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
T/F
Differentiated VIN is most dangerous in terms of risk of an invsice SCC w/ potential to invade and metastasize
True
This type is not HPV associated
Can arise from LS
epidermis is hyperplastic + atypia in basal layer
Be suspicious for a micorinvasive carcinoma nearby
What is Treatment of genital LP?
Largely similar to LS esp if eroded Must examine for LP elsewhere General measures Potent TCS Top Tacro Topical retinoids for hypertrophic/hyperkeratotic LP Pred, MTX, MMF, CsA, AZA PDT has been used for LP on penis Surgery
T/F
Vulval LP affects prebubescent girls
False
unlike LS
T/F
Non-specific Balanoposthitis is a diagnosis of exclusion
True
irritation and inflammation, can be erosive
Need to exclude all other causes inc STIs, other infections, dermatoses and malignancy
General measures may help
circumcision curative
T/F
Peyronie’s disease is treated with ILCS
True
T/F
Penis is a site of predilection for fixed drug eruption
True
What are the causes of fixed drug eruptions?
BARBwire PANTS (helps remember penis is comon site and it can be painful) Barbituates Phenolphthalein laxatives Aspirin NSAIDs inc ibuprofen Tetracyclines Sulphonamides esp TMP-SMX
What are risk factors for Fournier’s gangrene?
DM alcoholism anogenital infection chemotherapy HIV post-instrumentation/postoperative/trauma
What are the clinical variants of PIN?
Erythroplasia of Queyrat
- Red shiny patches or plaques of the ‘mucosal’ penis (glans and prepuce of the uncircumcised)
Bowen’s disease of the penis
- Red, sometime slightly pigmented, scaly patches and plaques of the keratinized penis
Bowenoid papulosis
- Multiple warty lesions, which are often pigmented in keratinised sites and more nubmerous and more inflamed at ‘mucosal’ sites
- Associated with a lesser risk of SCC than EQ and BDP
- Associated with HPV infection (esp HPV16) and HIV
What are the treatment options for genital warts?
Podophyllotoxin (not if preg) Imiquimod Cryotherapy Trichloroacetic acid Electrocautery Curettage Scalpel excision Laser ablation 5-FU (not if preg) Interferon (not if preg) Cidofovir Gardisil vaccine (HPV 6, 11, 16, 18)
T/F
smoking is a risk factor for scrotal carcinoma
False
is for penile Ca but not scrotal
T/F
coal tar use is a risk factor for penile carcinoma
False
is for scrotal Ca but not penile
T/F
HPV is a risk factor for penile carcinoma
True
16, 18, 31, 33
What are risk factors for penile Ca?
Risk factors for penis
- Uncircumcised
- Smoking
- Poor hygiene
- Chronic irritation and inflammation (phimosis and balanitis)
- Lichen sclerosus
- Lichen planus
- HPV (16, 18, 31, 33)
- HIV
- Intraepitherlial carcinoma (BDP, EQ, BP)
- Photochemotherapy (PUVA)
- Iatrogenic immunosuppression (renal transplant, SLE, IBD, radiotherapy)
What are risk factors for scrotal Ca?
Risk factors for scrotum
- Psoriasis treated with arsenic, coal tar, UVB and PUVA
- Radiotherapy
- scrotal HPV infection
- hidradenitis suppurativa
- Bowen’s disease
- Multiple cutaneous keratoses and epitheliomas
T/F
scrotal Ca has a good prognosis
False
poor prognosis 5yr mortality 50-60%
T/F In Extramammary Paget’s disease;
Internal malignancy is 5x more likely when perianal as opposed to vulvar or penoscrotal involvement
True
Up to 50% of men can have malignancies
T/F In Extramammary Paget’s disease;
In men, perianal disease is most common site
True
What is Pagetoid VIN?
Rare variant resembling EMPD or pagetoid Bowens disease
Abnormal cells are CK7 positive but negative for mucin stains and cam5.2
How is VIN graded?
