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Chapter 37: Skin Diseases Involving Multiple Body Regions

Noah Goldfarb; Steven W. Lin

INTRODUCTION TO CHAPTER

Many common diseases such as atopic dermatitis, psoriasis, drug rashes, urticaria, viral exanthems, bug bites, and vitiligo present with lesions in multiple body regions. Less common disorders such as syphilis, erythema multiforme, Stevens–Johnson syndrome/toxic epidermal necrolysis, the immunobullous diseases, cutaneous T-cell lymphomas, and connective tissue disorders also present in multiple body locations.

APPROACH TO DIAGNOSIS

Skin diseases affecting several anatomic sites simultaneously are listed in Table 37-1. Lesion distribution is frequently a very important clue to the diagnosis. For example, atopic dermatitis typically involves the flexor extremities, specifically the popliteal and antecubital fossae, whereas psoriasis vulgaris usually involves the elbows, knees, and extensor surfaces. It is still unclear why certain diseases have a predilection for specific anatomic locations.

Table 37-1.Differential diagnosis of skin diseases involving multiple body regions.
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Table 37-1. Differential diagnosis of skin diseases involving multiple body regions.
Disease Epidemiology History Physical Examination
Inflammatory
Allergic contact dermatitis

Common

F > M

Age: any age

Pruritic

Onset is hours to days after contact with allergen

Acute: papules and vesicles on an erythematous base (Figures 8-4 and 8-5)

Chronic: xerosis, fissuring, hyperpigmentation, and lichenification (Figures 8-1, 8-2, 8-3)

Typical locations: scalp, face, eyelids, earlobes, neck, hands wrists, or feet
Atopic dermatitis

Common

M > F

Age: usually presents in childhood but may persist

Pruritic

Chronic course with exacerbations. Worse in winter. Personal or family history of atopy

Infants: red papules, scaly plaques and excoriations on cheeks, trunk and extensor extremities (Figure 8-7)

Children and adults: red lichenified plaques, and excoriations (Figure 8-8) typically on neck, wrists, hands, ankles, feet, and flexor extremities, especially the antecubital and popliteal fossas
Nummular eczema

Common

M > F

Age: bimodal; peaks in young adults and the elderly

Pruritic

Chronic waxing and waning course

Associated with dry skin

 Round, light pink, scaly, thin, 1-3 cm plaques (Figure 8-11) on trunk and extremities
Prurigo nodularis

Uncommon

F > M

Can be idiopathic or secondary to other underlying etiology

 Pruritic. Persists for months to years. Variable patient insight. May admit to picking and/or scratching lesions Solitary or multiple discrete well-demarcated dome-shaped hyperpigmented papules or nodules often in variable stages of healing on extensor extremities (Figure 26-2)
Psoriasis

Common

M = F

Age: any age, but peaks in young adulthood (20s) and middle aged adults (50s)

Asymptomatic to mildly pruritic

Chronic. May have arthritis and family history of psoriasis

Red papules and plaques with silvery, thick, adherent scale on scalp, extensor extremities, elbows, knees, genitals, umbilicus, lower back, and retroauricular area (Figures 9-1, 9-2, 9-3)

Nail pitting/dystrophy
Lichen planus

Uncommon

F > M

Age: 30-60 years

 Pruritic. Lasts months to years May be drug-induced or associated with hepatitis C Multiple variants; classically flat-topped, well-defined, polygonal, violaceous, shiny papules ...

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