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 Fitzpatrick’s
Dermatology
Ninth Edition

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

Kang_DIGM-FM_Vol-I.indd 3 08/12/18 5:31 pm

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 SEWON KANG, MD, MPH
Noxell Professor and Chair
Department of Dermatology
Johns Hopkins School of Medicine
Dermatologist-in-Chief
Johns Hopkins Hospital
Baltimore, Maryland

MASAYUKI AMAGAI, MD, PhD

Professor and Chair
Department of Dermatology
Keio University School of Medicine
Tokyo, Japan

ANNA L. BRUCKNER, MD, MSCS

Associate Professor of Dermatology and Pediatrics
University of Colorado School of Medicine
Section Head, Pediatric Dermatology
Children’s Hospital Colorado
Aurora, Colorado

ALEXANDER H. ENK, MD
Professor and Chair
Department of Dermatology
University of Heidelberg
Heidelberg, Germany

DAVID J. MARGOLIS, MD, PhD

Professor of Dermatology and Epidemiology
Department of Dermatology
Department of Biostatistics and Epidemiology
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania

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

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 CONTENTS

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii 10 The Immunological Structure of the Skin . . . . . .130

Georg Stingl & Marie-Charlotte Brüggen
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxix

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxi 11 Cellular Components of the Cutaneous

Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Johann E. Gudjonsson & Robert L. Modlin

Volume One 12 Soluble Mediators of the Cutaneous

Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . . .159
Allen W. Ho & Thomas S. Kupper

PART 1 FOUNDATIONS OF CLINICAL 13 Basic Principles of Immunologic Diseases

DERMATOLOGY in Skin (Pathophysiology of Immunologic/
Inflammatory Skin Diseases) . . . . . . . . . . . . . . . . .192
1 Fundamentals of Clinical Dermatology: Keisuke Nagao & Mark C. Udey
Morphology and Special Clinical
Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 14 Skin Barrier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206
Erin H. Amerson, Susan Burgin, & Kanade Shinkai Akiharu Kubo & Masayuki Amagai

2 Pathology of Skin Lesions . . . . . . . . . . . . . . . . . . . .18 15 Epidermal and Dermal Adhesion. . . . . . . . . . . . .232

Rosalie Elenitsas & Emily Y. Chu Leena Bruckner-Tuderman & Aimee S. Payne

3 Epidemiology and Public Health 16 Microbiome of the Skin. . . . . . . . . . . . . . . . . . . . . .253

in Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Heidi H. Kong
Junko Takeshita & David J. Margolis
17 Cutaneous Photobiology . . . . . . . . . . . . . . . . . . . .265
Thomas M. Rünger

PART 2 STRUCTURE AND FUNCTION 18 Genetics in Relation to the Skin . . . . . . . . . . . . . .289

Etienne C. E. Wang, John A. McGrath,
OF SKIN & Angela M. Christiano
4 Developmental Biology of the Skin . . . . . . . . . . . .49
Luis Garza 19 Carcinogenesis and Skin. . . . . . . . . . . . . . . . . . . . .310
Kenneth Y. Tsai & Andrzej A. Dlugosz
5 Growth and Differentiation of the Epidermis . . . .62
Terry Lechler 20 Pigmentation and Melanocyte Biology . . . . . . . .328
Stephen M. Ostrowski & David E. Fisher
6 Skin Glands: Sebaceous, Eccrine, and
Apocrine Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 21 Neurobiology of the Skin . . . . . . . . . . . . . . . . . . . .351
Christos C. Zouboulis Sonja Ständer, Manuel P. Pereira,
& Thomas A. Luger
7 Biology of Hair Follicles . . . . . . . . . . . . . . . . . . . . . .89
George Cotsarelis & Vladimir Botchkarev

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

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 23 Nummular Eczema, Lichen Simplex 38 Subcorneal Pustular Dermatosis
Chronicus, and Prurigo Nodularis . . . . . . . . . . . .385 (Sneddon-Wilkinson Disease) . . . . . . . . . . . . . . . .617
Jonathan I. Silverberg Franz Trautinger & Herbert Hönigsmann

24 Allergic Contact Dermatitis . . . . . . . . . . . . . . . . . .395 39 Autoinflammatory Disorders . . . . . . . . . . . . . . . .621

Jake E. Turrentine, Michael P. Sheehan, Takashi K. Satoh & Lars E. French
& Ponciano D. Cruz, Jr.
40 Eosinophilic Diseases . . . . . . . . . . . . . . . . . . . . . . .649
25 Irritant Dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . .414 Hideyuki Ujiie & Hiroshi Shimizu
Susan T. Nedorost
41 Urticaria and Angioedema. . . . . . . . . . . . . . . . . . .684
26 Seborrheic Dermatitis . . . . . . . . . . . . . . . . . . . . . . .428 Michihiro Hide, Shunsuke Takahagi,
Dae Hun Suh & Takaaki Hiragun

27 Occupational Skin Diseases . . . . . . . . . . . . . . . . . .438 42 Mastocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .710

Contents

Andy Chern, Casey M. Chern, & Boris D. Lushniak Michael D. Tharp

PART 4 PSORIASIFORM DISORDERS PART 7 REACTIVE ERYTHEMAS

28 Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457 43 Erythema Multiforme . . . . . . . . . . . . . . . . . . . . . . .723
Johann E. Gudjonsson & James T. Elder Jean-Claude Roujeau & Maja Mockenhaupt

29 Pityriasis Rubra Pilaris . . . . . . . . . . . . . . . . . . . . . .498 44 Epidermal Necrolysis (Stevens-Johnson

Knut Schäkel Syndrome and Toxic Epidermal Necrolysis) . . . .733
Maja Mockenhaupt & Jean-Claude Roujeau
30 Parapsoriasis and Pityriasis Lichenoides . . . . . .505
Stefan M. Schieke & Gary S. Wood 45 Cutaneous Reactions to Drugs . . . . . . . . . . . . . . .749
Kara Heelan, Cathryn Sibbald, & Neil H. Shear
31 Pityriasis Rosea . . . . . . . . . . . . . . . . . . . . . . . . . . . .518
Matthew Clark & Johann E. Gudjonsson 46 Erythema Annulare Centrifugum and Other
Figurate Erythemas . . . . . . . . . . . . . . . . . . . . . . . . .765
Christine S. Ahn & William W. Huang

PART 5 LICHENOID AND

GRANULOMATOUS DISORDERS
PART 8 DISORDERS OF CORNIFICATION
32 Lichen Planus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .527
Aaron R. Mangold & Mark R. Pittelkow 47 The Ichthyoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . .775
Keith A. Choate & Leonard M. Milstone
33 Lichen Nitidus and Lichen Striatus . . . . . . . . . . .554
Aaron R. Mangold & Mark R. Pittelkow 48 Inherited Palmoplantar Keratodermas . . . . . . . .816
Liat Samuelov & Eli Sprecher
34 Granuloma Annulare . . . . . . . . . . . . . . . . . . . . . . .564
Julie S. Prendiville 49 Keratosis Pilaris and Other Follicular
Keratotic Disorders . . . . . . . . . . . . . . . . . . . . . . . . .867
35 Sarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .572 Anna L. Bruckner
Richard Marchell
50 Acantholytic Disorders of the Skin . . . . . . . . . . . .877
Alain Hovnanian

PART 6 NEUTROPHILIC, EOSINOPHILIC, 51 Porokeratosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .901

Cathal O’Connor, Grainne M. O’Regan,
AND MAST CELL DISORDERS & Alan D. Irvine
36 Sweet Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . .587
Philip R. Cohen & Razelle Kurzrock
PART 9 VESICULOBULLOUS DISORDERS
37 Pyoderma Gangrenosum . . . . . . . . . . . . . . . . . . . .605
Natanel Jourabchi & Gerald S. Lazarus 52 Pemphigus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .909
vi Aimee S. Payne & John R. Stanley

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 53 Paraneoplastic Pemphigus. . . . . . . . . . . . . . . . . . .934 69 Relapsing Polychondritis . . . . . . . . . . . . . . . . . . . 1186
Grant J. Anhalt & Daniel Mimouni Camille Francès

54 Bullous Pemphigoid . . . . . . . . . . . . . . . . . . . . . . . .944

Donna A. Culton, Zhi Liu, & Luis A. Diaz
PART 11 DERMAL CONNECTIVE
55 Mucous Membrane Pemphigoid . . . . . . . . . . . . .960 TISSUE DISORDERS
Kim B. Yancey
70 Anetoderma and Other Atrophic Disorders
56 Epidermolysis Bullosa Acquisita . . . . . . . . . . . . .971 of the Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1193
David T. Woodley & Mei Chen Catherine Maari & Julie Powell

57 Intercellular Immunoglobulin (Ig) 71 Acquired Perforating Disorders . . . . . . . . . . . . .1203

A Dermatosis (IgA Pemphigus) . . . . . . . . . . . . . .981 Garrett T. Desman & Raymond L. Barnhill

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

59 Dermatitis Herpetiformis . . . . . . . . . . . . . . . . . . .1002 PART 12 SUBCUTANEOUS TISSUE

Stephen I. Katz
DISORDERS
60 Inherited Epidermolysis Bullosa. . . . . . . . . . . . . 1011
73 Panniculitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1251
M. Peter Marinkovich
Eden Pappo Lake, Sophie M. Worobec,
& Iris K. Aronson

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

65 Psoriatic Arthritis and Reactive Arthritis . . . . . 1127 PART 14 ACNEIFORM DISORDERS

Ana-Maria Orbai & John A. Flynn
78 Acne Vulgaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1391
Carolyn Goh, Carol Cheng, George Agak,
66 Rheumatoid Arthritis, Juvenile Idiopathic
Andrea L. Zaenglein, Emmy M. Graber,
Arthritis, Adult-Onset Still Disease, and
Diane M. Thiboutot, & Jenny Kim
Rheumatic Fever . . . . . . . . . . . . . . . . . . . . . . . . . . 1146
Warren W. Piette
79 Rosacea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1419
Martin Steinhoff & Jörg Buddenkotte
67 Scleredema and Scleromyxedema . . . . . . . . . . . 1163
Roger H. Weenig & Mark R. Pittelkow
80 Acne Variants and Acneiform Eruptions. . . . . .1448
Andrea L. Zaenglein, Emmy M. Graber,
68 Sjögren Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 1170
& Diane M. Thiboutot
Akiko Tanikawa
vii

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 96 Solar Urticaria. . . . . . . . . . . . . . . . . . . . . . . . . . . . .1650
PART 15 DISORDERS OF ECCRINE Marcus Maurer, Joachim W. Fluhr, & Karsten Weller
AND APOCRINE SWEAT GLANDS
97 Phototoxicity and Photoallergy. . . . . . . . . . . . . .1657
81 Hyperhidrosis and Anhidrosis . . . . . . . . . . . . . .1459 Henry W. Lim
Anastasia O. Kurta & Dee Anna Glaser
98 Cold Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1666
82 Bromhidrosis and Chromhidrosis . . . . . . . . . . .1469 Ashley N. Millard, Clayton B. Green,
Christos C. Zouboulis & Erik J. Stratman

83 Fox-Fordyce Disease . . . . . . . . . . . . . . . . . . . . . . .1475 99 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1679

Powell Perng & Inbal Sander Benjamin Levi & Stewart Wang

84 Hidradenitis Suppurativa . . . . . . . . . . . . . . . . . .1480

Ginette A. Okoye
Contents

PART 18 PSYCHOSOCIAL SKIN DISEASE

100 Delusional, Obsessive-Compulsive, and
PART 16 DISORDERS OF THE HAIR Factitious Skin Diseases . . . . . . . . . . . . . . . . . . . .1693
Mio Nakamura, Josie Howard, & John Y. M. Koo
AND NAILS
85 Androgenetic Alopecia . . . . . . . . . . . . . . . . . . . . .1495 101 Drug Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1705
Ulrike Blume-Peytavi & Varvara Kanti Nicholas Frank, Cara Hennings, & Jami L. Miller

86 Telogen Effluvium . . . . . . . . . . . . . . . . . . . . . . . . .1507 102 Physical Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . .1717