No longer graded I-III
Now just called undifferentiated VIN if less aggressive, HPV-associated type
differentiated VIN is not HPV-associated and is more aggressive
T/F
Almost all women with VIN are smokers
True
T/F
VIN is usually multifocal and may be multicentric
True
multifocal = several distinct sites of vulva involved
multicentric = intraepithelial neoplasia also in the cervix, vagina and perianal skin
T/F
15% of VIN pts also have CIN of cervix
False
2/3 have CIN - must get smear/colposcopy
T/F
VIN can cause wart like overgrowths
True
T/F
VIN commonly extends into vagina
False
v rare
T/F
10% of VIN progress to invasive malignancy
True higher risk if; Immunocompromised perianal disease older women with solitary plaque
What is the Rx of VIN?
Depends on pt age, circumstances, preference etc
Must examine other sites regularly – cervix, vagina, perianal area – refer to gynae
If perianal area involved need proctoscopy to look inside – send to colorectal
Excision is treatment of choice for amenable solitary VIN
Efudix can be used on lab min, vestibule and clit but not on hair-bearing areas
Immiquimod useful for multifocal undiff VIN
In extensive undiff disease can follow up regularly and excise thick or polypid areas and biopsy suspicious areas
NB Cryo and laser not effective
T/F
younger women are more likely to get SCC arising from differentiated VIN
False
Of all vulval SCCs;
60% in elderly women with LP or LS (no HPV link – diff VIN)
40% in younger women with undiff VIN
What is the treatment of PIN?
topical 5FU Immiquimod cryosurgery curettage excision/Mohs PDT laser XRT Should screen for HPV, HIV, other STIs stop smoking advise sexual partners to be checked for HPV and STIs Nb circumcision removes major risk factors for cancer;
What are the histological types of vulval SCC?
Keratinizing – older women non HPV type
Basaloid – younger, HPV type
Warty – also younger HPV type
What is the staging of vulval SCC?
Stage T1: 1mm deep
Stage T2: Any size tumour invading lower vagina, urethra or anus
Stage T3: Any size tumour invading upper vagina, urethra, rectum or pubic bone
What is the Rx and prognosis of vulval SCC?
Wide excision/vulvectomy
Lymph node dissection is mandatory if stage 1b or above
Central lesions have bilateral drainage and need bilateral LN dissection
Adjuvent DXT if positive nodes
Palliative DXT if inoperable
Prognosis – 75% 5-year survival or 90% if No nodes involved
T/F
XRT is contraindicated for Rx of Verrucous carcinoma (Giant condylomata of Buschke-Lowenstein)
True
can induce anaplastic transformation with worse prognosis
T/F Verrucous carcinoma (Giant condylomata of Buschke-Lowenstein) has a worse prognosis that other genital SCC
False large but well circumscribed rarely metastasises treat with excision oral retinoids have been used
T/F Verrucous carcinoma (Giant condylomata of Buschke-Lowenstein) is strongly associated w/ HPV
True
T/F
melanoma accounts for 5% of vulval malignancies but is exceptionally rare on the penis
True
T/F
Langerhans cell histiocytosis mostly presents with perianal ulceration
True
can also be be plaques, nodules, erosions, ulcers or pustules
T/F
Langerhans cell histiocytosis affecting the genital region can be primary or secondary (disseminated)
True
T/F
Langerhans cell histiocytosis of the genital region is more common in men than women
False
F>M
Which rare tumours can affect the genitals?
DFSP, liposarcoma, epitheloid sarcoma, Merkel cell carcinoma, Kaposi’s sarcoma(in HIV), Bartholin’s gland carcinoma, Langerhan’s cell histiocytosis, lymphoma (NHL>Hodgkins)
Benign - trichoepithelioma (esp in Bazex), hidradenoma papilliferum (mostly on vulva)
Mets;
Cervix>endometrium>vagin>ovary
>urethra>kidney>breast>lung
endometriosis can affect the vulva
T/F
Necrolytic migratory erythema can affect the anogenital region
True
anogenital skin and buttocks, legs and lower abdomen as well as mouth, tongue and perioral skin
T/F
localised genital papular acantholytic dyskeratosis is thought to be an attenuated form (forme fruste) of one either Dariers or Hailey-hailey
True
T/F
Hypertrophy of labia minora seen in neurofibromatosis
True
T/F
clitoral pseudocyst is a feature of vulval LS
True
debris accumulates under clitoral hood adhesions
T/F
sexual abuse should be considered if supposed LS does not improve with Rx
True
T/F
It is illegal to perform FGM on an Australian citizen overseas
True
and illegal in all states of Australia
T/F
FGM is allowed if consent has been given
False consent (from the woman herself or parents of girl) is not a defence
T/F
Reporting FGM is mandatory for healthcare professionals
True
Which inflam dermatoses can cause vaginal discharge?
