adj.

丘疹の

ex.

maculopapular rash 斑状丘疹状皮疹

関: papula, papule

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/25 12:04:44」(JST)

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Where cutaneous conditions occur

Main article: Integumentary system

The skin weighs an average of four kilograms, covers an area of two square meters, and is made of three distinct layers: the epidermis, dermis, and subcutaneous tissue.^[1] There are two main types of human skin: glabrous skin, the nonhairy skin on the palms and soles (also referred to as the "palmoplantar" surfaces), and hair-bearing skin.^[15] Within the latter type, there are hairs in structures called pilosebaceous units, each with hair follicle, sebaceous gland, and associated arrector pili muscle.^[16] In the embryo, the epidermis, hair, and glands are from the ectoderm, which is chemically influenced by the underlying mesoderm that forms the dermis and subcutaneous tissues.^[17]^[18]^[19]

Epidermis

Main article: Epidermis (skin)

The epidermis is the most superficial layer of skin, a squamous epithelium with several strata: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and stratum basale.^[20] Nourishment is provided to these layers via diffusion from the dermis, since the epidermis is without direct blood supply. The epidermis contains four cell types: keratinocytes, melanocytes, Langerhans cells, and Merkel cells. Of these, keratinocytes are the major component, constituting roughly 95 percent of the epidermis.^[15] This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through the stratum spinosum to the stratum corneum, where cells are continually shed from the surface.^[15] In normal skin, the rate of production equals the rate of loss; it takes about two weeks for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum.^[21]

Dermis

Main article: Dermis

The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the papillary dermis and the reticular dermis.^[22] The superficial papillary dermis interdigitates with the overlying rete ridges of the epidermis, between which the two layers interact through the basement membrane zone.^[22] Structural components of the dermis are collagen, elastic fibers, and extrafibrillar matrix (previously called ground substance).^[22] Within these components are the pilosebaceous units, arrector pili muscles, and the eccrine and apocrine glands.^[20] The dermis contains two vascular networks that run parallel to the skin surface—one superficial and one deep plexus—which are connected by vertical communicating vessels.^[20]^[23] The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing.^[24]^[25]

Subcutaneous tissue

Main article: Subcutaneous tissue

The subcutaneous tissue is a layer of fat between the dermis and underlying fascia.^[5] This tissue may be further divided into two components, the actual fatty layer, or panniculus adiposus, and a deeper vestigial layer of muscle, the panniculus carnosus.^[15] The main cellular component of this tissue is the adipocyte, or fat cell.^[5] The structure of this tissue is composed of septal (i.e. linear strands) and lobular compartments, which differ in microscopic appearance.^[20] Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source.^[5]

Diseases of the skin

For a comprehensive list, see List of cutaneous conditions.

Diseases of the skin include skin infections and skin neoplasms (including skin cancer).

History

In 1572, Geronimo Mercuriali of Forlì, Italy, completed De morbis cutaneis (translated "On the diseases of the skin"). It is considered the first scientific work dedicated to dermatology.

Approach to diagnoses

The physical examination of the skin and its appendages, as well as the mucous membranes, forms the cornerstone of an accurate diagnosis of cutaneous conditions.^[26] Most of these conditions present with cutaneous surface changes termed "lesions," which have more or less distinct characteristics.^[27] Often proper examination will lead the physician to obtain appropriate historical information and/or laboratory tests that are able to confirm the diagnosis.^[26] Upon examination, the important clinical observations are the (1) morphology, (2) configuration, and (3) distribution of the lesion(s).^[26] With regard to morphology, the initial lesion that characterizes a condition is known as the "primary lesion," and identification of such a lesions is the most important aspect of the cutaneous examination.^[27] Over time, these primary lesions may continue to develop or be modified by regression or trauma, producing "secondary lesions."^[1] However, with that being stated, the lack of standardization of basic dermatologic terminology has been one of the principal barriers to successful communication among physicians in describing cutaneous findings.^[20] Nevertheless, there are some commonly accepted terms used to describe the macroscopic morphology, configuration, and distribution of skin lesions, which are listed below.^[27]

