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Fitzpatrick’s
Dermatology
ALEXANDER H. ENK, MD
Professor and Chair
Department of Dermatology
University of Heidelberg
Heidelberg, Germany
AMY J. McMICHAEL, MD
Professor and Chair
Department of Dermatology
Wake Forest University School of Medicine
Winston-Salem, North Carolina
JEFFREY S. ORRINGER, MD
Professor and Chief
Division of Cosmetic Dermatology
Department of Dermatology
University of Michigan
Ann Arbor, Michigan
EDITORS
SEWON KANG, MD, MPH
MASAYUKI AMAGAI, MD, PhD
ANNA L. BRUCKNER, MD, MSCS
ALEXANDER H. ENK, MD
DAVID J. MARGOLIS, MD, PhD
AMY J. McMICHAEL, MD
JEFFREY S. ORRINGER, MD
VOLUME I
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
8 Nail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
PART 3 DERMATITIS
Krzysztof Kobielak
22 Atopic Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . .363
Eric L. Simpson, Donald Y. M. Leung,
9 Cutaneous Vasculature . . . . . . . . . . . . . . . . . . . . . . 116
Lawrence F. Eichenfield, & Mark Boguniewicz
Peter Petzelbauer, Robert Loewe, & Jordan S. Pober
Contents
Takashi Hashimoto
72 Genetic Disorders Affecting Dermal
58 Linear Immunoglobulin A Dermatosis and Connective Tissue . . . . . . . . . . . . . . . . . . . . . . . . .1212
Chronic Bullous Disease of Childhood . . . . . . . .992 Jonathan A. Dyer
Matilda W. Nicholas, Caroline L. Rao,
& Russell P. Hall III
74 Lipodystrophy . . . . . . . . . . . . . . . . . . . . . . . . . . . .1295
PART 10 AUTOIMMUNE Abhimanyu Garg
CONNECTIVE TISSUE AND
RHEUMATOLOGIC DISORDERS
61 Lupus Erythematosus . . . . . . . . . . . . . . . . . . . . . .1037 PART 13 MELANOCYTIC DISORDERS
Clayton J. Sontheimer, Melissa I. Costner,
& Richard D. Sontheimer 75 Albinism and Other Genetic Disorders
of Pigmentation . . . . . . . . . . . . . . . . . . . . . . . . . . .1309
62 Dermatomyositis . . . . . . . . . . . . . . . . . . . . . . . . . .1061 Masahiro Hayashi & Tamio Suzuki
Matthew Lewis & David Fiorentino
76 Vitiligo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1330
63 Systemic Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . .1086 Khaled Ezzedine & John E. Harris
Pia Moinzadeh, Christopher P. Denton,
Carol M. Black, & Thomas Krieg 77 Hypermelanoses . . . . . . . . . . . . . . . . . . . . . . . . . .1351
Michelle Rodrigues & Amit G. Pandya
64 Morphea and Lichen Sclerosus . . . . . . . . . . . . . . 1106
Nika Cyrus & Heidi T. Jacobe
PART 17 DISORDERS DUE TO THE 107 Caring for LGBT Persons in Dermatology . . . .1792
Howa Yeung, Matthew D. Mansh,
ENVIRONMENT
Suephy C. Chen, & Kenneth A. Katz
92 Polymorphic Light Eruption . . . . . . . . . . . . . . . . 1611
Alexandra Gruber-Wackernagel
& Peter Wolf
PART 20 NEOPLASIA
93 Actinic Prurigo . . . . . . . . . . . . . . . . . . . . . . . . . . . .1628
108 Benign Epithelial Tumors, Hamartomas,
Travis Vandergriff
and Hyperplasias. . . . . . . . . . . . . . . . . . . . . . . . . .1799
Jonathan D. Cuda, Sophia Rangwala,
94 Hydroa Vacciniforme . . . . . . . . . . . . . . . . . . . . . .1634
& Janis M. Taube
Travis Vandergriff
109 Appendage Tumors of the Skin . . . . . . . . . . . . .1820
95 Actinic Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . .1639
Ruth K. Foreman & Lyn McDivitt Duncan
Robert S. Dawe
110 Epithelial Precancerous Lesions . . . . . . . . . . . . .1857
viii Markus V. Heppt, Gabriel Schlager, & Carola Berking
Contents
115 Melanocytic Nevi . . . . . . . . . . . . . . . . . . . . . . . . . .1944 131 Ectodermal Dysplasias . . . . . . . . . . . . . . . . . . . . .2372
Jonathan D. Cuda, Robert F. Moore, & Klaus J. Busam Elizabeth L. Nieman & Dorothy Katherine Grange
Contents
178 Scabies, Other Mites, and Pediculosis . . . . . . . .3274 Cytokines, Cytokine Receptors, and Growth
Chikoti M. Wheat, Craig N. Burkhart, Factors in Dermatology . . . . . . . . . . . . . . . . . . . .3531
Craig G. Burkhart, & Bernard A. Cohen Andrew Johnston, Yoshikazu Takada, & Sam T. Hwang
xii
Contributors
Dermatology Residency Program, Massachusetts [179] Dermatology, Department of
Walter Reed National Military Dermatology, The University of
Medical Center, Bethesda, Olivier Cogrel, MD Texas, Chief of Dermatology, North
Maryland [27] Dermatologic Surgery and Laser Texas Veterans Affairs Medical
