McGraw-Hill Education
Specialty Board Review
Dermatology
A Pictorial Review
Ali-FM_00i-xiv.indd 1
9/18/14 3:15 PM
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are
required. The authors and the publisher of this work have checked with
sources believed to be reliable in their efforts to provide information that
is complete and generally in accord with the standards accepted at the
time of publication. However, in view of the possibility of human error
or changes in medical sciences, neither the authors nor the publisher nor
any other party who has been involved in the preparation or publication
of this work warrants that the information contained herein is in every
respect accurate or complete, and they disclaim all responsibility for any
errors or omissions or for the results obtained from use of the information
contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular,
readers are advised to check the product information sheet included in the
package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been
made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection
with new or infrequently used drugs.
Ali-FM_00i-xiv.indd 2
9/18/14 3:15 PM
McGraw-Hill Education
Specialty Board Review
Dermatology
A Pictorial Review
Third Edition
Editor
Asra Ali, MD
Private Practice—Dermatology
Houston, Texas
New York Chicago San Francisco Athens London Madrid Mexico City Milan
New Delhi Singapore Sydney Toronto
Ali-FM_00i-xiv.indd 3
9/18/14 3:15 PM
Copyright © 2015 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication
may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher,
with the exception that the program listings may be entered, stored, and executed in a computer system, but they may not be reproduced for publication.
ISBN: 978-0-07-179324-7
MHID: 0-07-179324-0
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-179323-0,
MHID: 0-07-179323-2.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an
editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book,
they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs. To
contact a representative, please visit the Contact Us page at www.mhprofessional.com.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except
as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer,
reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill
Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use
the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE
ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION
THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS
OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation
will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission,
regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed
through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential
or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation
of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
Contents
C o n tr i b u t o r s / v i i
pre f ace / x i II
C h apter 1
C h apter 9
Hair Findings / 1
PIGMENTARY DISORDERS / 159
Paradi Mirmirani and Jennifer Ahdout
Kaveh A. Nezafati, Roger Romero, and Amit G. Pandya
C h apter 2
EYE FINDINGS / 19
Mirwat S. Sami and Charles S. Soparkar
C h apter 3
NAIL FINDINGS / 39
Ravi Ubriani
C h apter 1 0
DISORDERS OF FAT / 175
Hung Doan, Marigdalia K. Ramirez-Fort, Ryan J. Gertz, Andrew
J. Thompson, Farhan Khan, and Stephen K. Tyring
C h apter 1 1
CUTANEOUS TUMORS / 191
Joy H. Kunishige and Alexander J. Lazar
C h apter 4
C h apter 1 2
ORAL PATHOLOGY / 57
MELANOMA AND NON-MELANOMA SKIN
CANCER / 213
Kamal Busaidy, Jerry Bouquot, and Laith Mahmood
Sumaira Aasi and Michelle Longmire
C h apter 5
Genital Dermatology / 85
Libby Edwards
C h apter 1 3
Vascular Tumors And
Malformations / 225
Denise W. Metry, John C. Browning, and Asra Ali
C h apter 6
CONTACT DERMATITIS / 97
C h apter 1 4
Melissa A. Bogle, Giuseppe Militello, and Sharon E Jacob
GENODERMATOSIS / 239
C h apter 7
AUTOIMMUNE BULLOUS DISEASES / 113
