Herpes simplex 6 See roseola infantum

Herpes zoster, 38, 180-182, 180f, 193-194, 194f, 260-262, 261f, 380f

Herxheimer reaction. An acute reaction characterized by fever and aggravation of existing cutaneous lesions following the administration of penicillin or organic arsenic for the treatment of patients with syphilis, particularly the infectious form. In patients with central nervous system syphilis, neurologic findings may be aggravated. In patients with cardiovascular syphilis, the reaction may be fatal, but some observers doubt the occurrence of this severe form of Herxheimer reaction.

Hidradenitis. See Idiopathic recurrent palmoplantar hidradenitis.

Hidrocystoma. Benign tumor of the face that is cystic, quite small, may have a slight bluish discoloration and can be a derivative of the eccrine or apocrine sweat gland. Accentuated by warm environment.

Higoumenakia sign. Enlargement of the sternoclavicular joint due to osteitis and periostitis of congenital syphilis.

Histiocytoma progressive nodular. A normolipemic proliferative histiocytic syndrome with cutaneous tumors of two types: superficial xanthomatous papules and deep nodules.

Histiocytosis, benign cephalic. Rare histiocytic eruption of infants associated with erythematous pustules mainly on the face, neck or shoulders. There is no visceral involvement. Lesions often involute. Racquet-shaped organelles and S-100-staining cells are absent.

Histiocystosis X, 388. Also known as an L-cell (XX langerhans) granulomatosis, this includes Letterer-Siwe disease, Hand-Schuller-Christian disease, and eosinophilic granuloma. Characteristic racquet-shaped organelles of Langerhans cells are found on electron microscopy and histiocytes are S-100 positive.

Histoplasmosis, 194, 402-403, 403f. Histoplasmosis is endemic in the Midwestern United States and is caused by Histoplasma capsulatum, a soil saprophyte. Inhalation of the spores produces an asymptomatic pulmonary infection that rarely goes on to produce a disseminated organic disease. The secondary skin lesions are multiform, consisting of granulomatous ulcers, purpura, impetiginized lesions, and abscesses.

HIV. Human immunodeficiency virus.

HLA. The term originally meant human leukocyte antigen. Newer findings have expanded the known blood cell antigens.

Hodgkin's disease. See Lymphoma

Human papillomavirus (HPV), 183, 194, 194f

Hutchinson's teeth. Changes in the teeth of patients with congenital syphilis characterized especially by narrowing of the upper incisors with a central depression of the cutting edge.

Hutchinson's sign. 279. Extension of pigment onto the lateral and proximal nail fold from a subungual melanoma. Hutchinson's triad. The occurrence in patients with congenital syphilis of ocular keratitis, deafness, and dental defects. Hyalinosis cutis et mucosae. See Lipoid proteinosis

Hydroa aestivale, 301, 301f. This rare recurrent vesicular dermatosis occurs in the summer on the exposed areas of the body. It is more common in young males and usually disappears at the age of puberty. The erythema, urticaria-like lesions, vesicles, and crusted lesions develop following sun exposure and are aggravated by continued exposure. When the vesicle shows a central depression, as in a vaccination, the eruption is called Hydroa vacciniforme.

Hydroa vacciniforme. See Hydroa aestivale. A severe form of hydroa vacciniforme has been associated with non-Hodgkin's lymphoma.

Hypereosinophilic syndrome. Eosinophilia of 1.5 x 10 cells/L for at least 6 months with organ system involvement without other identifiable cause of eosinophilia. Urticaria, angioedema, erythematous papules, and nodules are commonest cutaneous manifestations.

Hyper-IgM immunodeficiency syndrome (HIM). Rare x-linked recessive with increase IgM and IgD and decrease IgA, IgG and IgE. Recurrent pyogenic infections treated with intravenous gamma globulins, and recalcitrant severe oral ulcers, and recalcitrant widespread warts are part of the syndrome.

Hyperkeratosis follicularis en cutem penetrans (Kyrle's disease). A rare, usually nonpruritic eruption, worse on the extremities, of discrete papules with a central keratotic plug. Deeper erythematous papules can leave atrophic scars.

Hyperkeratosis lenticularis perstans (Flegel's disease). Rare disease with tiny keratotic papules usually on lower extremities in middle aged persons. May have red halo, and removal leaves pinpoint bleeding site. Can involve oral mucosa.

Hypoplasia, focal dermal (Goltz syndrome). Rare syndrome usually seen in females with linear hypoplastic skin lesions and vertical striations of long bones. Digit and eye abnormalities also occur.