Lichen planus
Pemphigus
Mucous membrane pemphigoid
SJS
Which 3 common inflam dermatoses may involve the vulva without involving other sites?
Seb derm
Irritant contact dermatitis
Allergic contact dermatitis
T/F
allergic contact dermatitis of the vulva is more common than irritant
False
irritant much more common
Which iritants are implicated in vulval ICD?
urine vaginal discharge Topical medications soaps, bath additives lubricants, contraceptives disinfectants perfumes, deodorants
Which allergens are implicated in vulval ACD?
vaginal medicaments, IUD, condoms, sanitary wear
NB not semen - causes type 1 hypersens (urticaria)
Which allergens are implicated in vulval contact urticaria?
2 common causes – latex and semen
• Can use immunotherapy for semen allergy
What condition causes circinate balanitis (circiante ulcerative vulvitis)
Reactive arthritis (Reiter’s)
What is Chronic vulval purpura?
quite common condition
Purpuric patches often at vestibule
haemosiderin, plasma cells, non-specific features
may be assoc w/ PPD
T/F
5-10% of Crohn’s pts get anogenital invovlement
False
30%
direct extension or metastatic
Deep linear fissures along skin creases = knife cut sign
What are causes of genital (mainly vulval) ulcers?
Acute; Benign apthae - can be small or large Sutton's ulcer - solitary, recurrent, painful vulval ulcer Lipschutz’s ulcer – adolescent girls, often with EBV CMV can rarely cause ulcer Behcets diseas MAGIC syndrome HSV syphylitic chancre (painless) chancroid (haemophilus ducreyi) (painful 'Do Cry') EM Major SJS/TEN
Chronic; fixed chronic genital ulcer is cancer until proven otherwise; SCC>BCC>MM>rare tumours or mets Langerhans cell histiocytosis Bartholins gland abscess LGV - late stage Pemphigus vulgaris or vegetans MMP severe contact dermatitis LP LS Crohns HS PG Drugs XRT DA Malakoplakia - ulcerating soft plaque due to granuloamtous response to staph, pseudamonas, E.coli etc atypical infection - Fournier gangrene/nec fasc, TB, actinomycosis, deep mycobacteria
What are the anogenital complications of Crohns?
Anal and perianal conditions o Maceration o Erosion o Pruritis ani o Sin tags o Secondary infection o ‘metastatic’ granulomatous plaques o Perianal abscess o Fissure in ano o Fistula in ano Spreading ulceration of perineum and buttocks post colectomy • Skin changes around stoma sites • Genital lesions Men - Balanitis - Posthitis - Chronic penile lymphoedema and granulomatous lymphangiitis Women - Vulval lesions
what are the DDs of genital LS?
LP
morphoea
mucous membrane pemphigoid
lichen simplex chronicus
These are all DDs for each other
Clinical and histo overlap between morphoea, LP and LS (may be a spectrum)
what is the most common organism to cause vulval cellulitis?
Beta haemolytic group A strep
most commonly occurs after surgery
what is the most common organism to cause infection of anogenital hidradenitis suppuritiva?
Staph and strep esp Strep Milleri
T/F
Genital Diphtheria causes ulcers with greyish membrane
True
Corynebacteria diphtheriae
rare in developed countries due to vaccination
T/F
Pubic hair loss can be a feature of leprosy
True
What are triggers/predisposing factors for candidal vulvovaginitis?
pregnancy high dose Oe OCP diabetes immunosuppression antibiotics course
Which species of dermatophyte are most common in the perianal/ inguinal region?
T. Rubrum and Epidermophyton floccosum
What is the presentation of Trichomonas vaginalis (TV)?
Protozoan infection (most common type in vulva, STI)
asymptomatic in 50%
causes cervicitis
grey-green thin/thick malodorous discharge
Other rarer protozoa which can infect vulva;
• Leishmania tropica
• Entamoeba histolytica
• Schistosoma haematobium (schistosomiasis)
What is Bacterial vaginosis (BV)?
