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Vulvar Dermatitis

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121. 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

122. 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

123. Vaccinia (Follow-up)

-antagonists may also be at high risk. [ ] Avoid vaccination of children younger than 18 years unless indicated by a smallpox emergency. [ ] Current guidelines recommend that vaccinees defer blood donation for 21 days after vaccination or until the scab separates, whichever is later. Further studies indicate that extending the duration may be appropriate. Contraindications to nonemergency use of smallpox vaccine include the following: [ ] Persons with a history or presence of atopic dermatitis or other (...) active exfoliative skin conditions (eg, eczema, burns, impetigo, varicella zoster virus infection, herpes simplex virus infection, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis, or Darier disease [keratosis follicularis]) Persons with conditions associated with immunosuppression (eg, HIV infection or AIDS, leukemia, lymphoma, generalized malignancy, solid organ transplantation, or therapy with alkylating agents, antimetabolites, radiation, tumor necrosis factor

2014 eMedicine.com

124. 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

125. Basal Cell Carcinoma, Eyelid (Follow-up)

for nonfacial tumors. RT also is contraindicated in patients with connective tissue diseases or genetic conditions predisposing to skin cancer (eg, xeroderma pigmentosum, epidermodysplasia verruciformis, and basal cell nevus syndrome.) This histologic type in conjunction with RT may induce more tumors in the treated area. Radiation adverse effects include dermatitis, keratinization of the conjunctiva, and chronic keratitis. Cosmetic results are generally good to excellent, with a small amount (...) . . 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 . 2015 Mar. 2 (1):52-68

2014 eMedicine.com

126. Basal Cell Carcinoma (Follow-up)

for nonfacial tumors. RT also is contraindicated in patients with connective tissue diseases or genetic conditions predisposing to skin cancer (eg, xeroderma pigmentosum, epidermodysplasia verruciformis, and basal cell nevus syndrome.) This histologic type in conjunction with RT may induce more tumors in the treated area. Radiation adverse effects include dermatitis, keratinization of the conjunctiva, and chronic keratitis. Cosmetic results are generally good to excellent, with a small amount (...) . . 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 . 2015 Mar. 2 (1):52-68

2014 eMedicine.com

127. Basal Cell Carcinoma (Follow-up)

for nonfacial tumors. RT also is contraindicated in patients with connective tissue diseases or genetic conditions predisposing to skin cancer (eg, xeroderma pigmentosum, epidermodysplasia verruciformis, and basal cell nevus syndrome.) This histologic type in conjunction with RT may induce more tumors in the treated area. Radiation adverse effects include dermatitis, keratinization of the conjunctiva, and chronic keratitis. Cosmetic results are generally good to excellent, with a small amount (...) . . 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 . 2015 Mar. 2 (1):52-68

2014 eMedicine.com

128. 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

129. Fixed Drug Eruptions (Follow-up)

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, Kanelleas A, et al. Psoriasiform fixed drug eruption caused (...) Allergy Clin Immunol . 2003 Sep. 112(3):609-15. . Mizukawa Y, Shiohara T. Fixed drug eruption: a prototypic disorder mediated by effector memory T cells. Curr Allergy Asthma Rep . 2009 Jan. 9(1):71-7. . Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol . 2009 Aug. 9(4):316-21. . Weedon D. The lichenoid reaction pattern ('interface dermatitis'). Skin Pathology . 2nd ed. London, England: Churchill Livingstone; 2002. 42-43. Smoller BR, Luster AD, Krane JF

2014 eMedicine.com

130. 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

131. 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

132. 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

133. 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

134. Fixed Drug Eruptions (Treatment)

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, Kanelleas A, et al. Psoriasiform fixed drug eruption caused (...) Allergy Clin Immunol . 2003 Sep. 112(3):609-15. . Mizukawa Y, Shiohara T. Fixed drug eruption: a prototypic disorder mediated by effector memory T cells. Curr Allergy Asthma Rep . 2009 Jan. 9(1):71-7. . Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol . 2009 Aug. 9(4):316-21. . Weedon D. The lichenoid reaction pattern ('interface dermatitis'). Skin Pathology . 2nd ed. London, England: Churchill Livingstone; 2002. 42-43. Smoller BR, Luster AD, Krane JF

2014 eMedicine.com

135. 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

136. 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

137. 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

138. 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

139. 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

140. 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

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