Papulosis

Bowenoid lymphomatoid. See Lymphomatoid papulosis malignant atrophying (Degos' disease). A predominantly fatal disease with spotty, stark white, vascular lesions and subsequent atrophy of the overlying tissues, affecting the skin, intestines, and other organs, including the brain, kidney, and heart. It is differentiated from thromboangiitis obliterans and periarteritis nodosa.

Paraffinoma. A foreign body granuloma due to the injection of paraffin into the subcutaneous tissue for cosmetic purposes.

Parakeratosis. An example of imperfect keratinization of the epidermis resulting in the retention of nuclei in the horny layer. In areas of parakeratosis, the granular layer is absent.

Parapsoriasis. 134. A term for a group of persistent macular and maculopapular scaly erythrodermas. An acute form with the synonym pityriasis lichenoides et varioliformis acuta (Mucha-Habermann) (see entry) is now believed to be a distinct entity. One chronic form of parapsoriasis, parapsoriasis guttata, can resemble guttate psoriasis, pityriasis rosea, or seborrheic dermatitis. This condition does not itch and persists for years. A variant of this type of parapsoriasis is pityriasis lichenoides chronica (Juliusberg), which is a form of guttate parapsoriasis with slightly larger scaly areas. Another chronic form of parapsoriasis, parapsoriasis en plaque, is characterized by nonpruritic or slightly pruritic scaly brownish patches and plaques. A significant percentage of patients that are given this diagnosis develop mycosis fungoides.

Parry-Romberg's syndrome. Facial hemiatrophy in a child with or without sclerodermatous skin changes. Pasini and Pierini atrophoderma. See Atrophies of the skin

Pearly penile papules. Noninflammatory, innocuous acral angiofibromas located in a symmetrical ring around the glans of the penis.

Pemphigoid, 94, 383, 384f bullous, 233

localized cicatricial (Brunsting-Perry), 233, 245. In elderly patients, recurrent blisters are seen, most commonly of the head and neck. Histology and immunofluorescence are similar to cicatricial mucosal pemphigoid, but there is no mucous membrane involvement in this form. Heals with scarring.

Pemphigus, 94, 232

erythematosus, 234 familial benign chronic, 233 foliaceous, 234, 408

herpetiformis. A generalized bullous eruption which resembles dermatitis herpetiformis clinically and histologically, but resembles pemphigus by responding to steroids and immunosuppressive drugs and having a pemphigus direct immunofluorescent pattern.

malignancy with, 234-235

neonatorum, 146

paraneoplastic, 235

treatment of, 38

vegetans, 233, 234

Perforating skin disorders. Several dermatoses exhibit epidermal perforation as a histologic feature. Many represent transepithelial elimination. Four diseases are essential perforating disorders: elastosis perforans serpiginosa, reactive perforating collagenosis, perforating folliculitis, and Kyrle's disease.

Perianal streptococcal dermatitis. Group A beta-hemolytic streptococcal infection most commonly in male children with perianal erythema, itching, pain on defecation, and may have fissures or purulent exudate.

Perifolliculitis capitis abscedens et suffodiens, 117-118. (dissecting cellulitis of the scalp). Draining dissecting pustular sinuses and abscesses in the scalp. Part of the follicular occlusion triad that also includes cystic acne and hidradenitis suppurativa.

Pernio. See Chilblain and Frostbite

Phakomatosis pigmentovascularis. Rare syndrome of simultaneous occurrence of nevus flammeus and pigmented nevus, nevus pigmentosas, mongolian spot, nevus spilus, nevus verrucosus or nevus anemicus.

Phthiriasis. 229, 230f. Infestation with the crab louse.

Physical agents, dermatoses from, 106, 293-302, 294f, 296f, 298-301f, 383-385, 385f

Piezogenic papules. Herniation of fat into the dermis that are painful, seen only on standing on the lateral or medial heel. 2-5 mm and flesh colored.

Pink disease. See Acrodynia

Pityriasis alba. See Pityriasis simplex faciei.

Pityriasis amiantacea. A distinct morphologic entity characterized by masses of sticky, silvery overlapping scales adherent to the hairs and scalp. When the thick patch of scales is removed, the underlying scalp is red and oozing and often has a foul odor. The underlying cause can be tinea, pyoderma, neurodermatitis, or psoriasis.

Pityriasis lichenoides chronica (Juliusberg). A form of guttate parapsoriasis. See Parapsoriasis.

