Genital Dermatology Flashcards

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1
Q

When someone complains of itchy genitals what should we do?

A

Break it down into

  • Infectious
  • Inflammatory
  • Neoplastic
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2
Q

What are some causes of infection/infestation in the genitals?

A
  • Candidiasis - Treat partners aswell.
    • For ladies use cream and nightly pessaries for 1-3 nights.
    • If recalcitrant, give or fluconazole 150mg stat
    • If very resistant then for 1 week.
  • Scabies
  • Herpes Simplex - HSV-2. Treat with oral aciclovir.
  • HPV - condylomata accuminata - can be solitary or coalescent. Treat with CO2 laser, cryotherapy, podophyllin or imiquimod.
  • Erythrasma - symmetrical brown red scaling. Wood’s light flouresces coral red. Treat with azoles or erythromycin.
  • Tinea Cruris - usually never infects the labia minora or the scrotum or penis.
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3
Q

What are some inflammatory disorders in the genitals?

A
  • Eczema/Contact Dermatitis - if not responding to steroids consider patch testing.
  • Lichen Simplex Chronicus - check serum ferritin if generalised itch.
  • Psoriasis - genitals affected in 20% of cases.
  • Seborrhoeic Dermatitis
  • Lichen Sclerosus
  • Lichen Planus - tx with steroids, tacrolimus, antimalarials, dapsone or systemic immunosuppressants.
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4
Q

What is this?

A

Lichen sclerosus

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5
Q

Who usually gets lichen sclerosus?

A

Post-menopausal women

But can also occur in childhood.

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6
Q

What are some features of Lichen Sclerosus?

A
  • Whitish pallid atrophic
  • Sclerotic plaques affect the labia, clitoris or introitus, and the perianal area in women may also be involved - the so-called ‘figure of 8’ sign.
  • Longstanding
    • Fusion of the labia
    • Loss of the clitoral hood
    • Narrowing of the introitus.
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7
Q

What is this?

A

Lichen Planus

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8
Q

What are the clinical features of lichen planus on the genitals?

A
  • Keratinised skin lesions appear identical to those elsewhere - i.e. violaceous papules with Wickham’s striae.
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9
Q

What is this?

A

Genital Psoriasis.

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10
Q

What is this?

What are the penile and anal versions called?

A

VIN (Vulval Intraepithelial Neoplasia)

PIN (Penile Intraepithelial Neoplasia)

AIN (Anal Intraepithelial Neoplasia)

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11
Q

What is neoplasia of the genitals associated with?

A

HPV

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12
Q

What can VIN or PIN be confused with?

A

Lichen sclerosus, Lichen Planus or HPV infection.

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13
Q

If you suspect VIN or PIN what should you do?

A

Biopsy.

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14
Q

When someone complains of painful genitals, how should we subclassify it?

A

Genital pain with visible vulval lesions

Genital Pain WITHOUT visible vulval lesions.

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15
Q

What are some causes of genital pain with visible vulval lesions?

A
  • Infections -
    • Herpes simplex (acute or recurrent),
    • candidiasis (remember syphilitic primary chancre is painless)
  • Inflammatory
    • ​Lichen sclerosus,
    • lichen planus,
    • Behcet’s disease,
    • Pemphigus vulgaris,
    • Cicatricial Pemphigoid ,
    • Stevens Johnson syndrome,
    • Crohn’s disease
  • Neoplastic -VIN, SCC
  • Drugs - bullous drug eruption, TEN
  • Atrophic vulvovaginitis also relevant in an older patient.
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16
Q

What is the main cause of vulval pain WITHOUT visible vulval lesions?

A

Vulval Pain syndrome

This is subdivided into:

  • Vulvar Vestibulitis Syndrome
  • Dysaesthetic Vulvodynia
17
Q

Tell me about Vulvar vestibulitis Syndrome?

A
  • Premenopausal women.
  • Dyspareunia on penetration
  • O/E: normal vulva. Gently pressing the vestibule produces severe pain.
  • Treatment
    • Vulval care - avoid soaps and bubble baths, tight underwear and tight trousers.
    • Treat with TCA (Amitryptiline 25-50mg Nocte and titrate up.
    • Consider Gabapentine as an alternative.
18
Q

Tell me about Dysaesthetic Vulvodynia?

A
  • Persistent burning pain over the entire vulva.
  • Worsened by movement or wearing underwear.
  • Associated with IBS.
  • Treatment
    • TCA, acupuncture, self help groups.
19
Q

What is the male equivalent of dysaesthetic vulvodynia called?

A

Scrotodynia

20
Q

What is this?

A

Genital Psoriasis

21
Q

What is this?

A

Scabies

22
Q

What is this?

What is it associated with?

A

Lichen Sclerosus

Autoimmune diseases - in particular thyroid disease

23
Q

What is this and what is the treatment?

A

Lichen Planus

Topical steroids

24
Q

if you have genital warts, what are you at increased risk of getting?

A

Genital neoplasia

25
Q

What is this?

A

Genital Herpes

Treat with aciclovir.

26
Q

What is this?

A

Bowenoid Papulosis

  • Seborrhoeic keratosis-like lesions on genitalia
  • Sometimes over the thighs.
  • Pre-malignant and needs observing.
  • May respond to cryotherapy.
27
Q

Describe the 2 types of condylomata?

A
  • Condylomata lata - Syphilis
  • conylomata accuminata - HPV
28
Q

What are the infectious causes of penile lesions?

A
  • Syphilis - chancre on genitals or oral mucoa appears 2-3 weeks after sexual contact.
    • Painless and associated lymphadenopathy.
    • Condylomata lata - secondary syphilis - very infectious.
  • Human Papilloma Virus - the conylomata accuminata
  • Herpes Simplex
    • 3-4 weeks to heal.
    • 304 days of prodromal neuralgic pain.
  • Molluscum Contagiosum
29
Q

What are the inflammatory causes of penile lesions?

A
  • Lichen Sclerosus (Balanitis Xerotica Obliterans)
  • Lichen Planus - affects shaft or glans.
  • Zoon’s Balinitis
  • Psoriasis
  • Behcet’s Disease
30
Q

What is this?

A

Zoon’s Balanitis

  • A result of poor genital hygeine
  • Only happens in uncircumcised men
  • Cure is circumcision.
31
Q

What is this?

A

Penile Lichen planus

32
Q

What is this?

A

Penile Lichen sclerosus

aka BXO

(Balanitis Xerotica Obliterans)

33
Q

What is the treatment for BXO?

A

Super-potent topical steroids.

(It can predispose to SCC formation)