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Vulvar Dermatitis

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61. Balanitis Circumscripta Plasmacellularis (Follow-up)

plasmacellularis (plasma cell balanitis) and are not curative. Intralesional interferon-alfa was found to be helpful in treatment of the vulvar analog of balanitis circumscripta plasmacellularis (plasma cell balanitis). [ ] Griseofulvin therapy and oral tetracycline have been tried without success. Next: Surgical Care The treatment of choice for balanitis circumscripta plasmacellularis (plasma cell balanitis) is circumcision, which is usually curative. [ , , ] Patients must be informed that circumcision (...) SR, Patterson JW, Cousar JB, Wick MR. Idiopathic lymphoplasmacellular mucositis-dermatitis. J Cutan Pathol . 2010 Apr. 37(4):426-31. . Hernandez-Machin B, Hernando LB, Marrero OB, Hernandez B. Plasma cell balanitis of Zoon treated successfully with topical tacrolimus. Clin Exp Dermatol . 2005 Sep. 30(5):588-9. . Roe E, Dalmau J, Peramiquel L, Perez M, Lopez-Lozano HE, Alomar A. Plasma cell balanitis of zoon treated with topical tacrolimus 0.1%: report of three cases. J Eur Acad Dermatol Venereol

2014 eMedicine.com

62. Skin, Benign Skin Lesions

on this topic. Bowen disease and Bowenoid papulosis Bowen disease is considered a synonym for squamous cell carcinoma in situ . In contrast, bowenoid papulosis is a term used when histologic changes of squamous cell carcinoma are found within genital warts. The term bowenoid papulosis, and not Bowen disease or squamous cell in situ, for these cases is generally preferred since the papules typically follow a benign course. In bowenoid papulosis, itching is a common symptom. With vulvar involvement, the labia (...) the genitalia. Itching is a common symptom. With vulvar involvement, the labia majora tend to be involved more than the labia minora. The lesions are scaly, crusted, erythematous plaques. This lesion is considered to be a carcinoma in situ without spread beyond the dermal-epidermal junction. Over time, as many as 10% of these lesions experience invasion. Efforts have been made to correlate arsenic and Bowen disease. The results have been inconclusive at best. Squamous cell carcinoma from Bowen disease tends

2014 eMedicine Surgery

63. Skin Malignancies, Basal Cell Carcinoma

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine Surgery

64. Skin Malignancies, Merkel Cell Carcinoma and Rare Appendageal Tumors

scaly macules or papules. Bowen disease predominantly arises in the lower limbs and is characterized by a slowly growing scaly plaque, often resembling patches of dermatitis or psoriasis. Premalignant fibroepithelial tumor of Pinkus The fibroepithelial tumor of Pinkus is best considered a type of BCC. However, the distinguished dermatopathologist Leboit thinks it might be a fenestrated trichoblastoma. [ ] Originally identified by Herman Pinkus in the 1950s, the premalignant fibroepithelial tumor (...) that complete excision significantly improved overall survival. [ ] In addition, tumor size and location greatly impacted the outcome of surgical excision; a worse prognosis has been associated with primary tumors larger than 2 cm and located in the perianal and vulvar regions. The high rate of local recurrence even after surgical excision (~50%) argues strongly for regional lymphadenectomy. [ ] In a limited number of cases, Smith and colleagues demonstrated that patients with local and regional control

2014 eMedicine Surgery

65. Hidradenitis Suppurativa (Follow-up)

who advocate excision and healing by secondary intention claim that this technique permits adequate disease clearance and results in a cosmetically acceptable scar, superior to that obtained by skin grafting, with little limitation of movement. [ ] A report on five patients treated for stage III vulvar hidradenitis suppurativa showed that the only one patient who was managed without split-thickness skin grafting developed an introital stricture and this was the only patient who regretted (...) Surg . 2002 Sep. 55(6):507-9. . Rhode JM, Burke WM, Cederna PS, Haefner HK. Outcomes of surgical management of stage III vulvar hidradenitis suppurativa. J Reprod Med . 2008 Jun. 53(6):420-8. . Frohlich D, Baaske D, Glatzel M. [Radiotherapy of hidradenitis suppurativa--still valid today?]. Strahlenther Onkol . 2000 Jun. 176(6):286-9. . Kimball AB, Sobell JM, Zouboulis CC, Gu Y, Williams DA, Sundaram M, et al. HiSCR (Hidradenitis Suppurativa Clinical Response): a novel clinical endpoint to evaluate