Unit, Dermatology Department, Center, Dallas, Texas [24]
Anna L. Chien, MD CHU Bordeaux, Hôpital Saint-
Assistant Professor, Department André, Bordeaux, France [205] Jonathan D. Cuda, MD
of Dermatology, Johns Hopkins Assistant Professor of Dermatology,
School of Medicine, Baltimore, Bernard A. Cohen, MD Johns Hopkins School of Medicine,
Maryland [106, 185] Johns Hopkins Hospital Baltimore, Baltimore, Maryland [108, 115]
Maryland [178]
Keith A. Choate, MD, PhD Donna A. Culton, MD, PhD
Professor of Dermatology, Genetics Jeffrey I. Cohen, MD Department of Dermatology,
and Pathology, Yale University Chief, Laboratory of Infectious University of North Carolina at
School of Medicine, New Haven, Diseases, National Institute of Chapel Hill, Chapel Hill, North
Connecticut [47] Allergy and Infectious Diseases, Carolina [54]
National Institutes of Health,
Conroy Chow, MD Bethesda, Maryland [164] Nika Cyrus, MD
Assistant Professor, Department Department of Dermatology,
of Dermatology, Loma Linda Philip R. Cohen, MD Parkland Health and Hospital
University, Loma Linda, Professor of Dermatology, System, Dallas, Texas [64]
California [114] University of California San Diego
School of Medicine, San Diego, Adilson da Costa, MD
Luisa Christensen, MD California [36] Emory University School
Center for Medical Mycology, of Medicine, Department of
University Hospitals Cleveland Sean C. Condon, MD Dermatology, Atlanta, Georgia [195]
Medical Center, Case Western Department of Dermatology,
Reserve University, Cleveland, Cleveland Clinic, Cleveland, Jennifer S. Daly, MD
Ohio [188] Ohio [186] Clinical Chief, Infectious Diseases
and Immunology, Professor of
Sean R. Christensen, MD, PhD Melissa I. Costner, MD Medicine, Microbiology and
Assistant Professor of Dermatology, Associate Clinical Professor, Physiological Systems, University
Section of Dermatologic Surgery, Dermatology, UT Southwestern of Massachusetts Medical School,
Yale University School of Medicine, Medical School, North Dallas Worcester, Massachusetts [182]
New Haven, Connecticut [204] Dermatology Associates, Dallas,
Texas [61] Thomas N. Darling, MD, PhD
Angela M. Christiano, PhD Professor and Chair of Dermatology,
Department of Dermatology, George Cotsarelis, MD Uniformed Services University
Department of Genetics and Milton B. Hartzell Professor and of the Health Sciences, Bethesda,
Development, Columbia University, Chair, Department of Dermatology, Maryland [136]
New York, New York [18] Perelman School of Medicine
University of Pennsylvania, Mark D. P. Davis, MD
Emily Y. Chu, MD, PhD Director, Program on Epithelial Professor of Dermatology, Mayo
Assistant Professor of Dermatology, Regeneration and Stem Cells, Clinic College of Medicine,
Hospital of the University of University of Pennsylvania Department of Dermatology,
Pennsylvania, Perelman School Institute for Regenerative Medicine, Rochester, Minnesota [144]
of Medicine, Philadelphia, Philadelphia, Pennsylvania [7]
Pennsylvania [2]
xv
Jeffrey S. Dover, MD, FRCPC Ervin H. Epstein, Jr., MD Ruth K. Foreman, MD, PhD
SkinCare Physicians, Chestnut Hill, Children’s Hospital of Oakland Instructor of Pathology, Harvard
Massachusetts [208] Research Institute, UCSF, Oakland, Medical School, Dermatopathology
California [111] Unit, Department of Pathology,
Lyn McDivitt Duncan, MD Massachusetts General Hospital,
Professor of Pathology, Boston, Massachusetts [109]
Harvard Medical School,
Chief, Dermatopathology Unit,
Department of Pathology,
xvi Massachusetts General Hospital,
Boston, Massachusetts [109]
Contributors
Director Cosmetic and Laser Justin J. Green, MD
Esther E. Freeman, MD, PhD Surgery, Director of Clinical Division of Dermatology, Cooper
Assistant Professor of Dermatology, Research, Department of Medical School of Rowan
Harvard University Medical Dermatology, Saint Louis University University, Camden,
School, Director, Global Health School of Medicine, St. Louis, New Jersey [180]
Dermatology, Massachusetts Missouri [81]
General Hospital, Department Roy C. Grekin, MD
of Dermatology, Boston, Richard G. Glogau, MD Professor of Dermatology, Director,
Massachusetts [168] Clinical Professor of Dermatology, Dermatologic Surgery and Laser
University of California, Center, University of California,