Whitney A. High
Nnenna G. Agim, Joy H. Kunishige, Marzieh Thurber, Adrienne
M. Feasel, and Adelaide A. Hebert
C h apter 1 5
PEDIATRIC DERMATOLOGY / 269
C h apter 8
Disorders of Cornification,
Infiltration, and Inflammation / 129
Pamela Gangar and Rakhshandra Talpur
Nnenna G. Agim, John C. Browning, Denise W. Metry,
and Adrienne M. Feasel
C h apter 1 6
CUTANEOUS INFESTATIONS / 283
Dirk M. Elston, Asra Ali, Melissa A. Bogle, and Alyn D. Hatter
Ali-FM_00i-xiv.indd 5
9/18/14 3:15 PM
Contributors
Sumaira Z. Aasi, MD
Jerry E. Bouquot, DDS, MSD, FICD, FACD, FRCM (UK)
Professor
Department of Dermatology
Stanford University
Palo Alto, California
Chapter 12
Adjunct Professor
Department of Diagnostic & Biomedical Sciences
University of Texas School of Dentistry
Houston, Texas
Adjunct Professor
Department of Rural Health & Community Dentistry
West Virginia University School of Dentistry
Morgantown, West Virginia
Director of Research
The Maxillofacial Center for Education & Research,
Morgantown, West Virginia
Chapter 4
Nnenna G. Agim, MD
Assistant Professor of Dermatology
Children’s Medical Center
Dallas and University of Texas Southwestern Medical Center
Pediatric Dermatology
Houston, Texas
Chapters 14, 15
Jennifer Ahdout, MD
Department of Dermatology
UC Irvine
Irvine, California
Director of Dermatology, Lasers, and Skin Care
Spalding Drive Plastic Surgery & Dermatology
Beverly Hills, California
Chapter 1
Carolyn A. Bangert, MD
Associate Professor
Department of Dermatology
University of Texas
Houston, Texas
Chapter 22
Melissa A. Bogle
Director
The Laser & Cosmetic Surgery Center of Houston
Houston, Texas
Clinical Assistant Professor
Department of Dermatology
University of Texas M.D. Anderson Cancer Center
Houston, Texas
Chapters 16, 26
Ali-FM_00i-xiv.indd 7
Kamal Busaidy, BDS, FDSRCS
Associate Professor
Department of Oral and Maxillofacial Surgery
University of Texas-School of Dentistry
Houston, Texas
Chapter 4
John C. Browning, MD, FAAD, FAAP
Assistant Professor of Pediatrics and Dermatology
Baylor College of Medicine
Houston, Texas
Assistant Professor of Pediatrics and Dermatology
University of Texas Health Science Center
San Antonio, California
Chief of Dermatology
Children’s Hospital of San Antonio
San Antonio, California
Chapters 13, 15
Christopher T. Burnett, MD
Dermatology Associates of Wisconsin
Milwaukee, Wisconsin
Chapters 24, 28
Stephanie F. Chan
Graduate student in Biostatistics
Harvard University
Cambridge, Massachusetts
Chapter 29
9/18/14 3:15 PM
x CONTRIBUTORS
Natalia Mendoza, MD
Amit G. Pandya, MD
Department of Dermatology
University of Texas
Medical School at Houston
Houston, Texas
Chapter 17
Department of Dermatology
The University of Texas Southwestern Medical Center
Dallas, Texas
Chapter 9
Denise W. Metry, MD
Clinical Assistant Professor
FIU Wertheim College of Medicine
Miami, Florida
Chapter 33
Associate Professor of Dermatology and Pediatrics
Texas Children’s Hospital/Baylor College of Medicine
Houston, Texas
Chapters 13, 15
Jason H. Miller, MD
Resident Physician
Department of Dermatology
University of Texas at Houston Health Science Center
M. D. Anderson Cancer Center
Houston, Texas
Chapters 22, 23
Paradi Mirmirani, MD
Permanente Medical Group
Vallejo, California
University of California
San Francisco, California
Case Western Reserve University
Cleveland, Ohio
Chapter 1
Kiran Motaparthi, MD
Assistant Professor
Department of Dermatology
Baylor College of Medicine
Houston, Texas
Chapter 35
Kaveh A. Nezafati, MD
Department of Dermatology
The University of Texas Southwestern Medical Center
Dallas, Texas
Chapter 9
Tri H. Nguyen, MD, FACMS, FAAD, FACPH
Texas Surgical Dermatology
Houston, Texas
Chapter 25
Roberto A. Novoa, MD
Resident
Department of Dermatology
Case Western Reserve University
Case Medical Center
Cleveland, Ohio
Chapter 27
Ali-FM_00i-xiv.indd 10
Gustavo Pantol, MD
Giovanni Pellacani, MD
Professor
Department of Dermatology
Medical University of Modena and Reggio Emilia
