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Chapter19:DermatologicProblemsofSpecialPopulations
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DermatologicProblemsofSpecialPopulations

TreatmentofDermatologicConditionsinPregnancy
Pregnantandnursingwomenneedspecialconsiderationbecausepotentialmedicationrelatedteratogenicitycanlimitthetreatment
optionsfordermatologicdiseases.Dermatologicconditionscanbechronicandunchangedduringpregnancy,andpregnancyitself
caninducenormalchanges(Table36).TheFDAassignscategoriesforeverymedicationtoindicatethepotentialofadrugtocause
birthdefectsifusedduringpregnancy.Thesecategoriesandtherisktobenefitratioshouldbeconsideredbeforeprescribing
medicationstoanywomanofchildbearingpotential,includingthoseattemptingpregnancy,pregnantwomen,ornursingmothers.
Thespecifictrimesteranddevelopmentalstageshouldbeconsideredasmedicationscarrydifferentrisksdependingonthe
developmentalperiod.
Table36.OpeninNewWindowNormalDermatologicChangesObservedDuringPregnancy
Finding

Hyperpigmentation Melasma

Characteristics
Maskofpregnancy,brownpatchesonfaceandneck,
occasionallyextremities

Lineanigra

Lineofpigmentationontheabdomenthatmayextendcentrally
fromthepubistoxiphoid

Nipples,areolae,axillae,genitals

Skinmaydarkeninpregnancymolesalsomaydarken

Striaegravidarum Stretchmarks

Maystartpinktoredandthenbecomepalerovertime

HairandNails

Hair

Maythickenduringpregnancy,andthenlossofhairabout3
monthspostpartumiscommon(telogeneffluvium)

Nails

Maygrowfasterduringpregnancy

Spiderangiomas

Commononface,neck,extremities

Hemorrhoidsandvaricoseveins

Occurinabout40%ofwomen

Palmarerythema

Increasedrednessonpalmsseenintwothirdsofwomen

Edema

Diffuseswellingcanoccurlowerlegedemaiscommon

Vaginalerythema(Chadwicksign)andblue
discolorationofcervix(Goodellsign)

Duetoincreasedbloodflowandcongestion

Gingivalhyperemiaandedema

Occursinsomeextenttoallwomenpyogenicgranulomasalso
canoccur

Vascularchanges

FDApregnancycategoryXmedicationsshouldneverbeusedinpregnantornursingwomen,andthosespecificallyprescribedin
dermatologyaremethotrexate,thalidomide,andretinoids(Table37).Importantly,menwhoarepotentialfathersshouldnottake
methotrexate.ThereareregulatorysystemsthatmonitorcertainmedicationssuchasiPledgeforisotretinoinandSTEPsfor
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thalidomidebecauseofthesignificantpotentialdetrimenttofetuses.
Table37.Openin
New
WindowSelected
FDAPregnancy
CategoryXDrugsto
AvoidDuring
Pregnancyand
Lactation
Acitretin
Danazol
Estrogens
Finasteride
5Fluorouracil
Flutamide
Isotretinoin
Methotrexate
Stanozolol
Tazarotene(topical)
Thalidomide
Managementwithtopicalagentsoftenisconsideredbeforeprescribingsystemicmedicationsbecausetheyarelowerrisk,withthe
exceptionoftazarotene(categoryX).GlucocorticoidsarepregnancycategoryC,butaregenerallythoughttobesafe,especially
topicalformulations.Thelowestrequiredamountfortherapeuticefficacyisused.Antihistaminesalsoareconsideredsafein
pregnancy(excepthydroxyzineinthefirsttrimester),buttheyshouldbeavoidedinbreastfeedingmothersbecauseofrisksof
sedationininfants.
Tetracyclinesarefrequentlyusedindermatologyhowever,theyshouldbeavoidedbecauseoftheriskofstainingtheteethandbone
duringfetaldevelopment(categoryD).Trimethoprimsulfamethoxazoleshouldalsobeavoidedbecauseitcaninterferewithfolic
acidmetabolism(categoryC).Otherantibioticclassessuchasthepenicillins(categoryB)andcephalosporins(categoryB)aresafer
choicesduringpregnancy.Spironolactonemaybeusedtotreatacnebutshouldnotbeusedforacneinpregnantwomenbecauseof
risksoffeminizationinafetus.
Ifdermatologicsurgicalproceduresduringpregnancyareindicated,lowdosesoflocalanesthetics,includinglidocaineand
epinephrinearesafetousehowever,sedativesandopioidsshouldbeavoidedinpregnantandbreastfeedingwomen.

