Genital Dermatology Atlas

346 Pages·2010·29.127 MB·English

by  Libby Edwards, Peter J. Lynch

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Genital
Dermatology
Atlas
S E C O N D E D I T I O N
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Genital
Dermatology
Atlas
S E C O N D E D I T I O N
Libby Edwards, MD
Chief of Dermatology
Carolinas Medical Center
Charlotte, North Carolina
Peter J. Lynch, MD
Frederick G. Novy Jr. Professor of Dermatology
Department of Dermatology
University of California, Davis
Sacramento, California
With contributions from
Sallie M. Neill, MD, FRCP
Consultant Dermatologist
St. Johns Institute of Dermatology
Guy’s and St. Thomas’ NHS Trust,
London, United Kingdom
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Library of Congress Cataloging-in-Publication Data
Genital dermatology atlas/edited by Libby Edwards, Peter J. Lynch; with contributions from Sallie M. Neill.—
2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60831-079-1
1. Genitourinary organs—Diseases—Atlases. 2. Skin—Diseases—Atlases. I. Edwards, Libby. II. Lynch, Peter J.,
1936- III. Neill, Sarah M.
[DNLM: 1. Genitalia—pathology—Atlases. 2. Skin Diseases—diagnosis—Atlases. 3. Genital Diseases, Female—
diagnosis—Atlases. 4. Genital Diseases, Male—diagnosis—Atlases. WR 17 G331 2011]
RC872.G46 2011
616.5—dc22
2010006910
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To my Aunt Sara, who brings me joy and comfort
and
To Marrise Phillips, who, for her whole life, has brought joy and comfort to her patients,
family, and friends
Libby Edwards
To Barbara, my best friend and wife for nearly 50 years, to Deborah and Timothy, our
wonderful children together with their families: your love and support are a glorious gift that
gives my life meaning and happiness.
Peter Lynch
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C O N T E N T S
Preface vii Intraepithelial Neoplasia (Bowen Disease, Squamous
Cell Carcinoma in Situ, and Erythroplasia of Queyrat) 81
1 Genital Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
7 Red Papules and Nodules . . . . . . . . . . . . . . . . . . . 84
Libby Edwards
Female Genitalia 1 Peter J. Lynch
Male Genitalia 7 Folliculitis 84
Keratosis Pilaris 84
2 Principles of Genital Diagnosis and Therapy. . . 11 Nodular Scabies 85
Miscellaneous Bites and Infestations 86
Peter J. Lynch
Cherry Angioma 87
General Principles of Diagnosis 11
Angiokeratoma 87
General Principles of Therapy 14
Prurigo Nodularis (Picker’s Nodule) 88
General Considerations 14
Pyogenic Granuloma 89
3 Diagnostic and Therapeutic Procedures. . . . . . . 21 Urethral Caruncle 90
Urethral Prolapse 90
Libby Edwards Vulvar Endometriosis 91
Diagnostic Procedures 21 Hematoma 91
Therapeutic Procedures 29 Hidradenoma Papilliferum (Mammary-Like Gland
Adenoma) 92
4 Genital Pruritus and the Eczematous Diseases. . 31 Kaposi Sarcoma 92
Pseudowarts (Diaper Dermatitis of Jacquet, Granuloma
Peter J. Lynch
Gluteale Infantum) 93
Idiopathic (“Essential”) Pruritus 31
Furunculosis 93
Atopic Dermatitis and Lichen Simplex Chronicus 32
Inflamed Cysts 94
Irritant Contact Dermatitis 38
Hidradenitis Suppurativa (Acne Inversa) 95
Allergic Contact Dermatitis 41
Miscellaneous Red Papules and Nodules 98
Seborrheic Dermatitis and Intertrigo 43
8 Yellow and Pustular Lesions. . . . . . . . . . . . . . . . 101
5 Genital Pain Syndromes. . . . . . . . . . . . . . . . . . . . . 46
Libby Edwards
Libby Edwards
True Pustular Diseases 101
Causes of Genital Pain 46
Solid Lesions That Sometimes Appear Pustular 114
Other Diseases That Can Appear Yellow or Produce
6 Red Plaques and Patches. . . . . . . . . . . . . . . . . . . . 57
Crusting 118
Libby Edwards
9 Erosive and Vesiculobullous Diseases . . . . . . . 121
Atopic Dermatitis, Eczema, and Lichen Simplex Chronicus 57
Contact Dermatitis 57 Libby Edwards
Seborrheic Dermatitis 60
Noninfectious Inflammatory Dermatoses
