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FITZPATRICK’S
Color Atlas and Synopsis of Clinical Dermatology

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NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy are required. The authors and the
publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the
time of publication. However, in view of the possibility of human error or changes in medical
sciences, neither the authors nor the publisher nor any other party who has been involved in
the preparation or publication of this work warrants that the information contained herein
is in every respect accurate or complete, and they disclaim all responsibility for any errors
or omissions or for the results obtained from use of the information contained in this work.
Readers are encouraged to confirm the information contained herein with other sources.
For example and in particular, readers are advised to check the product information sheet
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dose or in the contraindications for administration. This recommendation is of particular
importance in connection with new or infrequently used drugs.

MCGH425-FM_pi-xxvi.indd 2 21/01/23 12:34 PM


FITZPATRICK’S
Color Atlas and Synopsis of
Clinical Dermatology
Ninth Edition

Arturo P. Saavedra, MD, PhD, MBA


Professor of Dermatology
Endowed Chair of Dermatology
University of Virginia Health System
Charlottesville, Virginia

Ellen K. Roh, MD
Assistant Professor of Dermatology
Harvard Medical School
Massachusetts General Hospital
Boston, Massachusetts

Anar Mikailov, MD
Clinical Assistant Professor in Dermatology
Tufts University School of Medicine
Boston, Massachusetts

New York Chicago San Francisco Athens London Madrid


Mexico City Milan New Delhi Singapore Sydney Toronto

MCGH425-FM_pi-xxvi.indd 3 21/01/23 12:34 PM


Copyright © 2023 by McGraw Hill LLC. All rights reserved. Except as permitted under the United States Copyright
Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a
database or retrieval system, without the prior written permission of the publisher.

ISBN: 978-1-26-427802-2
MHID: 1-26-427802-0

The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-427801-5,
MHID: 1-26-427801-2.

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corporate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.

Library of Congress Cataloging-in-Publication Data

Names: Saavedra, Arturo P., author. | Roh, Ellen, author. | Mikailov, Anar, author. | Wolff, Klaus, 1935- Fitzpatrick’s
color atlas and synopsis of clinical dermatology.
Title: Fitzpatrick’s color atlas and synopsis of clinical dermatology / Arturo P. Saavedra, Ellen K. Roh, Anar Mikailov.
Other titles: Color atlas and synopsis of clinical dermatology
Description: Ninth edition. | New York : McGraw Hill, [2023] | Includes index. | Summary: “The Color Atlas and Syn-
opsis of Clinical Dermatology facilitates dermatologic diagnosis by providing color photographs of skin lesions and,
juxtaposed, a succinct summary outline of skin disorders as well as the skin signs of systemic diseases”– Provided by
publisher.
Identifiers: LCCN 2022038571 (print) | LCCN 2022038572 (ebook) | ISBN 9781264278015 (paperback : alk. paper) |
ISBN 1264278012 (paperback : alk. paper) | ISBN 9781264278022 (ebook) | ISBN 1264278020 (ebook)
Subjects: MESH: Skin Diseases | Atlas
Classification: LCC RL81 (print) | LCC RL81 (ebook) | NLM WR 17 | DDC 616.5–dc23/eng/20221209
LC record available at https://lccn.loc.gov/2022038571
LC ebook record available at https://lccn.loc.gov/2022038572

TERMS OF USE

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possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim
or cause arises in contract, tort or otherwise.
This ninth edition of
Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology
is dedicated to all of those who mentor dermatology residents worldwide, and
specifically, to Drs. Richard Johnson and Klauss Wolff, who have been guiding lights
throughout our careers.

MCGH425-FM_pi-xxvi.indd 5 21/01/23 12:34 PM


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CONTENTS

Preface......................................................................................................................................................ix
Acknowledgments.................................................................................................................................xi
How to Use This Book........................................................................................................................xiii
Approach to Dermatologic Diagnosis......................................................................................... xiv
Outline of Dermatologic Diagnosis.............................................................................................. xv
Special Clinical and Laboratory Aids to Dermatologic Diagnosis..................................... xxiv
Video Videos that accompany this book may be obtained from McGraw Hill, under the
Downloads & Resources tab, at mhprofessional.com/FitzpatricksColorAtlas9e