KeyPoints
FDApregnancycategoryXmedicationsshouldneverbeusedinpregnantorbreastfeedingwomen,andthosespecifically
prescribedindermatologyaremethotrexate,thalidomide,andretinoids.
Managementwithtopicalagentsoftenisconsideredbeforeprescribingsystemicmedicationstopregnantwomenbecausethey
arelowerriskthansystemicmedications,withexceptionoftopicaltazarotene(FDApregnancycategoryX).

Aging
Severalcommonanduncommonskinconditionsbecomemoreprevalentduringaging,andtheskinstructureandfunctionchange
withage.Autoimmuneblisteringdiseasesarerare,butbullouspemphigoidismorecommonaftertheageof60years,andtherisk
increaseseachyearthereafter.Themostcommonskinconditionstoaffectolderpatientsarepruritus,inflammatorydermatoses,
fungalinfections,andbacterialandviralinfections.

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ChangesDuetoChronologicAgingandPhotoaging
Amyriadofchangesoccurintheskinovertimethesecanbeduetochronologicagingaloneorinfluencedbythecumulative
effectsofultravioletlightexposure(Table38).
Table38.OpeninNewWindowCommonSkinFindingsof
IntrinsicAgedVersusPhotoagedSkin
IntrinsicAging

Photoaging

Thinnedepidermis

Coarsefurrows

Lossofsubcutaneousfat

Finewrinkles

Finewrinkles

Diffusepigmentationbronzing

Dry,flakyskin

Lentigines

Lossofelasticity

Pebblytextureofskin(elastosis)

Skinpallor

Solarpurpura

Decreasedskintemperature Telangiectasia
Xerosis(dryskin)ismorecommoninolderpatientsandisoftenassociatedwithpruritus(seePruritus).Actinicpurpuraiscausedby
agerelatedcapillaryfragilityandbleedingunderatrophicskin.Itiscommonontheforearmsanddorsalhands,butmaybeseen
anywhereonthebody(Figure143).Itisnotasignofvasculitis,ableedingdisorder,ornutritionaldeficiency,anddoesnotrequire
additionalevaluationortherapy.Stellatepseudoscarsarejaggedorlinearatrophicscarsthatprimarilyoccurontheforearmsof
patientswithchronicactinicdamage.Patientsmayormaynotrecallantecedenttrauma.Stellatepseudoscarsareoftenseenin
conjunctionwithactinicpurpura.
Figure143.OpeninNewWindow

Actinicpurpuraontheforearmofapatientwithaniatrogenicfistula.

InflammatorySkinConditions
Xeroticeczemaoccursinareasofexcessivelydryskin.Thelowerlegsarecommonareas.Patientswithseverexeroticeczemacan
developpoorlydemarcated,scalypatchesinterspersedwithsuperficialredfissuresinanetlikedistribution(Figure144).The
appearancehasbeenlikenedtocrackedporcelainoradrylakebed(seeCommonRashes).
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Figure144.OpeninNewWindow

Severexeroticeczemaischaracterizedbyrednessandatilelikepatternondryskin(xerosis)withevidenceoftraumafrom
scratching.Thistypicallyoccursduringmidwinterinnorthernclimates.

Seborrheicdermatitisismorecommonasageincreases.Greasyscalingofthescalp,brows,nose,andcheeksmaydevelop.Areas
suchastheaxillaeandcentralchestmaybeaffected(seeCommonRashes).

Infection
Herpeszosterandpostherpeticneuralgiaaremorefrequentinolderpersons,andtheriskoftheseconditionscanbereducedwith
immunization(seeMKSAP17GeneralInternalMedicine).Infestationsbyscabies,lice,orbedbugscanoccuringroupliving
arrangements.Fungalinfectionsofthefeetandtoenailsareverycommoninolderpopulationshowever,notallnailchangesare
causedbyfungus.Thenailchangesincolor,texture,andthicknesswithage.Thesechangescanbemistakenforonychomycosis(see
NailDisorders).