Psoriasis 62
That Sometimes Erode 121
Tinea Cruris (Jock Itch) 67
Primary Blistering or Pustular Infections 128
Erythrasma 69
Noninfectious Blistering Eruptions 135
Candidiasis 70
Pseudovesicular Conditions 149
Perianal Streptococcal Disease (Perianal Streptococcal
Malignancies Presenting As Erosions 151
Cellulitis) 73
Genital Skin Fold Fissures 152
Lichen Planus 73
Posterior Fourchette Vulvar Fissures 154
Pityriasis Rosea 76
Pityriasis (Tinea) Versicolor 76 10 Ulcers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Plasma Cell Mucositis (Plasma Cell Vulvitis and Balanitis,
Peter J. Lynch
Zoon Mucositis, Vulvitis, and Balanitis Circumscripta
Plasmacellularis) 77 Syphilis 158
Vestibulodynia (Vulvar Vestibulitis Syndrome, Vestibular Chancroid 160
Adenitis) 79 Genital Herpes in Immunosuppressed Individuals 162
Red Scrotum Syndrome 79 Granuloma Inguinale (Donovanosis) 164
Extramammary Paget Disease 80 Lymphogranuloma Venereum 166
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viii | CONTENTS
Epstein–Barr Virus and Cytomegalovirus-Associated Ulcers 166 14 Pediatric Genital Disease. . . . . . . . . . . . . . . . . . . 245
Aphthous Ulcer and Complex Aphthosis 166
Libby Edwards
Behçet Disease 169
Aphthous-Like Ulcers Associated with Viral Infections 170 Normal Genitalia 245
Aphthous-Like Ulcers Associated with Medications 170 Congenital Abnormalities 246
Crohn Disease 171 Red Plaques and Papules 249
Pyoderma Gangrenosum 173 Skin-Colored Lesions 263
Ulcers Due to External Trauma 174 White Lesions 264
Miscellaneous Ulcers 176
15 Vaginitis and Balanitis . . . . . . . . . . . . . . . . . . . . . 268
11 White Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Libby Edwards
Sallie M. Neill Vaginitis 268
White Patches and Plaques 178 Balanitis 283
White Papules and Nodules 194
16 Special Issues in Genital Dermatology:
12 Skin-Colored Lesions . . . . . . . . . . . . . . . . . . . . . . 197 Psychosexual Matters, Concerns
of Immunosuppression, and Aging. . . . . . . . . . . 289
Peter J. Lynch
Peter Lynch and Libby Edwards
Genital Warts 197
Molluscum Contagiosum 202 Psychological Issues 289
Condyloma Latum 205 Psychosocial Dysfunction May Cause Disease 289
Lymphogranuloma Venereum 206 Psychosocial Dysfunction Influences the Course
Epidermal Cysts (Epidermoid Cysts) 206 of Disease 291
Mucinous Vestibular Cysts 207 Psychosocial Dysfunction Occurs as a Result of Disease 292
Cysts of the Median Raphe 208 Immunosuppression 293
Pilonidal Sinus (Pilonidal Cyst) 208 Infections 293
Bartholin Cysts and Abscesses 208 Noninfectious Inflammatory Diseases Associated with HIV 300
Skin Tag (Acrochordon, Fibroepithelial Polyp) 209 Neoplastic Diseases 303
Intradermal Nevi (Dermal Nevi) 210 Geriatric Issues 305
Neurofibroma 210
Lipoma 210 Appendix A Classification of Genital
Pearly Penile Papules 210 Disorders . . . . . . . . . . . . . . . . . . . . . . 311
Vulvar Vestibular Papillomatosis 211
Peter J. Lynch
Fordyce Spots and Sebaceous Gland Hyperplasia 211
The Rationale for Classification 311
Tyson Glands 212
Approaches Used for Classification 311
Fox–Fordyce Disease 212
Our Preferred Approach for Classification 311
Hidradenoma Papilliferum (Mammary-Like
Alternative Classifications 312
Gland Adenoma) 213
ISSVDClassification of Vulvodynia (2003) 312
Lichen Nitidus 213
ISSVDClassification of Squamous Cell Vulvar
Sclerosing Lymphangitis of the Penis 214
Intraepithelial Neoplasia (2004) 312
Squamous Carcinoma in Men 214
ISSVDClassification of Vulvar Dermatoses (2006) 313
Squamous Cell Carcinoma in Women 217
Basal Cell Carcinoma 220
Appendix B Patient Education Handouts. . . . . . 315
Genital Edema 222
Libby Edwards
13 Pigmented Disorders. . . . . . . . . . . . . . . . . . . . . . . 228
Atrophic Vagina and Atrophic Vaginitis 315
Peter J. Lynch Candida (Yeast) Vaginitis 316
Desquamative Inflammatory Vaginitis 317
Physiologic Hyperpigmentation 228