Modena, Italy
Chapter 32
Victor G. Prieto, MD, PhD
Professor
Departments of Pathology and Dermatology
The University of Texas M.D. Anderson Cancer Center
Houston, Texas
Chapter 30
Marigdalia K. Ramirez-Fort, MD
Department of Dermatology
Tufts Medical Center
Boston, Massachusetts
Chapters 10, 20, 32, 33
Ronald P. Rapini, MD
Chernosky Professor and Chair
Department of Dermatology
University of Texas Medical School at Houston and M.D. Anderson
Cancer Center
Houston, Texas
Chapter 21
Riva Z. Robinson, MD
Resident Physician
Department of Preventive Medicine
Texas A&M Health Science Center College of Medicine
Round Rock, Texas
Chapters 20, 33
Roger Romero, MD
Department of Dermatology
The University of Texas Southwestern Medical Center
Dallas, Texas
Chapter 9
9/18/14 3:15 PM
xi
CONTRIBUTORS
Mirwat S. Sami, MD
Marzieh Thurber, MD
Ophthalmic Plastic and Reconstructive Surgeon, Private Practice
Houston Oculofacial Plastic Surgery
Houston, Texas
Department of Head and Neck Surgery, Division of Surgery
University of Texas M.D. Anderson Cancer Center
Houston, Texas
Department of Surgery, Division of Ophthalmology
Texas Children’s Hospital
Houston, Texas
Department of Ophthalmology
Houston Methodist Hospital
Houston, Texas
Chapter 2
Jupiter Medical Center
Jupiter, Florida
Chapter 14
Charles S. Soparkar, MD, PhD
Ophthalmic Plastic and Reconstructive Surgery Private Practice
Plastic Eye Surgery Associates
Houston, Texas
Department of Ophthalmology
Baylor College of Medicine
Houston, Texas
Department of Ophthalmology
Weill Cornell Medical College
The Methodist Hospital
Houston, Texas
Chapter 2
Rakhshandra Talpur, MD
Senior Research Scientist, Dermatology Research
Department of Dermatology
University of Texas M.D. Anderson Cancer Center
Houston, Texas
Chapter 8
Ali-FM_00i-xiv.indd 11
Stephen K. Tyring, MD, PhD
Clinical Professor of Dermatology
University of Texas Health Science Center
Houston, Texas
Chapters 10, 17, 20
Ravi Ubriani, MD
Assistant Professor of Clinical Dermatology
Columbia University
New York, New York
Chapter 3
Kara E. Walton, MD
Assistant Professor
Department of Dermatology
Medical College of Wisconsin
Milwaukee, Wisconsin
Chapter 24
Rungsima Wanitphakdeedecha, MD
Associate Professor
Department of Dermatology
Faculty of Medicine
Siriraj Hospital
Mahidol University
Bangkok, Thailand
Chapter 25
9/18/14 3:15 PM
This page intentionally left blank
preface
McGraw-Hill Education Specialty Board Review Dermatology:
A Pictorial Review is now in its third edition.
The ever-changing field of dermatology demands constant updating of information. To address this need, the third edition presents
many new images as well as a new chapter on confocal microscopy.
The goal of this edition is similar to that of the previous two editions
of the book. Not only is the book an excellent tool for dermatologyrelated questions on board exams to prepare residents in dermatology, primary care, and other clinical specialties, it will also help
practicing dermatologists and other clinicians with their recertification exams.
As an invaluable resource in the clinical setting, the revised and
updated new edition of this practical guide provides comprehensive,
Ali-FM_00i-xiv.indd 13
yet concise, coverage of the diagnosis and management of common
dermatologic disorders as well as some less common but important
dermatologic conditions. Each chapter is organized in a readable and
helpful format. Principles of diagnosis, differential diagnosis, and
considerations for therapy are discussed in clinically related chapters.
There are chapters dedicated to cosmetic and surgical procedures
with helpful insights. As a result, the book will be useful to more
procedure-focused physicians as well. The questions and answers at
the end of each chapter were also updated with new questions in
order to make the learning process more interactive. It is hoped that
the reader will gain from this edition as much as the editor did in
preparing it.
