Genital Derm Dan Flashcards
Causes of phimosis?
Non-specific balanoposthitis (esp diabetics) Lichen sclerosus Lichen planus Hidradenitis suppurativa Crohn’s disease Cicatricial pemphigoid Chronic penile lymphoedema Cutaneous lymphoma Kaposi’s sarcoma Other tumour/warts under prepuce
Causes of paraphimosis?
Allergic contact dermatitis
Lichen sclerosus
Acute contact urticaria
Causes of (DDs) balanoposthitis?
Eczema (atopic, seborrhoeic, ACD, ICD) Psoriasis Reiter’s disease Zoon’s plasma cell balanitis Lichen sclerosus Gonorrhoea HPV HSV Candidiasis Rarer causes - Crohn’s - Other infections (strep, staph, gonorrheoea, syphilis, mycoplasma, tichomonas, LGV, tinea, amoebiasis) - Scabies - Erythroplasia of queyrat - kaposi’s sarcoma - chronic lymphatic leukemia - fixed drug eruption
What are Pearly penile papules?
tiny angiofibromas in rows on corona
Normal variant in 50% men
vestibular papillomatosis is female equivalent
What are Tyson’s glands?
Free sebaceous glnds on ventral penis/prepuce just below glans
What is Zoon’s balanitis/vulvitis?
what is Rx?
M>F esp uncircumcised uncertain cause - may be irritant dermatitis In women often complicates vulval LP 'Kissing lesions' - bright red or autumn brown patches on glans and visceral prepuce with sparing of keratinised penile shaft and outer foreskin cayenne pepper spots Rx hygeine measures Treat underlying dermatosis if present TCS laser circumcision
what is Histo of Zoons?
Epidermal atrophy, absent granular and horny layers
Epi has lozenge-shaped keratinocytes (pathognomonic) with wide intercellular spaces
Polyclonal dense papillary dermal infiltrate esp plasma cells w/ haemosiderin and RBCs
May be Russell bodies in plasma cells (large eosinophilic cytoplasmic inclusions)
T/F
LS is 10x more common in women then men
True
What are the disease associations of LS?
thyroid, vitiligo, morphoea in females
Rarely any assoc in males
should do FBC, ELFT, ANA, TFTs and thyroid Abs esp in women
T/F
5% of LS pts have extragenital disease
False
15-20%
T/F
Perianal LS is very rare in men
True
affects 30% of women
What is the risk of SCC in pts with genital LS?
2-6%
T/F
prepubertal LS resolves at puberty
False
Used to be thought this was true
T/F
LS does not affect the vagina
True
T/F
Hyperkeratosis is only clinical marker of LS pts most at risk of SCC development
True
epidermal hyperplasis may be a clue to ensuing differentiated VIN
T/F
LS is associated w/
HLA DQ7 or DRB1*12
True
What are
Balanitis xerotica obliterans and
posthitis xerotica obliterans
Complications of LS in men
although BXO often used interchangeably with male LS
means scarring/destruction of glans or prepuce
Where does extragenital LS occur?
submammary, shoulders, neck, wrists
asymptomatic, hypopigmented, wrinkeled patches with follicular plugging
T/F
Good control of LS reduces the risk of SCC
True
2015 Gayle Fischer paper asserted this
Textbooks say is not known
T/F
LS is a rare cause of secondary phimosis in school-age boys
False
most common cause
Management of LS?
Careful and thorough work up
check for extragenital disease
check if affecting urinating, sex, menstrual periods
sensitive examination with chaperone
Must biopsy to confrim
exclude SCC at presentation
Detailed information and support - refer if required to gynae, urology, counselling etc
Provdie deatils teratment plan and ensure correct expectations of treatment
general measures - hygeine, soap-free wash
avoid irritants
Potent TCS to gain control - dip ung nocte for 3 months and longer if skin colour and texture not normalised
Maintain w/ dip or AFO regularly NOT PRN eg twice a week and HCT on other days
consider risk of candida or reactivation of warts/HSV
Can used Top Tacro if unresponsive to TCS
Acitretin and CsA have been used
UVA1 and CO2 laser have also been used
Curcumcision for men if not responding/severe/phimosis/malignancy
women may need serial introital dilators or vulval surgery
T/F
Genital LP affects 50% of men and 25% of women with LP
False
other way around
What are the types of genital LP?
Classical LP - mons, lab maj, often annular on penis
Pigmented flexural LP - mons, inguinal and genitocrural folds; also affects axillae and inframammary areas
Erosive LP - vulvovaginal, often gingivitis too F only
Hypertrophic LP - hyperkeratotic white plaques
LPP - mons, lab maj
T/F
Genital LP does not increase risk of SCC
False
small increased risk