Morphology

Primary lesions

Chigger bites on human skin showing characteristic welts

Nodules

Macule and patch

Papule and plaque

Vesicles and bulla

Fissures, erosions and ulcers

Macule – A macule is a change in surface color, without elevation or depression and, therefore, nonpalpable, well or ill-defined,^[28] variously sized, but generally considered less than either 5^[28] or 10 mm in diameter at the widest point.^[27]
Patch – A patch is a large macule equal to or greater than either 5 or 10 mm,^[27] across depending on one's definition of a macule.^[1] Patches may have some subtle surface change, such as a fine scale or wrinkling, but although the consistency of the surface is changed, the lesion itself is not palpable.^[26]
Papule – A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to less than either 5^[28] or 10 mm in diameter at the widest point.^[27]
Plaque – A plaque has been described as a broad papule, or confluence of papules equal to or greater than 1 cm,^[27] or alternatively as an elevated, plateau-like lesion that is greater in its diameter than in its depth.^[26]
Nodule – A nodule is morphologically similar to a papule, but is greater than either 5^[26] or 10 mm in both width and depth, and most frequently centered in the dermis or subcutaneous fat.^[27] The depth of involvement is what differentiates a nodule from a papule.^[28]
Vesicle – A vesicle is a circumscribed, fluid-containing, epidermal elevation generally considered less than either 5^[28] or 10 mm in diameter at the widest point.^[27]
Bulla – A bulla is a large vesicle described as a rounded or irregularly shaped blister containing serous or seropurulent fluid, equal to or greater than either 5^[28] or 10 mm,^[27] depending on one's definition of a vesicle.^[1]

Pustule – A pustule is a small elevation of the skin containing cloudy^[26] or purulent material usually consisting of necrotic inflammatory cells.^[27] These can be either white or red.
Cyst – A cyst is an epithelial-lined cavity containing liquid, semi-solid, or solid material.^[28]
Erosion – An erosion is a discontinuity of the skin exhibiting incomplete loss of the epidermis,^[29] a lesion that is moist, circumscribed, and usually depressed.^[20]
Ulcer – An ulcer is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis and even subcutaneous fat.^[29]
Fissure – A fissure is a crack in the skin that is usually narrow but deep.^[26]
Wheal – A wheal is a rounded or flat-topped, pale red papule or plaque that is characteristically evanescent, disappearing within 24 to 48 hours.^[28]
Telangiectasia – A telangiectasia represents an enlargement of superficial blood vessels to the point of being visible.^[26]
Burrow – A burrow appears as a slightly elevated, grayish, tortuous line in the skin, and is caused by burrowing organisms.^[26]^[27]

Secondary lesions

Scale – dry or greasy laminated masses of keratin^[27] that represent thickened stratum corneum.^[26]
Crust – dried serum, pus, or blood usually mixed with epithelial and sometimes bacterial debris.^[28]
Lichenification – epidermal thickening characterized by visible and palpable thickening of the skin with accentuated skin markings.^[1]
Excoriation – a punctate or linear abrasion produced by mechanical means (often scratching), usually involving only the epidermis, but commonly reaching the papillary dermis.^[27]
Induration – dermal thickening causing the cutaneous surface to feel thicker and firmer.^[26]
Atrophy – refers to a loss of tissue, and can be epidermal, dermal, or subcutaneous.^[27] With epidermal atrophy, the skin appears thin, translucent, and wrinkled.^[26] Dermal or subcutaneous atrophy is represented by depression of the skin.^[26]
Maceration – softening and turning white of the skin due to being consistently wet.
Umbilication – formation of a depression at the top of a papule, vesicle, or pustule.

Configuration

"Configuration" refers to how lesions are locally grouped ("organized"), which contrasts with how they are distributed (see next section).

Agminate - in clusters
Annular or circinate - ring-shaped
Arciform or arcuate - arc-shaped
Digitate - with finger-like projections
Discoid or nummular - round or disc-shaped
Figurate - with a particular shape
Guttate - resembling drops
Gyrate - coiled or spiral-shaped
Herpetiform - resembling herpes
Linear
Mamillated - with rounded, breast-like projections
Reticular or reticulated - resembling a net
Serpiginous - with a wavy border
Stellate - star-shaped
Targetoid - resembling a bullseye
Verrucous - wart-like

Distribution

"Distribution" refers to how lesions are localized. They may be confined to a single area (a patch) or may exist in several places. Several distributions correlate an anatomical reference.^{[clarification needed]} Some correlate with the means by which a given area becomes affected. For example, contact dermatitis correlates with locations where allergen has elicited an allergic immune response. Varicella zoster virus is known to recur (after its initial presentation as chicken pox) as herpes zoster ("shingles"). Chicken pox appears nearly everywhere on the body, but herpes zoster tends to follow one or two dermatomes; for example, the eruptions may appear along the bra line, on either or both sides of the patient.

