Handbook of Dermatology

The Handbook of Dermatology consolidates the essential information required for best-practice patient care into one pocket-sized volume. This indispensable reference guide enables practicing and prospective dermatologists to easily look up information on a wide range of dermatological diseases and quickly access the algorithms, protocols, guidelines, and staging and scoring systems that are vital to both clinical practice and exam success. Written and edited by former residents and attending physicians, the Handbook contains up-to-date information on general dermatology, surgery, and therapeutics.

Margaret W. Mann is Associate Professor and Director of Aesthetic Dermatology, University Hospitals, Case Western School of Medicine, Cleveland, OH, USA. She is the Co-Founder of Innova Dermatology, Hendersonville, TN, USA.

Daniel L. Popkin is Assistant Chief of Dermatology, Louis Stokes VA Medical Center and Assistant Professor of Dermatology, University Hospitals, Case Western School of Medicine, Cleveland, OH, USA. He is the Co-Founder of Innova Dermatology, Hendersonville, TN, USA.

Preface xv

Acknowledgments xvii

Part 1 General Dermatology 1

Common Work-Ups, Signs, and Management 3

Dermatologic Differential Algorithm 3

Direct Immunofluorescence (Dif) 3

False positive/negative DIFs 3

Workup Quick Reference Orders 4

Acne 6

Alopecia Workup 7

Telogen effluvium 10

Androgenic alopecia 10

Alopecia areata 11

Other alopecia treatments 12

Aphthosis Workup and Treatment 13

Dermatologic Signs 15

Folliculitis 21

Melasma 22

Immunology and Immunologic Disease 24

Lupus Erythematosus 24

Autoantibody 26

Sensitivities and specificities 26

In connective tissue diseases 28

Anti‐nuclear antibodies 29

ANCA (Anti‐neutrophil cytoplasmic antibodies) 30

Treatment of ANCA‐associated vasculitis 30

Vasculitis 31

Small vessel vasculitis 31

Medium vessel vasculitis 33

Large vessel vasculitis 34

Cryoglobulinemia 34

Bullous Disorders 36

Intracorneal/subcorneal 36

Intraepidermal 36

Suprabasilar 37

Subepidermal with little inflammation 37

Epidermolysis bullosa 39

Major bullous diseases – clinicopathologic findings 42

Complement 46

Angioedema and complement levels 46

Complement deficiencies 47

GVHD 47

HLA associations 48

Th profiles 50

Special Sites: Glands, Nail, Bone, Mucosa 51

Glands 51

Nail terminology 53

Disorders or drugs associated with nail, Bone, or ocular findings 57

Genital ulcers 67

Infection and Infestations 68

Fungal Disease / Mycoses 68

Laboratory tests 68

Superficial mycoses 68

Cutaneous mycoses 69

Subcutaneous mycoses 71

Systemic mycoses 73

Opportunistic mycoses 75

Viruses and diseases 78

Human papilloma virus 79

Other viral diseases 80

Infections/Bugs 83

Vector‐borne diseases 83

Creatures in dermatology 88

Contact and Plant Dermatitis 93

Patch testing 93

Common contact allergens 95

Allergic vs. irritant contact dermatitis 104

Allergens – location specific 105

Features suggestive of specific irritant/toxin 106

Plants and Dermatoses 106

Tumors and Infiltrates 109

Cutaneous T Cell Lyphoma 109

Cutaneous B‐cell lymphoma 113

Leukemia cutis 113

Monoclonal Gammopathies in Dermatology 114

Tumors and gene associations 115

For Melanoma, BCC, and SCC, see Skin Cancer 221

Systemic and Metabolic Diseases 117

Amyloidoses 117

Histiocytosis 119

Xanthomas 124

Hyperlipoproteinemias 125

Vitamin Deficiencies/Hypervitaminoses 127

Pediatric and Pregnancy Dermatology 131

Vascular tumors and malformation 131

Infantile Hemangioma (IH) Management 132

Neonatal vesiculopustular eruptions 137

Genodermatoses 142

Chromosome abnormalities 171

Disorders of cornification 171

Disorders of connective tissue 175

Ehlers–Danlos 177

Collagen types 178

Disorder of hair, Nail, ectoderm 179

Tumor syndromes 185

Disorders of vascularization 186

Disorders of metabolism 189

Porphyrias 191

Disorders of pigmentation 193

Immunodeficiency syndromes 196

Miscellaneous 198

Dermatoses of pregnancy 200

Dermoscopy and Dermatopathology 202

Dermoscopy 202

Dermatopathology 206

Histochemical staining 206

Immunohistochemical staining 207

Pathologic bodies 210

Cysts 214

Other derm path buzzwords, Patterns, DDx 215

Part 2 Surgical and Cosmetic Dermatology 219

Surgical Dermatology 221

Skin cancer 221

Surgical margin guidelines 221

Indication for Mohs micrographic surgery 222

Melanoma 223

Squamous cell carcinoma (SCC) 228

Prophylactic antibiotics and antivirals 230

Guideline for Prophylactic antibiotics 230

Algorithm for antibiotic prophylaxis 231

Guideline for prophylactic antivirals 231