Manabu Ohyama Kelly M. MacArthur & Annie Grossberg

87 Alopecia Areata . . . . . . . . . . . . . . . . . . . . . . . . . . .1517

Nina Otberg & Jerry Shapiro
PART 19 SKIN CHANGES ACROSS
88 Cicatricial Alopecias . . . . . . . . . . . . . . . . . . . . . . .1524 THE SPAN OF LIFE
Nina Otberg & Jerry Shapiro
103 Neonatal Dermatology . . . . . . . . . . . . . . . . . . . . .1727
89 Hair Shaft Disorders . . . . . . . . . . . . . . . . . . . . . . .1537 Raegan Hunt, Mary Wu Chang, & Kara N. Shah
Leslie Castelo-Soccio & Deepa Patel
104 Pediatric and Adolescent Dermatology. . . . . . .1750
90 Hirsutism and Hypertrichosis. . . . . . . . . . . . . . .1555 Mary Wu Chang
Thusanth Thuraisingam & Amy J. McMichael
105 Skin Changes and Diseases in Pregnancy . . . . .1765
91 Nail Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . .1568 Lauren E. Wiznia & Miriam Keltz Pomeranz
Eckart Haneke
106 Skin Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1779
Michelle L. Kerns, Anna L. Chien, & Sewon Kang

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

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 111 Basal Cell Carcinoma and Basal Cell 127 Fabry Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2292
Nevus Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . .1884 Atul B. Mehta & Catherine H. Orteu
Jean Y. Tang, Ervin H. Epstein, Jr., &
Anthony E. Oro 128 Calcium and Other Mineral Deposition
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2307
112 Squamous Cell Carcinoma and Janet A. Fairley & Adam B. Aronson
Keratoacanthoma. . . . . . . . . . . . . . . . . . . . . . . . . .1901
Anke S. Lonsdorf & Eva N. Hadaschik 129 Graft-Versus-Host Disease . . . . . . . . . . . . . . . . . .2320
Kathryn J. Martires & Edward W. Cowen
113 Merkel Cell Carcinoma . . . . . . . . . . . . . . . . . . . . .1920
Aubriana McEvoy & Paul Nghiem 130 Hereditary Disorders of Genome Instability
and DNA Repair . . . . . . . . . . . . . . . . . . . . . . . . . .2342
114 Paget’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . .1934 John J. DiGiovanna, Thomas M. Rünger, &
Conroy Chow, Isaac M. Neuhaus, & Roy C. Grekin Kenneth H. Kraemer

Contents
115 Melanocytic Nevi . . . . . . . . . . . . . . . . . . . . . . . . . .1944 131 Ectodermal Dysplasias . . . . . . . . . . . . . . . . . . . . .2372
Jonathan D. Cuda, Robert F. Moore, & Klaus J. Busam Elizabeth L. Nieman & Dorothy Katherine Grange

116 Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1982 132 Genetic Immunodeficiency Diseases . . . . . . . . .2394

Jessica C. Hassel & Alexander H. Enk Ramsay L. Fuleihan & Amy S. Paller

117 Histiocytosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2018 133 Skin Manifestations of Internal

Astrid Schmieder, Sergij Goerdt, & Jochen Utikal
118 Vascular Tumors . . . . . . . . . . . . . . . . . . . . . . . . . .2042
Kelly M. MacArthur & Katherine Püttgen
119 Cutaneous Lymphoma . . . . . . . . . . . . . . . . . . . . .2072
Martine Bagot & Rudolf Stadler
120 Cutaneous Pseudolymphoma . . . . . . . . . . . . . . .2108
Werner Kempf, Rudolf Stadler, & Martine Bagot
121 Neoplasias and Hyperplasias of
Muscular and Neural Origin . . . . . . . . . . . . . . . .2130
Hansgeorg Müller & Heinz Kutzner
Organ Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . .2425
Amy K. Forrestel & Robert G. Micheletti
134 Cutaneous Paraneoplastic Syndromes . . . . . . .2441
Manasmon Chairatchaneeboon & Ellen J. Kim
135 The Neurofibromatoses . . . . . . . . . . . . . . . . . . . .2465
Robert Listernick & Joel Charrow
136 Tuberous Sclerosis Complex . . . . . . . . . . . . . . . .2480
Thomas N. Darling
137 Diabetes and Other Endocrine Diseases . . . . . .2493
April Schachtel & Andrea Kalus

122 Lipogenic Neoplasms . . . . . . . . . . . . . . . . . . . . . .2172

Thomas Mentzel & Thomas Brenn
PART 22 VASCULAR DISEASES
Volume Two 138 Cutaneous Necrotizing Venulitis . . . . . . . . . . . .2527
Nicholas A. Soter

PART 21 METABOLIC, GENETIC, AND 139 Systemic Necrotizing Arteritis . . . . . . . . . . . . . .2539

Peter A. Merkel & Paul A. Monach
SYSTEMIC DISEASES
123 Cutaneous Changes in Nutritional 140 Erythema Elevatum Diutinum . . . . . . . . . . . . . .2562
Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2199 Theodore J. Alkousakis & Whitney A. High
Albert C. Yan
141 Adamantiades–Behçet Disease . . . . . . . . . . . . . .2567
124 The Porphyrias . . . . . . . . . . . . . . . . . . . . . . . . . . . .2234 Christos C. Zouboulis
Eric W. Gou & Karl E. Anderson
142 Kawasaki Disease . . . . . . . . . . . . . . . . . . . . . . . . .2580
125 Amyloidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2258 Anne H. Rowley
Peter D. Gorevic & Robert G. Phelps
143 Pigmented Purpuric Dermatoses . . . . . . . . . . . .2590
126 Xanthomas and Lipoprotein Disorders . . . . . . .2273 Alexandra Haden & David H. Peng
Vasanth Sathiyakumar, Steven R. Jones, &
Seth S. Martin 144 Cryoglobulinemia and
Cryofibrinogenemia . . . . . . . . . . . . . . . . . . . . . . .2599
Julio C. Sartori-Valinotti & Mark D. P. Davis ix

Kang_DIGM-FM_Vol-I.indd 9 08/12/18 5:31 pm

 145 Raynaud Phenomenon . . . . . . . . . . . . . . . . . . . . .2613
Drew Kurtzman & Ruth Ann Vleugels PART 24 FUNGAL DISEASES
160 Superficial Fungal Infection . . . . . . . . . . . . . . . . .2925
146 Malignant Atrophic Papulosis
Lauren N. Craddock & Stefan M. Schieke
(Degos Disease) . . . . . . . . . . . . . . . . . . . . . . . . . . .2630
Dan Lipsker
161 Yeast Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . .2952
Iris Ahronowitz & Kieron Leslie
147 Vascular Malformations . . . . . . . . . . . . . . . . . . .2636
Laurence M. Boon, Fanny Ballieux,
162 Deep Fungal Infections . . . . . . . . . . . . . . . . . . . . .2965
& Miikka Vikkula
Roderick J. Hay
148 Cutaneous Changes in Arterial, Venous, and
Lymphatic Dysfunction . . . . . . . . . . . . . . . . . . . .2669
Sabrina A. Newman
PART 25 VIRAL DISEASES
Contents

149 Wound Healing . . . . . . . . . . . . . . . . . . . . . . . . . . .2700 163 Exanthematous Viral Diseases . . . . . . . . . . . . . .2989

Afsaneh Alavi & Robert S. Kirsner Vikash S. Oza & Erin F. D. Mathes

164 Herpes Simplex . . . . . . . . . . . . . . . . . . . . . . . . . . .3021

Jeffrey I. Cohen
PART 23 BACTERIAL DISEASES
165 Varicella and Herpes Zoster. . . . . . . . . . . . . . . . .3035
150 Superficial Cutaneous Infections and
Myron J. Levin, Kenneth E. Schmader,
Pyodermas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2719
& Michael N. Oxman
Lloyd S. Miller
166 Poxvirus Infections . . . . . . . . . . . . . . . . . . . . . . . .3065
151 Cellulitis and Erysipelas . . . . . . . . . . . . . . . . . . . .2746
Ellen S. Haddock & Sheila Fallon Friedlander
David R. Pearson & David J. Margolis
167 Human Papillomavirus Infections . . . . . . . . . . .3095
152 Gram-Positive Infections Associated with
Jane C. Sterling
Toxin Production . . . . . . . . . . . . . . . . . . . . . . . . . .2757
Jeffrey B. Travers
168 Cutaneous Manifestations of HIV
and Human T-Lymphotropic Virus . . . . . . . . . .3107
153 Necrotizing Fasciitis, Necrotizing Cellulitis,
Adam D. Lipworth, Esther E. Freeman,
and Myonecrosis . . . . . . . . . . . . . . . . . . . . . . . . . .2770
& Arturo P. Saavedra
Avery LaChance & Daniela Kroshinksy
169 Mosquito-Borne Viral Diseases . . . . . . . . . . . . .3135
154 Gram-Negative Coccal and
Edwin J. Asturias & J. David Beckham
Bacillary Infections . . . . . . . . . . . . . . . . . . . . . . . .2782
Breanne Mordorski & Adam J. Friedman

155 The Skin in Infective Endocarditis, Sepsis,

Septic Shock, and Disseminated
Intravascular Coagulation . . . . . . . . . . . . . . . . . .2815
Joseph C. English III & Misha Rosenbach
156 Miscellaneous Bacterial Infections with
Cutaneous Manifestations . . . . . . . . . . . . . . . . . .2827
Scott A. Norton & Michael A. Cardis
157 Tuberculosis and Infections with Atypical
Mycobacteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2858
Aisha Sethi
158 Actinomycosis, Nocardiosis, and
Actinomycetoma . . . . . . . . . . . . . . . . . . . . . . . . . .2876
Francisco G. Bravo, Roberto Arenas,
& Daniel Asz Sigall
159 Leprosy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2892
Claudio Guedes Salgado, Arival Cardoso de Brito,
x Ubirajara Imbiriba Salgado, & John Stewart Spencer
PART 26 SEXUALLY TRANSMITTED
DISEASES
170 Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3145
Susan A. Tuddenham & Jonathan M. Zenilman
171 Endemic (Nonvenereal) Treponematoses . . . . .3173
Francisco G. Bravo, Carolina Talhari,
& Khaled Ezzedine
172 Chancroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3186
Stephan Lautenschlager & Norbert H. Brockmeyer
173 Lymphogranuloma Venereum . . . . . . . . . . . . . .3193
Norbert H. Brockmeyer & Stephan Lautenschlager
174 Granuloma Inguinale . . . . . . . . . . . . . . . . . . . . . .3202
Melissa B. Hoffman & Rita O. Pichardo

Kang_DIGM-FM_Vol-I.indd 10 08/12/18 5:31 pm

 175 Gonorrhea, Mycoplasma, and Vaginosis. . . . . .3207 189 Antihistamines . . . . . . . . . . . . . . . . . . . . . . . . . . . .3451
Lindsay C. Strowd, Sean McGregor, & Rita O. Pichardo Michael D. Tharp

190 Cytotoxic and Antimetabolic Agents . . . . . . . . .3463

Jeremy S. Honaker & Neil J. Korman
PART 27 INFESTATIONS, BITES,
AND STINGS 191 Antiviral Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . .3493
Zeena Y. Nawas, Quynh-Giao Nguyen,
176 Leishmaniasis and Other Protozoan Khaled S. Sanber, & Stephen K. Tyring
Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3223
Esther von Stebut 192 Immunosuppressive and
Immunomodulatory Drugs . . . . . . . . . . . . . . . . .3517
177 Helminthic Infections . . . . . . . . . . . . . . . . . . . . . .3251 Drew Kurtzman, Ruth Ann Vleugels, & Jeffrey Callen
Kathryn N. Suh & Jay S. Keystone
193 Immunobiologics: Targeted Therapy Against

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

179 Lyme Borreliosis. . . . . . . . . . . . . . . . . . . . . . . . . . .3287 194 Molecular Targeted Therapies . . . . . . . . . . . . . . .3558

