Richard Ashton, Barbara Leppard, Hywel Cooper - Differential Diagnosis in Dermatology (2014, CRC Press)

DIFFERENTIAL DIAGNOSIS
IN DERMATOLOGY
FOURTH EDITION
“Brilliant... Take for granted the superb colour photographs, the comprehensive and
readable text, the clinical accuracy and acumen of the authors... what’s special is the
diagnostically and educationally helpful structure. This book understands that most of us do
not have photographic memories, and panic when we don’t immediately recognise a skin
lesion. Provided we can establish a few simple features of the rash – where it is, what colour,
how long it has been there, surface characteristics – we turn to the appropriate algorithm,
look at the picture for confi rmation and come up with the right answer. It is such a relief I
could burst into tears of gratitude.”
Postgraduate Education for General Practice, on the First Edition
Revised and updated for its Fourth Edition with specially added images of pigmented skins,
the key aim of Differential Diagnosis in Dermatology remains the same – to allow primary
care physicians to diagnose quickly and confi dently with the patient present. Chapters are
divided into different body areas and contain over 750 illustrations, combining excellent
clinical photography with practical text and clear diagrams throughout.
By looking inside the front cover at the intuitive “How To” guide and using the index
of algorithms found at the back, diagnosis can be effectively reached by identifying the
relevant clinical features. High quality images of white and pigmented skins illustrate each
condition, with a concise description of the clinical features and treatment options.
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Mukhtar Bizrah and Manaf Khatib
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Shiv Pareek
RICHARD ASHTON, BARBARA LEPPARD
and
HYWEL COOPER
DIFFERENTIAL DIAGNOSIS IN DERMATOLOGY FOURTH EDITION
RICHARD ASHTON, BARBARA LEPPARD AND HYWEL COOPER
ISBN: 978-1-90936-872-9
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SITE INDEX
How to use this book
This book has been written to aid in the diagnosis of an unknown
rash or lesion, and we encourage you to use it while examining
the patient. You will need to describe the rash or lesions using the
system outlined here.
1. Site
2. Erythematous (blanches on pressure) or Non-erythematous
3. Acute (<2 weeks’ duration) or Chronic (>2 weeks’ duration)
4. Surface features (see Chapter 1 for defi nitions):
normal/smooth (i.e. same as surrounding skin) or scaly,
hyperkeratotic, warty, crust, exudate, excoriated
5. Type of lesion(s) (see Chapter 1 for defi nitions):
fl at lesions – macules and patches
raised lesions – papules, plaques and nodules
fl uid-fi lled lesions – vesicles, bullae and pustules
surface broken – erosions, ulcers and fi ssures
And if non-erythematous, describe the
6. Colour:
due to blood – pink, red, purple, mauve
due to pigment – brown, black, blue
due to lack of blood/pigment – white
other colours – yellow, orange, grey
This will enable you to go to the algorithm that gives the differential diagnosis for
the clinical features that you have elicited. You can fi nd the index of algorithms on
the inside back cover or at the beginning of each chapter. Diagnoses in the dark blue
boxes are more common and likely to be seen in General Practice. Other diagnoses not
highlighted are rare, and may need a specialist to diagnose correctly.
Chapter 6 Chapters 4, 5 & 9 Chapter 3
Ears p. 159 Face & bald scalp Hairy scalp
Mouth p. 142 pp. 97, 111, 261 p. 69
Tongue p. 150
Lips p. 152
Chapters 7,
8 & 9
Chapter 10 Trunk & limbs
Flexures p. 335 pp. 165,
195, 261
Chapter 13
Hands p. 404
Chapter 11
Genitalia p. 351 Chapter 14
Chapter 12 Nails p. 435
Lower legs
p. 371
Chapter 14 Chapter 13
Nails Feet
p. 435 p. 419

Examples of how to describe the clinical
features of lesions or rashes
1. Site: face
2. Non-erythematous
3. Chronic
4. Surface: normal
5. Flat lesion: patch
6. Colour: white
GO TO algorithm on p.281
1. Site: dorsum hand
2. Erythematous
3. Chronic
4. Surface: scale
5. Raised lesion: plaques
GO TO algorithm on p.407
1. Site: trunk
2. Erythematous
3. Chronic
4. Surface: crust
5. Lesions: bullae and erosions
GO TO algorithm on p.255

For all the patients from whom we have learnt so much over the years
and to all those who we hope will benefi t from this book in the future

Differential Diagnosis in Dermatology
Fourth Edition
Richard Ashton
Consultant Dermatologist Portsmouth NHS Trust,
Nobles Hospital, Isle of Man
Barbara Leppard
Retired Consultant Dermatologist, Southampton University NHS Trust
Hywel Cooper
Consultant Dermatologist, Portsmouth NHS Trust
Boca Raton London New York
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