SkinofColor
Melanocytesareresponsibleforthewidevarietyofskincolorsobserved.Thevariationinskincoloramongindividualsisdueto
variabilityinthesize,distribution,andmelaninconcentrationofthemelanosomes.Melaninabsorbsandscattersenergyfrom
ultraviolet(UV)light,sopersonswithdarkerskinhavealowerriskofsundamage,butaremorelikelytodeveloppigmentation
alteration,bothhyperandhypopigmentation.Personswithskinofcolorcanbeaffectedbynovelandcommonskinconditions.
Inflammatorydermatosescanhaveamoresubtleappearancesincethepinkredcolorthatisasignofinflammationcanbedifficult
toseeondarkerskin(Figure145).Themostcommonskinproblemsinpeoplewithskinofcolorareacne,dyschromiaorany
alterationinskincolor(darkerorlighter),seborrheicdermatitis,atopicdermatitis,orothercausesofdermatitis.
Figure145.OpeninNewWindow

Erythemaduetoinflammationcanbedifficulttodistinguishinpeoplewithmoreskincolor.Thispatienthassecondarysyphilis
manifestingasdarkbrownpatcheswithouterythema.

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DifferencesinPigmentation
RelatedQuestion
Question64
Personswithskinofcoloroftenhavenormalvariationsinskincolorwithareasofhyperpigmentationalongthegingivaandlinesof
demarcationonthetrunkandextremities.Traumaticorinflammatoryskindamagecanalsocausepigmentalteration.Scrapes,bug
bites,oracneoftenhealwithhyperpigmentation.Areasofactiveinflammationfromseborrhea,eczema,orpsoriasismaydevelop
hypopigmentation.Topicalorintralesionalglucocorticoidscanalsocausehypopigmentation,whichcanbedifficulttodistinguish
fromtheeffectsofarashuponcessationofthemedicationthedyschromiawillimprove.Partialorcompletedepigmentationisalso
seeninidiopathicguttatehypomelanosis,whichmanifestsas2to6mmhypopigmentedmaculesonthetrunkandextremities.
Vitiligoaffectsabout1%to2%ofthegeneralpopulationbutismoredifficulttotreatforpatientswithdarkerskincolorbecauseof
thedramaticdifferenceinthedepigmented(white)skinandpreservedareasofnaturalpigmentedskin(Figure146).Thepeakonset
isbetween10and30yearsofage,andthemostcommonformisageneralizedformthathasapredilectionfortheeyes,nostrils,and
mouthandisoftenbilaterallysymmetric.Topicalglucocorticoidsarethemostfrequenttherapiesforvitiligoandcanbeusedfor
patientswithlimitedorgeneralizeddisease.Ultravioletlighttherapyisfrequentlyusedforgeneralizeddiseasesinceitcanbe
difficulttoapplymedicationsdiffusely.Whendepigmentationaffectsnearlytheentirebodyandisunresponsivetotreatment,
depigmentationoftheremainingnormalskinisconsidered.
Figure146.OpeninNewWindow

Symmetricpatchesofgeneralizedvitiligoontheeyelids.

Treatmentofhyperpigmentationischallenging.Depigmentingagentssuchashydroquinone,azelaicacid,andkojicacidtarget
differentstepsintheproductionofmelanin.Topicalretinoidscanbeusedincombinationwithdepigmentingagentsforadditional
effect.Proceduresincludingchemicalpeelingandlasertherapy,canbeeffectivebutcanbeexpensive,andadverseeffectscanbe
severe.Cosmeticcamouflageisanaffordableoptionformostpatients.Sunscreencanreducetherecurrenceofpigment.
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AcneKeloidalisNuchaeandPseudofolliculitisBarbae
RelatedQuestion
Question2
Bothacnekeloidalisnuchae(AKN)andpseudofolliculitisbarbae(PFB)arecharacterizedbyfirm,skincolored,pink,or
hyperpigmentedpapulesthatareoftencenteredonhairfollicles.AKNoftenoccursontheposteriorscalpandneck(Figure147),
whereasPFBoccursonthefaceandanteriorneck.Theseconditionsaremostlikelycausedbythetraumaofaningrownhair.The
hairfollicleinpeoplewithskinofcolorisoftencurved,andthehairgrowsoutoftheskininaspiral.Ratherthanspiraloutward
smoothly,occasionallythehairpuncturesthesideofthefollicleandcaninciteaninflammatoryresponseandsubsequentskin
lesionsthatrangefromsmallpapulestolargekeloids(seeHairDisorders).Thedifferentialdiagnosisincludesacneandbacterial
folliculitis.Acnewilloftenoccuratanysiteonthefaceratherthanbeinglimitedtoareasofterminalhairs.Infectiousfolliculitis
presentswithredpapulesandpustuleshowever,itisoftendistributedacrossanareasuchasthescalportrunkratherthan
preferentiallyinthebeardorposteriorscalp.Acneandfolliculitisdonotusuallyhealwithfibroticpapules.Therapyaimsto
minimizeinflammationandsecondaryinfection,flattenscars,andalterdamagedonebyhairs.Topicalandoralantibiotics,
glucocorticoids(topicalorintralesional),changesinshavinghabits,andlaserhairremovalcanbeused,oftenincombination.
Figure147.OpeninNewWindow

