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RED LESIONS

Eczema/Atopic Dermatitis/Neurodermatitis/Lichen Simplex Chronicus

  • Common genital dermatosis

  • Symptom of excruciating pruritus with pleasure upon rubbing and scratching

  • Frequent history of atopy and extragenital eczema

  • Posterior scrotal, any vulvar, and perianal locations, sometimes proximal, medial thighs

  • Variable morphology; lichenification and erosions which are often subtle (Fig. 5-1)

  • Diagnosis is by morphology, pruritus, and response to therapy

  • Therapy by ultrapotent corticosteroid ointments, nighttime sedation, avoidance of irritants

FIGURE 5-1

Thickened skin with lichenification and prurigo nodules, but no obvious erythema in this dark complexioned woman. (Used with permission from Dr. Libby Edwards.)

Contact Dermatitis (CD)

  • Common, especially irritant CD in older incontinent patients

  • For irritant CD, symptoms of irritation, rawness, and burning

  • For allergic CD, symptom of itching, sometimes irritation/pain from scratching

  • Morphology is usually nonspecific erythema for chronic CD, blisters or erosions for severe or acute CD

  • Uncommon but unique morphology is small, monomorphous, discrete erosions; when chronic, these can become red, eroded papules (Jacquet diaper dermatitis, granuloma gluteale infantum or adultorum) (Fig. 5-2)

  • Common etiologies for chronic irritant CD are incontinence, over washing, medication creams and gels; most common for acute irritant CD are medications for topical agents for anogenital warts

  • Common allergens for the specific sensitization of allergic CD are medication (benzocaine, diphenhydramine, neomycin), panty liners (formaldehyde- and formalin-releasing agents), fragrances, preservatives, and stabilizers in hygiene products

  • Diagnosis is by morphology, history and setting, and response to therapy

  • Therapy by removal of irritants, bland emollients, and for allergic CD, also ultrapotent corticosteroid ointment or systemic corticosteroids; for irritant CD, midpotency corticosteroids may be useful; nighttime sedation if pruritic

FIGURE 5-2

A unique morphology of contact dermatitis of the vulva consists of small, monomorphous erosions; there are nodules of granuloma gluteale in this photo as well. (Used with permission from Dr. Libby Edwards.)

Seborrhea/Seborrheic Dermatitis

  • Uncommon genital eruption in adults; most often in homeless, neurologically compromised, HIV infected

  • Symptoms can be absent, or consist of itching or irritation depending upon severity and individual patient

  • Morphology is nonspecific genital redness, with accentuation in skin folds/crural creases; accompanied by extragenital seborrhea with yellowish scale in axilla, scalp, face, etc.

  • Etiology is unknown; inability to bathe frequently and Pityrosporum ovale are possible

  • Diagnosis is by setting, presence of typical extragenital disease, and response to therapy

  • Therapy is frequent bathing, vigorous removal of scalp scale, and topical corticosteroids for the genital skin. Ketoconazole cream sometimes stings on anogenital skin

Psoriasis

  • Common skin disease that often affects anogenital skin because of local irritation

  • Symptoms include pruritus in some, and cosmetic annoyance and irritation in many

  • Morphology is that of ...

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