Hidradenitis Suppurativa 318
Acanthosis Nigricans 228
Lichen Planus 319
Postinflammatory Hyperpigmentation 229
Lichen Sclerosus 320
Seborrheic Keratoses 231
Genital Lichen Simplex Chronicus (Eczema,
Pigmented Warts 231
Neurodermatitis, and Dermatitis) 322
Genital Intraepithelial Neoplasia 232
Physiologic Vaginal Secretions (Physiologic
Pigmented Basal Cell Carcinoma 232
Vaginal Discharge) 323
Angiokeratomas 232
Vulvar Care 324
Kaposi Sarcoma 233
Vulvodynia/Vestibulodynia/Vestibulitis 325
Genital Varicosities 233
Genital Melanosis (Lentiginosis) 234
Melanocytic Nevus (Mole, Pigmented Nevus) 236
Index 327
Melanoma 240
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P R E FA C E
Patients with disorders of the external genitalia are is before he or she can look up other relevant information
cared for by individuals with many different educational such as laboratory evaluation and treatment options. In
backgrounds: dermatologists, gynecologists, urologists, contradistinction, the information in our book is organ-
primary care physicians, nurse practioners, and physician ized on the basis of clinical morphology. Once the ap-
assistants. Unfortunately, the training programs for each pearance of the condition is determined, use of the diag-
of these areas rarely provide the necessary educational nostic algorithm found in Chapter 2 quickly directs one
preparation needed to offer the level of care that patients to the chapter containing those disorders that constitute
with genital disease want and deserve. This textbook, the differential diagnoses for the unrecognized disease. At
which is based on the authors’ 70 years of combined expe- that point, a short review of the photos and the narrative
rience, is designed to offer additional comprehensive, clinical information generally allows for identification of
practical information that is needed to supplement what- the single most likely diagnosis. Using this approach, it is
ever baseline knowledge is being brought to the clinic. even possible to correctly recognize a disease that one has
Making the correct diagnosis represents both the first never previously encountered!
and most important step in caring for these patients. Most Many genital diseases present with a variety of clinical
disorders of the external genitalia are in the broadest sense appearances. To allow for correct diagnosis of these vari-
dermatologic in nature. Those trained in areas other than ants, such disorders are listed in multiple chapters with the
dermatology are likely to have appreciable difficulty in main coverage being located in the chapter representing
recognizing any but the most common of these condi- the most common presentation. The very large number of
tions. Moreover, because these diseases often have an atyp- photos included in this book is also helpful in this regard,
ical appearance due to their location in the warm, moist as this allows for visual depiction of the many clinical vari-
environment of the genital area, even dermatologists often ants of these diseases. We have also included additional
experience diagnostic difficulty. For this reason, one of the helpful material regarding normal anatomy (including
key features of this book is the arrangement of informa- common variants), symptoms (itching and pain), special
tion in a manner that provides immediate diagnostic help. considerations (immunosuppressive, psychologic, pedi-
Conventional textbooks almost always present infor- atric, and geriatric issues), basic diagnostic and therapeu-
mation organized by etiology or pathophysiology. In tic procedures, and patient handout material.
these books, diseases are arranged in sections such as “in-
fectious diseases,” “neoplastic diseases,” etc. To use such a Libby Edwards, MD
book, the clinician must a priori know what the diagnosis Peter J. Lynch, MD
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