Roger Clark & Linden Hu David Michael Miller, Bobby Y. Reddy, & Hensin Tsao

180 The Rickettsioses, Ehrlichioses, and 195 Antiangiogenic Agents . . . . . . . . . . . . . . . . . . . . .3590

Anaplasmoses . . . . . . . . . . . . . . . . . . . . . . . . . . . .3306 Adilson da Costa, Michael Y. Bonner,
Maryam Liaqat, Analisa V. Halpern, Justin J. Green, & Jack L. Arbiser
& Warren R. Heymann
196 Other Topical Medications . . . . . . . . . . . . . . . . . .3610
181 Arthropod Bites and Stings . . . . . . . . . . . . . . . . .3324 Shawn G. Kwatra & Manisha Loss
Robert A. Schwartz & Christopher J. Steen
197 Photoprotection . . . . . . . . . . . . . . . . . . . . . . . . . . .3623
182 Bites and Stings of Terrestrial and Jin Ho Chung
Aquatic Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3338
Camila K. Janniger, Robert A. Schwartz,
Jennifer S. Daly, & Mark Jordan Scharf
PART 29 PHYSICAL TREATMENTS
198 Phototherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3635
PART 28 TOPICAL AND SYSTEMIC Tarannum Jaleel, Brian P. Pollack, & Craig A. Elmets

TREATMENTS 199 Photochemotherapy and Photodynamic

Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3664
183 Principles of Topical Therapy . . . . . . . . . . . . . . .3363
Herbert Hönigsmann, Rolf-Markus Szeimies,
Mohammed D. Saleem,
& Robert Knobler
Howard I. Maibach, & Steven R. Feldman
200 Radiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3687
184 Glucocorticoids . . . . . . . . . . . . . . . . . . . . . . . . . . .3382
Roy H. Decker & Lynn D. Wilson
Avrom Caplan, Nicole Fett, & Victoria Werth

185 Retinoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3395

Anna L. Chien, Anders Vahlquist, PART 30 DERMATOLOGIC SURGERY
Jean-Hilaire Saurat, John J. Voorhees, & Sewon Kang
201 Cutaneous Surgical Anatomy . . . . . . . . . . . . . . .3697
186 Systemic and Topical Antibiotics . . . . . . . . . . . .3407 Arif Aslam & Sumaira Z. Aasi
Sean C. Condon, Carlos M. Isada,
& Kenneth J. Tomecki 202 Perioperative Considerations in
Dermatologic Surgery . . . . . . . . . . . . . . . . . . . . . .3706
187 Dapsone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3423 Noah Smith, Kelly B. Cha, & Christopher Bichakjian
Chee Leok Goh & Jiun Yit Pan
203 Excisional Surgery and Repair,
188 Antifungals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3436 Flaps, and Grafts . . . . . . . . . . . . . . . . . . . . . . . . . .3726
Mahmoud Ghannoum, Iman Salem, Adele Haimovic, Jessica M. Sheehan,
& Luisa Christensen & Thomas E. Rohrer xi

Kang_DIGM-FM_Vol-I.indd 11 08/12/18 5:31 pm

 204 Mohs Micrographic Surgery . . . . . . . . . . . . . . . .3761 211 Noninvasive Body Contouring . . . . . . . . . . . . . .3857
Sean R. Christensen & David J. Leffell Murad Alam

205 Nail Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3774 212 Treatment of Varicose Veins and

Robert Baran & Olivier Cogrel Telangiectatic Lower-Extremity Vessels. . . . . . .3871
Daniel P. Friedmann, Vineet Mishra,
206 Cryosurgery and Electrosurgery. . . . . . . . . . . . .3791 & Jeffrey T. S. Hsu
Justin J. Vujevich & Leonard H. Goldberg
213 Chemical Peels and Dermabrasion. . . . . . . . . . .3895
Gary Monheit & Bailey Tayebi

PART 31 COSMETIC DERMATOLOGY 214 Liposuction Using Tumescent

Local Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . .3906
207 Cosmeceuticals and Skin Care C. William Hanke, Cheryl J. Gustafson,
in Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . .3803
Contents

William G. Stebbins, & Aimee L. Leonard

Leslie Baumann
215 Soft-Tissue Augmentation . . . . . . . . . . . . . . . . . . 3911
208 Fundamentals of Laser and Lisa M. Donofrio & Dana L. Ellis
Light-Based Treatments . . . . . . . . . . . . . . . . . . . .3820
Omer Ibrahim & Jeffrey S. Dover 216 Botulinum Toxin . . . . . . . . . . . . . . . . . . . . . . . . . .3921
Richard G. Glogau
209 Laser Skin Resurfacing: Cosmetic
and Medical Applications . . . . . . . . . . . . . . . . . .3834 217 Hair Transplantation . . . . . . . . . . . . . . . . . . . . . . .3931
Bridget E. McIlwee & Tina S. Alster Robin H. Unger & Walter P. Unger

210 Nonablative Laser and Light-Based Therapy: Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3951

Cosmetic and Medical Indications . . . . . . . . . . .3846
Jeffrey S. Orringer

Videos can be accessed via the following link: mhprofessional.com/fitzderm9evideos

Chapter Number: Title Video Number: Title

Chapter 159: Leprosy Video 159-1: Sensitivity Test Monofilament

Video 159-2: Drop Foot
Video 159-3: Walking Impairment
Chapter 205: Nail Surgery Video 205-1: Lateral Longitudinal Biopsy
Video 205-2: Biopsy of the Distal Matrix
Video 205-3: Tangential Shave Excision
Video 205-4: Biopsy of Onychopapilloma