Pityriasis lichenoides et varioliformis acuta (Mucha-Habermann). An acute disease that appears as a reddish macular generalized eruption with mild constitutional signs including fever and malaise. Vesicles may develop and also papulonecrotic lesions. This disease gradually disappears in several months. Histologically, it is characterized by a vasculitis that differentiates it from the parapsoriasis group of diseases. It may improve with UVB therapy or oral antibiotics (tetracycline, erythromycin).

Pityriasis rosea, 18f, 132, 134-138, 135-137f, 138, 368

Pityriasis rubra pilaris. 387. Papulosquamous psoriasiform eruption that often begins in the scalp and progresses to an erythroderma with of islands of normal skin. Keratoderma of the palms and soles is common. It has a bimodal distribution in the first and fifth decades. A biopsy may help differentiate it from psoriasis. Retinoids and methotrexate are the mainstays of therapy.

Pityriasis simplex faciei (pityriasis alba), 368, 369f, 407. A common disorder of children seen predominantly in the winter as a rather well-localized scaly oval patch on the cheeks. The end result is hypopigmentation of the area, but the normal pigment returns when the eruption clears up (usually in the summer). We believe this condition to be a mild form of atopic eczema.

Plummer-Vinson syndrome. A syndrome characterized by dysphagia, glossitis, hypochromic anemia, and spoon nails in middle-aged women. The associated dryness and atrophy of the mucous membranes of the throat may lead to leukoplakia and squamous cell carcinoma.

POEMS syndrome 269. (polyneuropathy, organomegaly, endocrinopath, M-protein, and skin changes). Cherry-type and subcutaneous hemangiomas, hyperpigmentation, and hypertrichosis are reported in this syndrome.

Poikiloderma atrophicans vasculare (Jacobi). See Atrophies of the skin

Poikiloderma congenitale, 301. A rare syndrome characterized by telangiectasis, pigmentation, defective teeth, and bone cysts; may be similar to dyskeratosis congenita.

Polyarteritis nodosa. See Periarteritis nodosa.

Polychondritis, relapsing. Inflammation of cartilage most often involving the auricle of the ear but that may also involve inflammation of the eye, joints, nose, and most significantly heart valves or respiratory tract. The ear will demonstrate recurrent attacks of redness, pain, and swelling.

Polymorphous light eruption, 298, 300f, 300-301, 301f

Porokeratosis. A rare disorder that begins as a small, slightly elevated, wart-like papule that slowly enlarges, leaving an atrophic center with a keratotic, ridge-like border. The small individual lesions may coalesce and squamous cell cancers can arise in these tumors. A disseminated form (disseminated superficial actinic porokeratosis) develops in middle-aged persons on sun-exposed limbs. Histopathology may be characteristic.

Potassium permanganate. An oxidizing antiseptic usually used as a wet dressing in the concentration of 1:10,000.

Prausnitz-Kustner reaction. A demonstration of passive sensitization of the skin of a nonsensitive person. This is accomplished by the intradermal injection of serum from a sensitive patient into the skin of a nonsensitive person. After 24 to 48 hours, the atopen to be tested is injected intracutaneously into the previously injected site on the nonsensitive person's skin. Passive transfer of the sensitivity is manifested by the formation of a wheal.

Primary chancre-type diseases. These include the following: Anthrax

Blastomycosis, primary cutaneous type Chancroid

Coccidioidomycosis, primary cutaneous type Cowpox

Cutaneous diphtheria

Erysipeloid

Furuncle

Milker's nodules

Rat-bite fever Sporotrichosis

Syphilis (genital but also extragenital) Tuberculosis, primary inoculation type Tularemia Vaccinia

Proteus syndrome. Sporadic, progressive, congenital, rare condition which includes hemihypertrophy, epidermal nevi, macrodactyly, scoliosis, exotoses, and a variety of benign hamartomatous skin and sift tissue tumors. Elephant man (John Hermick) exhibited this syndrome.

Progeria. Extremely rare autosomal dominant mutation condition. Noticed early in life with characteristics of the elderly but no mental changes. Most patients die between 10 and 15 years of age. A factor may be a defect of hyaluronic acid.

Proliferating trichilemmal cysts (proliferating pilar tumor). Locally aggressively, rapidly growing, scalp (90% of time) tumors usually in women. Rare malignant transformation.

Protothecosis. Very rare chronic cutaneous infections with a nonpigmented algae (usually Prototheca wickerhamii) having protean clinical manifestations.

Prurigo. This term is used more commonly in Europe. It lacks a precise definition but implies itchy bumps. actinic. A chronic photodermatitis seen in native Americans and Hispanics.

