tumor 175
Churg-Strauss Syndrome 165 Diabetic Dermopathy 175
Cicatricial Pemphigoid 165 Diaper Dermatitis 175
Clear Cell Acanthoma 166 Digital Mucinous Pseudocyst 175
Coccidioidomycosis 166 Dissecting Cellulitis of Scalp 175
Cockayne Syndrome 166 Dowling-Degos Disease (Reticulate
Cold Panniculitis 166 Pigmented Anomaly) 175
 xiv Manual of Dermatological Differential Diagnosis

Dracunculiasis 176 Erythrasma 185

Drug Hypersensitivity Er ythroderma 185
Syndrome 176 Erythrokeratodermia Variabilis 185
Dyschromatosis Universalis Erythromelalgia 185
Hereditaria 176 Erythroplasia of Queyrat 185
Dyshidrotic Eczema Fabry Disease 186
(Pompholyx) 176 Facticial Dermatitis 186
Dyskeratosis Congenita 176 Favre-Racouchot Syndrome 186
Eccrine Angiomatous Favus 186
Hamartoma 176 Fibrous Papule 186
Eccrine Poroma 176 Fibrous Hamartoma of Infancy 186
Eccrine Spiradenoma 177 Fixed Drug Eruption 186
Ecthyma 177 Focal Dermal Hypoplasia 187
Ecthyma Gangrenosum 177 Folliculitis 187
Ectodermal Dysplasia, Folliculitis Decalvans 187
Anhidrotic 177 Fordyce Spots 187
Ectodermal Dysplasia, Hidrotic 177 Foreign Body Granuloma 187
Ehlers-Danlos Syndrome 177 Fox Fordyce Disease 188
Elastosis Perforans Freckles 188
Serpiginosa 178 Frontal Fibrosing Alopecia 188
Encephalocele 178 Frostbite 188
Eosinophilia-Myalgia Furuncle 188
Syndrome 178 Galli-Galli Disease 188
Eosinophilic Cellulitis 178 Gardner Syndrome 188
Eosinophilic Fasciitis 178 Gardner-Diamond Syndrome 189
Eosinophilic Folliculitis 179 Gaucher Disease 189
Epidermal Nevus 179 Geographic Tongue 189
Epidermodysplasia Verruciformis 180 Gianotti-Crosti Syndrome 189
Epidermoid Cyst 180 Giant Cell Arteritis 190
Epidermolysis Bullosa 180 Glanders 190
Epidermolysis Bullosa Glomus Tumor 190
Acquisita 181 Gonococcemia 190
Epstein’s Pearl 181 Graft versus Host Disease 190
Eruptive Vellus Hair Cysts 181 Granular Cell Tumor 190
Erysipelas 182 Granular Parakeratosis 190
Erysipeloid 182 Granuloma Annulare 191
Erythema Ab Igne 182 Granuloma Faciale 191
Erythema Annulare Granuloma Inguinale 191
Centrifugum 182 Granuloma Multiforme 191
Erythema Chronicum Migrans 182 Granulosis Rubra Nasi 191
Erythema Elevatum Diutinum 182 Griscelli Syndrome 191
Erythema Gyratum Repens 183 Hailey-Hailey Disease 192
Erythema Induratum 183 Hallerman-Streiff Syndrome 192
Erythema Infectiosum 183 Halo Nevus 192
Erythema Marginatum 183 Halogenoderma 192
Erythema Multiforme 183 Hand–Foot–Mouth Disease 192
Erythema Nodosum 184 Harlequin Ichthyosis 192
Erythema Nodosum Leprosum 184 Hartnup Disease 193
Erythema Toxicum Heck’s Disease 193
Neonatorum 184 Hemangioma 193
 Contents xv