Skincoloredpapulesandplaquesontheposteriorscalpandnapeoftheneckfromacnekeloidalisnuchae.

Keloids
Blackpersonsareatleasttwiceaslikelyaswhitepersonstodevelopkeloids.Keloidsareanovergrowthofdermalcollagenoftenin
responsetoskininjurysuchaspiercing,tattoo,surgery,oracne(Figure148).Theuppertrunk,neck,andearsarefrequentsites.
Keloidscanbeasymptomatic,painful,orpruritic.Incontrasttohypertrophicscarsandtypicalscars,keloidsextendbeyondthe
borderoftheoriginalinjury.Thereisnosinglepreferredtreatment.Optionsincludetopicalandintralesionalglucocorticoids,laser
therapy,intralesionalchemotherapy,andradiationtherapy.Intralesionalglucocorticoidsareoftenthefirstlinetherapybutmustbe
repeatedaboutevery8weeksandthreetofourinjectionsareneededtodemonstratesignificantimprovement.Topical
glucocorticoidsaregenerallyineffectiveforkeloidsbutcanbeeffectiveforhypertrophicscars.Surgicalexcisionaloneisavoidedas
recurrenceisfrequent,andsurgeryisoftenpairedwithintralesionalglucocorticoids.Similartosurgery,lasertherapy,forexample
withapulseddyelaser,isoftenpairedwithintralesionalglucocorticoids.
Figure148.OpeninNewWindow

Largekeloidontheearlobeasaresultofanearpiercing.

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SkinCancers
Althoughlesscommon,bothnonmelanomaandmelanomaskincancersoccurinskinofcolorpopulations.Althoughskincancer
ratesarelower,cancersareoftenfoundlaterthaninwhitepopulations.Bothpatientsandphysiciansneedtobesuspiciousof
growing,bleeding,orulceratinglesions.
Thefrequencyofbasalcellcarcinoma(BCC)isinverselycorrelatedwiththedegreeofpigmentationintheskinthosemost
commonlyaffectedarefairskinnedwhitepersons,followedbyHispanics,andtheleastfrequentlyaffectedareblackpersons.
PigmentedBCCismorecommoninthosewithdarkerskin.Otherwisethebehaviorandtreatmentarethesame,andmetastasisis
rare.
Darklypigmentedpersonscandevelopsquamouscellcarcinoma(SCC)however,incontrasttotheUVinducedtypeseeninthe
whitepopulation,SCCoftendevelopsinareasofchronicinflammationorscarringandisfoundmoreoftenonthelegs.SCC
developinginthesesettingshasametastasisrateof20%to40%,comparedwitharateof1%to4%inwhitepersonswithUV
inducedSCC.
Acrallentiginousmelanoma(ALM)constitutes5%to10%ofallmelanomasyetisthemostcommontypeinthosewithskinof
color.Themostcommonsitesarethepalms,soles,andnails(Figure149).Melanomaratesarelowerinpersonsofcolorthaninthe
whitepopulationhowever,theaveragetimetodiagnosisis2years.Evenafteradjustingforage,stage,site,andsocioeconomic
status,the5yearsurvivalratesofblacksandHispanicsarelowerthanthoseofwhitepersons.
Figure149.OpeninNewWindow

Acrallentiginousmelanomapresentsonanacralsitesuchasthefootorhandandmayinvolvethenail.Itoftenhasanirregular
shape,colorvariation,andinlaterstagesmayulcerate.

