Schneiderman Prelims Vol-I. qxd

EXOGENOUS AGENTS
Coal tar products – pitch, asphalt, creosote – diffuse melanosis
of exposed skin; evolves to atrophy, telangiectasia, lichenoid
papules, follicular keratosis 
Rook p.1791, 1998, Sixth Edition
Smoker’s face – linear wrinkling and atrophy 
AD 128:255–262,
1992
INFECTIONS AND INFESTATIONS
AIDS – lipoatrophy of face, arms, and legs (associated with
increase fat of abdomen) 
JAAD 42:727–730, 2000
Botryomycosis – granulomatous reaction to bacteria with
granule formation; single or multiple abscesses of skin
and subcutaneous tissue break down to yield multiple sinus
tracts; small papule; heals with atrophic scars; extremities,
perianal sinus tracts, face 
Int J Dermatol 22:455–459, 1983;
AD 115:609–610, 1979
Chronic tropical folliculitis
Herpes simplex; congenital herpes simplex infection due to
intrauterine infection – generalized cigarette paper atrophy
J Pediatr 110:97–101, 1987; Ped Derm 4:336–340, 1987
HIV disease – anetoderma 
AD 128:661–662, 1992
Leprosy – secondary anetoderma; Lucio’s phenomenon –
atrophic scars 
JAAD 48:958–961, 2003
Lyme borreliosis (
Borrelia burgdorferi) – acrodermatitis
chronica atrophicans – red to blue nodules or plaques;
tissue-paper-like wrinkling; pigmented; poikilodermatous;
hands, feet, elbows, knees; subcutaneous nodules of elbows
and knees, with ulnar fibrous bands; sclerosis of lower legs
with ulceration 
JAAD 49:363–392, 2003; BJD 121:263–269,
1989; Int J Derm 18:595–601, 1979
Molluscum contagiosum, healed – cribriform scarring 
BJD
144:1094–1095, 2001
64
A CLINICIAN
’
S GUIDE TO DERMATOLOGIC DIFFERENTIAL DIAGNOSIS, VOLUME 1
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Onchocerciasis – atrophic changes earliest of buttock,
shoulders, and legs; fine wrinkling and xerotic skin
AD
140:1161–1166, 2004; JAAD 45:435–437, 2001; BJD
121:187–198, 1989; atrophic white macules, ‘hanging groin’ due
to destruction of elastic fibers 
Cutis 65:293–297, 2000
Pinta – late secondary phase hypopigmented, depigmented
hyperpigmented atrophic skin 
Rook p.1274, 1998, Sixth Edition;
tertiary (late phase) – atrophy with thinning and wrinkling of skin
overlying large joints 
Rook p.1274, 1998, Sixth Edition
Pustular dermatitis atrophicans of the legs – folliculitis in Lagos,
West Africa
Rubella, congenital – deep dimples over bony prominences
(patellae); blueberry muffin baby 
J Pediatr 39:291–292, 1967
Syphilis – secondary anetoderma; tertiary syphilis – atrophic
scars 
Rook p.2009, 1998, Sixth Edition
Tuberculosis – secondary anetoderma; varioliform scars of
papulonecrotic tuberculid 
JAAD 14:815–826, 1986
Varicella – congenital (fetal) varicella syndrome – infection
between first and second trimester; dermatomal scars; low birth
weight, localized absence of skin, papular lesions resembling
connective tissue nevi, limb paresis, limb hypoplasia, malformed
digits, ocular anomalies (chorioretinitis), central nervous system
abnormalities 
BJD 150:357–363, 2004; Rook p.487–488, 1998,
Sixth Edition; varicella scars – small circular atrophic scars
Rook p.2009, 1998, Sixth Edition
Yaws – primary red papule, ulcerates, crusted; satellite papules;
become round ulcers, papillomatous or vegetative friable
nodules which bleed easily (raspberry-like) (framboesia); heals
with large atrophic scar with white center with dark halo 
Rook
p.1268–1271, 1998, Sixth Edition; tertiary – gumma; multiple
subcutaneous nodules; overlying skin ulcerates with purulent
discharge; atrophic pigmented scars (tissue paper scars) 
Rook
p.1271, 1998, Sixth Edition