Lars E. French, MD San Francisco, San Francisco, San Francisco, San Francisco,
Professor and Chairman, California [216] California [114]
Department of Dermatology,
University of Zurich, Zurich, Sergij Goerdt, MD Annie Grossberg, MD
Switzerland [39] Professor of Dermatology, Chair Associate Director, Dermatology
of Dermatology, Department Residency Program, Assistant
Sheila Fallon Friedlander, MD of Dermatology, Venereology Professor, Departments of
Professor of Dermatology and and Allergology, University Dermatology and Pediatrics, Johns
Pediatrics, University of California, Medical Center and Medical Hopkins University, Baltimore,
San Diego School of Medicine, Rady Faculty Mannheim, University Maryland [102]
Children’s Hospital, San Diego, of Heidelberg, Mannheim,
San Diego, California [166] Germany [117] Alexandra Gruber-
Wackernagel, MD
Adam J. Friedman, MD Carolyn Goh, MD Medical University of Graz,
Associate Professor of Dermatology, Assistant Clinical Professor of Research Unit for Photodermatology,
Director of Translational Research, Dermatology/Medicine, David Department of Dermatology,
Residency Program Director, Geffen School of Medicine at UCLA, Medical University of Graz, Graz,
Department of Dermatology, George Los Angeles, California [78] Austria [92]
Washington School of Medicine
and Health Sciences, Washington, Chee Leok Goh, MD, MBBS, Johann E. Gudjonsson,
DC [154] M. Med (Int. Med), MRCP (UK), MD, PhD
FRCP (Edin), Hon FACD, FAMS Assistant Professor, Department of
Daniel P. Friedmann, MD (Dermatology) Dermatology, Frances and Kenneth
Westlake Dermatology Clinical Clinical Professor, National Skin Eisenberg Emerging Scholar of
Research Center, Westlake Centre, Singapore [187] the Taubman Medical Research
Dermatology and Cosmetic Surgery, Institute, University of Michigan,
Austin, Texas [212] Leonard H. Goldberg, MD Ann Arbor, Michigan [11, 28, 31]
DermSurgery Associates, Houston,
Ramsay L. Fuleihan, MD Texas [206] Cheryl J. Gustafson, MD
Professor of Pediatrics, St. Vincent Carmel Medical Center,
Northwestern University Feinberg Peter D. Gorevic, MD Carmel, Indiana [214]
School of Medicine, Chicago, Professor of Medicine, Division
Illinois [132] of Rheumatology, Icahn School of Eva N. Hadaschik, MD
Medicine at Mount Sinai, New York, Department of Dermatology,
Abhimanyu Garg, MD New York [125] University Hospital Heidelberg,
Professor of Internal Medicine, Heidelberg, Germany [112]
Chief, Division of Nutrition and Eric W. Gou, MD
Metabolic Diseases, Department of Department of Internal Medicine, Ellen S. Haddock, AB, MBA
Internal Medicine and the Center Division of Gastroenterology University of California, San
for Human Nutrition, Distinguished and Hepatology, University of Diego School of Medicine, La Jolla,
Chair in Human Nutrition Research, Texas Medical Branch, Galveston, California [166] xvii
Dallas, Texas [74] Texas [124]
xviii
Contributors
Department of Dermatology Division of Infectious Diseases, Neil J. Korman, MD, PhD
University of Michigan School Toronto General Hospital, Toronto, Professor, Department of
of Medicine, Ann Arbor, Ontario, Canada [177] Dermatology, Case Western Reserve
Michigan [193] University, Cleveland, Ohio [190]
Ellen J. Kim, MD
Steven R. Jones, MD Sandra J. Lazarus Associate Kenneth H. Kraemer, MD
Ciccarone Center for the Prevention Professor in Dermatology, Chief, DNA Repair Section,
of Heart Disease, Division of Department of Dermatology, Dermatology Branch, Center for
Cardiology, Department of Perelman School of Medicine at Cancer Research, National Cancer
Medicine, Johns Hopkins Hospital, the University of Pennsylvania, Institute, National Institutes of
Baltimore Maryland [126] Perelman Center for Advanced Health, Bethesda, Maryland [130]
Medicine, Philadelphia,
Natanel Jourabchi, MD Pennsylvania [134] Thomas Krieg, MD, FRCP
Resident Dermatology Physician, Department of Dermatology and
Johns Hopkins School of Medicine, Jenny Kim, MD, PhD Venerology, University of Cologne,
Baltimore, Maryland [37] Professor of Dermatology/ Cologne, Germany [63]
Medicine/Nutrition, David Geffen
Andrea Kalus, MD School of Medicine at UCLA, Daniela Kroshinksy, MD, MPH
Associate Professor, University of Los Angeles, California [78] Associate Professor, Harvard
