Remains your authoritative source for comprehensive coverage of those skin diseases in which histopathology plays an important role in diagnosis. This edition maintains the proven, clinicopathologic classification of cutaneous disease while incorporating a “primer” on pattern-algorithm diagnosis. More than 1,800 full-color illustrations, including photomicrographs and clinical photographs, help you visualize and make the most of the clinical diagnostic process.

Lever's Histopathology of the Skin

Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon’s plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).

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Dermoscopy in General Dermatology: A Practical Overview

Dermatoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible by the naked eye. Trichoscopy (scalp dermatoscopy and videodermatoscopy) is useful for the diagnosis and follow-up of hair and scalp disorders. However, it is not widely used in the management of hair disorders. This review provides updated information from the literature and our experience on the dermoscopic features of the most common hair and scalp disorders. This will enable dermatologists to make fast diagnoses of tinea capitis and alopecia areata, distinguish early androgenetic alopecia from telogen effluvium, and differentiate scarring from nonscarring alopecia.

Hair and scalp dermatoscopy

Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology.

https://www.jaad.org/article/S0190-9622(15)02183-0/pdf

Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

Skin tumor is the most intriguing topic for the clinicians. This chapter covers a wide range of issues and provides with informative clues and tips associated with clinical features and pathological presentations and keeps pace with the latest development in molecular biology and immunohistochemistry to assist the readers in the establishment of accurate diagnosis. These following disorders are elaborately selected and arranged from a histopathological perspective.

Tumors of the Skin

Background Alopecia areata (AA) is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure. Objective The objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA. Methods and selection criteria A search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA's incidence, prevalence, distribution, disability-adjusted life years (DALYs), quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data. Results The lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions. Conclusion AA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease.

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Epidemiology and burden of alopecia areata: a systematic review.

Background Scalp dermoscopy plays an important role in the diagnosis of hair and scalp disorders, and specific dermoscopic patterns have recently been associated with several disorders causing noncicatricial alopecia, such as androgenetic alopecia, alopecia areata, trichotillomania, and tinea capitis. Observations We describe the morphologic and pathologic features of a new dermoscopic pattern, referred to as “follicular red dots,” that was found in scalp lesions of 5 patients with active discoid lupus erythematosus (DLE). Follicular red dots appear as erythematous polycyclic, concentric structures, with a diameter ranging from 0.16 to 0.47 mm, regularly distributed in and around the follicular ostia. In the pathologic findings, red dots correspond to widened infundibula plugged by keratin and surrounded by dilated vessels and extravasated erythrocytes. Retrospective blinded evaluation of the dermoscopic images of 155 patients with cicatricial alopecia suggests that follicular red dots are a specific feature of DLE because the pattern was not identified in the images of cicatricial alopecia resulting from other diseases. Conclusions The follicular red dot pattern is a specific feature of scalp lesions of active lupus erythematosus of the scalp. Recognition of this distinctive dermoscopic pattern may help the clinician to differentiate DLE from other diseases causing cicatricial alopecia.

https://jamanetwork.com/journals/jamadermatology/articlepdf/712297/dob90015_1406_1409.pdf

Follicular Red Dots: A Novel Dermoscopic Pattern Observed in Scalp Discoid Lupus Erythematosus

Until a few years ago the diagnosis of hair shaft disorders was based on light microscopy or scanning electron microscopy on plucked or cut samples of hair. Dermatoscopy is a new fast, noninvasive, and cost-efficient technique for easy in-office diagnosis of all hair shaft abnormalities including conditions such as pili trianguli and canaliculi that are not recognizable by examining hair shafts under the light microscope. It can also be used to identify disease limited to the eyebrows or eyelashes. Dermatoscopy allows for fast examination of the entire scalp and is very helpful to identify the affected hair shafts when the disease is focal.

Dermatoscopy of hair shaft disorders.

F RONTAL FIBROSING ALOPECIA (FFA) IS A VARIant of lichen planopilaris that mostly affects postmenopausal women and is characterized by progressive bandlike scarring alopecia involving the frontal hairline and the eyebrows. A 45-year-old white woman presented with a 2-year history of progressive hair loss. Clinical examination revealed a band of alopecia with regression of the frontal hairline. A few single terminal hairs were present in the midfrontal area (Figure1). Her eyebrows were sparse, and she had no hair on her upper and lower limbs. The diagnosis of FFA was confirmed by the findings of pathologic examination (Figure 1, inset), which showed a lichenoid infiltrate at the level of the upper follicle. The infiltrate was seen within the outer root sheaths surrounded by layers of perifollicular fibrosis. There were a few apoptotic keratinocytes in the outer root sheaths and a prominent cleft between the follicular epithelium and the stroma. The presence of isolated terminal hairs in the middle of the forehead, at site of the original hairline, is a clinical clue to the diagnosis of FFA. A retrospective review of pictures of biopsy-proved FFA showed that the isolated hairs were present in 30 of 39 patients (Figure 2) and (Figure 3). The solitary hairs are 3 to 7 cm long and may or may not be accompanied by perifollicular erythema and scaling. They may be localized in the central or lateral aspect of the forehead. This distinctive clue is useful in the clinical differential diagnosis of FFA, which includes traction alopecia, alopecia areata, and androgenetic alopecia, and it can improve the ability of dermatologists to diagnose FFA in their daily practice.

Mariya Miteva

Papers

Hair and scalp dermatoscopy

Epidemiology and burden of alopecia areata: a systematic review.

Follicular Red Dots: A Novel Dermoscopic Pattern Observed in Scalp Discoid Lupus Erythematosus

Dermatoscopy of hair shaft disorders.

Lonely hair: a clue to the diagnosis of frontal fibrosing alopecia.