9/18/14 3:15 PM
Chapter 1
Hair Findings
Paradi Mirmirani and Jennifer Ahdout
DEVELOPMENT
MICROSCOPIC STRUCTURE (FIG. 1-2)
• Follicles form during third month of gestation; form first
on head
• Lining of follicle = ectodermal origin
• Dermal papilla = mesodermal origin
• Epidermal invaginations occur at an angle to the surface
and over sites of mesenchymal cell collections
• Eventually these epidermal cells form a column that surrounds the mesenchymal dermal papilla to form the bulb
• The dermal papilla (along with “stem” cells in the bulge)
induces hair follicle formation by the overlying epithelium
• Additionally, 2 or 3 other collections of cells form along
the follicle:
• Upper collection becomes the mantle from which the
sebaceous gland will develop
• Lower swelling becomes the attachment for the arrector pili muscle and where follicle germinal cells reside
in telogen phase
• If a third collection of cells exists, it is found opposite
and superior to the sebaceous gland and develops into
the apocrine gland
• The hair follicle is arranged in concentric circles (from
outer to inner)
• Basement membrane (glassy membrane): PAS-positive,
acellular; thin during anagen and thickens during catagen
• Outer root sheath (ORS): present the length of the follicle; never keratinizes; stays fixed in place
• Inner root sheath (IRS): grows toward cell surface and
separates from the hair shaft at the level of the sebaceous gland
–– Henle layer: one cell thick and first to cornify
–– Huxley layer: two cells thick; eosinophilic-staining
trichohyalin granules
–– Cuticle
• Hair shaft: grows toward cell surface; cornifies without
trichohyalin or keratohyalin granules
• Cuticle: shingle-like hair cells that interlock with cuticle
cells of IRS
• Cortex: arises from cells in center of hair bulb; disulfide bonds in this region give hair its tensile strength;
keratinizes to form shaft; contains pigment of hair
• Medulla: contains melanosomes; found only in terminal
hairs
• Hair cycle: human follicles (Fig. 1-1) cycle in an asynchronous pattern (adjacent hairs in different stages)
• Anagen: growth phase, stages I–VI
–– Eighty-four percent of hair follicles at any one time;
last a few months to 7 years
–– Cells in the hair bulb are actively dividing
• Catagen: transitional or degenerative stage
–– Two percent of hair follicles at any one time
–– Last a few days to weeks
–– Matrix cells have stopped dividing
–– Incomplete keratinization
–– Thickened basement membrane (glassy layer)
–– Transient, lower portion of follicle is broken down
• Telogen: resting phase
–– Fourteen percent of hair follicles at any one time
–– Lasts about 3 months
STRUCTURE (FIG. 1-1)
• Longitudinal structure: (superior to inferior)
• Permanent portion of the hair follicle
–– Infundibulum
–– Area of the sebaceous gland
–– Isthmus: begins at sebaceous gland and ends at the
bulge (site of insertion of arrector pili muscle)
–– Area of the bulge: location of follicular stem cells
• Transient portion of the hair follicle
–– Lower hair follicle
–– Hair bulb: contains the matrix, melanocytes;
envelopes the dermal papilla; critical line of Auber
is at the widest diameter; below this line is the bulk
of mitotic activity
1
Ali-Ch01_p0001-018.indd 1
9/15/14 9:47 AM
2
Chapter 1
Hair Findings
Hair cycle and anatomy
Catagen
Telogen
Outer root
sheath
Anagen stage
Anagen
Infundibulum
Epidermis
Hair
Sebaceous
gland
Bulge
Exogen
Bulge
Sec Grm
Matrix
Dermal papilla
Bulge
Bulge
Suprabulbular
area
Bulb
Hair medulla
Hair cortex
Hair cuticle
Companion layer
Huxley layer
Henle layer
Inner root sheath
Cuticle
Outer root sheath
Connective tissue sheath
FIGURE 1-1 Hair cycle and anatomy. The hair follicle cycle consists of stages of rest
(telogen), hair growth (anagen), follicle regression (catagen), and hair shedding (exogen). The
entire lower epithelial structure is formed during anagen and regresses during catagen. The
transient portion of the follicle consists of matrix cells in the bulb that generate 7 different
cell lineages, 3 in the hair shaft, and 4 in the inner root sheath. (Reprinted with permission
from Goldsmith LA et al, Fitzpatrick’s Dermatology in General Medicine, 8th Ed. New York:
McGraw-Hill; 2012.)