xii

Kang_DIGM-FM_Vol-I.indd 12 08/12/18 5:31 pm


Sumaira Z. Aasi, MD
Clinical Professor, Dermatology,
Clinical Professor (By Courtesy),
Surgery–Plastic and Reconstructive
Surgery, Dermatology–North
Campus, Stanford University,
Redwood City, California [201]
George Agak, PhD
Research Scientist, Dermatology/
Medicine, David Geffen School of
Medicine at UCLA, Los Angeles,
California [78]
Christine S. Ahn, MD
Resident Physician, Wake Forest
School of Medicine, Winston Salem,
North Carolina [46]
Iris Ahronowitz, MD
Assistant Professor of Clinical
Dermatology, Keck School
of Medicine, University of
Southern California, Los Angeles,
California [161]
Murad Alam, MD, MSCI, MBA
Professor of Dermatology,
Otolaryngology, and Surgery,
Vice-Chair, Department of
Dermatology, Chief, Section of
Cutaneous and Aesthetic Surgery,
Director, Micrographic Surgery and
Dermatologic Oncology Fellowship,
Northwestern University, Chicago,
Illinois [211]
Afsaneh Alavi, MSc, MD, FRCPC
Assistant Professor of Dermatology,
Women’s College Hospital,
University of Toronto, Toronto,
Ontario, Canada [149]
Theodore J. Alkousakis, MD
Assistant Clinical Professor,
University of Colorado School of
Medicine, Medical Director, Adult
Dermatology, Aurora, Colorado [140]
Tina S. Alster, MD
Director, Washington Institute
of Dermatologic Laser Surgery,
Clinical Professor of Dermatology,
Georgetown University Medical
Center, Washington, DC [209]
Kang_DIGM-FM_Vol-I.indd 13
CONTRIBUTORS
Masayuki Amagai, MD, PhD
Professor and Chair, Department
of Dermatology, Keio University
School of Medicine, Tokyo,
Japan [14]
Erin H. Amerson, MD
Associate Professor, University
of California, San Francisco,
Department of Dermatology,
San Francisco, California [1]
Karl E. Anderson, MD, FACP
Departments of Preventive
Medicine and Community Health,
and Internal Medicine (Division of
Gastroenterology and Hepatology),
University of Texas Medical Branch,
Galveston, Texas [124]
Grant J. Anhalt, MD
Professor of Dermatology and
Pathology, Department of
Dermatology, Johns Hopkins
Hospital, Baltimore, Maryland [53]
Jack L. Arbiser, MD, PhD
Emory University School
of Medicine, Department of
Dermatology, Atlanta Veterans
Affairs Medical Center, Atlanta,
Georgia [195]
Roberto Arenas, MD
Mycology Section, Dr. Manuel Gea
Gonzalez General Hospital, Mexico
City, Mexico [158]
Adam B. Aronson, MD
Resident Physician, Dermatology,
University of Iowa Carver College
of Medicine, Iowa City, Iowa [128]
Iris K. Aronson, MD
University of Illinois at Chicago,
Chicago, Illinois [73]
Arif Aslam, MBChB, MRCP (UK),
MRCGP, MRCP (Dermatology)
Consultant Dermatologist and Mohs
Surgeon, St Helens and Knowsley
Teachings Hospitals NHS Trust,
St Helens, United Kingdom [201]
Edwin J. Asturias, MD
The Jules Amer Chair in
Community Pediatrics, Children’s
Hospital Colorado, Associate
Professor of Pediatrics and
Epidemiology, Division of Pediatric
Infectious Diseases, University
of Colorado School of Medicine,
Center for Global Health, Colorado
School of Public Health, Aurora,
Colorado [169]
Martine Bagot, MD, PhD
Department of Dermatology,
Hôpital Saint-Louis, Paris,
France [119, 120]
Fanny Ballieux, MD
Resident, Center for Vascular
Anomalies, Division of Plastic
Surgery, Cliniques Universitaires
St Luc and University of Louvain,
Brussels, Belgium [147]
Robert Baran, MD
Honorary Professor, Nail Disease
Center, Cannes, France [205]
Raymond L. Barnhill, MD
Professor, Department of Pathology,
Institut Curie, and University of
Paris Descartes Faculty of Medicine,
Paris, France, Department of
Pathology, Paris, France [71]
Leslie Baumann, MD
Board Certified Dermatologist,
Baumann Cosmetic and Research
Institute, Miami, Florida [207]
J. David Beckham, MD
Associate Professor, Director of
the Infectious Disease Fellowship
Training Program, Division of Adult
Infectious Diseases, University
of Colorado School of Medicine,
Denver, Colorado [169]
Carola Berking, MD
Department of Dermatology,
University Hospital Munich,
Ludwig-Maximilian University
(LMU), Munich, Germany [110]
08/12/18 5:31 pm
 Christopher Bichakjian, MD
Department of Dermatology,
University of Michigan Health
System, Ann Arbor, Michigan [202]
Carol M. Black, MD, FRCP
Centre for Rheumatology and
Connective Tissue Diseases, UCL
Medical School, Royal Free Hospital,
London, United Kingdom [63]
Ulrike Blume-Peytavi, MD
Department of Dermatology and
Allergy, Charité-Universitätsmedizin,
Berlin, Germany [85]
Contributors
Mark Boguniewicz, MD
Professor, Division of Allergy
and Immunology, Department of
Pediatrics, National Jewish Health
and University of Colorado School
of Medicine, Denver, Colorado [22]
Michael Y. Bonner, BA
Emory University School
of Medicine, Department of
Dermatology, Atlanta, Georgia [195]
Laurence M. Boon, MD, PhD
Coordinator of the Center for
vascular Anomalies, Division
of Plastic Surgery, Cliniques
Universitaires St Luc and Human
Molecular Genetics, de Duve
Institute, University of Louvain,
Brussels, Belgium [147]
Vladimir Botchkarev, MD,
PhD, FRSB
Professor and Deputy Director,
Centre for Skin Sciences, University
of Bradford, United Kingdom,
Adjunct Professor, Department of
Dermatology, Boston University
School of Medicine, Boston,
Massachusetts [7]
Francisco G. Bravo, MD
Associate Professor of Dermatology
and Pathology, Universidad
Peruana Cayetano Heredia, Lima,
Peru [158, 171]
Thomas Brenn, MD, PhD
Consultant Dermatopathologist
and Honorary Senior Lecturer,
Department of Pathology NHS
Lothian University Hospitals Trust
and the University of Edinburgh,
Edinburgh, United Kingdom [122]
Norbert H. Brockmeyer
Walk In Ruhr (WIR) Center for
Sexual Health and Medicine,
Department of Dermatology,
Venerology and Allergology,
xiv Ruhr-Universität Bochum, Bochum,
Germany [172, 173]
Kang_DIGM-FM_Vol-I.indd 14
Anna L. Bruckner, MD, MSCS
Associate Professor of Dermatology
and Pediatrics, University of
Colorado School of Medicine,
Section Head, Pediatric
Dermatology, Children’s Hospital
Colorado, Aurora, Colorado [49]
Leena Bruckner-Tuderman,
MD, PhD
Professor and Chair of Dermatology,
Medical Center-University of
Freiburg, Freiburg, Germany [15]
Marie-Charlotte Brüggen,
MD, PhD
Department of Dermatology,
University Hospital Zurich, Zurich,
Switzerland [10]
Jörg Buddenkotte, MD, PhD
Academic Research Scientist,
Department of Dermatology and
Venereology, Hamad Medical
Corporation, Doha, Qatar [79]
Susan Burgin, MD
Assistant Professor, Beth Israel
Deaconness Medical Center,
Harvard Medical School,
Department of Dermatology, Boston,
Massachusetts [1]
Craig G. Burkhart, MD
Sylvania, Ohio [178]
Craig N. Burkhart, MD
The University of North Carolina
at Chapel Hill, Chapel Hill, North
Carolina [178]
Klaus J. Busam, MD
Professor of Pathology and
Laboratory Medicine, Weill Medical
College of Cornell University,
Department of Dermatopathology
and Pathology, Memorial Sloan
Kettering Cancer Center, New York,
New York [115]
Jeffrey Callen, MD
Professor of Medicine
(Dermatology), University
of Louisville, Chief, Division
of Dermatology, Louisville,
Kentucky [192]
Avrom Caplan, MD
Department of Dermatology,
Hospital of the University of
Pennsylvania, Philadelphia,
Pennsylvania [184]
Michael A. Cardis, MD
Department of Dermatology,
Washington Hospital Center/
Georgetown University,
Washington, DC [156]
Arival Cardoso de Brito,
MD, PhD
Full Professor, Dermatology, Pará
Federal University, Belém, Pará,
Brazil [159]
Leslie Castelo-Soccio,
MD, PhD
Assistant Professor of Pediatrics
and Dermatology, The Children’s
Hospital of Philadelphia and
University of Pennsylvania Perlman
School of Medicine, Philadelphia,
Pennsylvania [89]
Kelly B. Cha, MD, PhD
Department of Dermatology,
University of Michigan Health
System, Ann Arbor, Michigan [202]
Manasmon
Chairatchaneeboon, MD
Clinical Instructor in Dermatology,
Department of Dermatology,
Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok,
Thailand [134]
Mary Wu Chang, MD
Clinical Professor of Dermatology
and Pediatrics, University of
Connecticut School of Medicine,
Farmington, Connecticut [103, 104]
Joel Charrow, MD
Professor of Pediatrics, Feinberg
School of Medicine, Northwestern
University, Ann and Robert H.
Lurie Children’s Hospital of
Chicago, Division of Genetics, Birth
Defects and Metabolism, Chicago,
Illinois [135]
Mei Chen, PhD
Director, USC Laboratories for
Investigative Dermatology, The
Keck School of Medicine, University
of Southern California, Los Angeles,
California [56]
Suephy C. Chen, MD, MS
Vice Chair and Associate Professor
of Dermatology, Emory University
School of Medicine, Atlanta,
Georgia [107]
Carol Cheng, MD
Assistant Clinical Professor of
Dermatology/Medicine, David
Geffen School of Medicine at UCLA,
Los Angeles, California [78]
08/12/18 5:31 pm
 Andy Chern, MD, MPH
Captain, Medical Corps, United
States Army, Associate Program
Director, Occupational and
Environmental Medicine Residency
Program, Uniformed Services
University of the Health Sciences, F.
Edward Hébert School of Medicine,
Department of Preventive Medicine
and Biostatistics, Bethesda,
Maryland [27]
Casey M. Chern, MD
Captain, Medical Corps, United
States Army, Dermatology Resident,
National Capital Consortium
Dermatology Residency Program,
Walter Reed National Military
Medical Center, Bethesda,
Maryland [27]
Anna L. Chien, MD
Assistant Professor, Department
of Dermatology, Johns Hopkins
School of Medicine, Baltimore,
Maryland [106, 185]
Keith A. Choate, MD, PhD
Professor of Dermatology, Genetics
and Pathology, Yale University
School of Medicine, New Haven,
Connecticut [47]
Conroy Chow, MD
Assistant Professor, Department
of Dermatology, Loma Linda
University, Loma Linda,
California [114]
Luisa Christensen, MD
Center for Medical Mycology,
University Hospitals Cleveland
Medical Center, Case Western
Reserve University, Cleveland,
Ohio [188]
Sean R. Christensen, MD, PhD
Assistant Professor of Dermatology,
Section of Dermatologic Surgery,
Yale University School of Medicine,
New Haven, Connecticut [204]
Angela M. Christiano, PhD
Department of Dermatology,
Department of Genetics and
Development, Columbia University,
New York, New York [18]
Emily Y. Chu, MD, PhD
Assistant Professor of Dermatology,
Hospital of the University of
Pennsylvania, Perelman School
of Medicine, Philadelphia,
Pennsylvania [2]
Kang_DIGM-FM_Vol-I.indd 15
Jin Ho Chung, MD, PhD
Professor and Chairman,
Department of Dermatology, Seoul
National University College of
Medicine, Seoul, Korea [197]
Matthew Clark, MD
Dermatology Resident, University
of Michigan Department of
Dermatology, Ann Arbor,
Michigan [31]
Roger Clark, DO
Assistant Professor of Medicine,
Tufts Medical Center, Brigham and
Women’s Faulkner Hospital, Boston,
Massachusetts [179]
Olivier Cogrel, MD
Dermatologic Surgery and Laser
Unit, Dermatology Department,
CHU Bordeaux, Hôpital Saint-
André, Bordeaux, France [205]
Bernard A. Cohen, MD
Johns Hopkins Hospital Baltimore,
Maryland [178]
Jeffrey I. Cohen, MD
Chief, Laboratory of Infectious
Diseases, National Institute of
Allergy and Infectious Diseases,
National Institutes of Health,
Bethesda, Maryland [164]
Philip R. Cohen, MD
Professor of Dermatology,
University of California San Diego
School of Medicine, San Diego,
California [36]
Sean C. Condon, MD
Department of Dermatology,
Cleveland Clinic, Cleveland,
Ohio [186]
Melissa I. Costner, MD
Associate Clinical Professor,
Dermatology, UT Southwestern
Medical School, North Dallas
Dermatology Associates, Dallas,
Texas [61]
George Cotsarelis, MD
Milton B. Hartzell Professor and
Chair, Department of Dermatology,
Perelman School of Medicine
University of Pennsylvania,
Director, Program on Epithelial
Regeneration and Stem Cells,
University of Pennsylvania
Institute for Regenerative Medicine,
Philadelphia, Pennsylvania [7]
Edward W. Cowen, MD
Head, Dermatology Consultation
Service, Dermatology Branch,
Center for Cancer Research,
National Cancer Institute, National
Institutes of Health, Bethesda,
Maryland [129]
Lauren N. Craddock, MD
Department of Dermatology,
University of Wisconsin-Madison,
Madison, Wisconsin [160]
Ponciano D. Cruz, Jr., MD
Distinguished Professor, Paul
Bergstresser Endowed Chair in
Contributors
Dermatology, Department of
Dermatology, The University of
Texas, Chief of Dermatology, North
Texas Veterans Affairs Medical
Center, Dallas, Texas [24]
Jonathan D. Cuda, MD
Assistant Professor of Dermatology,
Johns Hopkins School of Medicine,
Baltimore, Maryland [108, 115]
Donna A. Culton, MD, PhD
Department of Dermatology,
University of North Carolina at
Chapel Hill, Chapel Hill, North
Carolina [54]
Nika Cyrus, MD
Department of Dermatology,
Parkland Health and Hospital
System, Dallas, Texas [64]
Adilson da Costa, MD
Emory University School
of Medicine, Department of
Dermatology, Atlanta, Georgia [195]
Jennifer S. Daly, MD
Clinical Chief, Infectious Diseases
and Immunology, Professor of
Medicine, Microbiology and
Physiological Systems, University
of Massachusetts Medical School,
Worcester, Massachusetts [182]
Thomas N. Darling, MD, PhD
Professor and Chair of Dermatology,
Uniformed Services University
of the Health Sciences, Bethesda,
Maryland [136]
Mark D. P. Davis, MD
Professor of Dermatology, Mayo
Clinic College of Medicine,
Department of Dermatology,
Rochester, Minnesota [144]
xv
08/12/18 5:31 pm
 Robert S. Dawe, MBChB,
MD(Glasg), FRCP(Edin)
Consultant Dermatologist and
Honorary Reader in Dermatology,
Department of Dermatology and
Photobiology Unit, NHS Tayside
and University of Dundee, Dundee,
Scotland [95]
Roy H. Decker, MD, PhD
Associate Professor, Vice Chair
and Director of Clinical Research,
Department of Therapeutic
Radiology, Yale School of Medicine,
New Haven, Connecticut [200]
Contributors
Christopher P. Denton, PhD,
FRCP
Centre for Rheumatology and
Connective Tissue Diseases, UCL
Medical School, Royal Free Hospital,
London, United Kingdom [63]
Garrett T. Desman, MD
Assistant Professor of Pathology
and Dermatology, Icahn School of
Medicine at Mount Sinai, New York,
New York [71]
Luis A. Diaz, MD
Department of Dermatology,
University of North Carolina at
Chapel Hill, Chapel Hill, North
Carolina [54]
John J. DiGiovanna, MD
Senior Research Physician, DNA
Repair Section, Dermatology
Branch, Center for Cancer Research,
National Cancer Institute, National
Institutes of Health, Bethesda,
Maryland [130]
Andrzej A. Dlugosz, MD
Poth Professor of Cutaneous
Oncology, Departments of
Dermatology and Cell and
Developmental Biology, University
of Michigan Medical School, Ann
Arbor, Michigan [19]
Lisa M. Donofrio, MD
Associate Clinical Professor,
Department of Dermatology, Yale
School of Medicine, Yale University,
New Haven, Connecticut [215]
Jeffrey S. Dover, MD, FRCPC
SkinCare Physicians, Chestnut Hill,
Massachusetts [208]
Lyn McDivitt Duncan, MD
Professor of Pathology,
Harvard Medical School,
Chief, Dermatopathology Unit,
Department of Pathology,
xvi Massachusetts General Hospital,
Boston, Massachusetts [109]
Kang_DIGM-FM_Vol-I.indd 16
Jonathan A. Dyer, MD
Associate Professor of Dermatology
and Child Health, Departments of
Dermatology and Child Health,
University of Missouri, Columbia,
Missouri [72]
Lawrence F. Eichenfield, MD
Chief, Pediatric and Adolescent
Dermatology, Professor of
Dermatology and Pediatrics, Vice
Chair, Department of Dermatology,
University of California, San Diego
School of Medicine, San Diego,
California [22]
James T. Elder, MD, PhD
Kirk D. Wuepper Professor of
Molecular Genetic Dermatology,
Department of Dermatology,
University of Michigan, Ann Arbor,
Ann Arbor, Michigan [28]
Rosalie Elenitsas, MD
Professor of Dermatology, Director
of Dermatopathology, Hospital of
the University of Pennsylvania,
Perelman School of Medicine,
Philadelphia, Pennsylvania [2]
Dana L. Ellis, MD
Clinical Instructor, Department
of Dermatology, Yale School of
Medicine, Yale University,
New Haven, Connecticut [215]
Craig A. Elmets, MD
Professor and Emeritus Chair,
Department of Dermatology,
University of Alabama at
Birmingham, The Birmingham
VA Medical Center, Birmingham,
Alabama [198]
Joseph C. English III, MD
Professor of Dermatology,
University of Pittsburgh,
Department of Dermatology, UPMC
North Hills Dermatology, Wexford,
Pennsylvania [155]
Alexander H. Enk, MD
Professor and Chair,
Department of Dermatology,
University of Heidelberg,
Heidelberg, Germany [116]
Ervin H. Epstein, Jr., MD
Children’s Hospital of Oakland
Research Institute, UCSF, Oakland,
California [111]
Khaled Ezzedine, MD, PhD
Professor, Department of
Dermatology, Hôpital Henri
Mondor, EA EpiDermE
(Epidémiologie en Dermatologie
et Evaluation des Thérapeutiques),
UPEC-Université Paris-Est Créteil,
Créteil, France [76, 171]
Janet A. Fairley, MD
John S. Strauss Professor and
Chair, Department of Dermatology,
University of Iowa Carver College
of Medicine, Iowa City, Iowa [128]
Steven R. Feldman, MD, PhD
Department of Dermatology,
Wake Forest University School of
Medicine, Winston-Salem, North
Carolina [183]
Nicole Fett, MD, MSCE
Associate Professor of Dermatology,
Department of Dermatology,
Oregon Health and Science
University, Portland, Oregon [184]
David Fiorentino, MD, PhD
Professor in the Department of
Dermatology and the Department
of Immunology and Rheumatology
at Stanford University School
of Medicine, Redwood City,
California [62]
David E. Fisher, MD, PhD
Edward Wigglesworth Professor
and Chairman, Department of
Dermatology, Harvard Medical
School, Director, Melanoma
Program MGH Cancer Center,
Director, Cutaneous Biology
Research Center, Massachusetts
General Hospital, Boston,
Massachusetts [20]
Joachim W. Fluhr, MD
Oberarzt, Charité-
Universitätsmedizin Berlin, Klinik
für Dermatologie, Venerologie und
Allergologie, Berlin, Germany [96]
John A. Flynn, MD, MBA, MEd
Professor and Associate Dean of
Medicine, Johns Hopkins University,
Baltimore, Maryland [65]
Ruth K. Foreman, MD, PhD
Instructor of Pathology, Harvard
Medical School, Dermatopathology
Unit, Department of Pathology,
Massachusetts General Hospital,
Boston, Massachusetts [109]
08/12/18 5:31 pm
 Amy K. Forrestel, MD
University of Pennsylvania,
Department of Dermatology,
Philadelphia, Pennsylvania [133]
Camille Francès, MD
AP-HP, Hôpital Tenon, Université
Paris VI, Service de Dermatologie-
Allergologie, Paris, France [69]
Nicholas Frank, MD
Dermatology Resident, Vanderbilt
University Medical Center,
Department of Internal Medicine,
Division of Dermatology, Nashville,
Tennessee [101]
Esther E. Freeman, MD, PhD
Assistant Professor of Dermatology,
Harvard University Medical
School, Director, Global Health
Dermatology, Massachusetts
General Hospital, Department
of Dermatology, Boston,
Massachusetts [168]
Lars E. French, MD
Professor and Chairman,
Department of Dermatology,
University of Zurich, Zurich,
Switzerland [39]
Sheila Fallon Friedlander, MD
Professor of Dermatology and
Pediatrics, University of California,
San Diego School of Medicine, Rady
Children’s Hospital, San Diego,
