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Vulvar Dermatitis

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121. 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

122. 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

123. 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

124. Tinea Versicolor (Follow-up)

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

125. Tinea Versicolor (Diagnosis)

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 pityriasis versicolor (...) papillomatosis, seborrheic dermatitis, the provocation of psoriatic lesions, and some forms of . [ ] Studies also show that tinea versicolor occurs with and various diseases, including . Pregnancy and oral contraceptives may influence susceptibility, but firm data are lacking. Patients with AIDS may present with severe seborrhea but do not have a higher incidence of tinea versicolor. Systemic infections are attributed to Pityrosporum in extremely rare cases. Different rare clinical forms have been described

2014 eMedicine Pediatrics

126. 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

127. Child Abuse and Neglect: Sexual Abuse (Diagnosis)

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

128. Pathology: 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

129. 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 Emergency Medicine

130. Hidradenitis Suppurativa (Overview)

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 Emergency Medicine

131. Vulvovaginitis (Treatment)

: 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 Emergency Medicine

132. 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

133. Urinary Incontinence (Diagnosis)

. A nonfunctioning urethra can result in continuous leakage. Scarring and fibrosis from previous surgery, partial urethral resection for vulvar cancer, and urethral sphincter paralysis due to lower motor neuron disease can cause the urethra to fail. Pelvic irradiation may not only cause urogenital fistula but in rare cases causes bladder noncompliance that results in continuous incontinence. Congenital malformations of the genitourinary tract, such as bladder exstrophy, [ ] epispadias, and ectopic ureters, can

2014 eMedicine Emergency Medicine

134. 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 Emergency Medicine

135. Nonneoplastic Epithelial Disorders of the Vulva (Diagnosis)

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

136. Schistosomiasis (Diagnosis)

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

137. Paraneoplastic Diseases (Diagnosis)

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

138. Paget Disease, Extramammary (Diagnosis)

antigen is negative. No epithelial mucin is seen in these tumor cells. Crocker described a patient with erythematous patches on his penis and scrotum. Since he made this distinction, the term EMPD is more commonly used to describe the condition in women. This process targets the genital skin, perianal skin, and other cutaneous sites rich in apocrine glands. EMPD is not a common disorder, but it must be considered in the differential diagnosis of patients with chronic genital or perianal dermatitis (...) as pancytopenia and back pain. Curr Oncol . 2009 Sep. 16(5):81-3. . . Sendagorta E, Herranz P, Feito M, et al. Successful treatment of three cases of primary extramammary Paget's disease of the vulva with Imiquimod - proposal of a therapeutic schedule. J Eur Acad Dermatol Venereol . 2009 Oct 15. . Marchitelli C, Peremateu MS, Sluga MC, et al. Treatment of primary vulvar paget disease with 5% imiquimod cream. J Low Genit Tract Dis . 2014 Oct. 18(4):347-50. . Liau MM, Yang SS, Tan KB, Aw CW. Topical imiquimod

2014 eMedicine.com

139. Oral Manifestations of Systemic Diseases (Diagnosis)

. [ ] 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

140. Syringoma (Diagnosis)

cells. Some investigators have suggested that cases of eruptive syringoma may represent a hyperplastic response of the eccrine duct to an inflammatory reaction rather than a true adnexal neoplasm. [ ] In this setting, the term syringomatous dermatitis may be more appropriate. Likewise, the scalp “syringomas" seen in represent a reactive proliferation in response to the fibrosis. Previous Next: Etiology Syringomas are usually sporadic, but more than 10 cases of familial syringomas have been reported (...) dermis. J Am Acad Dermatol . 2014 Nov. 71 (5):e206-7. . Eckert F, Nilles M, Schmid U, Altmannsberger M. Distribution of cytokeratin polypeptides in syringomas. An immunohistochemical study on paraffin-embedded material. Am J Dermatopathol . 1992 Apr. 14(2):115-21. . Jamalipour M, Heidarpour M, Rajabi P. Generalized eruptive syringomas. Indian J Dermatol . 2009. 54(1):65-7. . . Karatzi C, Stefanidou M, Chaniotis V, Evangelou G, Krueger-Krasagakis S, Krasagakis K. Treatment of giant vulvar syringomas

2014 eMedicine.com

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