Washington School of Medicine, Medical School, Director of Inpatient
Division of Dermatology, Seattle, Robert S. Kirsner, MD, PhD Dermatology, Director of Pediatric
Washington [137] Chairman and Harvey Blank Dermatology, Massachusetts
Professor, Department of General Hospital/ MassGeneral
Sewon Kang, MD, MPH Dermatology and Cutaneous Hospital for Children, Boston,
Noxell Professor & Chair, Surgery, Professor, Department of Massachusetts [153]
Department of Dermatology, Public Health Sciences, University
Johns Hopkins School of Medicine, of Miami Miller School of Medicine, Akiharu Kubo, MD, PhD
Dermatologist-in-Chief, Johns Miami, Florida [149] Department of Dermatology,
Hopkins Hospital, Baltimore, Keio University School of Medicine,
Maryland [106, 185] Robert Knobler, MD Tokyo, Japan [14]
Associate Professor of Dermatology,
Varvara Kanti, MD Department of Dermatology, Thomas S. Kupper, MD
Department of Dermatology Medical University of Vienna, Thomas B. Fitzpatrick Professor,
and Allergy, Charité- Vienna, Austria [199] Department of Dermatology,
Universitätsmedizin, Berlin, Brigham and Women’s Hospital,
Germany [85] Krzysztof Kobielak, MD, PhD Harvard Medical School, Boston,
Group Leader of Laboratory of Massachusetts [12]
Kenneth A. Katz, MD, Stem Cells, Development and
MSc, MSCE Tissue Regeneration, Centre of Anastasia O. Kurta, DO
Department of Dermatology, New Technologies, University of Dermatology Resident, Department
Kaiser Permanente, San Francisco, Warsaw, Warsaw, Poland, Principal of Dermatology, Saint Louis
California [107] Investigator, Department of University School of Medicine,
Developmental and Cell Biology, St Louis, Missouri [81]
Stephen I. Katz, MD, PhD University of California, Irvine,
National Institute of Arthritis and Irvine, California [8]
Musculoskeletal and Skin Diseases,
Bethesda, Maryland [59]
xix
San Diego Moores Cancer Center, Colorado Denver, Denver, Dermatology, Medical University
San Diego, California [36] Colorado [22] Vienna, Vienna, Austria [9]
Contributors
South Carolina [35] University, Tel Aviv, Israel [53]
Amy J. McMichael, MD
David J. Margolis, MD, PhD Professor and Chair, Department Vineet Mishra, MD
Professor of Dermatology and of Dermatology, Wake Forest Assistant Clinical Professor,
Epidemiology, Department of University School of Medicine, Division of Dermatology and
Dermatology, Department of Winston-Salem, Cutaneous Surgery, The University
Biostatistics and Epidemiology, North Carolina [90] of Texas Health Science Center
University of Pennsylvania at San Antonio, San Antonio,
Perelman School of Medicine, Atul B. Mehta, MA, MB, BChir, Texas [212]
Philadelphia, Pennsylvania [3, 151] MD, FRCP, FRCPath
Professor, University College Maja Mockenhaupt, MD, PhD
M. Peter Marinkovich, MD London, Royal Free Campus Dokumentationszentrum schwerer
Attending Physician, VA Palo Alto and Royal Free London NHS Hautreaktionen (dZh), Department
Health Care System, Associate Foundation Trust, London, of Dermatology, Medical Center,
Professor and Director, Blistering United Kingdom [127] University of Freiburg, Freiburg,
Disease Clinic, Department of Germany, Dokumentationszentrum
Dermatology, Program in Epithelial Thomas Mentzel, MD schwerer Hautreaktionen (dZh),
Biology, Stanford University Consultant Dermatopathologist Department of Dermatology,
School of Medicine, Stanford, and Associated Professor, Medical Center and Medical Faculty,
California [60] Dermatopathologie Bodensee, University of Freiburg, Freiburg,
Friedrichshafen, Germany [122] Germany [43, 44]
Seth S. Martin, MD, MHS
Ciccarone Center for the Prevention Peter A. Merkel, MD, MPH Robert L. Modlin, MD, PhD
of Heart Disease, Division of Chief, Division of Rheumatology, Klein Professor of Dermatology,
Cardiology, Department of Professor of Medicine and Distinguished Professor of Medicine
Medicine, Johns Hopkins Hospital, Epidemiology, University of and Microbiology, Immunology
Baltimore Maryland [126] Pennsylvania, Philadelphia, and Molecular Genetics, Chief,
Pennsylvania [139] Division of Dermatology, Vice
Kathryn J. Martires, MD Chair for Cutaneous Medicine
Clinical Assistant Professor, Robert G. Micheletti, MD and Dermatology Research,