Infection caused by Gardnerella+ another bacteria together eg bacteroides, mycoplasma
grey, watery, fishy smelling d/c
Increased vaginal pH (less acidic)
Test
Whiff test - add 10% KOH to sample of discharge - +ve if strong fishy odour produced
Wet mount - smear of discharge on microscope slide with salt - Clue cells often seen if BV present
Not an STI
treat w/ metronidazole
T/F
Vulval molluscum is extremely rare
False
Not that rare
Lesions on mons and lab maj
Common in children and usually not a sign of abuse
More likely to be sexually transmitted in adults
Can be solitary or several
if many large mollusca think of immunosuppression/ deficiency including HIV
T/F
Cowpox is most commonly acquired from cows?
False
From domestic cats
Which viruses cause sexually transmitted and non- sexually transmitted genital infections/ulcers?
Herpes viruses
HSV - STI - type 2 in 50-80%
VZV (S3 dermatome shingles), non-STI
EBV (HHV8) – Sometimes causes genital ulcers during infectious mononucleosis, non-STI
CMV (HHV5) – very rare, immunosuppressed pts, perineal ulcers, non-STI
Papillomaviruses
genital warts and cancers
Pox viruses
Molluscum - can be STI esp in adults
Very rarely Orf or cowpox, non-STI
What is vulvodynia?
what are the subtypes?
Pain or discomfort for 3 months or more without any visible abnormality or explanation
o Strictly a diagnosis of exclusion
Types;
Dysaesthetic vulvodynia = spontaneous diffuse vulval pain; may or may not be triggered by touch or other stimuli; older, post-menopausal women
Vestibulodynia = pain localized to vulval vestibule triggered by touch alone; young women
Triad of
- Erythema of epithelium of vestibule
- tenderness to light touch
- dyspareunia
T/F
dermographism as this can mimic or exacerbate vulvodynia
True
assess for this elswhere if vulval discomfot and no cause found
T/F
Vestibulodynia can turn into dysaesthetic vulvodynia
True
What is management of of vulval pain syndromes?
First confirm and define diagnosis and exclude a physical cause of pain - full Hx and exam, psych Hx
Check for atrophic vaginitis in older women (and younger if early menopause)
Need lots of explanation/ hand holding
Avoid precipitants eg) excessive touching
General measures - soap free wash, avoid irritants
5% lidocaine ung useful and low risk of contact sensitivity. Avoid other amide anaesthetics as higher risk of sensitivity
Add oral antihistamine if pt ahs dermographism
Oral options – consider referral to pain clinic
Tricyclic antidepressant – amitryptaline
Pregabalin
Gabapentin
Carbamazepine
Involve psych if associated psych or psychosexual issues
Biofeedback useful esp if vaginismus
Self help group may be useful
T/F
pruritus vulvae affects most women at some time
True
T/F
pruritus vulvae/scroti is usually psychogenic
False
usually a cause
1 in 20 psychogenic
What is management of pruritus vulvae/scroti?
Need full work up similar to pruritus ani
In women most cases due to candida, BV or TV.
In acute cases consider infection or allergic or irritant contact derm
Chronic cases may be almost any dermatosis as most cause itch or malignancy or in women atrophic vaginitis
Rarely could be due to lumbosacral nerve damage/entrapment/radiculopathy
What is Dermatitis vegetans?
loose term for any vegetating looking inflamed lesion. This is a common occurrence of many conditions in the perianal area. The term is not a full diagnosis in itself
List some typical contact allergens in the perianal area
Neomycin
Caine mix (LA in haemorrhoid preparations)
Kathon CG (mix of MI + Methylchloroisothiazolinone)
Quinolones
Lanolin
Ethylenediamine
Nystatin
Latex (condoms)
Spermicides
Danthron – From laxatives not topical application
What is Danthron erythema?
Irritant contact dermatitis due to laxatives containing danthron
Danthron reduced in the bowel to chemical identical to dithranol
Pts with foecal incontinence get dermatitis that is essentially dithranol ‘burns’ – bizarre livid erythema in perianal area, groins, thighs and buttocks with sharp outlines
Seen in pts with Hirschsprungs disease or encopresis (foecal incontinence)
T/F
Lichen sclerosus et atrophicus does not occur in perianal region in men
True
What are the DDs for the appearance of perineal HS?