San Diego, California [166]
Adam J. Friedman, MD
Associate Professor of Dermatology,
Director of Translational Research,
Residency Program Director,
Department of Dermatology, George
Washington School of Medicine
and Health Sciences, Washington,
DC [154]
Daniel P. Friedmann, MD
Westlake Dermatology Clinical
Research Center, Westlake
Dermatology and Cosmetic Surgery,
Austin, Texas [212]
Ramsay L. Fuleihan, MD
Professor of Pediatrics,
Northwestern University Feinberg
School of Medicine, Chicago,
Illinois [132]
Abhimanyu Garg, MD
Professor of Internal Medicine,
Chief, Division of Nutrition and
Metabolic Diseases, Department of
Internal Medicine and the Center
for Human Nutrition, Distinguished
Chair in Human Nutrition Research,
Dallas, Texas [74]
Kang_DIGM-FM_Vol-I.indd 17
Luis Garza, MD, PhD
Associate Professor, Department
of Dermatology, Johns Hopkins
School of Medicine, Baltimore,
Maryland [4]
Mahmoud Ghannoum,
PhD, EMBA
Center for Medical Mycology,
University Hospitals Cleveland
Medical Center, Case Western
Reserve University, Cleveland,
Ohio [188]
Dee Anna Glaser, MD
Interim Chair and Professor,
Director Cosmetic and Laser
Surgery, Director of Clinical
Research, Department of
Dermatology, Saint Louis University
School of Medicine, St. Louis,
Missouri [81]
Richard G. Glogau, MD
Clinical Professor of Dermatology,
University of California,
San Francisco, San Francisco,
California [216]
Sergij Goerdt, MD
Professor of Dermatology, Chair
of Dermatology, Department
of Dermatology, Venereology
and Allergology, University
Medical Center and Medical
Faculty Mannheim, University
of Heidelberg, Mannheim,
Germany [117]
Carolyn Goh, MD
Assistant Clinical Professor of
Dermatology/Medicine, David
Geffen School of Medicine at UCLA,
Los Angeles, California [78]
Chee Leok Goh, MD, MBBS,
M. Med (Int. Med), MRCP (UK),
FRCP (Edin), Hon FACD, FAMS
(Dermatology)
Clinical Professor, National Skin
Centre, Singapore [187]
Leonard H. Goldberg, MD
DermSurgery Associates, Houston,
Texas [206]
Peter D. Gorevic, MD
Professor of Medicine, Division
of Rheumatology, Icahn School of
Medicine at Mount Sinai, New York,
New York [125]
Eric W. Gou, MD
Department of Internal Medicine,
Division of Gastroenterology
and Hepatology, University of
Texas Medical Branch, Galveston,
Texas [124]
Emmy M. Graber, MD, MBA
Dermatologist, The Dermatology
Institute of Boston, Boston,
Massachusetts [78, 80]
Dorothy Katherine Grange, MD
Professor of Pediatrics, Division of
Genetics and Genomic Medicine,
Department of Pediatrics,
Washington University School of
Medicine, St. Louis, Missouri [131]
Clayton B. Green MD, PhD
The Marshfield Clinic, Marshfield,
Wisconsin [98]
Contributors
Justin J. Green, MD
Division of Dermatology, Cooper
Medical School of Rowan
University, Camden,
New Jersey [180]
Roy C. Grekin, MD
Professor of Dermatology, Director,
Dermatologic Surgery and Laser
Center, University of California,
San Francisco, San Francisco,
California [114]
Annie Grossberg, MD
Associate Director, Dermatology
Residency Program, Assistant
Professor, Departments of
Dermatology and Pediatrics, Johns
Hopkins University, Baltimore,
Maryland [102]
Alexandra Gruber-
Wackernagel, MD
Medical University of Graz,
Research Unit for Photodermatology,
Department of Dermatology,
Medical University of Graz, Graz,
Austria [92]
Johann E. Gudjonsson,
MD, PhD
Assistant Professor, Department of
Dermatology, Frances and Kenneth
Eisenberg Emerging Scholar of
the Taubman Medical Research
Institute, University of Michigan,
Ann Arbor, Michigan [11, 28, 31]
Cheryl J. Gustafson, MD
St. Vincent Carmel Medical Center,
Carmel, Indiana [214]
Eva N. Hadaschik, MD
Department of Dermatology,
University Hospital Heidelberg,
Heidelberg, Germany [112]
Ellen S. Haddock, AB, MBA
University of California, San
Diego School of Medicine, La Jolla,
California [166] xvii
08/12/18 5:31 pm
 Alexandra Haden, MD
Assistant Professor of Clinical
Dermatology, Department of
Dermatology, University of
Southern California, Los Angeles,
California [143]
Adele Haimovic, MD
SkinCare Physicians, Chestnut Hill,
Massachusetts [203]
Russell P. Hall III, MD
J. Lamar Callaway Professor,
Department of Dermatology, Duke
University Medical Center, Durham,
North Carolina [58]
Contributors
Analisa V. Halpern, MD
Division of Dermatology, Cooper
Medical School of Rowan
University, Camden, New
Jersey [180]
Eckart Haneke, MD, PhD
Clinical Professor (em) of
Dermatology, Department of
Dermatology, Inselspital, University
of Berne, Bern, Switzerland [91]
C. William Hanke, MD,
MPH, FACP
St. Vincent Carmel Medical Center,
Carmel, Indiana [214]
John E. Harris, MD, PhD
Associate Professor, University
of Massachusetts Medical School,
Worcester, Massachusetts [76]
Takashi Hashimoto, MD
Professor and Director, Kurume
University Institute of Cutaneous
Cell Biology, Kurume, Fukuoka,
Japan [57]
Jessica C. Hassel, MD
Section Head, DermatoOncology,
Department of Dermatology and
National Center for Tumor Diseases,
University Hospital Heidelberg,
Heidelberg, Germany [116]
Roderick J. Hay, DM, FRCP,
FRCPath, FMedSci
Professor, Department of
Dermatology, Kings College
Hospital, Denmark Hill, London,
United Kingdom [162]
Masahiro Hayashi, MD, PhD
Associate Professor of Dermatology,
Yamagata University Faculty of
Medicine, Yamagata, Japan [75]
xviii
Kang_DIGM-FM_Vol-I.indd 18
Kara Heelan, MB BCh, BAO
Dermatology Department,
University College London
Hospitals, London, United
Kingdom [45]
Cara Hennings, MD
University of Tennessee/Erlanger
Medical Center, Chattanooga,
Tennessee [101]
Markus V. Heppt, MD
Department of Dermatology,
University Hospital Munich,
Ludwig-Maximilian University,
Munich, Germany [110]
Warren R. Heymann, MD
Division of Dermatology, Cooper
Medical School of Rowan
University, Camden,
New Jersey [180]
Michihiro Hide, MD, PhD
Department of Dermatology,
Institute of Biomedical and Health
Sciences, Hiroshima University,
Hiroshima, Japan [41]
Whitney A. High, MD, JD, MEng
Associate Professor of Dermatology
and Pathology, University of
Colorado School of Medicine,
Director of Dermatopathology
(Dermatology), Aurora,
Colorado [140]
Takaaki Hiragun, MD, PhD
Department of Dermatology,
Institute of Biomedical and Health
Sciences, Hiroshima University,
Hiroshima, Japan [41]
Allen W. Ho, MD, PhD
Resident Physician, Department
of Dermatology, Harvard Medical
School, Boston, Massachusetts [12]
Melissa B. Hoffman, MD
Resident, Dermatology, Wake Forest
School of Medicine, Winston Salem,
North Carolina [174]
Jeremy S. Honaker, CNP, PhD
Assistant Professor, Department of
Dermatology, Case Western Reserve
University, Cleveland, Ohio [190]
Herbert Hönigsmann, MD
Professor of Dermatology,
Emeritus Chairman, Department of
Dermatology, Medical University of
Vienna, Vienna, Austria [38, 199]
Alain Hovnanian, MD, PhD
Professor of Genetics, Department
of Genetics, Imagine Institute for
Genetic Diseases, Necker Hospital
for Sick Children, University Paris
Descartes-Sorbonne Paris Cité,
Paris, France [50]
Josie Howard, MD
Clinical Faculty, Departments
of Psychiatry and Dermatology,
University of California, San
Francisco, San Francisco,
California [100]
Jeffrey T. S. Hsu, MD
Clinical Assistant Professor,
Department of Dermatology,
University of Illinois College of
Medicine at Chicago, Co-Director
of Dermatologic, Laser and
Cosmetic Surgery, The Dermatology
Institute of DuPage Medical Group,
Naperville, Illinois [212]
Linden Hu, MD
Professor of Microbiology and
Medicine, Tufts University
School of Medicine, Boston,
Massachusetts [179]
William W. Huang, MD, MPH
Associate Professor of Dermatology,
Residency Program Director, Wake
Forest School of Medicine, Winston
Salem, North Carolina [46]
Raegan Hunt, MD, PhD
Assistant Professor of Dermatology
and Pediatrics, Texas Children’s
Hospital, Baylor College of
Medicine, Houston, Texas [103]
Sam T. Hwang, MD, PhD
Department of Dermatology,
University of California Davis
School of Medicine, Sacramento,
California [193]
Omer Ibrahim, MD
SkinCare Physicians, Chestnut Hill,
Massachusetts [208]
Alan D. Irvine, MD, DSc
Paediatric Dermatology and
National Children’s Research
Centre, Our Lady’s Children’s
Hospital Crumlin, Dublin, Clinical
Medicine, Trinity College, Dublin,
Ireland [51]
Carlos M. Isada, MD
Department of Infectious Disease,
Cleveland Clinic, Cleveland,
Ohio [186]
08/12/18 5:31 pm
 Heidi T. Jacobe, MD, MSCS
Associate Professor, Department
of Dermatology, UT Southwestern
Medical Center, Dallas, Texas [64]
Tarannum Jaleel, MD
Instructor, Department of
Dermatology, Duke Medical Center,
Durham, North Carolina [198]
Camila K. Janniger, MD
Clinical Professor, Dermatology,
Rutgers New Jersey Medical School,
Englewood, New Jersey [182]
Andrew Johnston, PhD
Department of Dermatology
University of Michigan School
of Medicine, Ann Arbor,
Michigan [193]
Steven R. Jones, MD
Ciccarone Center for the Prevention
of Heart Disease, Division of
Cardiology, Department of
Medicine, Johns Hopkins Hospital,
Baltimore Maryland [126]
Natanel Jourabchi, MD
Resident Dermatology Physician,
Johns Hopkins School of Medicine,
Baltimore, Maryland [37]
Andrea Kalus, MD
Associate Professor, University of
Washington School of Medicine,
Division of Dermatology, Seattle,
Washington [137]
Sewon Kang, MD, MPH
Noxell Professor & Chair,
Department of Dermatology,
Johns Hopkins School of Medicine,
Dermatologist-in-Chief, Johns
Hopkins Hospital, Baltimore,
Maryland [106, 185]
Varvara Kanti, MD
Department of Dermatology
and Allergy, Charité-
Universitätsmedizin, Berlin,
Germany [85]
Kenneth A. Katz, MD,
MSc, MSCE
Department of Dermatology,
Kaiser Permanente, San Francisco,
California [107]
Stephen I. Katz, MD, PhD
National Institute of Arthritis and
Musculoskeletal and Skin Diseases,
Bethesda, Maryland [59]
Kang_DIGM-FM_Vol-I.indd 19
Werner Kempf, MD
Kempf and Pfaltz, Histologische
Diagnostik, Department of
Dermatology, University Hospital
Zurich, Zurich, Switzerland [120]
Michelle L. Kerns, MD
Research Fellow, Department
of Dermatology, Johns Hopkins
School of Medicine, Baltimore,
Maryland [106]
Jay S. Keystone, MD, MSc
(CTM), FRCPC
Professor of Medicine, University
of Toronto, Tropical Disease Unit,
Division of Infectious Diseases,
Toronto General Hospital, Toronto,
Ontario, Canada [177]
Ellen J. Kim, MD
Sandra J. Lazarus Associate
Professor in Dermatology,
Department of Dermatology,
Perelman School of Medicine at
the University of Pennsylvania,
Perelman Center for Advanced
Medicine, Philadelphia,
Pennsylvania [134]
Jenny Kim, MD, PhD
Professor of Dermatology/
Medicine/Nutrition, David Geffen
School of Medicine at UCLA,
Los Angeles, California [78]
Robert S. Kirsner, MD, PhD
Chairman and Harvey Blank
Professor, Department of
Dermatology and Cutaneous
Surgery, Professor, Department of
Public Health Sciences, University
of Miami Miller School of Medicine,
Miami, Florida [149]
Robert Knobler, MD
Associate Professor of Dermatology,
Department of Dermatology,
Medical University of Vienna,
Vienna, Austria [199]
Krzysztof Kobielak, MD, PhD
Group Leader of Laboratory of
Stem Cells, Development and
Tissue Regeneration, Centre of
New Technologies, University of
Warsaw, Warsaw, Poland, Principal
Investigator, Department of
Developmental and Cell Biology,
University of California, Irvine,
Irvine, California [8]
Heidi H. Kong, MD, MHSc
Investigator, Dermatology Branch,
Center for Cancer Research,
National Cancer Institute, National
Institutes of Health, Dermatology
Branch Bethesda, Maryland [16]
John Y. M. Koo, MD
Professor, Psoriasis, Phototherapy,
and Skin Treatment Center and
Psychodermatology Clinic,
Department of Dermatology,
University of California
San Francisco, San Francisco,
California [100]
Contributors
Neil J. Korman, MD, PhD
Professor, Department of
Dermatology, Case Western Reserve
University, Cleveland, Ohio [190]
Kenneth H. Kraemer, MD
Chief, DNA Repair Section,
Dermatology Branch, Center for
Cancer Research, National Cancer
Institute, National Institutes of
Health, Bethesda, Maryland [130]
Thomas Krieg, MD, FRCP
Department of Dermatology and
Venerology, University of Cologne,
Cologne, Germany [63]
Daniela Kroshinksy, MD, MPH
Associate Professor, Harvard
Medical School, Director of Inpatient
Dermatology, Director of Pediatric
Dermatology, Massachusetts
General Hospital/ MassGeneral
Hospital for Children, Boston,
Massachusetts [153]
Akiharu Kubo, MD, PhD
Department of Dermatology,
Keio University School of Medicine,
Tokyo, Japan [14]
Thomas S. Kupper, MD
Thomas B. Fitzpatrick Professor,
Department of Dermatology,
Brigham and Women’s Hospital,
Harvard Medical School, Boston,
Massachusetts [12]
Anastasia O. Kurta, DO
Dermatology Resident, Department
of Dermatology, Saint Louis
University School of Medicine,
St Louis, Missouri [81]
xix
08/12/18 5:31 pm
 Drew Kurtzman, MD
Assistant Professor of Medicine
(Dermatology), Director, Connective
Tissue Disease Clinic, Director,
Immunobullous Disease Clinic,
The University of Arizona, Tucson,
Arizona [145, 192]
Razelle Kurzrock, MD
Professor of Medicine and Chief,
Division of Hematology and
Oncology; Senior Deputy Center
Director, Clinical Science; and
Director, Center for Personalized
Cancer Therapy and Clinical Trials
Office, University of California,
Contributors
San Diego Moores Cancer Center,
San Diego, California [36]
Heinz Kutzner, MD
Dermatopathology Friedrichshafen,
Friedrichshafen, Germany [121]
Shawn G. Kwatra, MD
Department of Dermatology,
Johns Hopkins School of Medicine,
Baltimore, Maryland [196]
Avery LaChance, MD, MPH
Dermatology Resident, Harvard
Combined Dermatology Residency
Training Program, Massachusetts
General Hospital, Boston,
Massachusetts [153]
Eden Pappo Lake, MD
University of Illinois at Chicago,
Chicago, Illinois [73]
Stephan Lautenschlager, MD
Associate Professor University of
Zurich, Chairman Outpatient Clinic
of Dermatology and Venereology,
City Hospital Triemli, Zurich,
Switzerland [172, 173]
Gerald S. Lazarus, MD
Professor of Dermatology and
Medicine, Johns Hopkins School of
Medicine, Baltimore, Maryland [37]
Terry Lechler, PhD
Associate Professor of Dermatology,
Duke University Medical Center,
Durham, North Carolina [5]
David J. Leffell, MD
David Paige Smith Professor
of Dermatology and Professor
of Surgery (Otolaryngology
and Plastic), Section Chief of
Dermatologic Surgery, Yale
University School of Medicine,
New Haven, Connecticut [204]
xx
Kang_DIGM-FM_Vol-I.indd 20
Aimee L. Leonard, MD
New England Dermatology
and Laser Center, Springfield,
Massachusetts [214]
Kieron Leslie, MBBS,
DTM&H, FRCP
Professor of Clinical Dermatology,
Dermatology Department,
University of California,
San Francisco, San Francisco,
California [161]
Donald Y. M. Leung, MD, PhD
Department of Pediatrics, National
Jewish Health, University of
Colorado Denver, Denver,
Colorado [22]
Benjamin Levi, MD
Director, Burn, Wound and
Regenerative Medicine Laboratory,
Assistant Professor of Surgery,
Ann Arbor, Michigan [99]
Myron J. Levin, MD
Section of Pediatric Infectious
Diseases, Department of Pediatrics,
University of Colorado School of
Medicine, Aurora, Colorado [165]
Matthew Lewis, MD, MPH
Clinical Assistant Professor in
the Department of Dermatology
at Stanford University School
of Medicine, Redwood City,
California [62]
Maryam Liaqat, MD
Division of Dermatology, Cooper
Medical School of Rowan
University, Camden,
New Jersey [180]
Henry W. Lim, MD
Emeritus Chair, Department of
Dermatology, Henry Ford Hospital,
Senior Vice President for Academic
Affairs, Henry Ford Health System,
Detroit, Michigan [97]
Dan Lipsker, MD, PhD
Professor of Dermatology, Faculté de
Medicine, Université de Strasbourg
and Clinique Dermatologique,
Hôpitaux Universitaires, Strasbourg,
France [146]
Adam D. Lipworth, MD
Assistant Professor of Dermatology,
Harvard University Medical
School, Director, Program
for Infectious Diseases of the
Skin, Director of Clinical Care
Redesign, Dermatology, Brigham
and Women’s Hospital, Boston,
Massachusetts [168]
Robert Listernick, MD
Professor of Pediatrics, Feinberg
School of Medicine, Northwestern
University, Ann and Robert H. Lurie
Children’s Hospital of Chicago,
Division of General Academic
Pediatrics, Chicago, Illinois [135]
Zhi Liu, PhD
Department of Dermatology,
University of North Carolina at
Chapel Hill, Chapel Hill, North
Carolina [54]
Robert Loewe, MD
Associate Professor, Department of
Dermatology, Medical University
Vienna, Vienna, Austria [9]
Anke S. Lonsdorf, MD
Department of Dermatology,
University Hospital Heidelberg,
Heidelberg, Germany [112]
Manisha Loss, MD
Department of Dermatology Johns
Hopkins School of Medicine,
Baltimore, Maryland [196]
Thomas A. Luger, MD
Center of Chronic Pruritus,
Department of Dermatology,
University of Münster, Münster,
Germany [21]
Boris D. Lushniak, MD, MPH
Rear Admiral, United States Public
Health Service (Retired), Professor
and Chair, Preventive Medicine and
Biostatistics, Uniformed Services
University of the Health Sciences,
F. Edward Hébert School of
Medicine, Department of Preventive
Medicine and Biostatistics,
Bethesda, Maryland [27]
Catherine Maari, MD, FRCPC
Associate Clinical Professor,
Division of Dermatology, Montreal
University Health Center, University
of Montreal, CHU Sainte-Justine,
Montreal, Quebec, Canada [70]
Kelly M. MacArthur, MD
Chief Resident, Department
of Dermatology, Johns
Hopkins University, Baltimore,
Maryland [102, 118]
Howard I. Maibach, MD
Department of Dermatology,
University of California, San
Francisco School of Medicine,
San Francisco, California [183]
08/12/18 5:31 pm
Another random document with
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where he would have been sure of a good reception, made him
adopt an unfortunate course. Unable, in face of his instructions from
home, to stop the expedition altogether, as in our case, he ordered
its leader to go towards the districts occupied by the Mossi, who
were wholly unprepared to receive it.
We left Sego on the morning of the 18th, and arrived the same
day at Sansanding, where my good friend Mademba was waiting for
us.
Every traveller who has been to Mademba’s, and has since
written an account of his journey, has made a point, not without
justice, of bearing grateful testimony to the merits of this noble fellow.
Mademba Seye is a native who was at one time in the employ of
the French post and telegraph office. He especially distinguished
himself during the construction of the line which, keeping alongside
of the Senegal, crosses the Toucouleur districts of the Senegalese
Foota. Just now the Toucouleurs were very much irritated against us,
and full of arrogance because no punishment had been inflicted on
them for their daily misdeeds. They stopped barges coming up from
St. Louis, they molested the traders and pillaged their merchandise,
and the greatest skill, courage, and savoir faire were needed on the
part of Mademba to conquer the difficulties besetting his path.
 MADEMBA.

