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Vulvar Dermatitis

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121. Skin Cancer: 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

122. 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

123. 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

124. 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

125. 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

126. 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

127. 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

128. 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

129. 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 Emergency Medicine

130. 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 Emergency Medicine

131. 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

132. 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

133. 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

134. 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

135. 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

136. 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

137. 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

138. 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

139. Child Abuse and Neglect: Sexual Abuse (Overview)

during examination. Courtesy of Carol D. Berkowitz, MD. Dermatologic conditions, such as lichen sclerosis and/or dermatitis (eg, atopic, contact, seborrhea) Infections, including sexually transmitted diseases (STDs), fungal infections, and/or nonspecific vulvovaginitis Endocrinologic causes, such as estrogen withdrawal as observed in the neonate and/or precocious puberty Neoplastic tissue, such as sarcoma botryoides Structural abnormalities, such as vulvar hemangioma Vaginal discharge Normal (...) redness This finding typically represents the result of inflammation. Differential diagnoses are as follows: Local irritation from sexual abuse, poor hygiene, restrictive clothing, and chemicals Anatomic/structural factors such as perianal fissuring and rectal prolapse Dermatologic conditions, such as lichen sclerosus, psoriasis, and dermatitis (atopic, contact, seborrhea) Infections, such as STDs, nonspecific vulvovaginitis, pinworm, scabies, fungal infections with Candida species, and perianal

2014 eMedicine Pediatrics

140. Tinea Versicolor (Treatment)

flora and its relevance in skin disorders. Cutis . 1997 Jan. 59(1):21-4. . Nakabayashi A, Sei Y, Guillot J. Identification of Malassezia species isolated from patients with seborrhoeic dermatitis, atopic dermatitis, pityriasis versicolor and normal subjects. Med Mycol . 2000 Oct. 38(5):337-41. . Levy JM, Magro C. Atrophying pityriasis versicolor as an idiosyncratic T cell-mediated response to Malassezia: A case series. J Am Acad Dermatol . 2017 Apr. 76(4):730-735. . Day T, Scurry J. Vulvar

2014 eMedicine Pediatrics

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