Clinics in Dermatology (2014) 32, 1–2
Commentary
Red face revisited: I Although the skin has basically the same components at different anatomic sites, it varies in thickness, texture, appendages, pigment cell density, vasculature, and other parameters, depending on location, such as, for example, the delicate skin of the eyelids, face, and neck compared with the sturdier skin of the palms and soles. Similarly, several common dermatoses have a predilection for particular anatomic sites and might have different morphologic appearance at various localizations. Skin diseases localized to certain anatomic areas are known as “regional dermatoses.” The standard method of classification of skin diseases in Western dermatology is usually a hybrid of systems based on a causative approach (eg, genodermatoses, infectious diseases, autoimmune, allergic, neoplastic, etc), as well as on a morphologic/pathologic approach (eg, papulosquamous diseases, bullous dermatoses, pigmentation disorders, etc). Classification of skin diseases, according to the areas of the body in which the disease is most likely to manifest itself, is not a common or acceptable practice in Western dermatology, although it is practiced in traditional Chinese dermatology. We present two issues of Clinics in Dermatology dedicated to several common dermatoses, according to the anatomic sites of their predilection. The aim of these issues is by no means to change practices that have been used since the beginning of dermatology, nor is it our intention to offer a new way of classifying skin diseases. The objective of this work is rather to shed light on another aspect of morphologic descriptive dermatology and to provide the clinician an additional tool for viewing the patient and performing the differential diagnosis of the pathology. Although the way we propose the organization of skin diseases may seem unconventional, we believe it is quite useful for practicing dermatologists. These issues may be considered a continuation of two previous ones of Clinics in Dermatology1,2 that had been devoted to the important but neglected topic of clinical morphologic descriptive dermatologic diagnosis. Dr. William Dock (1898–1990) termed one of his contributions to medical education “Sutton’s Law” after the notorious bank robber Willie Sutton (1901–1980) who, when asked why he always robbed banks, replied, “That’s where the money is.” Sir William Osler (1849–1919) said: “There is 0738-081X/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clindermatol.2013.06.002
no more difficult art to acquire than the art of observation.” Localization of a disease can, therefore, serve as a starting point from which the process of diagnosing can progress, thus facilitating the task of correctly diagnosing a skin disease. That is the importance of these issues. We take note that some two decades ago, Clinics in Dermatology published a symposium on “The Red Face.”3 We now wish to reexamine this fascinating topic in the 21st century.
Basic histology and anatomy of facial skin Because skin has several important functions such as protection, sensation, thermoregulation, homeostasis, and metabolic and sexual signaling, basic histologic structure and functions of facial skin will be reviewed first. For understanding the dermatologic disorders properly, complex anatomical features of the face including muscles, vasculature, and nerves will be demonstrated in detail by original figures.
Acneiform eruptions and rosacea Today, many people suffer from adult acne and rosacea. The acneiform eruptions paper provides practical data to understand and treat these patients properly. The rosacea and rhinophyma contribution highlights the recent clinical and pathophysiologic developments.
Granulomatous disorders Almost all granulomatous skin disorders can cause red lesions on the face. Such disorders include many bacterial, fungal, or parasitic infections; noninfectious inflammatory disorders; foreign body reactions; and even neoplasms. In the granulomatous article, the authors present information on the certain clinical patterns and differential diagnosis.
2
Pigmentation disorders Pigmentation disorders, even though mostly asymptomatic, have a great impact on a patient’s quality of life. They include a large number of heterogeneous conditions. In this paper, the authors review the most common pigmentation disorders that appear on the face.
Commentary group includes allergic and irritant contact dermatitis. These reviews cover clinical assessment of endogenous and exogenous dermatoses of the face.
Perioral and periorbital dermatitides
In view of the challenging area of dermatology regarding the exact diagnosis and precise control of the photosensitivity reactions, the contribution on photodermatoses including phototoxic and photoallergic reactions (internal and external) is important, both for the physicians and the patients.
Perioral dermatitides are relatively common inflammatory facial skin disorders. The authors describe the clinical characteristics, differential diagnosis, and treatment choices. In the periorbital dermatitis article, the authors review the key features of several common dermatides that affect the eyelids, such as atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, airborne contact dermatitis, rosacea, psoriasis, and others.