Department of Dermatology, University of Pennsylvania, David Geffen School of Medicine,
Stanford University School of Department of Dermatology, UCLA Med-Derm, Los Angeles,
Medicine, Palo Alto, California [129] Philadelphia, Pennsylvania [133] California [11]
xxii
Contributors
Manuel P. Pereira, MD, PhD Dermatology, Université Paris-Est
Center of Chronic Pruritus, Julie Powell, MD, FRCPC Créteil, Créteil, France [43, 44]
Department of Dermatology, Clinical Professor, Dermatology and
University of Münster, Münster, Pediatrics, University of Montreal, Anne H. Rowley, MD
Germany [21] Director, Pediatric Dermatology, Professor of Pediatrics and of
CHU Sainte-Justine, Montreal, Microbiology/Immunology,
Powell Perng, MD Quebec, Canada [70] Feinberg School of Medicine,
Johns Hopkins School of Medicine, Northwestern University Attending
Department of Dermatology, Julie S. Prendiville, MB, FRCPC Physician, Division of Infectious
Baltimore, Maryland [83] Clinical Professor in Pediatrics, Diseases, Ann and Robert H. Lurie
University of British Columbia, Children’s Hospital of Chicago,
Peter Petzelbauer, MD Head, Division of Pediatric Chicago, Illinois [142]
Professor of Microvascular Research, Dermatology, BC Children’s
Department of Dermatology, Hospital, Vancouver, British Thomas M. Rünger, MD, PhD
Medical University Vienna, Vienna, Columbia, Canada [34] Professor of Dermatology,
Austria [9] Pathology, and Laboratory
Katherine Püttgen, MD Medicine, Department of
Robert G. Phelps, MD Assistant Professor of Dermatology, Boston University
Professor, Departments of Dermatology and Pediatrics, Johns School of Medicine, Boston,
Dermatology and Pathology, Icahn Hopkins University, Baltimore, Massachusetts [17, 130]
School of Medicine at Mount Sinai, Maryland [118]
New York, New York [125] Arturo P. Saavedra, MD, PhD
Sophia Rangwala, MD Associate Professor of Dermatology,
Rita O. Pichardo, MD Fellow, Dermatopathology, Johns Harvard University Medical School,
Associate Professor of Dermatology, Hopkins School of Medicine, Vice-Chairman for Clinical Affairs
Wake Forest University School of Baltimore, Maryland [108] and Medical Director, Massachusetts
Medicine, Winston-Salem, North General Hospital, Boston,
Carolina [174, 175] Caroline L. Rao, MD Massachusetts [168]
Assistant Professor, Department
Warren W. Piette, MD of Dermatology, Duke University Mohammed D. Saleem,
Chair, Division of Dermatology, Medical Center, Duke University MD, MPH
Department of Medicine, John Medical Center, Durham, Department of Dermatology,
H Stroger, Jr. Hospital of Cook North Carolina [58] Wake Forest University School of
County, Professor, Department Medicine, Winston-Salem,
of Dermatology, Rush University Bobby Y. Reddy, MD North Carolina [183]
Medical Center, Chicago, Clinical Fellow, Department of
Illinois [66] Dermatology, Wellman Center for Iman Salem, MD
Photomedicine, Massachusetts Center for Medical Mycology,
Mark R. Pittelkow, MD General Hospital, Boston, University Hospitals Cleveland
Professor of Dermatology, Mayo Massachusetts [194] Medical Center, Case Western
Clinic, Chair of Dermatology, Reserve University, Cleveland,
Scottsdale, Arizona [32, 33, 67] Michelle Rodrigues, MBBS Ohio [188]
(Hons), FACD
Jordan S. Pober, MD, PhD Chroma Dermatology, Melbourne, Claudio Guedes Salgado,
Bayer Professor of Translational Australia, Department of MD, PhD
Medicine and Professor of Dermatology, St Vincent’s Hospital, Associate Professor, Pará Federal
Immunobiology, Pathology and Fitzroy, Victoria, Australia [77] University, President of the Brazilian
Dermatology, Department of Leprosy Society, Marituba, Pará,
Immunobiology, Yale School Thomas E. Rohrer, MD Brazil [159]
of Medicine, New Haven, SkinCare Physicians, Chestnut Hill,
Connecticut [9] Massachusetts [203] xxiii
Contributors
Unit, Tisch Hospital, New York, NHS Foundation Trust, Department Institute of Biomedical and Health
New York [138] of Dermatology, Addenbrooke’s Sciences, Hiroshima University,
Hospital, Cambridge University Hiroshima, Japan [41]
John Stewart Spencer, PhD Hospitals NHS Foundation Trust,
Associate Professor, Microbiology, Cambridge, United Kingdom [167] Junko Takeshita, MD,
Immunology and Pathology, PhD, MSCE