Hemochromatosis 193 Keratosis Follicularis Spinulosa

Henoch-Schonlein Purpura 193 Decalvans 206
Hereditary Hemorrhagic Keratosis Lichenoides Chronica 206
Telangiectasia 193 Keratosis Pilaris 206
Hermansky-Pudlak Syndrome 193 Keratotic and Micaceous
Herpangina 194 Pseudoepitheliomatous
Herpes Simplex 194 Balanitis 207
Herpes Zoster 194 KID Syndrome 207
Hidradenitis Suppurativa 195 Kindler’s Syndrome 207
Hidrocystoma 196 Klippel-Trenaunay (Parkes Weber)
Hirsutism 196 Syndrome 207
Histoplasmosis 197 Knuckle Pads 207
Hot tub Folliculitis 197 Kyrle’s Disease 207
Hunter Syndrome 197 Lamellar Ichthyosis 208
Hurler Syndrome 197 Langerhans Cell Histiocytosis 208
Hypereosinophilic Syndrome 197 Larva Currens 209
Hyper-IgE Syndrome 197 Laugier–Hunziker Syndrome 209
Hyperkeratosis Lenticularis Leiner’s Disease 209
Perstans 198 Leiomyoma Cutis 209
Hypertensive Ulcer 198 Leishmaniasis 210
Hypomelanosis of Ito 198 Lentigo Simplex 210
Ichthyosis Bullosa of Siemens 199 Leprosy 210
Ichthyosis Vulgaris 199 Leukemia Cutis 211
Idiopathic Guttate Leukoplakia 212
Hypomelanosis 199 Lichen Amyloidosus 213
Idiopathic Mid-dermal Elastolysis200 Lichen Nitidus 213
Idiopathic Scrotal Calcinosis 200 Lichen Planus 213
IFAP Syndrome 200 Lichen Sclerosus et Atrophicus 215
Impetiog 200 Lichen Scrofulosorum 216
Impetigo Herpetiformis 201 Lichen Simplex Chronicus 216
Incontinentia Pigmenti 201 Lichen Spinulosus 216
Infantile Digital Fibromatosis 201 Lichen Striatus 217
Infantile Myofibromatosis 201 Linear and Whorled Nevoid
Infectious Mononucleosis 202 Hypermelanosis 217
Inflammatory Linear Verrucous Linear Focal Elastosis 217
Epidermal Nevus 202 Linear IgA Disease 217
Intertrigo 202 Lipodermatosclerosis 218
IPEX Syndrome 202 Lipodystrophy 218
Jessner’s Lymphocytic Lipoid Proteinosis 218
Infiltrate 203 Lipoma 218
Juvenile Hyaline Fibromatosis 203 Livedoid Vasculopathy 218
Juvenile Plantar Dermatosis 203 Lobomycosis 219
Juvenile Xanthogranuloma 203 Lupus Erythematosus 219
Kaposi’s Sarcoma 203 Lupus Miliaris Disseminatum
Kaposi’s Varicelliform Facei 220
Eruption 204 Lupus vulgaris 221
Kawasaki Disease 204 Lymphangioma Circumscriptum 221
Keloids 204 Lymphogranuloma Venereum 222
Keratoacanthoma 205 Lymphomatoid Papulosis 222
Keratolysis Exfoliativa 205 Maffucci Syndrome 223
 xvi Manual of Dermatological Differential Diagnosis

Majocchi Granuloma 223 Neutral Lipid Storage Disease 234

Malakoplakia 223 Neutrophilic Eccrine
Malignant Atrophic Papulosis 223 Hidradenitis 234
Marfan Syndrome 223 Nevoid Basal Cell Carcinoma
Marie-Unna Hypotrichosis 223 Syndrome 234
Mastocytosis 224 Nevus Anemicus 234
McCune-Albright Syndrome 224 Nevus Comedonicus 234
Measles 225 Nevus Depigmentosus 235
Median Raphe Cyst 225 Nevus Flammeus 235
Melanocytic Nevus 225 Nevus Lipomatosus
Melanoma 225 Superficialis 235
Melasma 226 Nevus of Ito 235
Melioidosis 226 Nevus of Ota 236
Melkersson-Rosenthal Nevus Sebaceus 236
Syndrome 226 Nevus Simplex 236
Meningocele 226 Nevus Spilus 237
Meningococcemia 226 Nicolau-Balus Syndrome 237
Menkes Kinky Hair Nocardiosis 237
Syndrome 227 Noonan Syndrome 237
Merkel Cell Carcinoma 227 Nummular Dermatitis 237
Microscopic Polyangiitis 227 Ochronosis, Exogenous 238
Milia 227 Olmsted Syndrome 238
Miliaria 227 Omenn Syndrome 238
Milker’s Nodule 228 Onchocerciasis 238
Milroy’s Disease 228 Oral Florid Papillomatosis 239
Mixed Connective Tissue Oral Hairy Leukoplakia 239
Disease 228 Oral Submucous Fibrosis 239
Molluscum Contagiosum 228 Orf 239
Mondor’s Disease 229 Osteoma Cutis 239
Mongolian Spots 229 Oxalosis 239
Monilethrix 229 Pachydermoperiostosis 239
Morphea 229 Pachyonychia Congenita 240
Mucormycosis 230 Paget’s Disease 240
Muir-Torre Syndrome 231 Pagetoid Reticulosis 240
Multicentric Reticulohistiocytosis 231 Panniculitis 241
Mycetoma 231 Papular and Purpuric Gloves
Naegeli–Franceschetti– and Stockings Syndrome 241
Jadassohn Syndrome 232 Papular Urticaria 241
Nail–Patella Syndrome 232 Papuloerythroderma of Ofuji 241
Naxos Syndrome 232 Papulonecrotic Tuberculid 241
Necrobiosis Lipoidica Diabeticorum Paracoccidioidomycosis 241
232 Parapsoriasis 241
Necrobiotic Xanthogranuloma 233 Paronychia 242
Necrolytic Acral Erythema 233 Pearly Penile Papules 242
Necrolytic Migratory Erythema 233 Pediculosis 242
Necrotizing Fasciitis 233 Peeling Skin Syndrome 242
Nelson Syndrome 233 Pellagra 242
Nephrogenic Systemic Fibrosis 233 Pemphigus 243
Netherton Syndrome 233 Penicilliosis 244
Neurofibromatosis 234 Perforating Calcific Elastosis 244
 Contents xvii

