Manual of Tropical Dermatology

John H. S. Pettit Lawrence Charles Parish

Manual of Tropical DerIllatology

With 119 Figures and 12 Color Plates

Springer-Verlag New York Berlin Heidelberg Tokyo

John H.S. Pettit, M.D., F.R.C.P. (London), Department of Tropical Medicine, Liv­erpool School of Tropical Medicine, Liverpool, England; and Department of Medi­cine, Universiti Kebangsaan, Kuala Lumpur, Malaysia.

Lawrence Charles Parish, M.D., F.A.C.P., Department of Dermatology, Jefferson University, Philadelphia, Pennsylvania 19107; and Division of Dermatology, Univer­sity of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, 19104, U.S.A.

Library of Congress Cataloging in Publication Data Pettit, John H. S.

Manual of tropical dermatology. Bibliography: p. Includes index. I. Dermatology-Handbooks, manuals, etc. 2. Tropical

medicine-Handbooks, manuals, etc. I. Parish, Lawrence Charles. II. Title. RL74.P48 1984 616.5'00913 94-5323

© 1984 by Springer-Verlag New York, Inc.

Softcover reprint of the hardcover I st edition 1984

All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, U.S.A. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as under­stood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone.

While the advice and information of this book is believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to material contained herein.

Typeset by University Graphics, Incorporated, Atlantic Highlands, New Jersey.

9 8 7 6 5 4 3 2 1

ISBN-13 :978-1-4613-8294-2 DOl: 10.1 007/978-1-4613-8292-8

e-ISBN-13: 978-1-4613-8292-8

Dedicated to two of our favorite teachers and colleagues:

Geoffrey B. Dowling, M.D., F.R.C.P., (London) (deceased), Dermatologist, St. Thomas Hospital, London, and St. John's Hospital Diseases of the Skin, London and Herman Beerman, M.D., Sc.D., F.A.C.P., Emeritus Professor of Dermatol­ogy, University of Pennsylvania School of Medicine and Emeritus Professor and Chairman, Department of Dermatology, University of Pennsylvania Graduate School of Medicine, Philadelphia, Pennsylvania.

Contents

Foreword Francisco Kerdel-Vegas ix

Preface Xl

Acknowledgments xiii

I Introduction

Introduction to Tropical Dermatology 3 2 Clinical Index 6

II Bacterial Diseases

3 Anthrax 21 4 Yaws 27 5 Tuberculosis of the Skin 36 6 Leprosy 47 7 Buruli Ulcer (Mycobacterium Ulcerans) 78 8 Tropical Ulcers 88

III Fungal Diseases

9 Tropical Tineas 95 10 Chromomycosis 106 11 Madura Foot and Other Mycetomas 112 12 Sporotrichosis 118 13 Actinomycosis 124 14 Botryomycosis 129 15 Rhinosporidiosis 133 16 Rhinoscleroma 137 17 North American Blastomycosis 141 18 Paracoccidioidomycosis 146 19 Lobo's Disease 152

viii

IV Parasitic Diseases

20 Leishmaniasis 21 Amebiasis 22 Toxoplasmosis 23 Onchocerciasis 24 Filariasis 25 Dracunculosis 26 Schistosomiasis

V Other Dermatoses

27 Lichen Planus Tropicus 28 Dietary Deficiencies 29 Phrynoderma 30 Brazilian Pemphigus Foliaceous 31 Chronic Arsenical Poisoning

Appendix One Useful Techniques

Appendix Two Useful Addresses

Index

Contents

159 178 183 187 195 200 205

215 221 228 232 238

243

250

253

Foreword

We live today in a world densely populated by human beings living in close commu­nication with one another all over the surface of the planet. Viewed from a certain distance it has the look of a single society, a community, the swarming of an intensely social species trying to figure out ways to become successfully independent. We obvi­ously need, at this stage, to begin the construction of some sort of world civilization. The final worst-case for all of us has now become the destruction, by ourselves, of our species. I

Although this warning is often repeated, we must not forget its paramount importance and the commitment that each sector of society has to make a world civilization possible.

Tropical dermatology is a good example of an important area of our spe­cialty that has never caught the proper attention of the leading centers of research in the developed countries, even though it comprehends major infec­tious, parasitic, and nutritional problems of one-half of the world's land area and three-quarters of the world's population.

The relevance of tropical dermatology in this extensive and overpopulated area of the globe has public health connotations that emphasize its importance. The sheer size of the problem makes it an urgent and outright need to recruit and train adequate personnel to do a proper job, and that includes not only dermatologists but paramedical personnel, nurses, and laboratory technicians.

This book written by John H. S. Pettit and Lawrence Charles Parish is pre­cisely the type of guidance needed by the uninitiated, presented in a logical and intelligent manner so it can be used throughout the world as a training manual. Such initiative is welcome and needed, and complements very well other efforts in the same direction.