Prurigo nodularis. 149. A rare chronic dermatosis, usually of middle-aged women, consisting of discrete nodular pruritic excoriated papules and tumors scattered over the arms and the legs. This can be a warning sign of anemia, liver disease, renal disease, underlying cancer, and human immunodeficiency virus infection.

Pruritic hereditary localized patch on back (notalgia paresthetica). 104. A rather common, benign problem manifested by a single patch of approximately 4 to 8 cm, usually lichenified, on the back. Frequently, the person rubs the area on the door jamb or similar scratching post. May be slightly hyperpigmented.

essential, 99

generalized, 98-99

genital, 104

hiemalis, 98-99

seasonal, 22

senile, 99

treatment of, 30, 38-39, 41, 101-102, 103-104 uremic. See Uremic pruritus winter, 98-99

Pseudochancre redux. A late, gummatous, syphilitic inflammation occurring at the site of the original chancre. Purpura, 17, 112-113, 112f, 256, 378

fulminans. May be synonymous with symmetrical peripheral gangrene. Ecchymoses, hemorrhagic bullae, and gangrene usually in association with disseminated intervascular coagulopathy; often leads to death and can be associated with many underlying illnesses and infections. Also associated with Protein C and S proteins deficiency or malfunction.

Henoch's, 112, 263, 368, 368f nonthrombocytopenic, 112

pigmented, 113

senile, 112

solar, 301

stasis, 112

thrombocytopenic, 112. May be idiopathic or secondary to various chronic diseases or a drug sensitivity. The platelet count is below normal, the bleeding time is prolonged, and the clotting time is normal, but the clot does not retract normally.

Pustulosis, acute generalized exanthematous (AGEP). Acute, generalized, febrile, pustulosis mimicking pustular psoriasis clinically and histologically. Due most commonly to drugs (see C.h.ap,9) but less commonly to acute infections (especially enteroviruses).

Pyoderma faciale. Acneiform facial eruption of young females with sudden onset of inflammatory coalescent nodules and draining sinuses.

Rat-bite fevers. The bite of a rat can cause sodoku and Haverhill fever. Sodoku, caused by Spirillum minus, is manifested by a primary-type chancre and later by an erythematous rash. Haverhill fever, caused by Streptobacillus moniliformis, is characterized by joint pains and an erythematous rash.

Recombinant DNA technology. A manipulation of specific genetic information from one organism or cell to another.

Resorcinol. 30, 37. This agent is similar in its properties and use to salicylic acid.

Reticulohistiocytoma, giant-cell. The localized form consists of one or a few asymptomatic large intracutaneous nodules, which may involute with time. The generalized form (see multicentric reticulohistiocytosis) is characterized by many nodules over the body, especially around the fingers, usually associated with a destructive arthritis.

Reticulohistiocytosis, self-healing. Neonatal eruption resolving in first year of life. S-100 histiocytes and Birbeck granules are present.

Reticulosis, pagetoid (Woringer-Kolopp disease; localized epidermotropic reticulosis). Clinically represented by a single very slowly enlarging warty, plaque-type skin lesion without internal organ involvement. A disseminated type resembles mycosis fungoides. Histologically there is an extensive epidermal infiltration with atypical-appearing mononuclear cells.

Rhinosporidiosis. The fungus Rhinosporidium seeberi causes a raspberry-like papillomatous tumor of the nares of the nose.

Richner-Hanhart's syndrome. Photophobia, mental retardation, painful palmoplantar keratoderma, usually appearing in first year of life. Due to deficiency of tyrosine aminotransferase and may improve with restriction in dietary tyrosine and phenylalanine.

Riehl's melanosis. See Melanosis of Riehl

Ringworm, 210-212, 210f, 211f. See also Tinea

Romberg's sign. Swaying of the body when standing with the feet close together and the eyes closed, which occurs in patients with central nervous system syphilis of the tabetic type.

Rothmann-Makai syndrome. See Lipogranulomatosis subcutanea

Rothmund-Thomson syndrome. 319. A rare hereditary syndrome characterized by cataracts, scleroderma, photosensitivity, and poikiloderma-like changes, with telangiectasis developing in childhood. This syndrome is believed to be related to Werner's syndrome, but the latter manifests itself in the second and third decades of life.

Rowell's syndrome. Erythema multiforme-like annular lesions associated with lupus erythematosus and speckled antinuclear antibodies, positive rheumatoid factor, and anti-SSB antibodies.