–– “Club hair”; no inner root sheath
–– Dermal papilla retracted to higher position in
dermis
• Hair pigmentation
• Pigment comes from melanocytes located in the
matrix, above the dermal papilla
• Eumelanin: pigment of brown-black hair
• Pheomelanin: pigment of blonde-red hair
• Loss of melanocytes and decreased melanosomes cause
graying of hair—poliosis (can be seen in regrowth of
hair after alopecia areata). In youth, catalase breaks
down hydrogen peroxide so that the pigmentation of
hair is retained. With aging, the protective function of
catalase is lost, and hydrogen peroxide builds up and
turns hair gray or white.
Ali-Ch01_p0001-018.indd 2
• Hair growth
• Hair grows approximately 0.35 to 0.37 mm/d
• Longer anagen phase = longer hair
HAIR DISORDERS
Alopecia, Nonscarring
Diffuse
1. Telogen effluvium
• Hair shedding, often with an acute onset
• Reactive process, response to a physical event (surgery,
pregnancy, thyroid disease, iron deficiency, high fever),
medications (Table 1-1), or severe mental or emotional
stress
9/15/14 9:48 AM
3
HAIR DISORDERS
FIGURE 1-2 Morphology and fluorescent
A
B
E
C
microscopy of human hair follicle at distinct
hair cycle stages. A–D. Morphology of
human hair follicle during telogen (A), late
anagen (B), and early and late catagen (C, D).
(E) Immunofluorescent visualization of the
melanocytes (arrows) in the hair bulb of late
anagen hair follicle with anti–melanomaassociated antigen recognized by T cells
antibody. (F) Immunofluorescent detection
of proliferative marker Ki-67 (arrows) and
apoptotic TUNEL+ cells (arrowheads) in early
catagen hair follicle. FP = follicular papilla;
HM = hair matrix. (Reprinted with permission
from Goldsmith LA et al. Fitzpatrick’s
Dermatology in General Medicine, 8th Ed.
New York: McGraw-Hill; 2012.)
D
F
A large number of hairs shift from anagen to telogen at
one time
• Telogen hairs move back to anagen in 3 to 4 months
following the inciting event; hair density may take 6 to
12 months to return to baseline
• The percentage of hairs in telogen rarely goes beyond
50%
• Positive pull test: more than 6 telogen hairs
• Telogen hairs on hair mount (Fig. 1-3)
• Histology: increased number of telogen hairs
• Prognosis: recovery is spontaneous and occurs within
6 months if inciting cause is reversed. Regrowing hairs
with tapered or pointed hairs can be seen in the recovery phase
2. Loose anagen syndrome
• Fair-haired children with thin, sparse, hair; no need for
haircuts; easily dislodgable hair
• Examination reveals sparse growth of thin, fine hair
and diffuse or patchy alopecia
• Anagen hairs are easily and painlessly pulled from scalp
•
Ali-Ch01_p0001-018.indd 3
Diagnosis: epilated hairs are predominantly in anagen
phase; hair mount shows distorted anagen bulb, ruffled
cuticle (Fig. 1-4)
• Histology: premature and abnormal keratinization of
the inner root sheath
• Improves with age
3. Anagen effluvium (aka anagen arrest)
• Hair broken off and not shed
• Radiation therapy and chemotherapy agents; occurs
2 to 4 weeks after treatment
• Hair shafts are abruptly thinned (Pohl-Pinkus constrictions) and break off at skin surface
• Other causes: mercury intoxication, boric acid intoxication, thallium poisoning, colchicine, severe protein
deficiency
• Histology: normal follicles
•
Patchy
1. Alopecia areata (Fig. 1-5)
• Abrupt onset
9/15/14 9:48 AM
4
Chapter 1
Hair Findings
Table 1-1 ommon Medications Causing
C
Telogen Effluvium
Angiotensin-converting enzyme inhibitors (ACEIs)
Anticancer
Anticoagulation (heparin, coumadin)
Anticonvulsant (sodium valproate, carbamazepine)
Selective serotonin reuptake inhibitors (SSRIs),
tricyclic antidepressants (TCAs), and other psychiatric
medications (amitriptyline, doxepin, haloperidol,
lithium, haloperidol)
FIGURE 1-4 Hair mount showing a dystrophic
anagen hair with a ruffled cuticle in a patient with loose
anagen syndrome. (Used with permission from
Dr. Paradi Mirmirani.)
