Sixth Edition
Neena Khanna MD
Professor Department of Dermatology and Venereology All India Institute of Medical Sciences
New Delhi, India
Saurabh Singh MD DNB
Assistant Professor Department of Dermatology and Venereology Employees' State Insurance Corporation (ESIC) Medical College and Hospital
Faridabad, Haryana, India
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Bhutani's Color Atlas of Dermatology
First Edition: 1982
Sixth Edition: 2015
9789351523024
Printed at
5Dedicated to
7Foreword to the First Edition
It gives me great pleasure to contribute a foreword for this book, which has been written by an eminent teacher and research worker. Professor Lalit K Bhutani, who is the Head of the Department of Dermatology and Venereology at the All India Institute of Medical Sciences, New Delhi, is a renowned dermatologist, a teacher of repute and an internationally recognized research worker in the field of dermatology. He has been guest lecturer at many national and international universities and holds memberships of several international dermatological societies. His research interests have centered around such subjects as leprosy, pigmentary problems, mycological diseases and sexually transmitted diseases. He has made special contributions in the field of immunology of leprosy.
This book is the result of much painstaking work and reflects the vast experience of Professor Bhutani. Through the excellent reproduction of colored pictures of dermatological lesions, the author has provided a clear understanding of various dermatological disorders. His stress on dermatological problems seen in the tropics is praiseworthy. The material has been well planned and presented in a very lucid manner. The book will be useful to clinicians in general as well as specialists in this field. I congratulate Professor Bhutani for his praiseworthy attempt and wish this work all success.
1982
VTH Gunaratne FRCP DPH
World Health Organization
Dr Bhutani, an eminent physician, and a dermatologist and venereologist of international repute, contributed immensely to the development of the discipline in India and placed it on the global dermatology map. He was deeply involved in the management of sexually transmitted diseases including HIV and AIDS besides development and progression of modern management of leprosy in India and beyond. His other fields of interest were dermatopathology and photobiology. He was the first to describe the condition lichen planus pigmentosus.
A graduate of University of Punjab (1958), he moved to join All India Institute of Medical Sciences (AIIMS), New Delhi. An almost reluctant entrant into the field of dermatology and venereology, he became one of its most brilliant teachers and took over the reins of the department of AIIMS in 1979. He eventually rose to become the Dean and Director of this prestigious institute from which he retired in 1996. He continued to provide invaluable service as an honorary consultant dermatologist at Sitaram Bhartiya Institute of Science and Research, New Delhi, until his death. He was appointed Honorary Physician to the President of India in 1983.
In recognition of his brilliant academic achievements, he was awarded Honorary Fellowship of the Royal College of Physicians (Edinburgh) in 1987 and received the prestigious BC Roy Award for excellence in teaching. His commitment to teaching was reflected in his authorship of two immensely popular (almost Biblical) atlases “Colour Atlas of Dermatology” and “Atlas of Sexually Transmitted Diseases”. A keen researcher, he had to his credit nearly 150 publications in national and international journals of repute and contributed chapters to several books of Medicine and Dermatology.
He held several prestigious positions in his specialty and was elected President of Indian Association of Dermatology and Venereology (1979–80) and its General Secretary (1973–74). That he successfully hosted the VII International Congress of Dermatology and Venereology in New Delhi in 1994, (first ever for an Asian country) speaks volumes of his organizational skills.
He was invited to participate in and chair a number of national and international conferences and seminars. He was honored with a number of visiting professorships at various institutes internationally, such as Mayo Clinic, Rochester, USA, and King Faisal University, Dammam, Saudi Arabia, where he was the architect of its postgraduate residency program which is still being followed. He was associated in various capacities with a number of international and national professional bodies such as American Academy of Dermatology, British Association of Dermatology, American Society of Photobiology, International Society 10of Dermatopathology, American Venereal Disease Association, and European Society of Dermatologic Research. He also served on a number of WHO, sponsored consultancies and acted as an adviser on sexually transmitted diseases including HIV and AIDS in many countries around the world.