HS STIs eg) lymphogranuloma venereum Non venereal infection (is there diabetes or immunosuppression?) Crohn’s Chloracne Simple faruncle or perianal abscess or pilonidal sinus Severe acne Developmental fistulae
T/F
Long term Hidradenitis suppuritiva in perianal region has signif risk of SCC
True
+ rarely verrucous carcinoma
T/F
Perianal skin is affected in 75-90% of Crohn’s patients
True Can be; Maceration Erosion Pruritus ani Sin tags Secondary infection ‘metastatic’ granulomatous plaques Perianal abscess Fissure in ano Fistula in ano
T/F
anus involved in 25% of SJS
False
5%
T/F
Pruritus ani is 4x more common in men
True
T/F
Pts with colostomies dont get pruritus ani
True
T/F
Pruritus ani affects 15% of population
False
1-5%
T/F
Primary pruritus ani where no cause is found accounts for 50% of cases
True
The other 50% are secondary where there is a cause - cutaneous, anorectal or colonic disorder
List causes of pruritus ani
Often multifactorial
Foecal contamination is a common aetiological factor in many cases - infection and/or contact dermatitis may complicate the primary cause
- Skin diseases – most common causal group; LP, LS, Pso, Seb derm, ACD
- Infection; candida, staph, folliculitis, erythrasma, tinea, genital warts, pinworms
- Local Malignancy; anal or colonic, Pagets, IEC
- Any cause of generalized pruritus; liver Dx, Renal Dx, Thyroid Dx, iron deficiency, lymphoma, polycythaemia, pregnancy, diabetes
- Deficiency; Pellagra, zinc, Vit A or D (fat malabsorption or low fat diet)
- Anal leakage/recurrent diarrhoea
- Drugs (opiates, laxatives), XRT
- Psych; habitual, delusions of parasitosis
T/F
Excision of skin tags if present can help settle pruritus ani
False
often no help
T/F
Menthol cream is good for relieving the symptoms of pruritus ani
False
menthol not effective
Management plan for pruritus ani
Need full work up - Hx and exam whole body, diet, exclude cancer, patch test if req, Blds for causes of itch
Treat underlying cause
Avoid irritants
Soap free wash
Stop topical medicaments unless contact allergy excluded
Moisturize after washing – ointment not cream; zinc or silicone preparations
Apply barrier cream before opening bowels
Must have meticulous hygiene
Sitz baths or bidet can help
Cool compresses
Avoid rubbing with toilet paper –dab or wash in bidet if possible
Avoid moist wipes as often cause irritation/ACD unless bland formulation
Loose cotton underwear
Diet – avoid laxatives
Can use topical steroid/antibiotic/antifungal if needed for acute episodes
Oral or intralesional steroids
antihistamines
Wick of bandage impregnated with 1% HCT and 10% silicone inserted in natal cleft
T/F
perianal fissure is most commonly anterior
False
Mostly posterior
90% in men, 70% in women
T/F
Topical GTN cream relaxes the sphincter allowing a perianal fissure to heal
True
Botox also
What is a perianal fistula?
An abnormal epithelialized connection between anal canal and perianal skin
Caused by infection of anal glands resulting abscess and sinus that become a fistula
• Can be caused by Crohn’s, foreign body or TB
• Hidradenitis suppuritiva is differential
What is Goodsall’s law
Regarding perianal fistulae;
if the external opening is in the posterior perianal region it usually opens into the anus in the midline
If the external opening is anterior it opens directly into anus in a straight line
T/F
Haemorrhoids occur at the 11, 3 and 7 o clock positions
True
T/F
Pilonidal sinus derives from a perineal pilosebaceous unit which froms a cyst and then a deep sinus track
True
T/F
SCC is a rare complication of both perianal fistula and pilonidal sinus
True
T/F
Anogenital shingles is a relatively benign form
False
can be serious
Rare; S2-4 >L1-2 dermatomes
Can cause acute cystitis and urinary retention
Can cause foecal retention
Need to hospitalize and treat and fully work up with colorectal and urological examination
Check for HIV or other immunosuppression
T/F
Women with AIN have increased risk of CIN and VIN
True
– need full gynae exam
What are the risk factors for anal carcinoma?
smoking CIN, anogenital warts MSM Crohn’s (10x increased risk) STIs; including Chlamydia, gonorrhoea, HSV and HPV Immunosuppression LS, LP, HS
T/F
anal carcinoma is most often adenocarcinoma
False
>50% SCC
T/F
anal carcinoma is
o More common in women
o More aggressive in men
True
T/F
75% of perianal EMPD presents as pruritus ani
True
What are the treatments of EMPD?
surgery is mainstay
– may need margin control multistep procedure/Mohs
Plastic repair with grafting/flap
XRT is option for if surgery contraindicated or refused or recurrent
PDT and laser have been used
Others as per genital EMPD – efudix, aldara
What is Proctalgia fugax?