Colorado State University, Georg Stingl, MD Assistant Professor of Dermatology
Fort Collins, Colorado [159] Professor and Chair, Division of and Epidemiology, Department
Immunology, Allergy and Infectious of Dermatology, Department of
Eli Sprecher, MD, PhD Diseases (DIAID), Department of Biostatistics and Epidemiology,
Professor and Chair, Department Dermatology, Medical University of University of Pennsylvania
of Dermatology, Tel Aviv Sourasky Vienna, Vienna, Austria [10] Perelman School of Medicine,
Medical Center, Tel-Aviv, Israel and Philadelphia, Pennsylvania [3]
Department of Human Molecular Erik J. Stratman, MD
Genetics and Biochemistry, Sackler Clinical Professor, Department Carolina Talhari, MD
Faculty of Medicine, Tel Aviv of Dermatology, University of Associate Professor of Dermatology,
University, Tel Aviv, Israel, Tel Aviv, Wisconsin School of Medicine State University of Amazonas,
Israel [48] and Public Health, Marshfield, Manaos, Brazil [171]
Wisconsin [98]
Rudolf Stadler, MD, PhD Jean Y. Tang, MD, PhD
University Clinic for Dermatology, Lindsay C. Strowd, MD Department of Dermatology,
Johannes Wesling Medical Centre, Assistant Professor of Dermatology, Stanford University, School
University of Bochum, Minden, Wake Forest University School of of Medicine, Redwood City,
Germany [119, 120] Medicine, Winston-Salem, California [111]
North Carolina [175]
Sonja Ständer, MD Akiko Tanikawa, MD, PhD
Center of Chronic Pruritus, Dae Hun Suh, MD, PhD Assistant Professor, Department
Department of Dermatology, Professor, Department of of Dermatology, Keio University
University of Münster, Münster, Dermatology, Seoul National School of Medicine, Tokyo,
Germany [21] University College of Medicine, Japan [68]
Acne and Rosacea Research
John R. Stanley, MD Laboratory, Seoul National Janis M. Taube, MD
Professor, Department of University Hospital, Seoul, Associate Professor of Dermatology,
Dermatology, Perelman School South Korea [26] Johns Hopkins School of Medicine,
of Medicine, University of Section Head, Dermatopathology,
Pennsylvania, Philadelphia, Kathryn N. Suh, MD, FRCPC Baltimore, Maryland [108]
Pennsylvania [52] Associate Professor of Medicine,
University of Ottawa, Division of Bailey Tayebi, MD, MBA
William G. Stebbins, MD Infectious Diseases The Ottawa Total Skin and Beauty Dermatology,
Vanderbilt University, Nashville, Hospital, Ottawa, Ontario, Birmingham, Alabama [213]
Tennessee [214] Canada [177]
Michael D. Tharp, MD
Christopher J. Steen, MD, FAAD Tamio Suzuki, MD, PhD The Clark W. Finnerud, MD
Portland, Maine [181] Professor and Chairman of Professor and Chair, Department
Dermatology, Yamagata University of Dermatology, Rush University
Faculty of Medicine, Yamagata, Medical Center, Chicago,
Japan [75] Illinois [42, 189]
xxv
Contributors
Professor of Dermatology of Medicine at the University Immunology, Dessau Medical
and Bioimmunotherapy, Vice of Pennsylvania, Philadelphia, Center, Brandenburg Medical
Chair of the Department of Pennsylvania [123] School Theodor Fontane, Dessau,
Dermatology, Medical University Germany [6, 82, 141]
of Graz, Research Unit for Kim B. Yancey, MD
Photodermatology, Department of Professor and Chair, Department of
Dermatology, Medical University of Dermatology, University of Texas
Graz, Graz, Austria [92] Southwestern Medical Center,
Dallas, Texas [55]
Gary S. Wood, MD
Johnson Professor and Chairman, Howa Yeung, MD
Department of Dermatology, School Chief Resident in Dermatology,
of Medicine and Public Health, Emory University School of
University of Wisconsin-Madison, Medicine, Atlanta, Georgia [107]
Madison, Wisconsin [30]
xxvii
A much-treasured legacy of Dr. Thomas B. Fitzpat- To further enhance the utility of this gold-standard
rick, who served as editor-in-chief for the first four textbook we have also improved the indexing. A good
editions of the book, Fitzpatrick’s Dermatology in index is imperative to allow readers, including busy
General Medicine (DIGM) has always aimed to be a practicing clinicians, to easily and quickly find the
comprehensive source of information for those inter- particular information about a concept, condition, or
ested in the clinical and basic science of dermatol- therapy that they are interested in at any given time.