Salicylic acid. 30, 37. Locally, this agent acts as a keratoplastic chemical in strengths up to 3% and as a keratolytic in strengths over 3%. Its greatest use is in treatment of chronic fungus infection of the feet and lichenified patches seen with psoriasis or neurodermatitis. It macerates and peels off the thickened horny layer of the skin when used in the stronger strengths.

Salt rheum. An old term for weeping eczema.

SAPHO syndrome. Synovitis, acne, pustulosis, hyperostosis and osteitis.

Sarcoid, Darier-Roussy. A deep subcutaneous form of sarcoid resembling erythema induratum.

Schick test. An intradermal test using diphtheria toxin that, if positive as shown by the development of an erythematous wheal, indicates that the person lacks immunity for diphtheria.

Schultz-Charlton reaction. A blanching reaction seen when the scarlet fever antitoxin or convalescent serum is injected intradermally into a bright red area of the scarlet fever rash. Neutralization of the streptococcal toxin causes the blanching.

Scleredema, A self-limited rare disease characterized by benign but spreading induration and swelling of the skin and the subcutaneous tissues. It usually follows an acute infection. It resembles scleroderma but usually involutes in 3 to 12 months.

Scleromyxedema. Rare syndrome with plaques and lichenoid papules especially on trunk and upper extremities associated with sclerodactyly, Raynaud's phenomenon, myopathy, neurologic defects, restrictive lung disease, esophageal dysmotility and monoclonal gammopathy.

Sclerotherapy. An injection technique to rid patients of sunburst varicosities.

Scurfy scalp. A scalp dermatosis in infants that can be either true dandruff or the so-called milk crust due to the disinclination of the mother to cleanse the presumably delicate scalp of the newborn, or it can be a mixture of dandruff and lack of cleanliness. This old term may also be used by the lay person to designate atopic eczema of the scalp in infants.

Seborrhiasis. A name for an entity that clinically appears as a cross between seborrhea and psoriasis. Senear-Usher syndrome. Another term for pemphigus erythematosus. Seven-year itch. See Scabies.

Sicca syndrome. Xerostomia and xerophthalmia usually associated with Sjogren's syndrome.

Simmond's disease. Also known as hypophyseal cachexia, this disease is characterized by emaciation, amenorrhea, hypogenitalism, hypoglycemia, hypotension, and generalized pigmentation. The disease is due to necrosis of the pituitary, usually due to postpartum hemorrhage into the gland.

Sister Mary Joseph's nodule. Firm indurated nodule of the umbilicus indicating metastatic carcinoma.

Sixth disease. Another term for roseola infantum.

Sjogren-Larsson syndrome. 307. Rare triad of ichthyosis, spasticity, and mental retardation.

Slack skin syndrome (granulomatous slack skin syndrome). Rare cutaneous T-cell lymphoma characterized by wrinkled pendulous erythematous folds of skin. Granulomatous inflammation and phagocytosis of elastic stroma as well as atypical lymphocytes is seen on histopathology. Especially in young males.

Smooth muscle hamartoma, congenital. See Hamartoma.

Sneddon and Wilkinson disease. See Dermatosis, subcorneal pustular

Sneddon's syndrome. Livedo reticularis associated with slowly progressive multisystem medium and small vessel occlusion and vasculitis. Central nervous system often involved.

Solenonychia (Sutton). An acquired, longitudinal tubular deformity of a nail plate.

Spanish toxic oil syndrome. A multisystem disease that appeared in Spain in May 1981, affecting 18,000 people and causing more than 200 deaths. Both the acute and chronic phases had cutaneous lesions. It apparently was caused by ingestion of rapeseed oil denatured with aniline.

Speckled lentiginous nevus. See nevus spilus.

Spicules, hyperkeratotic. Follicular, minute, horny follicular, asymptomatic spicules associated with Crohn's disease, dysgammaglobulinemia, lymphoma, multiple myeloma, renal failure, other malignant diseases and can be idiopathic. Anywhere on skin but especially face and especially nose and scalp.

Stewart-Treves syndrome. Angiosarcoma arising at a site of chronic lymphedema usually following mastectomy and axillary lymph node dissection.

Stomas. Artificial openings from an internal tract to the outside of the body that require specialized care.

Subungual exostosis. Bony subungual tumor most often in women (2:1) usually on distal medial great toenail bed. Benign, acquired, and uncommon.

Sulfur, 30, 31, 37, 229. This chemical has many uses in dermatology as a result of its antiparasitic, antiseptic, and keratolytic properties. It is useful in the treatment of psoriasis, seborrheic dermatitis, acne, fungus, infection, and scabies.

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