Later he did wonders in the Sudan, and his defence of the village
of Guinina was a glorious feat of arms. He was victorious over the
troops of Fabu, the brother of Samory, though he had no one with
him but the few employés helping him to put down the line. Colonel
Gallieni sent for him to be a kind of chief interpreter, and he held that
position until, the Toucouleurs having been driven from Sego and
Nioro, the country just conquered by the French was properly
organized.
A small kingdom, with Sansanding as capital, was placed under
Mademba; he had in his service a certain number of sofas, or
captive Amadu warriors, who had surrendered to the French and to
the natives. Our postmaster-general soon became the Fama
Mademba, the word fama signifying a chief or king among the
natives of Bambara.
 Mademba gathered a court about him, showing a very clear sense
of the right policy to pursue. When with us his manners and tastes
were quite civilized, but he knew that to get an influence over his
new subjects he must adopt the customs of their chiefs. He began by
building himself a palace, which consists of a vast rectangular
enceinte, with a door embellished with rough ornaments in clay. In
the first vestibule, or bolo, are the guards, or dalasiguis, armed with
muskets. This porch gives access to a series of courts and other
bolos, where of an evening bellow the cattle and bleat the sheep
belonging to the chief. A last door, guarded or rather watched over
by some fifteen children, gives access to the favourite apartment of
the Fama. Why should children be employed? Because they are the
only people who can be depended on to tell the truth, and if they
notice anything unusual they are very sure, sooner or later, to tell
what they have seen. For the same reason, perhaps, and also on
æsthetic grounds, the Fama is waited on by women only, most of
whom are the daughters of blacksmiths or griots, specially attached
to the chief, their name, Korosiguis, meaning, “those who sit beside.”
Moreover, Mademba showed great acumen in his choice of servants,
and I never saw so many pretty girls anywhere else in the Sudan.
Behind the royal apartments, and completely surrounding the vast
enclosure, are the huts of Mademba’s wives; but there begins the
private life of the chief, and I can’t introduce you to that, for the
simple reason that I have never seen anything of it myself.
Surrounded by his male and female griots, wearing a grand green
burnous, on which gleamed the Cross of the Legion of Honour, the
reward of his courage in the service of France, Mademba came to
the banks of the river to welcome us. Shouts and acclamations of
delight and sympathy with us greeted us as we landed, and if we had
not known what all the fuss meant, we might have mistaken it for a
declaration of war.
We went home with the Fama, and there, taking off his burnous,
the black chief disappeared, to be replaced by our old friend
Mademba, cultivated, refined, a charming talker, quite up-to-date in
all that was going on in Europe, the man whom all Frenchmen who
have been in the Sudan know and appreciate. He did the honours of
an excellent, almost European meal, and we drank a glass of
champagne together, in spite of his being a good Mussulman, for he
has none of the stupid fanaticism of his fellow believers.
Just before we started I had made the following little speech to my
coolies: “My friends, I know I am asking what will cost you a good
deal of self-denial, but you must oblige me by not being too attentive
to the women you meet until we have reached Timbuktu. You know
that that sort of thing leads to disputes, sometimes even to regular
quarrels, with the natives, and we shall have quite enough hostility to
contend with without creating any ill-feeling ourselves. I warn you,
moreover, that I shall give you no more pay after we leave
Sansanding till we reach our goal. I will, however, give you two
months’ pay in advance at Sansanding, and you will have three days
to spend it in. For a year therefore, and perhaps more, after you
leave Sansanding, remember, you have done with women.”
Truth to tell, I had learnt from experience that the ardent
temperaments of negroes forming the escorts of expeditions really
often jeopardized success, if their amours did not actually bring
about failure. Of course I can’t be sure that my orders, which I
repeated later, were always strictly obeyed, but at all events I did a
good deal to lessen the evil.
 YAKARÉ.

