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Neurology and the skin
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  1. Orest Hurkoa,
  2. Thomas T Provostb
  1. aNeuroscience Research, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park North H25/124, Third Avenue, Harlow, Essex, UK, bDepartment of Dermatology, The Johns Hopkins University School of Medicine, 10 th Floor, 550 North Broadway, Baltimore, MD, USA
  1. Dr Orest Hurko, Neuroscience Research, SmithKline Beecham Pharmaceuticals, New Frontiers Science Park North H25/124, Third Avenue, Harlow, Essex CM19 5AW, UK. Telephone 0044 1279 622 739; fax 00441279 622 371; email Orest_2_Hurko{at}sbphrd.com

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Many disorders affect both the nervous system and the skin. The complementary—and some would say—diametrically opposite—clinical methods of the dermatologist and the neurologist can in these circumstances reduce an otherwise dauntingly large differential into a more tractable, smaller list. Often triangulation with these and other clinical findings is sufficient for accurate diagnosis, but in other cases, serological or genetic data must be considered before diagnosis is secure.

We have purposely avoided traditional groupings such as phakomatoses, and immunological, infectious, or genetic diseases. Such distinctions are becoming increasingly obscure. Instead, we have organised the roughly 300 disorders with manifestations both in the skin and nervous system into clinically relevant groupings, as they may be first encountered by a practicing physician: neurocutaneous disorders associated with impaired immunity; stroke; neuropathy; meningitis or meningoencephalitis; vesicular lesions; ecchymoses, non-palpable purpura, and petechiae; cafe au lait spots; amyloidosis; rheumatoid arthritis; cutaneous vasculitis; photosensitivity; and melanoma. For disorders mentioned only in the tables, or not at all, the reader is referred to the encyclopaedic text of Fitzpatricket al 1 and more specialised compendia.2 3

Neurocutaneous disorders of impaired immunity

AIDS

Eighty five per cent of those affected with AIDS have skin lesions, the most common of which are infectious, the result of impaired cell mediated immunity. Even such banal infections as verruca vulgaris and molluscum contagiosum are problematic. Both types of viral infection are resistant to therapy. Giant mollusca may disseminate over the body. Tinea corporis and recurrent bacterial infections, especiallyStaphylococcal aureus, may occur. The most common cutaneous manifestation, however, is recalcitrant seborrheic dermatitis, a chronic inflammation typically of the scalp and face, but which can also involve the intermammary region of the chest, groin, and axilla. It is thought to result from infection byPityrosporum orbiculare, a saprophytic organism. Usually, it can be successfully suppressed by continued use …

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