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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