ogy. Indeed, from the very first edition of Fitzpatrick’s We hope that you agree the improved indexing allows
DIGM, printed in 1971, this authoritative textbook you to achieve this aim.
has been grounded in science. We have continued No modern textbook is complete without an online
this tradition in the ninth edition of the book whilst presence. The ninth edition is also available in the
rearranging the discussion to make it more reader online format, and we plan to regularly post online
friendly and to minimize repetition. With coverage updates to the book as new studies and/or guide-
of subject matters expanding beyond General Medi- lines are published. You will also have access to other
cine, we have appropriately modified the book title useful features in the online version of Fitzpatrick’s
to Fitzpatrick’s Dermatology. Important general basic Dermatology on AccessMedicine.com.
science concepts are extensively covered in dedicated Finally, as a completely new group of editors that is
chapters appearing in an early section of the book, diverse in expertise and international in location of prac-
allowing subsequent clinical chapters to focus on rel- tice, we have endeavored to build on the achievements
evant disease-specific pathophysiology in addition of previous editorial groups led by Drs. Thomas B.
to clinical features, diagnosis, clinical course, and Fitzpatrick, Irwin M. Freedberg, Klaus Wolff, and
management. Lowell A. Goldsmith, whilst providing fresh insight
Dermatology is a particularly visual specialty. In into the content, new thinking regarding the optimal
the preparation of this edition of the book, we have structure of the book, and ultimately helping the book
placed special emphasis on display items (in the form to evolve into the most relevant resource for the modern
of clinical images, tables, and algorithmic summa- practicing or trainee dermatologist or skin biologist.
ries), as we strongly believe that these components
are vital for the complete understanding of all read- Sewon Kang
ers, but particularly for those in training. What better Masayuki Amagai
way to optimize the visual content provided in our Anna L. Bruckner
chapters than to seek input from trainees themselves? Alexander H. Enk
We had trainees review every chapter and provide David J. Margolis
feedback on additional display items they would find Amy J. McMichael
useful. Jeffrey S. Orringer
We thank the many expert authors who wrote chap- McGraw-Hill Education who kept the whole edito-
ters for the ninth edition of Fitzpatrick’s Dermatology. rial team motivated and helped to bring our ideas to
We greatly appreciate the time they dedicated to creat- fruition, and to our editorial project manager Bryony
ing their masterpieces and acknowledge how difficult Mearns, who helped to coordinate submission and
it must have been to fit the task in with the demands review of the 217 chapters, keep on top of the status
of their dermatology practice, teaching, and research. of each chapter, and encourage authors and editors to
We are truly grateful. We also appreciate their patience progress with their book-related tasks. We also appre-
with the editorial team while we reviewed the sub- ciate the efforts of Kim Davis and Sonam Arora who
missions and then reviewed them again because we expertly coordinated everything from submission
wanted to carefully consider all the visual elements of the finalized chapters to the McGraw-Hill team
included in the book. through to print publication.
With regard to visual elements, we owe much grati- Finally, we are truly grateful for the understand-
tude to Noori Kim and Hester Lim who took the time ing and patience of our families. Without their sup-
to carefully read every individual chapter and provide port, this textbook would never have been completed.
detailed feedback on what additional display items A book like Fitzpatrick’s Dermatology demands many
they thought would aid the reader. With more than 200 evening and weekend hours that would normally be
chapters included in the book, we appreciate the sheer spent with loved ones, and we thank them for allow-
enormity of this task and their dedication to attention ing us to dedicate many of these hours to Fitzpatrick’s
to detail. Dermatology.