Id reaction, 82, 198, 216. This phenomenon is characterized by an erythematous, vesicular, or eczematous eruption that occurs in disseminated parts of the skin. Most commonly id reactions are seen to follow inflammatory fungus infections of the feet, varicose ulcers, inflammatory fungus infections of the scalp, and severe contact dermatitis of the hands. See Dermatophytid, Epidermophytid, and Trichophytid

Idiopathic guttate hypomelanosis. Small macular, whitish, sharply marginated, approximately 0.5-cm lesions found on sun-exposed extremities, mainly the legs, but never on the face. Related to excessive sun exposure in genetically predisposed persons. Therapy is not necessary or indicated.

Idiopathic recurrent palmoplantar hidradenitis. Tender multiple red nodules on palms and soles that occurs in children and spontaneously involutes in 2-21 days without sequelae. May be related to heat or trauma and has a characteristic histopathology when biopsied.

Immersion foot. See Frostbite

Iododerma, 234. A dermatosis due to the ingestion of iodides, usually of a pustular nature. See also Drug eruption.

Itch, 5, 98-104. See also Pruritus anal, 102-104 genital, 104

swimmer's, 397-398, 398f treatment of, 101-102, 103-104

Itching. See Pruritus

Janeway nodes. Palmar, plantar, palmar fingers and plantar toes with painless, irregular, hemorrhagic, nonblanchable papules seen with acute bacterial endocarditis.

Jarisch-Herxheimer reaction. See Herxheimer reaction

Jessner's syndrome. Benign lymphocytic infiltration of the skin, mainly of the face, resembling deep chronic discoid lupus erythematosus. Job's syndrome (HIES). 96. Hyperimmunoglobulin E, recurrent infections. Rare, congenital.

Jogger's nipples. Painful erosions of nipples in runners, especially braless females, and when hard, irritating clothing is worn. Jungle rot. A "G.I." term for a group of bacterial and mycotic infections of the skin seen in the South Pacific during World War II. Jungling's disease. Osteitis fibrosa cystica of the small long bones, particularly of the fingers, due to sarcoidosis. Juxta-articular nodes. Syphilitic gummatous tumors occurring in the corium or subcutaneous layer of the skin in the region of the joints.

Kasabach-Merritt syndrome. Enlarging cavernous hemangioma associated with thrombocytopenia, which may respond to aspirin therapy. Kassowitz-Diday's law. The observation that successive children of a syphilitic mother will become progressively less infected with syphilis or not be infected at all. Kawasaki disease,38, 254. See also Mucocutaneous lymph node syndrome Keloid, 16f, 17, 339, 339f treatment of, 38, 339. Intralesional corticosteroids, 585-nm pulsed dye laser, 30 second liquid nitrogen cryosurgery and silicon gel sheets for 12 to 24 hours each day for at least 2 months.

Keratoacanthoma centrifugum marginatum. A rare variant of keratoacanthoma that shows progressive peripheral growth with coincident central healing.

Keratoderma blennorrhagicum. A rare chronic inflammatory dermatosis with horny pustular crusted lesions mainly on the palms and the soles; occurs in conjunction with gonorrheal infection of the genital tract and Reiter's syndrome.

Keratoderma climacterium. Circumscribed hyperkeratotic lesions of the palms and the soles of women of the menopausal age. These lesions resemble psoriasis, and the majority of cases are considered to be this disease.

Keratoses, stucco. Discrete, flat, keratotic papules, "stuck on" to the skin in elderly persons. They can be removed by scratching without causing bleeding. Keratosis lichenoides chronica. Rare, chronic, progressive, violaceous, lichenoid papules arranged in linear plaques. May be a variant of lichen planus. KID syndrome. Keratitis, ichthyosis and deafness in a congenital syndrome affecting ectodermal tissue. Kimura's disease. See Angiolymphoid hyperplasia with eosinophilia

Kindler syndrome. A rare condition presenting simultaneous manifestations of both poikiloderma congenitale and epidermolysis bullosa.

Klippel-Trenaunay-Parkes-Weber syndrome. Hemihypertrophy of arm or leg associated with varicosities and nevus flammeus (or hemangioma) with an arteriovenous malformation.

Klippel-Trenaunay-Weber syndrome. Hemihypertrophy of arm or leg associated with varicosities and nevus flammeus or hemangioma

Koebner phenomenon, 137, 149. The ability of the skin to react to trauma by the production of lesions of the existing skin disease. This phenomenon occurs in patients with psoriasis, lichen planus, flat warts and lichen nitidus.

