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Vulvar Dermatitis

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101. Lichen Simplex Chronicus (Overview)

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

102. Oral Manifestations of Systemic Diseases (Overview)

. [ ] 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

103. Lentigo (Overview)

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

104. Dermatologic Manifestations of Gastrointestinal Disease (Overview)

[ ] 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

105. Vulvovaginitis (Overview)

: 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

106. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Overview)

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 the correct diagnosis. In adult (...) 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 in common

2014 eMedicine.com

107. Hidradenitis Suppurativa (Treatment)

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.com

108. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Treatment)

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

109. Dermatologic Manifestations of Gastrointestinal Disease (Treatment)

[ ] 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

110. Gynecologic Pain (Treatment)

. [ ] 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

111. Lichen Simplex Chronicus (Treatment)

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 (...) chronicus on a limb is commonly treated with a highly potent topical corticosteroid or intralesional corticosteroids, whereas vulvar lesions are more commonly treated with a mild topical corticosteroid or a topical calcineurin inhibitor. Widespread lesions are more likely to require systemic treatment or total body phototherapy. Topical steroids are the current treatment of choice because they decrease inflammation and itch while concurrently softening the hyperkeratosis. [ , , ] Because lesions

2014 eMedicine.com

112. Nonneoplastic Epithelial Disorders of the Vulva (Follow-up)

the following: Lichen sclerosus Squamous cell hyperplasia (with and without atypia) (localized neurodermatitis) Primary irritant dermatitis Fixed drug eruption Reiter disease Lupus erythematosus Darier disease Aphthosis and Behçet disease Pyoderma gangrenosum Plasma cell vulvitis Vulvar vestibulitis Blistering diseases involving the vulvar region include the following: Familial benign chronic pemphigus (Hailey-Hailey disease) Pigmentary changes involving the vulvar region include the following (...) -scratch-itch cycle. The initial stimulus to itch may be underlying seborrheic dermatitis, intertrigo, tinea, or psoriasis; however, in most cases, the underlying cause is not evident and may have been transient vulvitis or vaginal discharge. [ ] Any itching disease of the vulva may become secondarily lichenified. Primary irritant dermatitis In the absence of any immune reactivity, this condition is a common cause of vulvar burning and pruritus due to irritation. Chemical agents that remove surface

2014 eMedicine.com

113. Oral Manifestations of Systemic Diseases (Follow-up)

. [ ] 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

114. Lichen Simplex Chronicus (Follow-up)

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 (...) chronicus on a limb is commonly treated with a highly potent topical corticosteroid or intralesional corticosteroids, whereas vulvar lesions are more commonly treated with a mild topical corticosteroid or a topical calcineurin inhibitor. Widespread lesions are more likely to require systemic treatment or total body phototherapy. Topical steroids are the current treatment of choice because they decrease inflammation and itch while concurrently softening the hyperkeratosis. [ , , ] Because lesions

2014 eMedicine.com

115. Paraneoplastic Diseases (Follow-up)

given together with ultraviolet-A (UV-A) phototherapy. Extramammary Paget disease Paget disease is characterized by a solitary, pruritic (but painless), sharply demarcated, erythematous, superficial, eczematous, slightly infiltrated plaque, which usually appears on the areola. The lesion of (EMPD) is clinically indistinguishable from that of Paget disease, except for its location; lesions in persons with EMPD typically appear on the apocrine gland–bearing perianal or vulvar skin. Occasionally, cases (...) diagnosis of EMPD includes Bowen disease, amelanotic superficial spreading malignant melanoma, and eczematous dermatitis. Clinical course and prognosis Skin lesions slowly increase in size. Over time, the lesions may progress from pruritic to painful, and they may become ulcerated. Regional lymph nodes may become involved. The general course of the disease depends on the presence of an underlying internal cancer. EMPD patients have a 5-year survival rate of 72-85%. Patients with EMPD without an internal

2014 eMedicine.com

116. Dermatologic Manifestations of Gastrointestinal Disease (Follow-up)

[ ] 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

117. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Follow-up)

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

118. Vulvovaginitis (Follow-up)

: 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

119. Gynecologic Pain (Follow-up)

. [ ] 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

120. 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.com

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