Generalized
Symmetric - one side mirrors the other
Flexural - on the front of the fingers
Extensor - on the back of the fingers
Intertriginous - in an area where two skin areas may touch or rub together
Morbilliform - resembling measles
Palmoplantar - on the palm of the hand or bottom of the foot
Periorificial - around an orifice such as the mouth
Periungual - under a fingernail or toenail
Blaschkoid - following the path of Blaschko's lines in the skin
Photodistributed - in places where sunlight reaches
Zosteriform or dermatomal - associated with a particular nerve

Other related terms

Collarette
Comedo
Confluent
Eczema (a type of dermatitis)
Evanescent (lasting less than 24 hours)
Granuloma
Livedo
Purpura
Erythema (redness)
Horn (a cell type)
Poikiloderma

Combined (conjoint) terms (maculopapular, papuloerosive, papulopustular, papulovesicular, papulosquamous, tuberoulcerative, vesiculobullous, vesiculopustular) are used to describe eruptions that evolve from one type of lesion to the next, so often appear as having traits of both.^{[citation needed]}

Histopathology

Hyperkeratosis
Parakeratosis
Hypergranulosis
Acanthosis
Papillomatosis
Dyskeratosis
Acantholysis
Spongiosis
Hydropic swelling
Exocytosis
Vacuolization
Erosion
Ulceration
Lentiginous

References

^ ^a ^b ^c ^d ^e ^f Miller, Jeffrey H.; Marks, James G. (2006). Lookingbill and Marks' Principles of Dermatology. Saunders. ISBN 1-4160-3185-5.
^ Lippens S, Hoste E, Vandenabeele P, Agostinis P, Declercq W (April 2009). "Cell death in the skin". Apoptosis 14 (4): 549–69. doi:10.1007/s10495-009-0324-z. PMID 19221876.
^ King, L.S. (1954). "What Is Disease?". Philosophy of Science 21 (3): 193–203. doi:10.1086/287343.
^ Bluefarb, Samuel M. (1984). Dermatology. Upjohn Co. ISBN 0-89501-004-6.
^ ^a ^b ^c ^d Lynch, Peter J. (1994). Dermatology. Williams & Wilkins. ISBN 0-683-05252-7.
^ Tilles G, Wallach D (1989). "[The history of nosology in dermatology]" (in French). Ann Dermatol Venereol 116 (1): 9–26. PMID 2653160.
^ Lambert WC, Everett MA (October 1981). "The nosology of parapsoriasis". J. Am. Acad. Dermatol. 5 (4): 373–95. doi:10.1016/S0190-9622(81)70100-2. PMID 7026622.
^ Jackson R (1977). "Historical outline of attempts to classify skin diseases". Can Med Assoc J 116 (10): 1165–8. PMC 1879511. PMID 324589. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1879511/.
^ Copeman PW (February 1995). "The creation of global dermatology". J R Soc Med 88 (2): 78–84. PMC 1295100. PMID 7769599. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1295100/.
^ Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.; Suurmond, Dick; Richard Suurmond (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology. McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4.
^ Werner B (August 2009). "[Skin biopsy and its histopathologic analysis: Why? What for? How? Part I]" (in Portuguese). An Bras Dermatol 84 (4): 391–5. PMID 19851671.
^ Werner B (October 2009). "[Skin biopsy with histopathologic analysis: why? what for? how? part II]" (in Portuguese). An Bras Dermatol 84 (5): 507–13. doi:10.1590/S0365-05962009000500010. PMID 20098854.
^ Xiaowei Xu; Elder, David A.; Rosalie Elenitsas; Johnson, Bernett L.; Murphy, George E. (2008). Lever's Histopathology of the Skin. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7363-6.
^ Weedon's Skin Pathology, 2-Volume Set: Expert Consult - Online and Print. Edinburgh: Churchill Livingstone. 2009. ISBN 0-7020-3941-1.
^ ^a ^b ^c ^d Burns, Tony; et al. (2006) Rook's Textbook of Dermatology CD-ROM. Wiley-Blackwell. ISBN 1-4051-3130-6.
^ Paus R, Cotsarelis G (1999). "The biology of hair follicles". N Engl J Med 341 (7): 491–7. doi:10.1056/NEJM199908123410706. PMID 10441606.
^ Goldsmith, Lowell A. (1983). Biochemistry and physiology of the skin. Oxford University Press. ISBN 0-19-261253-0.
^ Fuchs E (February 2007). "Scratching the surface of skin development". Nature 445 (7130): 834–42. doi:10.1038/nature05659. PMC 2405926. PMID 17314969. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2405926/.
^ Fuchs E, Horsley V (April 2008). "More than one way to skin .". Genes Dev. 22 (8): 976–85. doi:10.1101/gad.1645908. PMC 2732395. PMID 18413712. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2732395/.
^ ^a ^b ^c ^d ^e ^f Wolff, Klaus Dieter; et al. (2008). Fitzpatrick's Dermatology in General Medicine. McGraw-Hill Medical. ISBN 0-07-146690-8.
^ Bolognia, Jean L.; et al. (2007). Dermatology. St. Louis: Mosby. ISBN 1-4160-2999-0.
^ ^a ^b ^c Rapini, Ronald P. (2005). Practical dermatopathology. Elsevier Mosby. ISBN 0-323-01198-5.
^ Grant-Kels JM (2007). Color Atlas of Dermatopathology (Dermatology: Clinical & Basic Science). Informa Healthcare. pp. 163. ISBN 0-8493-3794-1.
^ Ryan, T (1991). "Cutaneous Circulation". In Goldsmith, Lowell A. Physiology, biochemistry, and molecular biology of the skin (2nd ed.). New York: Oxford University Press. p. 1019. ISBN 0-19-505612-4.
^ Swerlick RA, Lawley TJ (January 1993). "Role of microvascular endothelial cells in inflammation". J. Invest. Dermatol. 100 (1): 111S–115S. doi:10.1038/jid.1993.33. PMID 8423379.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Callen, Jeffrey (2000). Color atlas of dermatology. Philadelphia: W.B. Saunders. ISBN 0-7216-8256-1.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o James, William D.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Fitzpatrick, Thomas B.; Klauss Wolff; Wolff, Klaus Dieter; Johnson, Richard R.; Suurmond, Dick; Richard Suurmond (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology. New York: McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4.
^ ^a ^b Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. ISBN 0-7216-0187-1.

