STEFANO VERALDI MARCO ROMANELLI ALESSANDRO FARRIS ATLAS OF SKIN ULCERS 2
STEFANO VERALDI Istituto di Scienze Dermatologiche, I.R.C.C.S., Università di Milano, Italia MARCO ROMANELLI Clinica Dermatologica, Sezione di Riparazione Tessutale, Università di Pisa, Italia ALESSANDRO FARRIS Unità Operativa di Dermatologia, Ospedale San Paolo, Savona, Italia ATLAS OF SKIN ULCERS
S. Veraldi, M. Romanelli, A. Farris For the collaboration the authors thank: Francesca Alessi Silvia Bottini Marinella Brambati Carlo Carrera Claudia Francia Luisa Lunardon Maria Chiara Persico Gianluca Tadini of Istituto di Scienze Dermatologiche dell Università di Milano Rossana Schianchi of Istituto Dermatologico Europeo di Milano Antonio Di Maio Coordinator of the volume Copyright 2011 Edizioni Scripta Manent s.n.c. Via Bassini, 41-20133 Milano Tel. 0270608060 / 0270608091 - Fax 0270606917 E-mail: scriman@tin.it Graphics Piero Merlini IV This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way and storage in data banks. Violations are liable for prosecution under the Italian Copyright Law.
Atlas of skin ulcers Contents Ulcers in the course of hereditary diseases Porokeratoses pag. 2 Epidermolysis bullosa pag. 4 Hemophilia pag. 10 Thalassemia pag. 12 Sickle cell anemia pag. 14 Ulcers in the course of infectious and parasitic diseases Ulcers in the course of AIDS pag. 18 Mycetomas pag. 22 Intertrigo due to Gram-negative bacteria pag. 24 Erysipelas pag. 28 Ecthyma pag. 32 Boils pag. 38 Tropical ulcers pag. 42 Tubercolosis pag. 46 Mycobacterioses pag. 48 Syphilis pag. 50 Filariases pag. 52 Dracunculiasis pag. 54 Entomodermatitis pag. 56 Tungiasis pag. 58 Myiases pag. 60 Spider bites pag. 62 Ulcers in the course of inflammatory and immune-mediated diseases Necrobiosis lipoidica pag. 66 Gout pag. 70 Pemphigus pag. 74 Ulcerative lichen pag. 76 Pyoderma gangrenosum pag. 78 Calciphylaxis pag. 84 Vasculitis pag. 86 Systemic Lupus erythematosus pag. 90 Sneddon s sindrome pag. 92 Sistemic sclerosis pag. 94 Rheumatoid arthritis pag. 98 Cryoglobulinemiae pag. 100 Prurigo pag. 102 V
Contents Ulcers in the course of vascular diseases Martorell s ulcers pag. 106 Arterial ulcers pag. 108 Ulcers due to venous insufficiency pag. 112 Diabetic foot pag. 120 Ulcers in the course of neoplastic diseases Radiodermatitis pag. 126 Basal cell carcinoma pag. 128 Bowen s carcinoma pag. 134 Squamous cell carcinoma pag. 136 Melanoma pag. 138 Lymphomas pag. 140 Metastases pag. 148 Post-traumatic ulcer pag. 152 Self-inflicted ulcers pag. 154 Other ulcers VI
ULCERS IN THE COURSE OF HEREDITARY DISEASES
S. Veraldi, M. Romanelli, A. Farris POROKERATOSES Porokeratoses are autosomal dominant hereditary disorders. They are caused by abnormalities of keratinisation: typical lesions include keratotic and verrucous papules and plaques, which can occasionally ulcerate. According to the clinical point of view, five clinical varieties of porokeratosis have been identified: porokeratosis of Mibelli, actinic superficial disseminated porokeratosis, linear porokeratosis, punctate porokeratosis and porokeratosis palmaris et plantaris disseminata. Porokeratoses are not rare in transplanted and AIDS patients. Exposure to both natural and artificial UV light brings out, maintains and worsens lesions. Degeneration into squamous cell carcinoma is not an exceptional event. Essential references Razack E.M.A., Natarajan M. Ulcerative systematized porokeratosis (Mibelli). Arch Dermatol 1977; 113: 1583-1584. Rémond B., Dompmartin A., Mandard J.C., Leroy D. Carcinome spinocellulaire et porokératose actinique superficielle disséminée. Ann Dermatol Venereol 1994; 121: 50-52. Watanabe T., Murakami T., Okochi H., Kikuchi K., Furue M. Ulcerative porokeratosis. Dermatology 1998; 196: 256-259. 2
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