Antigout (probenecid, allopurinol)
•
Antithyroid (methimazole, propylthiouracil)
•
β-blockers (propanolol, timolol)
Antibiotics (nitrofurantoin, sulfasalazine)
Oral contraceptives: containing progestins with high
androgen potential
Other (amiodarone, indomethacin, vitamin A, oral
contraceptives)
•
•
•
•
Exclamation point hairs which are broken hairs that
are tapered at the scalp (Fig. 1-6)
Pigmented hair affected first, subsequently gray hair
may also be targeted (Fig. 1-7)
Peach- or salmon-colored scalp
Hair pull test positive for telogen hairs when disease is
active
•
•
•
•
•
Follicular damage in anagen; then rapid transformation
into telogen
Alopecia totalis: total scalp hair loss
Alopecia universalis: total scalp and body hair loss
Ophiasis: localized hair loss along the periphery of the
scalp
Nails: pitting, mottled lunula, trachyonychia, or
onychomadesis
Histology: peribulbar infiltrate of T cells and macrophages (“swarm of bees”)
Associations: In the patient: atopic disorders, thyroid
disease, vitiligo. In the family: atopic disorders, thyroid
disease, vitiligo, diabetes mellitus, pernicious anemia,
systemic lupus erythematosus (other autoimmune
conditions)
FIGURE 1-3 Hair mount showing a telogen hair.
(Reprinted with permission from Weedon D, ed.
Weedon’s Skin Pathology, 3rd Ed. London: Churchill
Livingston Elsevier; 2010.)
Ali-Ch01_p0001-018.indd 4
FIGURE 1-5 Patchy alopecia areata. (Used with
permission from Dr. Paradi Mirmirani.)
9/15/14 9:48 AM
5
HAIR DISORDERS
Treatment: Patchy, or more than 50%: intralesional
steroids, minoxidil 5% solution or foam, anthralin,
topical steroids. Unresponsive or extensive: topical
immunotherapy (squaric acid dibutylester [SADBE] or
diphenylcyclopropenone [DPCP]), systemic cortisone
(short-term or bridge treatment), psoralen plus ultraviolet A (UV-A), excimer laser.
2. Trichotillomania
• Impulse-control disorder
• Repeated plucking or pulling of hairs
• Confluence of short, sparse hairs within an otherwise
normal area of the scalp
• Varying lengths of regrowth, “friar tuck” distribution of
hair loss (Fig. 1-8)
• Regrowing hair is blunt tipped instead of pointed
• Eyebrows and upper eyelashes may be affected
• Often have other habits: nail biting, skin picking
• Histology: pigment casts, increased catagen hairs,
trichomalacia
• Treatment: psychological intervention and/or psychiatric
medication to modify behavior
3. Pityriasis amiantacea (Fig. 1-9)
• Thick scale, matted hair
• May mimic severe seborrheic dermatitis or psoriasis;
however, hair that is involved is easily dislodged on
attempts to physically remove the scale
• Treatment: keratolytics, corticosteroids, oil, improves
with age
•
FIGURE 1-6 Exclamation point hairs in alopecia
areata. (Used with permission from Dr. Paradi
Mirmirani.)
FIGURE 1-7 Alopecia areata primarily affecting
pigmented hairs. (Used with permission from Dr. Paradi
Mirmirani.)
Ali-Ch01_p0001-018.indd 5
FIGURE 1-8 Trichotillomania. (Used with permission
from Dr. Paradi Mirmirani.)
9/15/14 9:48 AM
- Xem thêm -