Chapter 5: Genital Dermatology

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

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

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 ...