2014 eMedicine Surgery

66. Hidradenitis Suppurativa (Diagnosis)

of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol . 2008 Dec. 159(6):1309-14. . Hynes PJ, Earley MJ, Lawlor D. Split-thickness skin grafts and negative-pressure dressings in the treatment of axillary hidradenitis suppurativa. Br J Plast Surg . 2002 Sep. 55(6):507-9. . Rhode JM, Burke WM, Cederna PS, Haefner HK. Outcomes of surgical management of stage III vulvar hidradenitis suppurativa. J Reprod Med . 2008 Jun. 53(6):420-8. . Frohlich D, Baaske D, Glatzel M

2014 eMedicine Surgery

67. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Diagnosis)

and diagnostic tests, including KOH and Tzanck preparations, can help determine the correct diagnosis. Biopsy is generally not necessary, although a lack of response to treatment warrants a biopsy to exclude premalignant or malignant lesions. Differential diagnoses The differential diagnoses include intertrigo (see ); irritant dermatitis; and candidal (see ), viral, or fungal infections. [ , ] As emphasized above, the clinical history, in association with KOH and Tzanck preparations, often helps to determine (...) and is characterized microscopically by a plasma cell–rich inflammatory infiltrate. [ ] Although far less common, an equivalent condition, plasma cell vulvitis, is seen in the vulvar region of females. [ ] Pathophysiology The etiology of this condition is unknown. Some reports have suggested the lesions represent a plasma cell–rich variant of lichen planus. In one study, immunoglobulin (Ig) E and IgG were determined to be major immunoglobulin classes in plasma cellular infiltrate; thus, the disorder may have more

2014 eMedicine.com

68. Dermatologic Manifestations of Gastrointestinal Disease (Diagnosis)

[ ] Esophagitis Scleroderma GI bleeding Hereditary hemorrhagic telangiectasia Cirrhosis Liver disease secondary to alcohol or other factors Vesicles/blisters/erosions Esophageal webs Epidermolysis bullosa Esophageal erosion Pemphigus vulgaris Pyloric atresia Junctional epidermolysis bullosa Hepatitis Porphyria cutanea tarda Malabsorption Dermatitis herpetiformis and celiac sprue Velvety hyperpigmented plaques, tripe palms, mucosal hyperplasia Gastric cancer Malignant acanthosis nigricans Yellowish papules (...) and extrarenal manifestations than younger patients. Dermatitis herpetiformis This uncommon blistering disorder is characterized by the development of small vesicular lesions found in a symmetric distribution of both upper and lower extensor surfaces and the scalp. First described in 1884 by Louis Duhring, MD, the usual age of onset of (DH) is in the third decade of life. Most patients experience severe pruritus as a result of the skin lesions, although some are almost completely asymptomatic. Pruritus can

2014 eMedicine.com

69. Gynecologic Pain (Diagnosis)

. [ ] Diagnosis of the erythematous and often painful skin lesions can be elusive because they may closely resemble other inflammatory and infectious causes of vulvar pain. An exhaustive search for the offending substance is sometimes needed, and that may be best handled by an allergist. Urinary incontinence, sometimes unreported, can also be responsible for contact dermatitis. A detailed history along with a 1-2 day phenazopyridine (Pyridium) test can be employed, looking for orange staining of a sanitary (...) pad. Correction of incontinence, along with warm rinsing and a skin protectant are management strategies. Diaper dermatitis can develop in a remarkably short time when skin is exposed to fecal material. Discussion can be awkward but should not be deferred. Allergic dermatitis (e.g. latex) may also occur with attendant itching and pain. Again, an allergist is an important team member. Behavioral and Psychological Behavioral and psychological causes of vulvar pain require careful, appropriate