I gave my jolly fellows three days to enjoy themselves in, and they
took me at my word. Until half-past one on the 22nd I saw next to
nothing of them on board, and when the time for starting arrived I
had to send to hunt up our little Abdulaye Dem, who had quite
forgotten how the time went in the society of a coal black Circe.
Meanwhile, we Europeans amused ourselves far more usefully in
arranging for our further journey, and in trying the effect on the
natives of our most attractive possessions, viz. the little organ, the
bicycle, and the phonograph.
The organ had already done wonders, and as for our Suzanne, as
we called our bicycle, she caused a perfect delirium of joy.
Mademba had an ancient-looking negress of Amadu, named
Yakaré, in his suite. She was really only about forty years old, but
she was considered one of the cleverest women in all Bambara.
There was a certain ring about her songs of war and love which
would be appreciated even in Europe, and the following specimen, in
which she glorifies Donga or the vulture, Monson, the greatest fama
of Bambara, will serve to give an idea of the rhythm.

Braves! Heroes, who of you dares rail at Donga?

I tell you evil will come upon you if you mock at him.
Raillery of him was fatal to Diakuruna Tutun.
Samaniana Baci thought to play with Donga,
He fancied he could make merry with him;
But that did not please the vulture,
And he took Bamana Dankun
And cut off his head, yes, took his head from his shoulders.
Dankun had only said that the Bambaras
Could not pause in sacrifices already begun.[4]
I sing of Donga Jaribata,[5]
The vulture of four wings,
A mighty bird, whose talons
Can tear up the soil of the earth;
A bird who if he will
Can dig a well with his claws.

You can just imagine the sensation when, after the negress had
finished her chant, the phonograph repeated it without anybody’s
help.
 LARGE NIGER CANOES.

But all good things must come to an end, and to the great regret
of my coolies, I gave the signal for departure on the 22nd.
Below Sansanding the Niger increases sensibly in depth. This fact
explains alike the former and the future importance of the village as
a commercial centre. The trade of the country is, in fact, conveyed
up and down by water in big canoes some 60 feet long, capable of
carrying twenty tons, and made of planks tied together. Holes are
pierced in these planks, through which ropes are passed made of
the fibres, which are very strong, of the leaves of a kind of hibiscus.
When Sansanding, Jenné, and Timbuktu were prosperous places,
when the savage hordes of Toucouleurs had not yet spread death
and desolation everywhere in the name of Islam, these heavy craft,
sometimes drawing more than six feet, used to halt at Sansanding.
For the traffic further up stream smaller boats were used, which plied
to and fro nearly all the year round. A central mart was absolutely
indispensable to the Sudan merchants, and Sansanding was fitted
by nature to become that mart. I believe that in its most prosperous
times it numbered from thirty to forty thousand inhabitants, though
now these are reduced to some three or four thousand, in spite of
the fresh impulse given by the more prosperous times of to-day, and
the intelligence of the governor Mademba.
When the railway has been pushed from Kayes to Kolikoro, and
when steamboats ply on the Niger, similar causes will of course
produce similar results. Steamboats will not, however, be able to go
beyond Sansanding all the year round, for no amount of
improvement in their build can reduce their draught below one and a
half or two feet. Above this point, however, the river is navigable for a
longer or shorter time every year in such barges as are now in use.
At the most, the traffic is only interrupted for about four months in the
year. Sansanding will again become a central emporium and
transhipping station; all its old importance will be restored to it.
I may add, that it has fortunately many other advantages,
including good anchorage and landing places, where boats can be
moored in shelter during the violent storms of Central Africa; the soil
too is very dry, so that the place is healthier than many others in the
Sudan, and the people are gentle, intelligent, and industrious.
Beyond Sansanding the course of the Niger changes
considerably. Thus far the river flows between pretty straight uniform
banks, but now the hills are lower, and behind them the country is
perfectly flat, without so much as an undulation, so that they are
completely flooded, often for an immense distance, when the water
is high. Here and there villages rise from slight eminences, the
clumps of hibiscus surrounding them rendering them visible from
afar. Now too appears the sweet grass which the natives call burgu,
a special characteristic of the riverside vegetation as far as Say. It is
a kind of aquatic couch-grass nearly level with the soil when on the
subsiding of the floods the ground becomes dry again. Directly the
soil is once more inundated, however, the burgu sends out shoots
with extraordinary rapidity, and they grow so fast that they soon
reach the top of the water. The natives make a sweet beverage of
the leaves of this grass, of too sickly a taste to be fancied by
Europeans, but negroes are very fond of it. For our hydrographical
surveys the burgu was a most invaluable help, growing as it does, as
I have already remarked, wherever the solid ground reappears after
the floods. If, therefore, we should be overtaken by a tornado on the
open river, we can always take refuge from the waves by anchoring
in the middle of the submerged tracts.
On January 1 we reached Gurao on Lake Debo, where I had
recently resided for two years in charge of the Niger flotilla,
consisting of the two gunboats Niger and Mage, and a few barges
made of the wood of the country. Two of these barges, it will be
remembered, were now part of our exploring expedition.
We paid a visit between whiles to the tomb of Sidi Hamet Beckay,
in the village of Saredina. I shall often have occasion later to refer to
this worthy, so I will content myself with adding but a few words
about him here. It was thanks to him that Barth was able to stop six
months at Timbuktu, pursue his voyage in safety, and go down the
river by Say to Sokoto, whence he had started eighteen months
before. Thanks to him too, Barth was able to send details to Europe
of the hitherto mysterious city of Timbuktu, which had previously
been visited by no white men except René Caillé.
When El Hadj Omar and his fanatical hordes came to devastate
Massina, Hamet Beckay did his utmost to stop the course of the
Toucouleur conqueror, by urging on him his own interpretation of the
Mussulman religion, which he also professed: an interpretation too
noble and elevated to be adopted by any but a few votaries. It was
all in vain; his remonstrances were unheeded by El Hadj. Beckay
had to be content with organizing a stout resistance; he summoned
to arms his faithful friends the Tuaregs and the Fulahs, his former
adversaries. But, alas! he died at Saredina before he could
accomplish anything. The story goes, that when in perfect health he
was seized with a gloomy presentiment of his approaching end. He
called his intimate friends together, telling them that he might
perhaps soon be summoned to make a distant journey, and giving to
them his turban and his sword, the former for his son Abiddin, the
latter for his son-in-law, Beckay Uld Ama Lamine, which signified that
he bequeathed his spiritual power to Abiddin and his temporal
authority to Ama Lamine. Then he begged to be left alone to pray
during the hour of the siesta. When his followers returned they found
the great marabout, his chaplet, clasped in his hands, and his eyes
closed in an attitude of ecstasy. After watching him for a short time
they became alarmed at his immobility, they touched him to try and
awake him. But his lifeless body fell to the ground, the spirit of
Hamet Beckay had left its earthly tabernacle. Beckay Uld Ama
Lamine continued the struggle begun by his father-in-law, and to him
and his faithful adherents is due the honour of having besieged and
killed El Hadj Omar at Hamdallahi. The blood-stained course of the
Toucouleurs was checked for the moment, and the Western Sudan
was saved from falling into the hands of the ferocious warriors of El
Hadj.
Saredina is about two and a half miles from the river, and to reach
it we had to cross a partially inundated plain over-grown with grass,
in which nested quantities of aquatic birds. Arrived at the village we
asked to be directed to the tomb, and found it to consist of little more
than a small earthen case upheld by wooden poles, for the mass of
dried bricks which had originally formed the monument to Hamet
Beckay had all but disappeared. The natives of the neighbourhood
had shown little respect for the great chief’s resting-place, and had
used the materials of his tomb to weight their nets and make their
agricultural implements. In my report to the governor of the French
Sudan I put in a plea for a grave more worthy of Hamet Beckay. I
hope my suggestion will be attended to, for it would be not only
fitting, but good policy to preserve the memory of a man whose
character was the more estimable in that such tolerance as his is
rare indeed amongst his fellow believers. Such an act of pious
respect for a Mussulman on our part would greatly increase our
moral influence amongst the Mahommedans of the neighbourhood,
especially amongst those of the interesting Kunta tribe to which
Hamet Beckay belonged.
THE TOMB OF HAMET BECKAY AT SAREDINA.

