Integument

Integument
8-A. Alopecia
Nonscarring
Aging (pattern baldness)
Androgenic alopecia (e.g., secondary to ovarian or adrenal dysfunction)
Traction or other trauma (trichotillomania, heat exposure)
Drugs
  • Cytotoxic agents, interferon
  • Oral contraceptives (withdrawal)
  • Amphetamines
  • Anticoagulants (heparin, Coumadin)
  • Beta-blockers, captopril
  • Lithium, anticonvulsants
  • Vitamin A, retinoids
  • Immunoglobulin
  • Cholesterol-lowering agents
  • Cimetidine
  • Isoniazid
  • Propylthiouracil
Serious systemic illness, childbirth, weight loss, other stresses (telogen effluvium)
Cutaneous disease
  • Seborrheic dermatitis
  • Eczema
  • Tinea capitis
  • Psoriasis
  • Cosmetics, other local irritants
Lupus erythematosus
Hypothyroidism, hyperthyroidism
Hypopituitarism
Syphilis, secondary
Nutritional deficiency states (kwashiorkor, marasmus, or iron, zinc, or biotin deficiency)
Human immunodeficiency virus (HIV) infection
Alopecia areata
Hereditary or congenital
Scarring
Physical and chemical agents
  • Burns (hot combs or curlers)
  • Freezing
  • Mechanical trauma
  • Acid, alkali
  • Radiation
  • Body art: tattooing, scarification
Infection
  • Bacterial (including pyogenic infection, tertiary syphilis, leprosy, or lupus vulgaris)
  • Fungal (e.g., ringworm)
  • Viral (especially varicella-zoster, variola)
  • Protozoal (leishmaniasis)
Systemic disease
  • Lupus erythematosus, systemic or discoid
  • Scleroderma or morphea
  • Sarcoidosis
  • Dermatomyositis
  • Amyloidosis
  • Neoplasm
    • Metastatic carcinoma
    • Lymphoma
Cutaneous disease
  • Basal cell carcinoma
  • Lichen planus
  • Cicatricial pemphigoid
  • Necrobiosis lipoidica diabeticorum
Congenital or idiopathic (pseudopelade of Brocq)
References
1. Habif T. Hair diseases. See Bibliography, 1.
2. Tosti A, Pazzaglia M. See Bibliography, 2.
3. Braverman P. Body art: piercing, tattooing, and scarification. Adolesc Med. 2006;17;505-519.
8-B. Erythema Multiforme
Infections
  • Viral [especially herpes simplex virus (HSV), Epstein-Barr, Coxsackie virus, echovirus, and influenza]
  • Bacterial (e.g., Yersinia, Francisella tularensis)
  • Mycoplasma pneumoniae
  • Chlamydial (lymphogranuloma venereum)
  • Fungal (especially histoplasmosis, coccidioidomycosis)
  • Parasitic (Trichomonas, malaria)
Vaccines [e.g., smallpox, polio, bacilli Calmette-Guérin (BCG)]
Drugs and toxins
  • Antibiotics (especially penicillin, sulfonamides, tetracyclines)
  • Metals (mercury, arsenic, gold)
  • Antihistamines
  • Barbiturates, codeine
  • Phenytoin, carbamazepine
  • Quinine
  • Salicylates, nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Hydralazine
  • Thiazides
Neoplastic and hematologic disorders
  • Lymphoma
  • Leukemia
  • Multiple myeloma
  • Polycythemia vera
Physical factors and contact reactions
  • Radiation and sunlight
  • Cold
  • Poison oak, fire sponge (Tedania ignis)
Collagen vascular disease
  • Lupus erythematosus, systemic or discoid
  • Rheumatoid arthritis
  • Polyarteritis nodosa
  • Wegener granulomatosis
  • Dermatomyositis
  • Reiter syndrome
Sarcoidosis
Menstruation, pregnancy
Löffler syndrome
Beer ingestion
References
1. Chung V. See Bibliography, 3.
2. Habif T. See Bibliography, 1, p. 626.
3. Lamoreux M, Sternbach MR, Hsu WT. Erythema multiforme. Am Fam Physician. 2006;74:1883-1888.
8-C. Erythema Nodosum
Infection
  • Bacterial
    • Streptococci
    • Yersinia
    • Cat scratch fever (Bartonella henselae)
    • Salmonella
    • Campylobacter
    • Mycoplasma pneumoniae
    • Tularemia
    • Tuberculosis
    • Leprosy
    • Chlamydial (lymphogranuloma venereum, psittacosis)
  • Fungal
    • Histoplasmosis
    • Coccidioidomycosis
    • Blastomycosis
  • Viral
    • Hepatitis B and C, HSV, HIV
Drugs
  • Antibiotics (penicillin, sulfonamides)
  • Salicylates
  • Iodides, bromides
  • Oral contraceptives
Sarcoidosis
Behçet syndrome
Radiation therapy
Inflammatory bowel disease
Pregnancy
Leukemia, lymphoma, other malignancies
Idiopathic
References
1. Mandell G, et al. Chapter 49. See Bibliography, 4.
2. Goldman L. Chapter 475. See Bibliography, 5.
3. Schwartz R, Nervi S. Erythema nodosum: a sign of systemic disease. Am Fam Physician. 2007;75:695-700.
8-D. Hirsutism and Generalized Hypertrichosis
Anorexia, malnutrition
Drugs
  • Minoxidil
  • Androgenic steroids and corticosteroids
  • Progestins
  • Phenytoin
  • Cyclosporin, penicillamine
Endocrine disorders
  • Androgenital syndrome
  • Adrenal hyperplasia, adenoma, carcinoma
  • Pituitary tumor (especially Cushing disease, acromegaly, prolactin-secreting tumors)
  • Polycystic ovary syndrome
  • Ovarian tumor
  • Hyperandrogenism, insulin resistance, acanthosis nigrans (HAIR-AN) syndrome
  • Hypothyroidism
Central nervous system disease
  • Encephalitis
  • Multiple sclerosis
  • Head trauma
Dermatomyositis
Hereditary or congenital conditions
  • Cutaneous porphyria
  • Hurler syndrome
  • Morquio syndrome
  • Insulin receptor gene mutation
  • de Lange syndrome
Hamartomas
Idiopathic
References
1. Tosti A, Pazzaglia M. See Bibliography, 2.
2. Habif T. See Bibliography, 1, p. 846.
3. Essah PA. Dermatology of androgen related disorders. Clin Dermatol. 2006;24:289-298.
8-E. Maculopapular Eruption, Generalized
Drugs (especially antibiotics)
Infections
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Jun 19, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Integument

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