2014 eMedicine.com

70. Basal Cell Carcinoma (Diagnosis)

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine.com

71. Basal Cell Carcinoma, Eyelid (Diagnosis)

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine.com

72. Basal Cell Carcinoma (Diagnosis)

Jan. 27(1):125-35. . Kara M, Colgecen E, Yildirim EN. Vulvar basal cell carcinoma. Indian J Pathol Microbiol . 2012 Oct-Dec. 55 (4):583-4. . . Newman JC, Leffell DJ. Correlation of embryonic fusion planes with the anatomical distribution of basal cell carcinoma. Dermatol Surg . 2007 Aug. 33(8):957-64; discussion 965. . Karagas MR, Gossai A, Pierce B, Ahsan H. Drinking Water Arsenic Contamination, Skin Lesions, and Malignancies: A Systematic Review of the Global Evidence. Curr Environ Health Rep

2014 eMedicine.com

73. Vulvovaginitis (Diagnosis)

: Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Vulvovaginitis Overview Practice Essentials Vulvovaginitis is a general term referring to many types of vaginal infection, although this article focuses on the following disorders, which affect the vulvar region: Vulvovaginal candidiasis Atrophic vaginitis Vulvar vestibulitis Contact dermatitis Signs and symptoms Acute vulvovaginal candidiasis Vulvar pruritus and burning - Primary symptoms (...) , and a feeling of rawness that is aggravated by stress, exercise, tight clothing, coitus, and tampon use. The pain is usually not considered constant but is elicited by any attempt to enter the vagina. Other symptoms may include the following: Irritating vaginal discharge Vulvar burning sensation Small spots of erythema around the vestibular glands, with rare ulceration Contact dermatitis Pruritus is the cardinal symptom. However, an acute reaction may develop as a result of exposure to a potent irritant

2014 eMedicine.com

74. Vaccinia (Diagnosis)

. The sequelae of eczema vaccinatum include prolonged hospital stays and, occasionally, death. Recent research has shown that patients with atopic dermatitis have an overabundance of a class A scavenger receptor known as macrophage receptor with collagenous structure (MARCO) on keratinocytes. Vaccinia virus bound directly to MARCO increases susceptibility to eczema vaccinatum. This breakthrough represents a potential area for future therapeutic strategies to prevent vaccinia virus infection in patients (...) to 21 days following vaccination. Vaccinia virus should not be administered to children younger than 3 years, individuals with eczema or CNS disorders, or immunosuppressed individuals. Individuals vaccinated within the preceding 21 days can also spread the virus to unvaccinated contacts. In particular, these individuals should avoid contact with young children, immunocompromised persons, pregnant persons, and individuals with a history of atopic dermatitis. If this contact is unavoidable, vaccinated

2014 eMedicine.com

75. Lichen Simplex Chronicus (Diagnosis)

E, Grossberg AL, Püttgen KB, Cohen BA, Kwatra SG. Itching at night: A review on reducing nocturnal pruritus in children. Pediatr Dermatol . 2018 Jun 26. . Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC. Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings. An Bras Dermatol . 2018 Jan-Feb. 93 (1):108-110. . Ball SB, Wojnarowska F. Vulvar dermatoses: lichen sclerosus, lichen planus, and vulval dermatitis/lichen simplex chronicus. Semin Cutan (...) , but the underlying pathophysiology is unknown. Some skin types are more prone to lichenification, such as skin that tends toward eczematous conditions (ie, atopic dermatitis, atopic diathesis). A relationship likely exists between central and peripheral neural tissue and inflammatory cell products in the perception of itch and ensuing changes in lichen simplex chronicus. Emotional tensions, such as in patients with anxiety, depression, or obsessive-compulsive disorder, may play a key role in inducing a pruritic

2014 eMedicine.com

76. Lentigo (Diagnosis)

in KRT10 . [ ] The LEOPARD syndrome may be associated with a mutation in the PTPN11 gene at Thr468Met. [ ] Previous Next: Etiology The cause of lentigo formation depends on the type of lesion, as follows: The cause of lentigo simplex is unknown. Case reports have described simple lentigines developing in children after use of topical tacrolimus for atopic dermatitis. [ ] Solar lentigo and ink-spot lentigo are associated with sun exposure in fair-skinned people. PUVA lentigines [ , , ] are associated (...) , prominent skin signs of aging, develop earlier and are more pronounced in Japanese than in German women. [ ] Inherited patterned lentiginosis can occur in blacks, particularly those with mixed American Indian heritage and those with relatives with red hair. [ ] Ephelides, PUVA lentigines, tanning-bed lentigines, vulvar lentigines, ink-spot lentigines, [ ] oral and labial melanotic macules, and Laugier-Hunziker syndrome are also more common in people with light skin than in those with dark skin. Ink-spot