Actinic keratoses
Dermatologic diseases of the external ear
Actinic keratoses are the earliest stage in the development of squamous cell carcinoma and represent important biomarkers for patients at risk for development of invasive squamous cell cancer. The paper “Morphologic Grading and Treatment of Facial Actinic Keratosis” describes noninvasive diagnostic tools and the choice of treatments that are currently available.
Dermatologic diseases on the external ear are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners, and general and plastic surgeons are regularly consulted regarding cutaneous lesions on the ear. This paper focuses on clinical manifestations and treatment modalities.
Pigmented macules
Connective tissue disorders
The differential diagnosis of pigmented macules on the chronic sun-damaged skin of the face is challenging and includes lentigo maligna, pigmented actinic keratosis, and solar lentigo. The “Flat Pigmented Macules on Sun-Damaged Skin of the Head/Neck: Junctional Nevus, Atypical Lentiginous Nevus or Melanoma In Situ?” contribution provides accurate diagnosis and appropriate management. In the “Diagnosis and Management of Facial Pigmented Macules” review, the authors give information in detail.
Red face is not a rare finding in connective tissue disorders. In the “Connective Tissue Disorders” contribution, the authors give information about face manifestations of systemic lupus erythematosus, systemic sclerosis, and dermatomyositis.
Photodermatoses
Lymphocytic infiltration The most important diseases with lymphocytic infiltration of the face are pseudolymphomas. The authors provide clinical information on various types of cutaneous pseudolymphomas and other diseases with lymphocytic infiltration mainly involving the face.
Yalçın Tüzün, MD Department of Dermatology, Cerrahpaşa Medical Faculty Istanbul University, 34098, Fatih, Istanbul, Turkey E-mail address: [email protected] Ronni Wolf, MD The Dermatology Unit, Kaplan Medical Center 76100 Rechovot, Israel Hebrew University-Hadassah Medical School Jerusalem, Israel E-mail address: [email protected]
References Endogenous and exogenous dermatoses The endogenous dermatitis group includes atopic dermatitis and seborrheic dermatitis. The exogenous dermatitis
1. Wolf R, Parish LC. Advances in dermatologic diagnosis. Clin Dermatol. 2011;29:123-240. 2. Wolf R, Parish LC. Advances in dermatologic diagnosis: Part II. Clin Dermatol. 2011;29:481-565. 3. Rebora A. The red face. Clin Dermatol. 1993;11:188-328.
Commentary
Red face revisited: I Although the skin has basically the same components at different anatomic sites, it varies in thickness, texture, appendages, pigment cell density, vasculature, and other parameters, depending on location, such as, for example, the delicate skin of the eyelids, face, and neck compared with the sturdier skin of the palms and soles. Similarly, several common dermatoses have a predilection for particular anatomic sites and might have different morphologic appearance at various localizations. Skin diseases localized to certain anatomic areas are known as “regional dermatoses.” The standard method of classification of skin diseases in Western dermatology is usually a hybrid of systems based on a causative approach (eg, genodermatoses, infectious diseases, autoimmune, allergic, neoplastic, etc), as well as on a morphologic/pathologic approach (eg, papulosquamous diseases, bullous dermatoses, pigmentation disorders, etc). Classification of skin diseases, according to the areas of the body in which the disease is most likely to manifest itself, is not a common or acceptable practice in Western dermatology, although it is practiced in traditional Chinese dermatology. We present two issues of Clinics in Dermatology dedicated to several common dermatoses, according to the anatomic sites of their predilection. The aim of these issues is by no means to change practices that have been used since the beginning of dermatology, nor is it our intention to offer a new way of classifying skin diseases. The objective of this work is rather to shed light on another aspect of morphologic descriptive dermatology and to provide the clinician an additional tool for viewing the patient and performing the differential diagnosis of the pathology. Although the way we propose the organization of skin diseases may seem unconventional, we believe it is quite useful for practicing dermatologists. These issues may be considered a continuation of two previous ones of Clinics in Dermatology1,2 that had been devoted to the important but neglected topic of clinical morphologic descriptive dermatologic diagnosis. Dr. William Dock (1898–1990) termed one of his contributions to medical education “Sutton’s Law” after the notorious bank robber Willie Sutton (1901–1980) who, when asked why he always robbed banks, replied, “That’s where the money is.” Sir William Osler (1849–1919) said: “There is 0738-081X/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clindermatol.2013.06.002
no more difficult art to acquire than the art of observation.” Localization of a disease can, therefore, serve as a starting point from which the process of diagnosing can progress, thus facilitating the task of correctly diagnosing a skin disease. That is the importance of these issues. We take note that some two decades ago, Clinics in Dermatology published a symposium on “The Red Face.”3 We now wish to reexamine this fascinating topic in the 21st century.