Perforating Folliculitis 244 Erythrokeratoderma 255

Perioral Dermatitis 244 Proteus Syndrome 255
Perniosis 244 Prurigo Nodularis 255
Peutz-Jeghers Syndrome 245 Prurigo Simplex 256
Peyronie’s Disease 245 Pruritic Urticarial Papules and
Phaeohyphomycosis 245 Plaques of Pregnancy 256
Phakomatosis Pigmento+ Pseudocyst of the Auricle 256
vascularis 245 Pseudofolliculitis Barbae 256
Phenylketonuria 245 Pseudopelade of Brocq 256
Pheochromocytoma 245 Pseudoporphyria 256
Piebaldism 246 Pseudoxanthoma Elasticum 256
Piedra 246 Psoriasis 257
Piezogenic Pedal Papules 246 Purpura Fulminans 258
Pigmented Purpuric Pyoderma Gangrenosum 258
Dermatosis 246 Pyogenic granuloma 259
Pilar Cyst 247 Radiation Dermatitis 260
Pilomatricoma 247 Reactive Perforating
Pilonidal Cyst/Sinus 247 Collagenosis 261
Pinta 247 Reflex Sympathetic Dystrophy
Pitted keratolysis 248 Syndrome 261
Pityriasis Alba 248 Refsum Disease 261
Pityriasis Amiantacea 249 Reiter’s Disease 261
Pityriasis Lichenoides Relapsing Fever 262
Chronica 249 Relapsing Polychondritis 262
Pityriasis Lichenoides et Reticular Erythematous
Varioliformis Acuta (PLEVA) 249 Mucinosis 262
Pityriasis Rosea 250 Reticulate Acropigmentation
Pityriasis Rotunda 250 of Kitamura 262
Pityriasis Rubra Pilaris 250 Reticulohistiocytoma 263
Pityrosporum Folliculitis 250 Rheumatoid Nodule 263
Plantar Fibromatosis 251 Rhinoscleroma 263
Poikiloderma of Civatte 251 Rhinosporidiosis 263
Polyarteritis Nodosa 251 Riehl’s Melanosis 263
Polycystic Ovary Syndrome 251 Rosacea 263
Polymorphous Light Eruption 251 Roseola Infantum 264
Porokeratosis 251 Ross Syndrome 264
Porokeratotic Eccrine Ostial Rothmund-Thomson syndrome 264
and Dermal Duct Nevus 253 Rubella 264
Porphyria 253 Rud Syndrome 264
Postinflammatory Sarcoidosis 265
Hyperpigmentation 254 Scabies 266
Postinflammatory Hypopigmentation Scarlet Fever 266
254 Scleredema 267
Post-kala-azar Dermal Sclerema Neonatorum 267
Leishmaniasis 254 Scleromyxedema 267
Pretibial Myxedema 254 Schopf–Schulz–Passarge
Progeria 254 Syndrome 267
Progressive Macular Scrofuloderma 267
Hypopigmentation 255 Scrotal Tongue 268
Progressive Symmetrical Scurvy 268
xviii Manual of Dermatological Differential Diagnosis