As a completely new editorial board, we are very
grateful for the engagement, advice, and encouragement Sewon Kang
afforded to us by the previous editor-in-chief Lowell Masayuki Amagai
A. Goldsmith. We truly appreciate the time and effort Anna L. Bruckner
he invested to enable the smooth transition of editorial Alexander H. Enk
direction for the new edition of this much-loved book. David J. Margolis
A special shout-out to Karen Edmonson, our Amy J. McMichael
straight-talking and very patient senior editor at Jeffrey S. Orringer
APPROACH TO THE
THE ART AND SCIENCE PATIENT
OF DERMATOLOGIC HISTORY
DIAGNOSIS Dermatology is a visual specialty, and some skin con-
The diagnosis and treatment of cutaneous diseases ditions may be diagnosed at a glance. History may be
requires the physician’s ability to recognize the pri- crucial in complex cases, such as the patient with rash
mary lesions and reaction patterns of the skin, and to and fever, or the patient with generalized pruritus.
put these visual clues into context with the patient’s There is therapeutic value in receiving a patient’s nar-
history and overall health. In this chapter, we discuss a rative thread, as they feel heard, and they may reveal
fundamental approach to the patient presenting with a information relevant to treatment choice or invite
skin problem. We introduce the technical vocabulary of opportunities for education and reassurance. In prac-
dermatologic description, also known as morphology. tice, many dermatologists take a brief history, perform
Accurately identifying morphology is an essential step a physical examination, then undertake more detailed
exposures
■ Therapies tried, including nonprescription or home remedies, and
PHYSICAL EXAMINATION response to therapy
■ Prior similar problems, prior diagnosis, results of biopsies or other
Plaque: A plaque is a solid plateau-like elevation Vesicles and bullae arise from cleavage at various
or depression that has a diameter of 1 cm or larger levels of the epidermis (intraepidermal) or the dermal–
(Fig. 1-4). epidermal interface (subepidermal), sometimes extend-
ing into the dermis. The tenseness or flaccidity of the
Nodule: A nodule is a palpable lesion greater than vesicle or bulla may help determine the depth of the
1 cm with a domed, spherical or ovoid shape. They
split. However, reliable differentiation requires histo-
may be solid or cystic. Depending on the anatomic
pathologic examination of the blister edge.
component(s) primarily involved, nodules are of
5 main types: (1) epidermal, (2) epidermal–dermal, Pustule: A pustule is a circumscribed, raised papule
(3) dermal, (4) dermal–subdermal, and (5) subcutane- in the epidermis or infundibulum containing visible
ous. Texture is an important additional feature of nod- pus. The purulent exudate, composed of leukocytes
ules: firm, soft, boggy, fluctuant, etc. Similarly, different with or without cellular debris, may contain organisms
surfaces of nodules, such as smooth, keratotic, ulcer- or may be sterile. The exudate may be white, yellow,
ated, or fungating, also help direct diagnostic consider- or greenish-yellow in color. Pustules may vary in size
ations (Fig. 1-5). Tumor, also sometimes included under and, in certain situations, may coalesce to form “lakes”
the heading of nodule, may be used to describe a more of pus. When associated with hair follicles, pustules
irregularly shaped mass, benign or malignant. may appear conical and contain a hair in the center
(Fig. 1-8).
6
Figure 1-8 Pustule, pustular psoriasis. Figure 1-9 Ichthyosiform scale, ichthyosis vulgaris.
or decreased elasticity of the involved tissue. Fissures common types of color on the skin are variations
frequently occur on the palms and soles where the in brown (hyperpigmentation) and red (erythema),
thick stratum corneum is least expandable. which will be discussed in depth below. Other colors
and their histopathologic correlations are described in
Table 1-5.
inflammation leading to hyperemia (subtle vascular to purple hue can result from the either malformed or
dilation). More saturated red to purple can indicate ectopic blood vessels (Fig. 1-13) or extravasated erythro-
8 intense hyperemia or vascular congestion (also called cytes (petechiae or purpura, see “vascular reaction pat-
rubor, as seen in erysipelas); even more saturated red tern” below). Variations in the hue of erythema are vast
9
Figure 1-14 Violaceous Gottron papules, dermatomyositis. Figure 1-16 Yellow, necrobiosis lipoidica diabeticorum.
Figure 1-17 Annular lesion, granuloma annulare. Figure 1-19 Reticular eruption, livedo racemosa.
::
Foundations of Clinical Dermatology
from the edges to the center (nummular eczema, Stellate: Having multiple angulated edges, resem-
plaque-type psoriasis, discoid lupus) (Fig. 1-18). bling a star (Fig. 1-11).
10
Figure 1-18 Nummular lesion, nummular dermatitis. Figure 1-20 Serpiginous erythema, jellyfish sting.
Updated editions will replace the previous one—the old editions will
be renamed.
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