Basic histology and anatomy of facial skin Because skin has several important functions such as protection, sensation, thermoregulation, homeostasis, and metabolic and sexual signaling, basic histologic structure and functions of facial skin will be reviewed first. For understanding the dermatologic disorders properly, complex anatomical features of the face including muscles, vasculature, and nerves will be demonstrated in detail by original figures.
Acneiform eruptions and rosacea Today, many people suffer from adult acne and rosacea. The acneiform eruptions paper provides practical data to understand and treat these patients properly. The rosacea and rhinophyma contribution highlights the recent clinical and pathophysiologic developments.
Granulomatous disorders Almost all granulomatous skin disorders can cause red lesions on the face. Such disorders include many bacterial, fungal, or parasitic infections; noninfectious inflammatory disorders; foreign body reactions; and even neoplasms. In the granulomatous article, the authors present information on the certain clinical patterns and differential diagnosis.
2
Pigmentation disorders Pigmentation disorders, even though mostly asymptomatic, have a great impact on a patient’s quality of life. They include a large number of heterogeneous conditions. In this paper, the authors review the most common pigmentation disorders that appear on the face.
Commentary group includes allergic and irritant contact dermatitis. These reviews cover clinical assessment of endogenous and exogenous dermatoses of the face.
Perioral and periorbital dermatitides
In view of the challenging area of dermatology regarding the exact diagnosis and precise control of the photosensitivity reactions, the contribution on photodermatoses including phototoxic and photoallergic reactions (internal and external) is important, both for the physicians and the patients.
Perioral dermatitides are relatively common inflammatory facial skin disorders. The authors describe the clinical characteristics, differential diagnosis, and treatment choices. In the periorbital dermatitis article, the authors review the key features of several common dermatides that affect the eyelids, such as atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, airborne contact dermatitis, rosacea, psoriasis, and others.
Actinic keratoses
Dermatologic diseases of the external ear
Actinic keratoses are the earliest stage in the development of squamous cell carcinoma and represent important biomarkers for patients at risk for development of invasive squamous cell cancer. The paper “Morphologic Grading and Treatment of Facial Actinic Keratosis” describes noninvasive diagnostic tools and the choice of treatments that are currently available.
Dermatologic diseases on the external ear are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners, and general and plastic surgeons are regularly consulted regarding cutaneous lesions on the ear. This paper focuses on clinical manifestations and treatment modalities.
Pigmented macules
Connective tissue disorders
The differential diagnosis of pigmented macules on the chronic sun-damaged skin of the face is challenging and includes lentigo maligna, pigmented actinic keratosis, and solar lentigo. The “Flat Pigmented Macules on Sun-Damaged Skin of the Head/Neck: Junctional Nevus, Atypical Lentiginous Nevus or Melanoma In Situ?” contribution provides accurate diagnosis and appropriate management. In the “Diagnosis and Management of Facial Pigmented Macules” review, the authors give information in detail.
Red face is not a rare finding in connective tissue disorders. In the “Connective Tissue Disorders” contribution, the authors give information about face manifestations of systemic lupus erythematosus, systemic sclerosis, and dermatomyositis.
Photodermatoses
Lymphocytic infiltration The most important diseases with lymphocytic infiltration of the face are pseudolymphomas. The authors provide clinical information on various types of cutaneous pseudolymphomas and other diseases with lymphocytic infiltration mainly involving the face.
Yalçın Tüzün, MD Department of Dermatology, Cerrahpaşa Medical Faculty Istanbul University, 34098, Fatih, Istanbul, Turkey E-mail address: [email protected] Ronni Wolf, MD The Dermatology Unit, Kaplan Medical Center 76100 Rechovot, Israel Hebrew University-Hadassah Medical School Jerusalem, Israel E-mail address: [email protected]
References Endogenous and exogenous dermatoses The endogenous dermatitis group includes atopic dermatitis and seborrheic dermatitis. The exogenous dermatitis
1. Wolf R, Parish LC. Advances in dermatologic diagnosis. Clin Dermatol. 2011;29:123-240. 2. Wolf R, Parish LC. Advances in dermatologic diagnosis: Part II. Clin Dermatol. 2011;29:481-565. 3. Rebora A. The red face. Clin Dermatol. 1993;11:188-328.