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Melanonychia
RelatedQuestion
Question56
Melanonychiareferstobrownorblackcolorationofthenails.Longitudinalmelanonychiaisacommonforminwhichbrownlines
traversethenailproximallytodistally.Thisisanormalvariantthatisfoundin50%ofblackpersons.Thethumbandforefingerare
mostcommonlyaffected(Figure150).Theconditionisoftenbilateral.Theprevalenceandnumberofnailsaffectedincreaseswith
age.Thedifferentialdiagnosisincludesotherpigmentedlesionsofthenailsuchasanevus,acrallentiginousmelanoma,
postinflammatoryhyperpigmentation,pigmentedsquamouscellcarcinoma,bloodextravasationfromtrauma,anddrug
pigmentation.Abiopsyofapigmentedbandinthenailshouldbeconsideredonlyifasingledigitisaffected,ifitdevelopedduring
thefourthdecadeorlater,ifthereisassociatednaildystrophy,ifthediameteris4mmorgreater,ifthecharacteristicsoftheband
changes,orifthereisapersonalorfamilyhistoryofmelanoma.
Figure150.OpeninNewWindow

Longitudinalmelanonychiashowinghyperpigmentationattheproximalnailfold,aclinicalsignsuggestingthepresenceof
subungualmelanoma.

KeyPoints
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Acnekeloidalisnuchaeandpseudofolliculitisbarbaearecharacterizedbyfirm,skincolored,pink,orhyperpigmentedpapules
centeredonhairfolliclesinpeopleofcolor.
Keloids,resultingfromaskininjurysuchaspiercing,tattoo,surgery,oracne,aretwiceaslikelytooccurintheblack
population.
Acrallentiginousmelanomaisthemostcommontypeofcancerinpersonswithskinofcolor.

TheHomeless
Skinproblems,mostcommonlyinfectionsandinfestations,arethemainreasonsthehomelessseekmedicalattention.Thefootisthe
mostfrequentsiteofdisorderssuchasulcers,cellulitis,erysipelas,andgasgangrene.Poorfoothygiene,inadequatefootwear,and
excessivemoisturearefrequentandresultinhighratesoftineapedis(30%to40%)andpittedkeratolysis(20%).Infestationswith
scabies,lice,andbedbugsarefrequentandaffect25%ofthoseinashelter.ThebodylousecantransmitBartonellaquintana,which
hascausedtrenchfever,bacillaryangiomatosis,endocarditis,andchronicafebrilebacteremiainthehomeless.Epidemictyphus
causedbyRickettsiaprowazekiiandrelapsingfevercausedbyBorreliarecurrentisarealsolouseborne.
Pruritusisacommonproblemofthehomelessandmaybeattributedtoaprimaryskindermatosis,medicationsorillicitdruguse,or
occultoruncontrolledinternaldisease.Pruritusisoftenaccompaniedbybacterialinfectionfrompoorhygieneandsecondary
infectionofexcoriations.Commonskindermatoses,suchaspsoriasis,seborrheicdermatitis,andatopiceczema,occurinthe
homeless.Itisn'tknownifinflammatorydermatosesaremorefrequentinthispopulationhowever,itispossiblethatcommon
dermatosesaremoreseverebecauseofpoorhygiene,exposuretocold,moisture,anddifficultmedicalaccess.

DermatologicDiseasesofOverweightPatients
Intertrigo
RelatedQuestion
Question21
Intertrigoisaninflammatoryprocessfoundinskinfoldareassuchastheinframammaryregion,abdominalpannus,andcruralfolds.
Itisparticularlyproblematicinhot,moistconditions,andthusannualexacerbationsduringthesummerarecommonlyseen.The
rashconsistsofconfluent,welldemarcatederythema,generallysymmetricallydistributed.Secondaryinfectionbyyeastcanoften
occurandisgenerallycharacterizedbymultiplesmallredmaculesthatsurroundthemainrash(satellitosis).Treatmentconsistsof
keepingtheareadryandwellventilated.Antifungalpowdersmaybeusefulincontrollingmoistureandarefrequentlyusedto
reducethelikelihoodofflares.Lowormidpotencytopicalglucocorticoidcreamsmaybeusedforashortperiodoftime,but
prolongeduseshouldbeavoidedtopreventskinthinningandstretchmarkformation.Ifsecondaryinfectionwithyeastispresent,
concomitanttreatmentwithtopicalantifungalagentsmaybeadded.

