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Chapter 8. Atopic Dermatitis and Its Analogues (lichen simplex chronicus, prurigo nodularis, picker’s nodules, and erosions and ulcerations secondary to excoriation) | Chondrodermatitis Nodularis Helicis

Distribution

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Fig. 8-1

Periorbital erythematous, slightly scaly patches and plaques consequent to vigorous rubbing.


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Fig. 8-2

Hemorrhagic crusts atop excoriated papules, and periorbital dusky erythema (“allergic shiners”).


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Fig. 8-3

Red patches and plaques, erosions, hemorrhagic and yellow crusts, and scales. Note spared zones are untouched.


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Fig. 8-4

Erythematous scaly patches and plaques. Paranasal folds, tip of the nose, and skin below the lower lip are unaffected.


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Fig. 8-5

Erythematous papules, many excoriated.


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Fig. 8-6

Erythematous, slightly scaly patches and plaques eroded secondary to excoriation.


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Fig. 8-7

Erythematous scaly patches and plaques on cheeks. Sites spared are protected from rubbing and scratching.


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Fig. 8-8

Erythroderma with erosions covered by hemorrhagic crusts.


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Fig. 8-9

Lichenified dusky red plaques interrupted by fissures and covered by scales.


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Fig. 8-10

Erythematous patches, plaques, and papules, many eroded and covered by crust. Some plaques are lichenified.


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Fig. 8-11

Keratotic papules and plaques.


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Fig. 8-12

The lateral aspect of the eyebrows is missing as a consequence of prolonged rubbing (“Herthoge sign”).


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Fig. 8-13

Scales and fissures in the retroauricular region.


Individual Lesions

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Fig. 8-14

Scale-crusts interrupted by fissures on cheeks (“eczemacraquelé”) and yellow crusts on scalp (“crusta lactea”).


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Fig. 8-15

Excoriations covered by crusts in company with lichenification, erythema, and scaling.


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Fig. 8-16

Erythematous scaly plaques. The paranasal folds are largely spared because they are indented.


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Fig. 8-17

Erosions and hemorrhagic crusts atop lichenified plaques. Signs of scratching are the excoriations.


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Fig. 8-18

Erythroderma, erosions covered by hemorrhagic crusts, and lichenification in an obviously atopic person.


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Fig. 8-19

Diffuse erythema traversed by linear excoriations and covered by subtle scale-crusts.


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Fig. 8-20

Lichenification covered by scales and associated with erosions and ulcerations.


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Fig. 8-21

Lichenification surmounted by scales and traversed by fissures.


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Fig. 8-22

Erythematous scaly plaques with indistinct borders.


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Fig. 8-23

Reticulated hyperpigmentation and lichenification (“dirtyneck”).


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Fig. 8-24

Hyperpigmentation and lichenification.


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Fig. 8-25

Lichenification and fissures at the angles of the mouth and lichenification of the upper lip.


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Fig. 8-26

Erythema, scales, and a fissure of the tip of a toe whose nail is dystrophic.


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Fig. 8-27

Dusky erythema, lichenification, and scales on wrinkled skin (juvenile plantar dermatosis). Arches are spared.


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Fig. 8-28

Shiny nails result from buffing them by longstanding intense rubbing.


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Fig. 8-29

Accentuation of palmar creases (hyperlinearity of palms).


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Fig. 8-30

Lichenification of the scrotum.


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Fig. 8-31

Linear zones of pallor after a recent scratch of erythematous skin (“white dermographism”).


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Fig. 8-32

“White dermographism” induced artifactually by strokes of a blunt-tipped object against erythematous skin.


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Fig. 8-33

Hypopigmented scaly patches in an atopic child (“pityriasis alba”).


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Fig. 8-34

Hypopigmented scaly patches of pityriasis alba in an atopic child.


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Fig. 8-35

Monomorphous nonkeratotic follicular papules.


Lichen Simplex Chronicus

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Fig. 8-36

Ill-defined lichenified plaque.


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Fig. 8-37

Zones of lichenification.


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Fig. 8-38

Lichenified hyperpigmented lesions secondary to rubbing.


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Fig. 8-39

Lichenified plaque.


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Fig. 8-40

Lichenified plaque.


Prurigo Nodularis

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Fig. 8-41

Papules consequent to persistent forceful rubbing of each discrete site.


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Fig. 8-42

Hyperpigmented, hypopigmented, and depigmented papules have resulted from the effects of rubbing and scratching.


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Fig. 8-43 A

Hyperpigmented and hyperkeratotic papules, and hyperpigmented lichenified plaques consequent to rubbing. The chalky appearance of linear lesions derives from scratching the keratotic surface of papules.


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Fig. 8-43 B

Hyperpigmented and hyperkeratotic papules, and hyperpigmented lichenified plaques consequent to rubbing. The chalky appearance of linear lesions derives from scratching the keratotic surface of papules.


Picker's Nodules

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Fig. 8-44 A

Papules, many of which are ulcerated and hyperpigmented.


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Fig. 8-44 B

Papules, many of which are ulcerated and hyperpigmented.


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Fig. 8-45

Ulcers covered by purulence and surrounded by redness and lichenification.


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Fig. 8-46

Hyperpigmented ulcerated papules.


New! Additional Images

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Fig. 8-50

All of the lesions pictured, namely, macules, papules, erosions, and crusts, resulted from external trauma, to wit, excoriation, the condition being factitious entirely.


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Fig. 8-51

The blotchy patches and plaques shown here are secondary to rubbing vigorously.


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Fig. 8-52

Ill-defined zone of lichenification, evidenced by thickening of skin whose markings are accentuated, resulted from persistent, firm rubbing; the hemorrhagic crusts derived from animated scratching.


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Fig. 8-53

All of the changes depicted, i.e., hemorrhagic crusts atop papules and scale-crusts that cover ill-defined plaques punctuated by fissures, result from scratching and rubbing.


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Fig. 8-54

The constellation of shininess, scaliness, accentuation of skin markings, and incipient fissures, known colloquially as “juvenile plantar dermatitis,” is a manifestation of “atopic dermatitis,” resulting as it does, in large measure, from rubbing.