[Dermatology] Atlas of Pruritus and Neurocutaneous Diseases

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This portion of the atlas will guide you through the clinical manifestations related to pruritic disorders. This is a part of the Andrews' Diseases of the Skin Clinical Atlas 1st Edition 2018 book

[Dermatology] Atlas of Cutaneous Signs and Diagnosis (Part 3)

[Dermatology] Atlas of Cutaneous Signs and Diagnosis (Part 2)

[Dermatology] Atlas of Cutaneous Signs and Diagnosis (Part 1)

Pruritus often produces distinctive skin lesions, characterized by angulated borders. Endogenous diseases (in common parlance, an “inside job”) tend to produce lesions that are rounded in character, whereas exogenous caustic agents, scratching, and other forms of external trauma tend to produce angulated, linear, or geometric shapes (signs of an “outside job”).

Pruritus can also result in the isomorphic (Koebner) phe- nomenon, where lesions of an endogenous disease localize in areas of trauma. These lesions often demonstrate a hybrid morphology, suggesting both endogenous origin and external trauma.

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Lichenification results from chronic scratching or rubbing and is characterized by hyperkeratosis and papillary dermal fibrosis. The resulting clinical morphology includes slight induration and accentuation of skin markings. Excoriation results in eosinophilic necrosis of the granular layer. The corneum can remain intact, but more severe excoriation results in loss of the corneum and viable epidermis. More pronounced trauma can result in ulceration, in which the injury extends to the level of the dermis.

Broad areas of lichenification are characteristic of lichen simplex chronicus. Discrete papules with focal evidence of excoriation are typical of prurigo nodularis and arthropod bites, including those caused by bedbugs. This portion of the atlas will guide you through the clinical manifestations related to pruritic disorders.

Fig. 4.1 Excoriations secondary to pruritus of Hodgkin disease.

Fig. 4.2 Acquired perforating disease in renal failure.

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Fig. 4.3 Acquired perforating disease in renal failure.

Fig. 4.4 Acquired perforating disease in renal failure

Fig. 4.5 Prurigo nodularis in a chronic renal failure patient

Fig. 4.6 Jaundice.

Fig. 4.7 Palmar xanthomas in hepatic cholestasis.

Fig. 4.8 Lichen simplex chronicus in Alagille disease.

Fig. 4.9 Hyperpigmentation in primary biliary cirrhosis.

Fig. 4.10 Winter itch.

Fig. 4.11 Lichen simplex chronicus in pruritus ani.

Fig. 4.12 Lichen simplex chronicus of the scrotum.

Fig. 4.13 Lichen simplex chronicus of the vulva.

Fig. 4.14 Prurigo pigmentosa

Fig. 4.15 Prurigo pigmentosa

Fig. 4.16 Prurigo pigmentosa

Fig. 4.17 Papuloerythroderma of Ofuji with deck chair sign.

Fig. 4.18 Lichen simplex chronicus.

Fig. 4.19 Lichen simplex chronicus.

Fig. 4.20 Lichen simplex chronicus.

Fig. 4.21 Lichen simplex chronicus.

Fig. 4.22 Lichen simplex chronicus with 

dyspigmentation and early nodule formation.

Fig. 4.23 Prurigo nodularis.

Fig. 4.24 Prurigo nodularis with excoriation

Fig. 4.25 Compulsive finger biting.

Fig. 4.26 Chronic lip licking.

Fig. 4.27 Dryness secondary to compulsive hand washing

Fig. 4.28 Washboard nails secondary to habitual trauma to the matrix.

Fig. 4.29 Fibroma secondary to chronic tongue biting

Fig. 4.30 Enamel erosion secondary to vomiting with bulimia

Fig. 4.31 Delusions of parasitosis

Fig. 4.32 Delusions of parasitosis

Fig. 4.33 Psychogenic excoriations

Fig. 4.34 Psychogenic excoriations

Fig. 4.35 Skin picking in Prader-Willi syndrome

Fig. 4.36 Factitial ulcers induced by parents.

Fig. 4.37 Factitial dermatitis

Fig. 4.38 Factitial ulcers.

Fig. 4.39 Cigarette burn, factitial.

Fig. 4.40 Factitial ulcer.

Fig. 4.41 Factitial bruising

Fig. 4.42 Factitial blisters and erosions

Fig. 4.43 Factitial scarring

Fig. 4.44 Healed factitial lacerations

Fig. 4.45 Factitial ulcers and scarring

Fig. 4.46 Factitial erosions and scarring

Fig. 4.47 Trichotillosis, with loss of eyelashes and partial loss of eyebrows.

Fig. 4.48 Trichotillosis, with partial loss of eyelashes

Fig. 4.49 Trichotillosis

Fig. 4.50 Notalgia paresthetica

Fig. 4.51 Complex regional pain syndrome

Fig. 4.52 Complex regional pain syndrome.

Fig. 4.53 Blistering and atrophy, complex

regional pain syndrome

Fig. 4.54 Trigeminal trophic syndrome

Fig. 4.55 Neuropathic ulcer of the hand in a diabetic patient

REFERENCES

Andrews' Diseases of the Skin Clinical Atlas 1st Edition 2018