StasisDermatitis
Obesepersonsandthosewithpoorvenouscirculationareparticularlypronetostasisdermatitis.Treatmentconsistsofcompression
stockingsandtopicalglucocorticoids(seeCommonRashes).Longstandinguntreatedperipheraledemacanalsoleadtomassive
localizedlymphedemaandelephantiasisnostrasverrucosa,adebilitatingconditioncharacterizedbysubstantialswellingofthe
lowerextremitieswithskinthickeningandthedevelopmentofmultiplewartyappearingnodulesintheaffectedarea.

Acrochordons
Acrochordons(skintags)arecommonlyfoundinobesepersonsinareasofrecurrentfriction,suchastheaxillaeandgroin.They
mayalsobeseenontheeyelidsandaroundtheneck.Althoughharmless,theyareoftenofcosmeticconcern.Thecombinationof
acanthosisnigricansandskintagsaroundtheneckandintheaxillaeisoftenseeninobesepatientswithdiabetesmellitus.

Bibliography
BrouquiP,RaoultD.Arthropodbornediseasesinhomeless.AnnNYAcadSci.2006Oct1078:22335.PMID:17114713
CallenderVD,StSurinLordS,DavisEC,MaclinM.Postinflammatoryhyperpigmentation:etiologicandtherapeutic
considerations.AmJClinDermatol.2011Apr112(2):8799.PMID:21348540
GlosterHMJr,NealK.Skincancerinskinofcolor.JAmAcadDermatol.2006Nov55(5):74164.PMID:17052479
HugginsRH,SchwartzRA,JannigerCK.Vitiligo.ActaDermatolovenereolAlpPanonicaAdriat.200514(4):13742.PMID:
16435042
JeffersonJ,RichP.Melanonychia.DermatolResPract.20122012:952186.PMID:22792094
LeachmanSA,ReedBR.Theuseofdermatologicdrugsinpregnancyandlactation.DermatolClin.2006Apr24(2):16797.
PMID:16677965
ManuskiattiW,FitzpatrickRE.Treatmentresponseofkeloidalandhypertrophicsternotomyscars:comparisonamong
intralesionalcorticosteroid,5fluorouracil,and585nmflashlamppumpedpulseddyelasertreatments.ArchDermatol.2002
Sep138(9):114955.PMID:12224975
MoyJA,SanchezMR.Thecutaneousmanifestationsofviolenceandpoverty.ArchDermatol.1992Jun128(6):82939.
PMID:1599274
PatelT,YosipovitchG.Themanagementofchronicpruritusintheelderly.SkinTherapyLett.2010Sep15(8):59.PMID:
20844849
RaoultD,FoucaultC,BrouquiP.Infectionsinthehomeless.LancetInfectDis.2001Sep1(2):7784.PMID:11871479
RichardsKA,StaskoT.Dermatologicsurgeryandthepregnantpatient.DermatolSurg.2002Mar28(3):24856.PMID:
11896778
SchmidtE,dellaTorreR,BorradoriL.Clinicalfeaturesandpracticaldiagnosisofbullouspemphigoid.ImmunolAllergyClin
https://mksap17.acponline.org/app/groups/dm/topics/mk17_a_dm_s19/sections/mk17_a_dm_s19_5_3

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7/4/2016

DermatologicProblemsofSpecialPopulationsDermatologyMKSAP17

NorthAm.2012May32(2):21732.PMID:22560135
StratigosAJ,SternR,GonzalezE,etal.Prevalenceofskindiseaseinacohortofshelterbasedhomelessmen.JAmAcad
Dermatol.1999Aug41(2Pt1):197202.PMID:10426888
TylerKH,ZirwasMJ.Pregnancyanddermatologictherapy.JAmAcadDermatol.2013Apr68(4):66371.PMID:23182064
VenugopalSS,MurrellDF.Diagnosisandclinicalfeaturesofpemphigusvulgaris.ImmunolAllergyClinNorthAm.2012
May32(2):23343.PMID:22560136
YalinB,TamerE,ToyGG,OztaP,HayranM,AlliN.Theprevalenceofskindiseasesintheelderly:analysisof4099
geriatricpatients.IntJDermatol.2006Jun45(6):6726.PMID:16796625
YosipovitchG,DeVoreA,DawnA.Obesityandtheskin:Skinphysiologyandskinmanifestationsofobesity.JAmAcad
Dermatol.2007Jun56(6):90116.PMID:17504714
ThiscontentwaslastupdatedinAugust2015.

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Chapter19
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DermatologicProblemsofSpecialPopulations
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