Mainly young adult males
Often occurs at night – may wake pt from sleep
Sudden onset cramp-like or stabbing pain in rectal area which resolves in few minutes or is relieved by digital dilatation of anal sphincter
What is Episodic burning perineal pain with itch?
Stressed individuals
Short lived intense symptoms
May be precipitated by full rectum
Skin is normal
What is a sister Mary-Joseph’s nodule?
Skin met from GIT tumour to umbilicus mostly from stomach cancer F>M 41% present before diagnosis of the primary tumour DDs EMPD Pyogenic granuloma talc granuloma endometriosis choristia - intestinal mucosa
T/F
Gastroschisis usually protrudes to the left of the umbilicus
False
always to the right side of umbilicus
= extrusion of abdominal contents without a covering membrane
What is prune belly syndrome?
v rare conditon named due to wrinkled abdominal skin triad; hypoplastic abdominal musculature urinary tract abnormalities cryptorchidism
T/F
early surgery is recommended for congenital umbilical hernia
False
usually resolves by age 5
surgery only if complications (common)
What are associations of congenital umbilical hernia?
Low birth weight afro-caribbean ethnicity congenital hypothyroidism Ehlers-Danlos (dermatospraxis type) Beckwith-Wiedmann syndrome mucopolysaccharidoses cutis laxa
T/F
Umbilical granuloma is most common cause of umbilical mass in neonates
True glistening red topical silver nitrate scan +/- biopsy of non-resolving DD is omphalomesenteric duct malformation
T/F
delayed separation of the umbilical stump may be due to leukocyte adhesion defects
True
T/F
Angiokeratomas in Fabrys disease can present as a perimumbilical rosette
True
Which 2 allergens commonly cause periumbilcal allergic contact dermatitis?
Nickel
dibenzyldithlocarbamate - rubber chemical in elastic waist bands which reacts with bleach
What is clear cell papulosis?
Rrae disease of young children
may be related to EMPD
due to defect in melanogenesis
hypopigmented macules or flat papules on lower abdomen close to umbilicus or along milk lines
Which bullous diseases have a predilection for the region of the umbilicus?
pemphigoid gestationis
Linear IgA/ chronic bullous disease of childhood
T/F
periumbilical thumbprint purpura is a sign of hyperinfection syndrome caused by larva currens (strongyloides)
True
T/F
perimumbilical Rose spots are a feature of measles
False
pale pink abdominal macules seen in enteric fever due to salmonella typhi or paratyphi
pt has fever, abdo pain, hepatosplenomegally, anorexia, constipation
What is an omphalith?
Omphalith is an accumulation of keratinous and
sebaceous material in the umbilicus, commonly
resulting from poor hygiene
T/F
umbilical erythema affects 9% of pts with cows milk protein intolerance
True
T/F
Primary systemic amyloidosis may present with umbilical petechiae, purpura, and ecchymoses
True
Which benign neoplasms affect the umbilicus?
acrochordon keloid lipoma neurofibroma dermatofibroma seb k pyogenic granuloma umbilical polyp syringoma melanocytic naevi (special site) epidermoid cyst epidermal naevus desmoid tumour endometriosis condylomata acuminata granular cell tumour
Which malignant neoplasms affect the umbilicus?
BCC SCC Melanoma EMPD Adenocarcinoma of urachal elements MF
Which genodermatoses may be associated with vulval melanosis?
JAAD paper 2015 Peutz-Jeghers carney complex LEOPARD Bannayan-Riley-Ruvalcaba Dowling-Degos
What percentage of pts with genital LS have extragenital disease?
15-20%
T/F
most prepubertal girls with LS will grow out if by puberty
F
used to think it resolved in most but latest data says it persists in 75%