Kyrle's disease. See Hyperkeratosis follicularis en cutem penetrans

LAMB syndrome. Lentigines, atrial myxoma, mucocutaneous myxomas, and blue nevi.

Labial melanotic macule (solitary labial lentigo). Pigmented macules (often singular) on lower lip (most common), tongue or intraoral mucosa. Lassar's paste. Zinc oxide paste (U.S.P.) containing 25% zinc oxide, 25% starch, and 50% petrolatum.

Laugier-Hunziker syndrome. Rare disorder of numerous pigmented macules mainly on lower lip, hand, palate and tips of fingers. No underlying gastrointestinal polyposis. Occur in 3rd to 5th decade and may also be seen on nails (may be a linear band), soles, abdomen, neck, thorax, floor of mouth, gums and labial commissures.

Leiner's disease. A generalized exfoliative erythroderma seen in newborns. Thought to be a severe form of seborrheic dermatitis. Diarrhea and a failure to thrive are seen.

Lentigines, 254-255, 258, 345, 355, 375, 376f. PUVA-induced or tanning bed. Stellate or star-like brown macules on buttocks, groin, penis, trunk but spares palms, soles, gluteal cleft and axillae. May persist up to 2 years after PUVA therapy. Tanning bed lentigines. Acral brown macules especially on legs, arms, neck and chest. May occur abruptly or after prolonged tanning-bed exposure. Lentigo maligna, 347, 355

LEOPARD syndrome. 254-255. Lentigines (multiple), electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalitie of genitalia, retardation of growth, deafness, and osseous deformities.

Leser-Trelat sign. The sudden appearance of multiple seborrheic keratoses, which may be a cutaneous marker for adenocarcinoma of stomach, uterus, breast, lung or hematopoietic malignancy.

Figure I-2. Rarer dermatoses. (Smith-Kline-Beecham) Lewandowsky-Lutz disease. See Epidermodysplasia verruciformis

Libman-Sacks' syndrome. Characterized by an atypical verrucous endocarditis with bacteria-free vegetations and the eruption of systemic disseminated lupus erythematosus.

Lichen myxedematosus. See Scleromyxedema

Lichen nitidus. A rare chronic inflammatory disease characterized by pinhead-sized, flat-topped papules that resemble very small lesions of lichen planus. Some dermatologists believe lichen nitidus to be a variant of lichen planus.

Lichen planus pemphigoides. Typical lichen planus that develops vesicles or bullae on affected or unaffected skin that are clinically and histologically identical to bullous pemphigoid.

Lichen ruber moniliformis. A very rare dermatosis characterized by the appearance of narrow beaded bands running more or less parallel with each other in the long axis of the extremities. Myxedema-like changes can be present.

Lichen sclerosus et atrophicus, 292, 334-335, 380f. See also Atrophies of the skin

Lichen spinulosus. This ill-defined disorder resembles keratosis pilaris.

Light eruptions. See Photosensitivity dermatoses

Lines of Blaschko. A pattern of distribution on the skin followed by some congenital nevoid lesions and acquired inflammatory skin diseases. An example is the third stage of incontinentia pigmenti.

Lipodermatosclerosis. Hyperpigmentation or erythema, induration, and pain of lower extremities often associated with venous insufficiency. Hypodermatitis sclerodermaformis and sclerosing panniculitis are synonymous.

Lipodystrophy. Atrophy of subcutaneous fat tissue. This can be classified as total lipodystrophy, congenital or acquired; partial; or localized, associated with insulin or other parenteral injections.

Lipogranuloma. Fat necrosis of breast tissue commonly due to trauma.

Lipogranulomatosis subcutanea (Rothmann-Makai syndrome). Characterized by subcutaneous nodules mainly on the legs, tender to touch, lasting 6 to 12 months. Seen mainly in children. Patients are afebrile.

Lipoid proteinosis (Urbach-Wiethe disease). Autosomal recessive disease in which infiltration of glycoprotein causes hoarseness, induration of the tongue, and nodular lesions on the eyelids, elbows, knees, hands, and face.

Lipomatosis. See Encephalocraniocutaneous lipomatosis.

Livedo reticularis. A reddish blue mottled discoloration of the skin of the extremities, which can be divided into three forms: (1) cutis marmorata, which develops following exposure to cold and disappears on warming the skin; (2) idiopathic form not related to temperature changes; and (3) a secondary form associated with vascular disease.