Antiseptic scrubs 232

Anesthetics 234

Dose calculation 234

Standard formula for buffered Lidocaine 234

Tumescent anesthesia 234

Topical anesthetic (see drug section pg. 316) 235

Adverse reaction to local anesthetics 235

Local anesthetic 236

Nerve blocks 237

Surgical anatomy 237

Anatomy of the face 237

Danger zones in surgery 242

Dermatomal distribution of sensory nerves 244

Anatomy of the lower extremity venous system 245

Anatomy of the nail 246

Cutaneous reconstruction 247

Undermining depths in reconstruction 248

Reconstruction algorithm: STAIRS 248

Sutures 260

Absorbable 260

Nonabsorbable 261

Suture removal time 262

Electrosurgery 262

Wound healing 262

Wound dressing 263

Cosmetic Dermatology 264

Laser 264

Laser fundamentals 264

Laser treatment of tattoo pigment 266

Photoinduced eye injury 267

Laser wavelength depth of penetration and the electromagnetic spectrum 268

Absorption spectra of major skin chromophores 268

Photodynamic therapy 269

Photosensitizer properties and options 269

PDT Protocol 270

UV spectrum 271

UV spectrum and wavelengths 271

UVB protection vs SPF 272

UV protection measurements 272

UV associations/specificities 273

Glogau wrinkle scale 273

Fitzpatrick skin type 274

Chemical peels 274

Pre‐peel consideration 274

Peeling agents 275

Botulinum toxin 277

Injectable for adipolysis 280

Fillers 281

Protocol for vascular occlusion from fillers 288

Venous disease treatment 288

Vein treatment algorithm 288

Sclerotherapy 289

Preparing dilution of sclerosants 290

CEAP classification for venous disease 292

Venous clinical severity score 292

Part 3 Drugs and Therapies 293

Medication Quick Reference 295

Topical steroids classified by strength 295

Nonsteroidals 297

Commonly used drugs in dermatology 297

Systemic Medications 302

Antimalarials 302

Immunosuppressive agents 303

Systemic retinoids 306

Biologics 307

General Reference 310

Metric measurements 310

Dose calculations 310

Topical medication dispensing and absorption 310

Corticosteroid Dosage Equivalence 311

Acne – Topical 311

Antibiotics/antimicrobial 311

Keratolytics 312

Retinoids 313

Others 313

Acne – Oral 314

Antibiotics 314

Retinoids 315

Others 315

Analgesics 315

Anesthetics – topical (see also topical anesthetic pg. 235) 316

Anesthetics – topical compounded 316

Antibiotics 316

Topical/antiseptic 316

Systemic 317

Preoperative prophylaxis see pg. 230

Postoperative skin infection 319

Sensitivity 321

Regimens 322

STDs 323

Antifungals 324

Topical 324

Oral 325

Antifungal regimens 327

Candidal infection 327

Pityrosporum folliculitis 327

Onychomycosis 327

Tinea versicolor (Malassezia) 328

Tinea capitis 328

Tinea corporis 328

Tinea pedis 329

Antiparasitics 330

Scabies 330

Lice 330

Antivirals 331

HSV 331

Herpes zoster/VZV 333

Genital warts 333

Verruca vulgaris 334

Molluscum 334

Antihistamines 334

Sedating 335

Nonsedating 335

H2‐blockers 335

Antipruritic 336

Topical 336

Oral 336

Anxiolytics/Sedation 338

Benzodiazepines 338

Antihistamines 339

Bleaching Agents/Depigmenting Agents 340

Hair 341

Alopecia – androgenic 341

Alopecia – areata 341

Hypertrichosis 342

Hypotrichosis – eyelash 342

Hyperhidrosis 342

Psoriasis 343

Topical agents 343

Tar 343

Anthralin/dithranol 343

Systemic agents 343 (see also Systemic Medications pg. 306)

Rosacea 344

Antibiotics/antimicrobial – topical 344

Keratolytics 344

Vasoconstrictor 344

Other 344

Antibiotics – systemic 344

Seborrheic Dermatitis 345

Skin Cancer – Topical and Oral Chemotherapy 345

Actinic keratoses (AK) 345

Basal cell carcinoma (BCC) 346

CTCL 346

Melanoma 347

Vasoactive/Antiplatelet Agents 347

Vitamins/Nutritional Supplements 348

Wound Care 348

Miscellaneous Meds 348

Cytochrome P‐450 interactions 349

Pregnancy Categories of Commonly Used Dermatologic Agents 350

Common Dermatologic Drugs and Teratogenic Effects 351

Dermatologic Drugs Reportedly Associated with Contraceptive Failure 352

Drug Eruptions 352

Chemotherapeutic Agents and Skin Changes 355

Antidote to extravasation of chemotherapeutic agents 358

UV Light Treatment 359

UVA/UVB dosing 359

NBUVB dosing 359

PUVA 359

Toxic Epidermal Necrolysis (TEN) Protocol 361

Diagnosis of TEN 361

Triage algorithm for TEN patients 362

Treatment for all TEN patients 363

Appendix I American Burn Assocation Burn Center Referral Criteria 364

Appendix SCORTEN Score 365

Appendix III IVIg 365

Appendix IV Further Reading for TEN/SJS 366

Index 367

Color plate section can be found facing page 208

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