Even in tropical countries, tropical dermatology does not occur everywhere, and the ordinary tourist, staying in a metropolitan hotel, rarely becomes exposed to what were once called exotic diseases. The moment the pleasures of

ILewis Thomas: Late Night Thoughts on Listening to Mahler's Ninth Symphony. New York, Viking Press, 1983.

x Foreword

a big city are left behind, however, it seems that, in the rural areas of many developing countries and in this century of unprecedented scientific and tech­nologic advances, most people remain living under conditions that have not changed for centuries and suffering from a host of infecious and contagious diseases that are the main obstacle to any program designed to improve their lives.

It is the duty of the medical profession, and in this case the dermatologists, to study these problem with the greatest attention and coherence and to pro­duce a strategy to overcome this burden in a short period of time. What has been done until now is not sufficient and the problem remains unsolved.

Francisco Kerdel-Vegas, M.D. Caracas, Venezuela and Department of Dermatology Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania U.S.A.

Preface

When the world was young and transport was difficult, most people lived their lifetime without venturing far from home. Migrants were few, whether they traveled on foot, on horseback, or by boat, but those who did travel carried their diseases with them as well as other more accepable examples of their culture. The unacceptable ones often led to war, an additional method of spreading disease.

As travel has become easier, diseases have become increasingly widespread, but unfortunately knowledge of such illnesses has not extended as rapidly as the diseases themselves. This book has been so conceived that it will aid in the recognition and treatment of some of the more exotic of the world's diseases.

September, 1984 John H. S. Pettit, M.D. Lawrence Charles Parish, M.D.

Acknowledgments

We want to acknowledge the magnificent resource material available at the Library of the College of Physicians of Philadelphia (Anthony Aguirre, librar­ian) and the Scott Medical Library of the Jefferson Medical College, Thomas Jefferson University (John Timour, librarian).

Although many of the illustrations are of our own patients, we have called upon a number of colleagues throughout the world for their assistance. Our most heartfelt thanks to all of them; all such collaborators are acknowledged under the appropriate pictures. We hope we have not missed any.

Dr. Florante C. Bocobo, Princeton, New Jersey reviewed the chapters on actinomycosis and North American blastomycosis. Dr. Joseph Scrafani, Scher­ing-Plough Corporation, Kenilworth, New Jersey provided a grant-in-aid for the production of the color plates.

Lastly, we wish to thank Carmela Ciferni and Margaret DiFrancesco of Philadlephia for working through this project and typing the manuscript.

Color Plates

Plate 1 Ulcer, lepromatous-Note the granulation tissue in the ulcer on the sole and the lack of surrounding erythema. This Malaysian patient had lepromatous leprosy.

Plate 2 Ulcer, phagedenic-Note the extending margins of this patient with a pha­gedenic ulcer of the foot. The diagnosis was tropical ulcer.

Plate 3 Verrucous formation-Note the warty heaped-up lesions, reddish, and slightly scaling on the buttocks of a Chinese man. The diagnosis was tuberculosis ver­rucosa cutis.

Plate 4 Sun sensitivity-Note the symmetrical reddish-brown pigmentation with sharp borders indicating the photosensitive areas. This Egyptian woman had pellagra. (Courtesy of Mohsen Soliman, M.D., Cairo, Egypt.)

Plate 5 Erosion, ear-Note the destruction, ulceration, and surrounding erythema on the upper aspects of the outer ear. This Philadelphia anthropology student had contracted chic1ero ulcer on a dig.

Plate 6 Papules, coalescent-Note the coalescent papules with purplish color. This Italian man was sun sensitive and developed lichen planus tropicus. (Courtesy of F. Ayala, M.D., Naples, Italy.)

Plate 7 Ulcer, Buruli-Note the destruction with shaggy borders on the ankle. This Malaysian aborigine first developed swelling seven months before the ulcer appeared.

Plate 8 Nodules, heaped-up-Note the heaped-up, shiny lesions in this patient with lepromatous leprosy which was sulfone resistant.

Plate 9 Ulcer, penile-Note the granulomatous formation at the edge of the ulcer, which is somewhat shaggy. This North Carolina man had North Americn blastomy­cosis. (Courtesy of David M. Warshauer, M.D., Chapel Hill, North Carolina.)

Plate 10 Verrucous formation-Note the warty papules that have coalesced and have become covered with thick scale and the sharp borders of the lesions on the foot of this 58 year old Indian man who worked barefoot on a farm. The diagnosis was chromomycosis.

Plate 11 Keratoses-Note the crusting, scaling, and hyperkeratoses characteristic of arsencial keratoses. This Malay youth had used a Thai folk remedy containing 21.5% arsenic.

Plate 12 Scarring-Note the destructive atrophic scars in this Iranian patient with lupoid leishmaniasis.

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Plate 1 Ulcer, lepromatous Plate 2 Ulcer, phagedenic

Plate 3 Verrucous formation Plate 4 Sun sensitivity

Plate 5 Erosion, ear Plate 6 Papules, coalescent

Plate 7 Ulcer, Buruli Plate 8 Nodules, heaped-up

Plate 9 Ulcer, penile Plate 10 Verrucous formation

Plate 11 Keratoses Plate 12 Scarring