UpToDate Contents

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1. 皮膚疾患診断へのアプローチ approach to dermatologic diagnosis
2. ジアノッティ・クロスティ症候群（丘疹性末端皮膚炎） gianotti crosti syndrome papular acrodermatitis
3. 南京虫 bedbugs
4. リンパ腫様丘疹症 lymphomatoid papulosis
5. 脱毛の評価および診断 evaluation and diagnosis of hair loss

English Journal

Disease causing homozygous variants in the human hairless gene.

Mehmood S1, Jan A1,2, Raza SI1,3, Ahmad F1, Younus M1, Irfanullah1, Shahi S1, Ayub M4, Khan S2, Ahmad W1.
International journal of dermatology.Int J Dermatol.2016 Sep;55(9):977-81. doi: 10.1111/ijd.13109. Epub 2015 Dec 18.
BACKGROUND: Atrichia with papular lesions (APL) is a rare irreversible form of complete hair loss inherited in autosomal recessive manner. Hair loss is often followed by the appearance of multiple keratin-filled cysts or papules on exterior parts of the body. This phenotype results due to mutations
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Papular acantholytic dyskeratosis of the anogenital and genitocrural area: case series and review of the literature.

Al-Muriesh M1, Abdul-Fattah B1, Wang X1, Zhao M1, Chen S1, Huang C1.
Journal of cutaneous pathology.J Cutan Pathol.2016 Sep;43(9):749-58. doi: 10.1111/cup.12736. Epub 2016 Jun 1.
BACKGROUND: Papular acantholytic dyskeratosis (PAD) of the anogenital/genitocrural area is described as a rare distinct clinicopathological entity known to dermatopathologists, although its characteristic histopathologic pattern resembles both Hailey-Hailey disease and Darier disease. The objective
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Atypical Pityriasis Rosea: Clinical Evaluation of 27 Patients.

Kilinc F1, Akbas A1, Sener S2, Aktaş A3.
Cutaneous and ocular toxicology.Cutan Ocul Toxicol.2016 Aug 25:1-21. [Epub ahead of print]
BACKGROUND: Pityriasis rosea is a common, acute, self-limiting inflammatory skin disease. It can easily be recognized with its typical clinical presentation. However, unusual clinic bunun yanısıra presentations can cause difficulty in diagnosis. Up to now, not many atypical forms are reported.OBJE
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