2014 eMedicine.com

77. Fournier Gangrene (Diagnosis)

with cocaine [ ] Urethral instrumentation Prosthetic penile implants Intramuscular injections Steroid enemas (used for the treatment of radiation proctitis) Rectal foreign body [ ] In women, septic abortions, vulvar or Bartholin gland abscesses, hysterectomy, and episiotomy are documented sources. In men, anal intercourse may increase risk of perineal infection, either from blunt trauma to the area or by spread of rectally carried microbes. In children, the following have led to the disease: Circumcision (...) inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora, MD. Photograph of a morbidly obese male with long-standing phimosis. This condition led to urinary incontinence, perineal diaper rash–like dermatitis, and urinary tract infection. Ultimately, he presented with exquisite perineal pain. An examination with the patient under anesthesia was necessary to discover the necrotizing infection that appeared

2014 eMedicine.com

78. Fixed Drug Eruptions (Diagnosis)

pustulosis, lichenoid dermatitis, vasculitis, Stevens-Johnson syndrome, or fixed drug eruption (FDE). The term fixed drug eruption describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with reexposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop in addition to "lighting up" the older hyperpigmented lesions (...) -Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol . 2003 Dec. 49(6):1003-7. . Ozkaya-Bayazit E, Bayazit H, Ozarmagan G. Drug related clinical pattern in fixed drug eruption. Eur J Dermatol . 2000 Jun. 10(4):288-91. . Fischer G. Vulvar fixed drug eruption. A report of 13 cases. J Reprod Med . 2007 Feb. 52(2):81-6. . Gupta S, Gupta S, Mittal A, David S. Oral fixed drug eruption caused by gabapentin. J Eur Acad Dermatol Venereol . 2009 Feb 19. . Katoulis AC, Bozi E

2014 eMedicine.com

79. Oral Manifestations of Systemic Diseases (Treatment)

. [ ] Systemic features of Crohn disease include arthritis, clubbing of the fingers, and sacroiliitis. [ ] Skin findings include knifelike fissures and ulcerations, as well as fistulae. Vulvar manifestations, such as fissures, edema, tenderness to palpation, and nonspecific aphthae, have also been reported. [ ] Cutaneous manifestations of Crohn disease may also be noncontiguous: metastatic Crohn disease is defined as a granulomatous inflammation of the skin that is not contiguous with the GI tract. Although (...) with a prevalence estimated between 0.4-4% in the general population. [ , ] Notably, however, the association between HCV infection and LP is greater in Europe and Asia than it is in the United States. [ , ] Cutaneous lesions are classically pruritic, violaceous, polygonal papules and often present on the trunk or extremities, although nail, vulvar mucosal, and oral mucosal involvement can be significant. [ ] Oral manifestations of LP are more common in women aged 30-70 years. [ , ] Oral LP may be classified

2014 eMedicine.com

80. Schistosomiasis (Overview)

intercalatum , may also cause systemic human disease. Less importantly, other schistosomes with avian or mammalian primary hosts can cause severe dermatitis in humans (eg, swimmer's itch secondary to Trichobilharzia ocellata ). (See Etiology.) Characteristics of schistosomiasis Schistosomiasis is due to immunologic reactions to Schistosoma eggs trapped in tissues. Antigens released from the egg stimulate a granulomatous reaction involving T cells, macrophages, and eosinophils that results in clinical (...) Schistosomal nephropathy Renal failure Pyelonephritis Hematuria Hemospermia Squamous cell bladder cancer Sepsis ( Salmonella ) Pulmonary hypertension Cor pulmonale Neuroschistosomiasis - Transverse myelitis, paralysis, and cerebral microinfarcts Infertility Severe anemia Low ̶ birth-weight babies Spontaneous abortion Higher risk for ectopic pregnancies End-organ disease Portal hypertension Obstructive uropathy Pregnancy complications from vulvar or fallopian granuloma Carcinoma of the liver, bladder

2014 eMedicine.com

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