Lofgren's syndrome. Erythema nodosum and bilateral arthritis usually heralding sarcoidosis.

Lupus erythematosus, 38, 246-250, 247-248f Chilblain, see chilblain lupus erythematosus chronic discoid, 117, 247f, 248, 249 neonatal, 362, 363f.

systemic, 116-117, 123, 248f, 250, 265-266, 266f vulgaris, 159

Lyell's disease. See Toxic epidermal necrolysis

Lymphangitis, sclerosing, of the penis. Cord-like lesion in the coronal sulcus that usually resolves within 2 months, is sudden in onset, and usually is asymptomatic.

Lymphedema. 152. This may be congenital (Milroy's disease) or acquired. Acquired lymphedema of unknown cause can occur in young women, and it can occur following chronic or recurrent cellulitis and lymphangitis ( elephantiasis nostras, 164). The classic form of lymphedema is the elephantiasis associated with filariasis of the tropics.

Lymphogranulomatosis benigna. See Sarcoidosis

Lymphomatoid granulomatosis. A serious vasculitis, primarily of the lungs. Skin lesions occur in more than one third of patients, mainly erythematous papules, plaques, and subcutaneous nodules, which may ulcerate. Approximately 15% develop lymphoma.

Lymphomatoid papulosis. Self-healing, erythematous, maculopapular lesions that occasionally ulcerate. Clinically these look benign, but histologically they appear malignant. The more chronic form may eventuate as a lymphoma, but most cases run a benign course.

McCune-Albright syndrome. 312f, 314. Sexual precocity with polyostotic fibrous dysplasia, cafe-au-lait spots, pituitary adenomas, adrenal hypercorticoidism, hyperthyroidism, and osteomalacia.

Maffucci's syndrome. Multiple enchondromas (Ollier's disease) and subcutaneous hemangiomas with up to 30% of patients developing chondrosarcomas. Majocchi's granuloma. A deep mycotic infection due to dermatophyte fungi, especially T. rubrum.

Malacoplakia. Rare condition of accumulation of phagocytic macrophages usually in immunocompromised patients. Usually involves genitourinary tract but can involve the skin mainly the perineal areas. Michaelis-Gutmann bodies are electron dense intracytoplasmic laminations seen in macrophages.

Malignant disease. See Cancer; Carcinoma

Malherbe's tumor. 352, 352f. Calcifying epithelioma. See also Tumors

Mange. A skin condition, particularly of dogs, caused by allergic eczema, seborrheic dermatitis, bacterial infection, or parasitic infestation of the skin. Marshall's syndrome. Pediatric Sweet's syndrome (acute neutrophilic dermatosis) and cutis laxa due to loss of dermal elastic tissue.

Mediterranean Fever, Familial. Autosomal recessive syndrome of recurrent febrile episodes of peritonitis, pleuritis, and joint synovitis. Erysipelas-like skin lesions occur most commonly but bullae, pyoderma, panniculitis and vasculitis may be seen. Predominantly in Arabic, Turkish, Armenian, and Sephardic Jewish people.

Melanosis, Becker's (Becker's nevus). Large localized mottled hypermelanotic noncongenital and hypertrichotic patches, located especially on the upper back; not associated with underlying structural abnormalities and without cancer potential.

Melanosis of Riehl. A brownish pigmentation of the skin on the sun-exposed areas of the body that have come into contact with certain tars. See Poikiloderma of Civatte and Pigmentary disorders

Melioidosis. An infectious disease of rodents and humans with abscesses and pustules of the skin and other organs, similar to glanders.

Melkersson-Rosenthal syndrome. 291. Idiopathic facial swelling, facial nerve palsy, and lingua plicata (fissured tongue).

Menkes' Kinky Hair syndrome. 316. Impaired metabolism of copper (serum C below 25% of normal), x-linked, hair shaft abnormalities (pili torti, monilethrix), stretchable skin (especially over hands), central nervous system abnormalities, and failure to thrive.

Mercury, ammoniated. An antiseptic chemical that, prior to the advent of the antibiotics, was useful in the treatment of impetigo and other pyodermas. It is valuable in the treatment of psoriasis.

Merkel cell cancer. Highly malignant, rare, reddish, dome-shaped tumor of neuroendocrine origin, usually seen on the face. Meyerson's nevus. An eczematous halo reaction described in benign nevocellular nevi, atypical nevi, and congenital nevi.

