Schneiderman Prelims Vol-I. qxd

viii
Schneiderman Prelims Vol-I.qxd 5/17/2006 5:17 PM Page viii

---

Introduction
Dermatologic differential diagnosis represents a continuous challenge both to the new student and the
most seasoned practitioner. This textbook is designed to assist in the diagnosis of skin disease by
presenting a unique and comprehensive approach to differential diagnosis. We expect this book to
function as a tool to improve our readers’ skills in physical examination of the skin and sharpen their
analytical thinking in dermatology.
Useful in the diagnosis of patients in emergency rooms, private offices, or hospital beds, this text is
practical for a large group of motivated diagnosticians including academicians, private practitioners,
residents in dermatology, internal medicine, or pediatrics, medical students and even self-diagnosing
patients. For the resident and student, complete lists of differential diagnoses will expand their breadth of
knowledge of human skin disease. For the experienced attending dermatologist caring for the patient with
a difficult diagnostic enigma, this reference will aid in thinking beyond initial clinical impressions.
The concept of this textbook evolved from the two authors’ team teaching of dermatology
residents over the past 26 years. Whether through the intense scrutiny of Kodachrome color slides or
examination of patients in the clinic, office, or hospital bedside, each week we presented our residents
with clinical “unknowns.” Provided with no histories or laboratory data, the residents were challenged
to rely on their clinical examination skills to generate lists of possible diagnoses based solely on the
morphology of the skin lesions and clinical settings. They quickly learned the critical importance of
accurate morphologic recognition in order to direct them to the appropriate differential diagnostic
category. The resident lists of diagnoses were then used to expand and update our original materials
and to extend the scope and content of this work.
With this teaching model, students and residents learned the importance of thorough and precise
observation as the cornerstone of dermatologic diagnosis. Hence the companion atlas with over 4000
color photographs will direct the reader to more precise pictorial descriptions paralleling the text.
The use of this book requires a fundamental knowledge of primary, secondary, and special skin
lesions as well as their pattern and distribution. The table of contents is organized into sections based
on the morphology of the skin lesions. Each section is subdivided into putative pathophysiologic
mechanisms including 
ix
autoimmune,
congenital,
degenerative,
drug reactions,
exogenous agents,
infections and infestations,
infiltrative,
inflammatory,
metabolic,
neoplastic,
paraneoplastic,
primary cutaneous,
psychocutaneous,
syndromes,
trauma, and 
vascular diseases.
Some diseases and conditions fall into multiple categories. We have included those to make them
easier to find. Some entities have multiple names and have suffered from being named and renamed
over time. An attempt has been made to eliminate outdated or confusing names and to use only one
for consistency.
The content of this textbook includes rare clinical manifestations of common cutaneous
conditions and common clinical manifestations of rare cutaneous conditions. In addition there are
Schneiderman Prelims Vol-I.qxd 5/17/2006 5:17 PM Page ix

---

Acknowledgment
Most of the photographs of the patients in these volumes are selected from the collections of the two
authors, who have personally cared for these patients either in their private offices in Syosset,
Manhattan, and White Plains, New York or at the outpatient Vanderbilt Clinic and the Inpatient
Dermatology Consult Service at Columbia Presbyterian Hospital in New York City. The authors are
grateful to our patients for permitting us to photograph them. Dr. Kenneth E. Greer, Professor and
Chairman of the Department of Dermatology at the University of Virginia Medical Center has
graciously and generously contributed numerous clinical slides from his personal collection. A few
selected images were contributed by Dr. Robert Kalb, Dr. Gary Peck, and the Yale University
Department of Dermatology.
David Bloomer, Robert Peden, and Martin Lister from Informa Healthcare have been instrumental
in bringing this long term project to fruition. The authors are deeply indebted to these wonderful
people for the faith they have had in this work and their great effort which made it a reality.
new versions of old maladies and new diseases never learned or encountered and other conditions
perhaps forgotten by the reader. The text delivers key references to the fingertips of community
practitioners and academicians to start or accelerate their search engines. The diseases comprising
each chapter may be used to develop a list of larger and broader differential diagnostic possibilities for
the patient who otherwise might have appeared routine. More importantly, a new diagnosis may be
offered which better fits the patient’s clinical presentation and which better suits the practitioner’s
clinical impression. References are provided as starting points for further study.
This text is only a beginning for self-education. For the resident and student, extensive lists of
differential diagnosis expand their portfolio of cutaneous pathology and give them fresh perspectives
to contribute in the academic setting. The experienced attending dermatologist can then prioritize the
differential diagnosis both by frequency and significance. We hope our book serves as a paradigm for
the clinician as lifelong learner to be emulated by residents and students. Even those few patients with
difficult diagnostic dilemmas may find insight in this text to share with their physicians.
We have not only included the rare and exotic diseases but the esoteric and unusual aspects of the
common and mundane dermatologic conditions encountered in daily practice. Caution should be
exercised when using this text so that every set of perceived hoofbeats does not herald a zebra instead
of a horse. But be prepared to recognize either when they trot toward you. We acknowledge that the
skills needed to know when to pursue the unusual and when to confirm the common are acquired
with much experience and thoughtful practice. We hope these combined texts foster the development
and refinement of these sophisticated specialized skills.
The literature changes rapidly. Unique case reports, new diseases and treatments with novel side
effects and complications are reported daily. The authors and publishers welcome additions, deletions,
substitutions and corrections for future editions and encourage the readers’ participation in this
process. We look forward to refining and extending this work.
It is our sincere hope as urban/suburban/community/academic dermatologists that these companion
books will be as helpful to you and your patients as they have been to us and ours.
Paul I. Schneiderman
Syosset, New York
Marc E. Grossman
Scarsdale, New York