A brilliant orator, his talks were full of clarity and peppered with humor. He dotted his presentations with the most fascinating clinical pictures many of which are now part of this atlas. His well-catalogued collection of clinical photographs could easily be passed off as a ‘Library of Dermatological Images’.
Dr Bhutani, much loved by his colleagues and friends, was an inspiration to those around him. Many a young doctors have been propelled to clinical excellence by his warm bedside manner and teaching abilities and many dermatologists will remain indebted to him.
11Preface to the Sixth Edition
A classic is often known by the name of its creator rather than by the title given to it. This is so true for the Color Atlas of Dermatology. It is frequently referred to as Dr Bhutani's atlas or simply as LKB's atlas. One of the most popular books in dermatology, several batches of undergraduate and postgraduate students swear by it even today. It is also a ‘must have’ for general practitioners (GPs) and practicing dermatologists.
This atlas, like the previous editions, is intended for senior medical students, general practitioners and also entrants into the field of dermatology. The book is divided into 25 chapters: some diseases have been classified etiologically while others have been grouped conventionally; however, some groupings have been made morphologically to emphasize how dermatoses, with different etiogenesis, may simulate each other. Newer therapies have been incorporated (albeit briefly) to make the book comprehensive. Throughout the book, Professor Bhutani's inimitable and crisp style, which became very popular and identified with the atlas, has been retained.
Neena Khanna
13Preface to the First Edition
This atlas is intended primarily for senior medical students, general practitioners and residents in dermatology and internal medicine. Next to the actual patient, a color photograph is perhaps the most useful learning material in dermatology. Such atlases in the West have an understandable bias on locally important conditions. A certain emphasis on tropical dermatoses may be discernable here; other more cosmopolitan diseases have been given adequate coverage.
On account of the ease with which populations from one part of the world have moved to another, the physician is constantly faced with the challenge of diagnosing and treating exotic conditions. The projection in this atlas of skin lesions on a pigmented background will aid the physician in his diagnosis. A brief description has been given for an easy interpretation; selected photomicrographs are added for further help. Notes on treatment are brief and meant as a guideline. The book combines visual impression of morphologic lesions with factual information, and supplements the standard textbooks.
The book is divided into nineteen chapters with various diseases conventionally grouped; some unconventional grouping has also been made to emphasize close clinical simulation. A chapter on sexually transmitted diseases has been included since in many countries the specialities of dermatology and venereology are practised jointly.
All photographs including photomicrographs have been taken by myself. Most are from patients seen in India; some are from patients seen in Africa or South-East Asia. Acknowledgment is made for permission to reproduce my two fluorescent photographs on page 98 from Arch. Derm. 110:427, 1974, copyright 1974, American Medical Association.
Three persons played a dominant role in shaping my career in dermatology: Professor KC Kandhari, my teacher and mentor, initiated me into dermatology; Professor IA Magnus and Professor CD Calnan encouraged me to continue. This book is in a sense a tribute to them.
My colleague and friend Dr RK Pandhi generously gave his valuable time and suggestions at every stage; but for his inestimable help, this book would not have been completed. Other friends helped in different ways: Professor NC Nayak with advice on selection of photomicrographs and histologic description; Drs Roger Harman, R Bikhchandani, AS Kumar, Jose Thomas, Sharad Goel, Jasleen Kaur, Anuradha Kathpalia, Messfin Demisse with help in critical evaluation of the manuscript and galley proofs. Dr E Nair provided specimens of pediculi and mite. Professors RK Panja, BMS Bedi and Dr Dharam Pal gave useful suggestions. Professors YK Malhotra, R Patnaik and Dr Daljit S Nagreh permitted the use of their patients’ photographs. Mr ML Bhalla and Mr Awasthy helped in the processing of photomicrographs. Mr Krishan Kumar rendered useful secretarial assistance.
