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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


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


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


  • 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 ...

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