PART I • DISORDERS PRESENTING IN THE SKIN AND MUCOUS


MEMBRANES 1
SECTION 1 DISORDERS OF SEBACEOUS, ECCRINE,
AND APOCRINE GLANDS..................................................................................... 2
SECTION 2 ECZEMA/DERMATITIS...........................................................................................21
SECTION 3 PSORIASIS, PSORIASIFORM, AND PITYRIASIFORM
DERMATOSES........................................................................................................52
SECTION 4 ICHTHYOSES......................................................................................................... 74
SECTION 5 MISCELLANEOUS EPIDERMAL DISORDERS.................................................89
SECTION 6 GENETIC AND ACQUIRED BULLOUS DISEASES.........................................97
SECTION 7 NEUTROPHIL-MEDIATED DISEASES.............................................................. 121
SECTION 8 THE ACUTELY ILL AND HOSPITALIZED PATIENT...................................... 138
SECTION 9 BENIGN NEOPLASMS AND HYPERPLASIAS............................................... 152
SECTION 10 PHOTOSENSITIVITY, PHOTO-INDUCED DISORDERS,
AND DISORDERS BY IONIZING RADIATION............................................... 201
SECTION 11 PRECANCEROUS LESIONS AND CUTANEOUS CARCINOMAS........... 236
SECTION 12 MELANOMA PRECURSORS AND PRIMARY
CUTANEOUS MELANOMA.............................................................................. 263
SECTION 13 PIGMENTARY DISORDERS.............................................................................. 294

PART II • DERMATOLOGY AND INTERNAL MEDICINE 311


SECTION 14 THE SKIN IN IMMUNE, AUTOIMMUNE, ­AUTOINFLAMMATORY,
AND RHEUMATIC ­DISORDERS....................................................................... 312
SECTION 15 ENDOCRINE, METABOLIC, AND NUTRITIONAL DISEASES.................... 391
SECTION 16 GENETIC DISEASES........................................................................................... 418
SECTION 17 SKIN SIGNS OF VASCULAR INSUFFICIENCY............................................ 427
SECTION 18 SKIN SIGNS OF RENAL INSUFFICIENCY..................................................... 444
SECTION 19 SKIN SIGNS OF SYSTEMIC CANCERS......................................................... 448
SECTION 20 SKIN SIGNS OF HEMATOLOGIC DISEASE.................................................. 465
SECTION 21 CUTANEOUS LYMPHOMAS AND SARCOMA............................................ 483
SECTION 22 SKIN DISEASES IN SOLID ORGAN AND BONE MARROW
TRANSPLANTATION..........................................................................................506
vii

MCGH425-FM_pi-xxvi.indd 7 21/01/23 12:34 PM


viii Contents

SECTION 23 ADVERSE CUTANEOUS DRUG REACTIONS............................................... 513


SECTION 24 DISORDERS OF PSYCHIATRIC ETIOLOGY................................................. 537

PART III • DISEASES CAUSED BY MICROBIAL AGENTS 545


SECTION 25 BACTERIAL COLONIZATIONS AND INFECTIONS OF SKIN
AND SOFT TISSUES.......................................................................................... 546
SECTION 26 FUNGAL INFECTIONS OF THE SKIN, HAIR,
AND NAILS............................................................................................................ 619
SECTION 27 VIRAL DISEASES OF SKIN AND MUCOSA.................................................. 676
SECTION 28 ARTHROPOD BITES, STINGS, AND CUTANEOUS
INFESTATIONS.................................................................................................... 752
SECTION 29 SYSTEMIC PARASITIC INFECTIONS.............................................................. 781
SECTION 30 SEXUALLY TRANSMITTED DISEASES.......................................................... 789

PART IV • SKIN SIGNS OF HAIR, NAIL, AND MUCOSAL DISORDERS 823


SECTION 31 DISORDERS OF HAIR FOLLICLES AND
RELATED DISORDERS...................................................................................... 824
SECTION 32 DISORDERS OF THE NAIL APPARATUS...................................................... 849
SECTION 33 DISORDERS OF THE MOUTH..........................................................................873
SECTION 34 DISORDERS OF THE GENITALIA, PERINEUM,
AND ANUS...........................................................................................................900
SECTION 35 GENERALIZED PRURITUS WITHOUT SKIN LESIONS
(PRURITUS SINE MATERIA).............................................................................. 921
Appendices......................................................................................................................................... 925
Appendix A: Differential Diagnosis of Pigmented Lesions.................................................... 926
Appendix B: Dermoscopy............................................................................................................... 932
Nicole Trepanowski and Rebecca I. Hartman
Appendix C: Drug Use in Pregnancy........................................................................................... 936