I am most grateful to Mr SN Mehta, the publisher, and Mrs Susan Gale, the editor, for all their help. They displayed rare patience and understanding in handling the manuscript, the pictures and the entire work.14
Professor V Ramalingaswami and Professor HD Tandon supported and encouraged me throughout. I am most thankful to them.
Nitin and Nishit, my sons, made some very useful and valuable suggestions.
Manorama, my wife, was a constant, unfailing source of encouragement, help and inspiration-a crutch which I could lean upon-any time and every time.
LK Bhutani
15Acknowledgments
The present work would not have been possible without the contributions of several of my colleagues. Drs Riti, Kamal, Ajay, Gitika, and Tanir who nit-picked the manuscript to its culmination. Ms Tanu and Meenu who helped in correcting the manuscript in its initial stages.
I am grateful to Dr Somesh Gupta for permitting me to use pictures of his ‘operated’ patients (2 pictures on page 470 and 4 pictures on page 472). So also my gratitude to my faculty colleagues (many of whom are Dr Bhutani's students) for letting us photograph their ‘in-patients’. I am also grateful to Dr Harsh Mohan for permitting me to use picture of histopathology of sarcoidosis (on page 199).
I express my appreciation and gratitude to Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Group President) of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, which is one of the largest Medical Publishers in the world, for their assistance and help. Mr Tarun Duneja (Director-Publishing) has been instrumental in getting the final shape of the book. Also, my acknowledgments to Ms Samina Khan (Executive Assistant to Director-Publishing), Mr KK Raman (Production Manager), Mr Sunil Kumar Dogra (Production Executive), Mr Neelambar Pant (Production Coordinator), Mr Manoj Pahuja (Senior Graphic Designer), Mr Varun Rana (Typesetter), Mr Himanshu Sharma (Proofreader) and other members for their immense patience to bring out the book.
The task of completing the book would have been impossible, had it not been for the ever-encouraging presence of Mr Ranbir Singh, whose untiring efforts smoothened all obstacles during the production of the book. His patience and eye for detail are the reasons for the quality of this book.
I am indeed indebted to Dr (Mrs) Bhutani for again reposing faith in me and believing that I could carry out the herculean task of bringing out a book which had acquired ‘Biblical status’. Her presence and perseverance were pivotal in helping us meet the targeted dates. She was always there as the guiding force and her unflinching encouragement brought out the best in the team.
I would be failing in my duty if I did not thank the ‘behind the scene’ people. Anil and my brats who put up with sharing my time with the laptop.
Neena Khanna
First of all, I am grateful to Dr Neena Khanna for entrusting me with this herculean task of carrying forward and being a part of Dr LK Bhutani's atlas, the work for which I had a desire since my undergraduate days at AIIMS, New Delhi, India. And I share and echo indebtedness to Dr Mrs Bhutani for giving this opportunity. The love and support of my parents and sisters have been my guiding force. The ‘quartet’ of you have always allowed me the liberty to be a ‘parasite’, take the honest utmost difficult path to success and to bask in the glory thence forth; Papa, Mummy and Didis’, I dedicate this to you! My love to my tiny little nieces and nephews who had virtually labelled me ‘laptop Mama’, without expecting even an ounce of attention from my end. I would be failing in my duty if I do not thank Dr Shanta Passi (Dermatology Specialist, ESIC Hospital, Faridabad) for taking care of OPDs and my patients thus relieving me for book work whenever needed and allowing photography of few of her patients for the same purpose. I am grateful to Dr Asim Das, Dean, ESIC College, for allowing me to work on the book and to the office orderly. Mr 16Shailender for keeping office open, when needed, beyond office hours. I am especially thankful to Drs Mayank, Piyush and Narendra, for they had been my ‘official chariots’, and all other faculty members of our college for providing a ‘healthy’ workplace. Finally, a toast to our MBBS teacher Dr Deorari (Prof. Neonatology, AIIMS, New Delhi) who mentioned once that I must also embark on writing an Atlas since I had joined a department of Dr Bhutani's repute!
Saurabh Singh