Sebaceous Adenoma 268 Tinea Unguium 280

Sebaceous Hyperplasia 268 Tinea Versicolor 281
Seborrheic Dermatitis 269 Toxic Epidermal Necrolysis 281
Seborrheic Keratosis 269 Toxic Shock Syndrome 281
Serum Sickness 269 Transient Neonatal Pustular
Sjögren Larsson Syndrome 269 Melanosis 281
Sjögren-Syndrome 270 Trichinosis 281
Smooth Muscle Hamartoma 270 Trichoepithelioma 282
Sneddon’s Syndrome 270 Trichomycosis Axillaris/Pubis 282
Speckled Lentiginous Nevus 270 Trichorhinophalangeal Syndrome
Spider Angioma 270 282
Spiradenoma 270 Trichostasis Spinulosa 282
Spitz Nevus 270 Trichothiodystrophy 282
Sporotrichosis 271 Trichotillomania 283
Squamous Cell Carcinoma 271 Tropical Ulcer 283
Staphylococcal Scalded Skin Tuberous Sclerosis 283
Syndrome 272 Tufted Angioma 283
Stasis Dermatitis 272 Ulerythema Ophryogenes 284
Steatocystoma Multiplex 272 Umbilical Granuloma 284
Stevens-Johnson Syndrome 272 Unilateral Laterothoracic Exanthem
Striae Distensae 273 284
Subacute Bacterial Endocarditis 274 Urticaria 284
Subcorneal Pustular Urticaria Pigmentosa 285
Dermatosis 274 Varicella 285
Subcutaneous Fat Necrosis Variola 285
of the Newborn 274 Vasculitis 285
Subcutaneous Zygomycosis 274 Verruca Plana 285
Supravenous Serpentine Verruca Vulgaris 285
Hyperpigmentation 274 Verruciform Xanthoma 286
Sweet Syndrome 274 Verrucous Carcinoma 286
Syphilis 275 Verrucous Epidermal Nevus 286
Syringocystadenoma Papilliferum 276 Verrucous Hemangioma 286
Syringoma 277 Vincent’s Disease 287
Syringomyelia 277 Vitiligo 287
Systemic Sclerosis 277 Vogt-Koyanagi-Harada
Syndrome 287
Takayasu’s Disease 278
Waardenburg Syndrome 288
Targetoid Hemosiderotic Heman-
Warty Dyskeratoma 288
gioma 278
Watson Syndrome 288
Terra Firma-Forme Dermatosis 278
Wegener’s Granulomatosis 288
Thromboangiitis Obliterans 278
Werner Syndrome 288
Thyroglossal Duct Cyst 278
White Sponge Nevus 288
Tinea Barbae 278 White-Aldrich Syndrome 288
Tinea Capitis 278 Xanthogranuloma 288
Tinea Corporis 279 Xanthoma 289
Tinea Cruris 279 Xanthoma Disseminatum 289
Tinea Manuum 279 Xeroderma Pigmentosum 290
Tinea Nigra 280 Yellow Nail Syndrome 291
Tinea Pedis 280 Zoon’s Balanitis 291
Bibliography 293
Index 295
 Contents xix

Introduction

T he skill of dermatologic diagnosis depends on accurately recognizing

and classifying the lesions based on their morphology, configuration
(shape), arrangement (spatial relationship between multiple lesions), and
distribution (location, extent, and pattern of involvement).
Morphology of the lesion is the foremost visual finding for diagnosis of
any dermatosis. Categorizing the condition into distinct morphological types
(macule/papule/nodule, etc.) is the first step in the differential diagnosis of
skin diseases. Qualifying the primary morphology (based on shape/color/
presence of scales/associated symptoms, etc.) can further narrow down the
diagnostic possibilities. Multiple lesions are often arranged in distinct patterns
(linear, annular, sporotrichoid, etc.) that can provide important diagnostic
clues. The first part of the manual contains lists of diseases associated with
different primary and secondary lesions of the skin as well as characteristic
arrangements of such lesions.
Distribution of the lesions provides further invaluable clues to the
diagnosis of the condition. Although most dermatoses can occur over any
area of the body, there are distribution patterns peculiar to many skin
conditions. In the second part of the manual, lesions that are characteristically
distributed on different sites are listed.
Signs that are present de novo or elicited by the clinician are often highly
characteristic of many skin conditions. Several cutaneous signs can also
provide important clues to underlying systemic diseases. The reader can find
in the third part of the manual a comprehensive listing with description of
nearly 200 skin signs associated with various dermatoses or internal diseases.
Adverse cutaneous drug reactions are very common. While some patterns,
such as a morbilliform rash, are commonly recognized as such, there is a
plethora of common and not so common patterns of drug reactions that can
resemble any known dermatoses. A meticulous drug history is thus
mandatory for eliciting the etiology of skin diseases. A list of dermatoses
and the drugs most typically/commonly associated with them is provided
in the fourth part of the manual.
The final part of the manual (Chapter 5) provides a brief description of
nearly 600 conditions listed under various headings in the previous chapter.
The readers will find in this section a ready source of information on the
essential diagnostic features of these conditions.
Although listing of conditions by their alphabetical order or by their
etiological groups is generally useful for memorizing the differential
diagnoses, I have deliberately avoided this, and to emulate the thought
process that is generally employed in the actual clinical setting, the diagnoses
or causes are listed in order of their commonness and typicality.
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