Index..................................................................................................................................................... 937

MCGH425-FM_pi-xxvi.indd 8 21/01/23 12:34 PM


PREFACE

“The process may seem strange and yet it is very true. I did not so much gain the knowledge of
things by the words, as words by the experience I had of things.”
—Plutarch

Forty years ago in 1983, the first edition of this book appeared and has been expanded
pari passu with the major developments that have occurred in dermatology over the past four
decades. Dermatology is now one of the most sought-after medical specialties because the bur-
den of skin disease has become enormous and the many new innovative therapies available today
attract large patient populations.
The Color Atlas and Synopsis of Clinical Dermatology has been used by thousands of primary
care physicians, dermatology residents, dermatologists, internists, and other health care pro-
viders principally because it facilitates dermatologic diagnosis by providing color photographs
of skin lesions and, juxtaposed, a succinct summary outline of skin disorders as well as the skin
signs of systemic diseases. It can be used as a clinical companion, as a way to look up specific
information or as a way to test oneself in the important features of the clinical examination. We
invite you to open our atlas to random pages, cover up the figure legend, and to try and describe
the findings you see while making a diagnosis. No clinical resource, however, could replace
the teachings of the skin of our patients. Even amidst the wild changes that have occurred
in therapy, the subtleties and intricacies of the skin examination, continue to fascinate us with
new lessons each day.
The ninth edition has been extensively revised and expanded by new material. There is a com-
plete update of etiology, pathogenesis, management, and therapy. There is also an online version.
For this edition, videos containing clinical material relevant to the text are available at: mhprofes-
sional.com/FitzpatricksColorAtlas9e, under the Downloads & Resources tab.

ix

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ACKNOWLEDGMENTS

In the present McGraw Hill team, we appreciated the counsel of Leah Carton, Associate Editor,
and Kim J. Davis, Director of Medical Development. Their attention to detail, patience and profes-
sional demeanor have contributed to an even better book than we could have produced without
their guidance. Their diligence and efforts will have lasting effects on the education of students and
future dermatologists.

xi

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MCGH425-FM_pi-xxvi.indd 6 21/01/23 12:34 PM


HOW TO USE THIS BOOK

The Color Atlas and Synopsis of Clinical Dermatology is proposed as a “field guide” to the recog-
nition of skin disorders and their management. The skin is a treasury of important lesions that
can usually be recognized clinically. Gross morphology in the form of skin lesions remains the
hard core of dermatologic diagnosis. Therefore, this text is accompanied by more than 1000 color
photographs illustrating skin diseases, skin manifestation of internal diseases, infections, tumors,
and incidental skin findings in otherwise well individuals. We have endeavored to include
information relevant to gender dermatology and a large number of images showing skin disease
in different ethnic populations. Important dermoscopic issues, biologic therapy, and artificial
intelligence have been highlighted. This Atlas covers the entire field of clinical dermatology but
does not include very rare syndromes or conditions. With respect to these, the reader is referred
to another McGraw Hill publication: Fitzpatrick’s Dermatology, 9th edition, 2019, edited by
Sewon Kang, Masayuki Amagai, Anna L. Bruckner, Alexander H. Enk, David J. Margolis, Amy J.
McMichael, and Jeffrey S. Orringer.
This text is intended for all physicians and other health care providers, including medical
students, dermatology residents, internists, oncologists, and infectious disease specialists dealing
with diseases with skin manifestations. For nondermatologists, it is advisable to start with
“Approach to Dermatologic Diagnosis” and “Outline of Dermatologic Diagnosis” to familiarize
themselves with the principles of dermatologic nomenclature and lines of thought.
The Atlas is organized into four parts, subdivided into 35 sections, and there are four short
appendices. Each section has a color label that is reflected by the bar on the top of each page.
This is to help the reader find his or her bearings rapidly when leafing through the book. Each
disease is labeled with the respective ICD10 codes.

xiii

MCGH425-FM_pi-xxvi.indd 13 21/01/23 12:34 PM


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