Milker's nodules. A virus disease contracted from infected udders of cows. The lesions, usually on the hands, consist of brown-red or purple firm nodules that subside in 4 to 6 weeks, conferring immunity.

Mitochondrial DNA syndromes. A group of genetic diseases that may appear at any age. Growth retardation, myopathy, seizures, renal failure, eye disease and occasionally skin disease. Symmetrical cervical lipomas and poikiloderma are the commonest skin manifestations. Defects of mitochondrial DNA can be acquired and be related to aging and many other diseases.

Mole. See Nevus

Monoclonal antibodies. Specific antibodies produced from a hybrid cell. This hybrid cell results from the fusion of nuclear material from two cells. May eventually be helpful as an anti-cancer modality.

Mosaic "fungus." Not a fungus but an artifact commonly found in KOH slide preparations taken from the feet and the hands. They consist of beaded lines along outlining epidermal cells.

Mucinosis. When fibroblasts produce an excess amount of acid mucopolysaccharides (mucin), they may replace the connective tissue elements. This occurs in myxedema and localized pretibial myxedema. See also Myxedema, localized follicular (alopecia mucinosa). This rare disease is characterized by one or more symptomatic, well-circumscribed, indurated, slightly erythematous plaques with loss of hair. The most common site is the face. The plaques involute spontaneously after several months. Some cases are associated with a T-cell lymphoma. papular. A rare cutaneous fibromucinous disease with a monoclonal serum protein of cathodal mobility. Clinically seen are localized or generalized papules, plaques, or nodules.

Mucinosis, reticular erythematous (REM). Erythematous papules and plaques mainly on chest of middle-aged women. Worsens with sun exposure. Characteristic mucin and lymphocytic infiltrate around vessels and follicles.

Muckle-Wells syndrome. Rare autosomal dominant with urticaria-like eruptions in infancy associated with progressive perceptive deafness, limb pain, periodic fever, malaise, and amyloid nephropathy.

Mucocutaneous lymph node syndrome. 254. (Kawasaki's disease). A self-limited febrile illness seen mainly in children, with conjunctivitis, dryness and redness of lips, reddening of palms and soles with later desquamation, polymorphous exanthema of the trunk, and swelling of cervical lymph nodes. May be associated with coronary artery aneurysms.

Mucormycosis. Nodules and ulcerations caused by Mucor or Rhizopus fungi in patients that are uremic, diabetic, or otherwise immunocompromised. May also occur under adhesive tape.

Muir-Torre syndrome. Rare genodermatosis (autosomal dominant) of sebaceous neoplasms (adenomas - especially sebaceous adenoma, epitheliomas, carcinomas) and visceral cancer (especially genitourinary and gastrointestinal) with prolonged survival.

Multicentric reticulohistocytosis. Rare condition of reddish or yellow papules on the dorsal hands (especially nail folds and distal interphalangeal joints), ears, and bridge of nose. Associated with arthritis mutilans, and one fourth of patients have an underlying cancer. The histiocytic infiltrate is characteristic on pathology and may involve internal organs.

Multinucleate cell angiohistiocytoma. Rare red-brown grouped papules especially in middle-aged and elderly females. Innocuous and may spontaneously dissipate. Confused with Kaposi's sarcoma and angiofibromas but histopathology is characteristic.

Myiasis. Infestation of the skin with flies (Diptera), usually the larva.

Nails, 6, 278-287, 373, 373f biting, 6, 279, 279f candidiasis of, 194, 218, 280, 280f, 282

claw, 286, 286f clubbed, 285, 285f contact reactions, 281-282

cosmetics for, 281

diseases of, 278-287, 316

drug reactions, 286

fragile, 198, 278

habit tic deformity of, 282, 282f hangnail, 280 hippocratic, 285, 285f ingrown, 280

internal diseases and, 284-286 lines of, 279, 281, 285 paronychia, 373

psoriasis of, 283-284, 283f, 373 rare diseases, 316 spoon, 285

thickening of, 286, 286f tinea, 207-208, 207f, 282, 282f twenty-nail dystrophy, 284, 373, 373f. Longitudinal striations with distal splitting of all the nail plates, may be a variant of lichen planus. warts of, 283, 283f, 373 white spots, 281, 281f yellow, 287

NAME syndrome. Nevi, atrial myxoma, myxoid neurofibromata, and ephelides.

Nasal glioma. Red protruding tumors usually found at the central base of the nose, just inferior to the glabella. May represent true encephaloceles or at least protrusion of brain tissue.