SARAFÉRÉ.
 At Gurao we had to collect the ammunition for our guns and
cannons, and also to pick up some of our actual weapons, notably a
certain machine gun which had belonged to the Niger flotilla. The
work involved in all this delayed us till the 3rd, but on the afternoon
of that day we resumed our journey.
On the 7th we reached Saraféré, an important market-place near
the junction of the Niger and the Kolikolo, which latter is an arm of
the river, branching off from it a little above Lake Debo. Here old
Abdul Dori, the guide we had engaged at Sego, brought us a young
man named Habilulaye, who was a Kunta, and I seize the
opportunity of his visit to say something about the tribe to which he
belonged, as I shall often have to refer to it.
The Kuntas are of the Arab race, and are descended from the
famous conqueror of North Africa, Sidi Okha, who was a native of
Yemen. After winning over to the religion of Mahomet a considerable
portion of North Africa, his dominion extending nearly to Tangiers,
the victor was assassinated near Biskra, where his tomb is still to be
seen.
His descendants spread in many directions, and the Kuntas took
root at Tuat, where as venerated marabouts they exercised, indeed
they still exercise, a very great influence.
During the first half of the present century, Timbuktu occupied a
very difficult and most precarious position. About 1800 a Fulah
marabout, named Othman dan Fodio, carved out for himself a
regular empire between Lake Tchad and the Niger, and his example
led to the revolt, and the generally successful revolt, of nearly all the
Fulahs distributed throughout the river basin. At Massina, Amadu
Lobbo Cissé, a chief—of Soninké birth, it is true, but who had long
resided amongst the Fulahs—raised the standard of revolt in the
name of Islam, and his attempt, after various vicissitudes,
succeeded. He and his son founded later an empire, the influence of
which, with Hamda-Allahi as its capital, soon extended on both
banks of the Niger as far as Timbuktu. Arrived there, however, the
Fulahs found themselves face to face with the Tuareg tribes, who
were very jealous of the maintenance of their independence. War of
course soon broke out, and it lasted for half-a-century without any
subjugation of the Tuaregs. It was not until later that the invasion of
the Toucouleurs, led by El Hadj Omar, united the combatants against
their common foe.
During this time of struggle and trouble Timbuktu, standing as it
did between the two contending parties, passed first to one and then
to the other, and pillaged by both sides, she rapidly declined in
prosperity, and was in danger of complete ruin.
Under these trying circumstances, the merchants of the city,
eager to obtain some sort of security for their lives, their goods, and
their trade, sent to Tuat an earnest petition that some venerated
Kunta marabout should come and live near Timbuktu, hoping that
the respect felt for his piety might put a stop to the depredations of
which their town was the victim.
Sidi Moktar responded to this appeal. He came, and took up his
abode with his family and a few of his more distant relations near
Timbuktu. Of these relations the most celebrated were his brothers
Sidi Aluatta and Sidi Hamet Beckay with his nephew Amadi.
Barth has told us much about them all, but we have now specially
to deal with Hamet Beckay, the doctor’s chief protector.
Imbued through reading Barth’s travels with a belief that the very
fate of my expedition might depend on finding, as he did, some man
universally loved and respected to take me and my followers under
his protection, I earnestly hoped to find such a man amongst the
Tuaregs, with whom I had become well acquainted during my two
years’ residence in the Sudan.
As will be borne out by my further narrative, these Tuaregs
seemed to me far less black than they were painted in Europe. At
the same time, I recognized that certain peculiarities of their
character might involve me in great difficulties. If they were not
exactly instinctively ferocious, I knew that they were quick to take
offence, defiant, full of dread of innovation, and ready to look on
every stranger as a spy. To them a traveller is but the harbinger of
some warlike expedition, which will wrest from them their greatest
treasure, their independence.
But I had to get some one to go bail for me, some one to take me
under his patronage and protection, and I had resolved, if it could
possibly be done, to find that some one amongst the Kuntas. Surely,
I thought, the traditions of tolerance of which Hamet Beckay had
given such striking proof, must have been handed down to some of
his descendants.
I did not, however, disguise from myself that in the very nature of
things, since other marabouts had, since Beckay’s death, come to
preach a holy war, and to inculcate hatred of the infidel, that the
Kuntas would necessarily be forced—if they did not wish to lose their
prestige—to howl with the rest of the wolves. But I reflected there is
still time to appeal to the example of their grandfather, and
experience proved that I was right.
I put out all my eloquence and powers of persuasion to win over
young Habibulaye, and I succeeded. From him I learned that the
Kuntas were now divided into several groups. He and his brother
Hamadi, the sons of Sidi Aluatti, the brother of Hamet Beckay, had,
however, remained at Timbuktu when the French occupied that town,
and had all espoused our cause.
Aluatti, the son of Amadi, was in authority on the southern side of
the river, and he looked on our expedition with a favourable eye.
Further on, Baye and Baba Hamet, the sons of Hamet Beckay,
would, I expected, be useful auxiliaries to us if only for the sake of
their father’s memory.
Habibulaye did not, it is true, conceal from me the fact that other
Kuntas were bitterly hostile to us, notably a certain Abiddin, who
generally resided at Tuat, and who meant to rouse the Hoggars
against us. He had, in fact, twice gone quite close to Timbuktu to try
and make the people rise against the French.
More confirmed than ever by all that I heard in my resolve, and
having now got all the information I could out of Habibulaye, who
was but a child, I made up my mind, as soon as I got to Timbuktu to
take Hamadi into my confidence, and get him to give me
recommendations to his relations.
A strong east wind, which lashed the river into waves and was
dead against us, delayed us so much that we did not reach Kabara
until the evening of January 11.
As is well known, Timbuktu is not actually on the river, but at low
water is some eight or nine miles off. Djitafe is then the nearest point
of approach for canoes, but when the river rises they go up a lateral
arm, and come first to Koriomé and then to Day. At certain times a
stream, the bed of which is said to have been hollowed out, or at
least deepened by the hand of man, enables very small craft to get
up to Kabara, whilst more rarely, that is to say, when the inundations
are at their height, the various excavations behind the Kabara dune
are successively filled up, and boats can reach the capital itself. As a
general rule, however, merchandise is taken into Timbuktu on the
backs of camels and asses, the route varying according to the state
of the river.
The ancient capital of Nigritia, or the Sudan, as it was still called
not long ago in geographical text-books, has lost all its mystery since
it passed into the hands of the French, and opinions are divided as
to its present and future position. My friend Felix Dubois has
described it, and it would be alike a waste of time and presumption
on my part to attempt to supplement what he has said so well. I shall
content myself with noting the reason of the former great commercial
importance of Timbuktu; relatively considered of course. “Timbuktu,”
says an Arab author, “is the point of meeting of the camel and the
canoe.” That fact alone would not, however, be enough to account
for its prosperity; many other places on the river fulfil this condition,
as well if not better than Timbuktu, for, as we can ourselves testify,
the canoe and the camel only meet there a few days in the year, and
not always even as often as that.
In my opinion we have to seek the explanation elsewhere, and I
think I have found it. Here it is: camels cannot with impunity
approach rivers or other water-courses, for this reason. The banks
are subject to constant inundations, and, especially in the Niger
basin, quantities of succulent grass, containing a great deal of water,
everywhere spring up, which, though the camel eats them
gluttonously, are fatal to the “ship of the desert,” used as it is to dry
food.
Now by a strange freak of nature, the part of the desert, I will not
say exactly the driest part, but certainly the portion containing neither
streams nor permanent pools, that vast expanse improperly called
the Sahara, stretches up to the very gates of Timbuktu, so that
caravans can reach the city without any risk to the animals. In a
word, may we not say that Timbuktu is not a port of the Niger in the
Sahara, but a port of the Sahara near the Niger?
As long as the trade of Timbuktu is carried on chiefly by caravans
coming from the north, it will, in my opinion, retain its importance, but
as soon as the Sudan railway is completed, merchandise will come
by way of it and the river, and the commerce of Timbuktu will be
reduced to a trifling trade in salt, which is dug out in considerable
quantities from the mines of Towdeyni, about twenty days’ march on
the north.
When we arrived, we could only bring our boats up to Kabera.
The port was blocked with big canoes made of planks tied together
in the manner already described, and a brisk trade in salt and grain
was going on on the quays.
 A MOSQUE AT TIMBUKTU.

The next day I went to Timbuktu, and was received with open
arms by the commandant, M. Rejou, who was in charge of the whole
district.
I had one thing very much at heart, and I set to work to see about
it at once. It was to persuade Father Hacquart, superior of Pères
blancs mission at Timbuktu, to accompany us on our expedition.
When I said persuade, I did not perhaps use quite the right word,
for I did not for one moment doubt the readiness of the good father
to go with us. The companion of Attanoux in his journey amongst the
Tuaregs of the north, formerly Commandant des Frères armés of
Mgr. Lavigerie, Father Hacquart could not fail to be won over by the
idea of accomplishing a similar journey. But I knew him to be too
devoted to his duty to hesitate an instant between a project, however
attractive to his tastes and desires, and the interests of the mission,
which had been under his direction at Timbuktu for more than a year,
and to which his rare qualities had already given such life and
success.
 On the other hand, even from the point of view of the work to
which Father Hacquart and his companions had devoted
themselves, going down the Niger, opening relations with the natives
on its banks, and obtaining all the information necessary for the work
of their future evangelization, was really perhaps to bring about the
good results hoped for years before they could otherwise have been
achieved. The aim of Father Hacquart was really the same as ours,
to see, to study on the spot, and to make friends, leaving to his
superiors the task of deciding how his future campaign should be
carried out.
As for me, nothing could be better for the success of my
undertaking than the co-operation of Father Hacquart. Already
familiar with the manners and customs of the Tuaregs, he would be a
most valuable adviser; a distinguished Arabic scholar, he could in
many cases converse without an interpreter with the natives, a
matter of the greatest importance. He could, moreover, check the
translations and reports of my Arab interpreter, Tierno Abdulaye
Dem. Then his intelligence, the loftiness of his aims and views, the
uprightness and energy of his character, were a sure guarantee that
in him I should find a most valuable controller of my own acts and
schemes, for of course I should ever be ready to listen to what he
might suggest.
 FATHER HACQUART.

Father Hacquart turned out indeed to be all that I have just

described. I often changed all my plans in accordance with his
advice, and I never had cause to regret having done so. He must
pardon me for giving expression here to all my gratitude, and for
proclaiming it on every occasion as loud as I can, for it was in a very
great measure to him I owed the remarkable fact, that my Niger
expedition was accomplished in the midst of tribes so diverse and
sometimes badly disposed towards the French—without the firing of
a single shot.
As I hoped, Father Hacquart yielded to my persuasions, and we
now numbered five Europeans.
 On the other hand, our native escort was reduced. One of our
coolies, Matar Samba, had been out of sorts ever since we left
Sansanding. During the last few days he had become worse, and
both Dr. Taburet and a medical man at Timbuktu were of opinion that
he was suffering from tubercular disease, and would only hamper,
not help me, in the further journey. I decided therefore to leave him
at Timbuktu, and when I came back from Dakar on our return I had
the pleasure of finding him much better, if not completely cured.
Aided by Father Hacquart, I at once opened relations with
Hamadi, the Kunta of whom I have already spoken, and he promised
to do all he could to persuade his relation Aluatta to go with us. It
was significant that when I begged Hamadi to join us himself, he
replied, “No; I might merely arouse opposition, and you might suffer
through my being with you. I would rather write to Aluatta; he will be
more likely to say yes then, for, like a dutiful relation, I shall only urge
him to come and share the windfall of all your beautiful presents.”
The next thing I did was to try and meet at Timbuktu with some
natives who were on friendly relations with the Awellimiden, the
important Tuareg tribe to which I shall so often have to refer later, but
whether they spoke the truth or were deceiving me, one and all
declared that they knew absolutely nothing about them.
To make up for this, however, a native of Tuat, a certain Bechir
Uld Mbirikat, who had long lived at Timbuktu, and whom I had met
before, gave me some letters for his cousin Mohammed, who was
living amongst the Igwadaren Tuaregs, and for Sheriff Salla Uld
Kara, chief of the village of Tosaye, who had once been the pupil of
Hamet Beckay, and the friend of Barth.
Moreover, Bechir gave me a valuable bit of advice, which I
immediately followed, without, however, fully realizing its importance
at the time. This counsel, perhaps, contributed more than anything
we did to the success of our expedition. “Tell them,” said Bechir, “that
you are the son of Abdul Kerim.” Now Abdul Kerim was the Arab
name assumed by Dr. Barth during his journey. This custom of taking
an Arab name seemed almost comic, and reminded me of a little
play I once saw acted at the Châtelet Theatre in Paris. I forget the