Necrobiosis granulomatosis, 223. Occurs in older women, with histopathologic picture of sarcoid or tuberculosis.

Necrobiotic xanthogranuloma. A rare condition with large violaceous plaques, where xanthomatosis changes occur on the border. There is a characteristic biopsy with necrobiosis, giant multinucleated cells, foam cells, and cholesterol clefts. Commonest locations are the face, trunk, and limbs. There is an association with paraproteinemia.

Necrolysis, toxic epidermal. See Toxic epidermal necrolysis Necrolytic migratory erythema. Associated with glucagonoma syndrome.

Necrotizing fasciitis. Characterized by rapid development of redness, pain, and edema of the superficial fascia of the skin, which progresses to blisters, and usually to gangrene of the area. Mortality is in the range of 20% to 50% of cases. Early surgical debridement may be life-saving. Usually caused by multiple bacteria (especially Group A Streptococci). A toxic shock syndrome may develop.

Netherton's syndrome. 265, 307. Autosomal recessive disorder showing trichorrhexis invaginata and a form of ichthyosis called icthyosiform linearis circumflexa that may have a characteristic "double-edged" scale.

Nettle rash. Urticaria or hives.

Neuroma, traumatic. Also referred to as amputation neuroma or rudimentary supernumerary digit. Papular lesion found at the site of a true supernumerary digit that is at the outer edge of the base of the fifth finger. Occurs as a result of destruction of a supernumerary digit.

Neuroma, mucosal. 257. Early sign of multiple endocrine neoplasia III (MEN type III) where multiple tumors occur within the first decade of life on lips, eyelids and oral mucosa. Medullary thyroid carcinoma, pheochromocytoma, intestinal ganglioneuromas and Marfanoid features are the main characteristics of the syndrome.

Neutrophilic eccrine hidradenitis. Uncommon neutrophilic inflammation of eccrine sweat glands seen most often after cytarabine therapy for acute myelogenous leukemia. Other drugs and underlying conditions can also cause.

Neutrophilic dermatosis, acute febrile (Sweet's syndrome). Characterized by fever, raised painful erythematous plaques on the limbs, face, and neck, with a polymorphonuclear leukocytosis. Histologically, these cells are also seen as a dense dermal infiltrate. Most cases develop in women and follow a respiratory tract infection. Systemic corticosteroids are effective. Ten to 15% of cases (especially men) are associated with underlying cancer (especially acute myelogenous or myelomonocytic leukemia).

Nevus, 265, 325, 343-347, 344f, 346f, 355, 360, 386, 387f basal cell syndrome, See Basal cell nevoid syndrome bathing trunk, 347 benign, 348

blue, cellular. Histology differs from common blue nevus. Rare malignant degeneration, especially sacrococcygeal and buttocks, 1-3 cm, and slightly larger than common blue nevus, blue-black, slightly elevated.

blue, common 345, 355. A blue-black, slightly elevated, pea-sized or smaller nodule that can occur anywhere on the body but most commonly on the dorsum of the hand or the foot. Histologically, it contains dopa-positive melanocytes.

combined. Combination of either type of blue nevus in the same tumor as a melanocytic nevus. congenital giant pigmented, 360, 361f connective tissue. 312, 314f. Indurated white or flesh-colored plaques and papules that can occur without underlying signs of other organ involvement can be seen with osteopoikilosis in the Buschke-Ollendorf syndrome or as shagreen patches in tuberous sclerosis. Biopsy shows increased amounts of collage bundles and elastic fibers.

dysplastic syndrome, 343 epidermal, see Epidermal nevus halo, 245, 343, 344f intradermal, 366

junctional, 343, 344f, 366 melanocytic, 343, 344f sebaceous, 350-351, 351f, 367 speckled lentiginous. See nevus spilus Spitz, 345

treatment of, 345-346

Nevus, speckled lentiginous (nevus spilus). Congenital light brown lentigo with scattered spots of junctional nevi. Very rarely a precursor of malignant melanoma. Nevus, spilus. See Nevus, speckled lentiginous.

Nikolsky's sign. The Nikolsky's test is positive in patients with pemphigus and toxic epidermal necrolysis and demonstrates acantholysis histologically. The test is performed by pulling the ruptured wall of the blister back into the apparently normal skin, or by rubbing off the epidermis near the bullae with slight friction and producing a moist surface.

Nocardiosis. Various species of Nocardia can cause cutaneous, pulmonary, and systemic infection. The cutaneous lesions of the subcutaneous tissue and bones are clinically similar to maduromycosis.

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