Genitals



Genitals





OVERVIEW

A large number of conditions involve the skin and mucous membranes of the pubic and genital regions: sexually transmitted diseases such as syphilis, venereal warts, herpes virus infections, molluscum contagiosum, scabies, and pediculosis pubis (“crabs”). A vast number of cutaneous disorders that are found elsewhere on the body, such as psoriasis, atopic dermatitis, seborrheic dermatitis, and lichen planus, are also found in the genital area.



SCROTUM/VULVA


Lichen Simplex Chronicus/Atopic Dermatitis








Distinguishing Features



  • Chronic or paroxysmal pruritus is the primary symptom


  • Thick, leathery skin due to constant scratching and rubbing results in thickening of the skin and exaggerated skin markings (lichenification), with little or no scale (Fig. 16-1)


  • In men, LSC occurs particularly in the posterior portion of the scrotum and the crural creases (Fig. 16-2); the penis is generally spared


  • In women, the labia majora is most often affected (Fig. 16-3)


  • Perianal skin is often involved in both sexes




helpful hintsHelpful Hints



  • A chronic itchy scrotal or vulvar rash is rarely the result of a fungal infection, since tinea infections tend to involve the inguinal areas and spare the scrotum and labia


  • Allergic or irritant contact dermatitis from overwashing, feminine hygiene products, spermicides, and various topical medications, condoms and diaphragms, should also be considered as possible causes (Fig. 16-4)








Scrotal Cyst



Distinguishing Features



  • Solitary or multiple (Fig. 16-5) white cystic lesions


  • When incised, a cheesy-white, rancid, malodorous keratin material can be expressed


  • Such cysts may calcify



Angiokeratomas of Fordyce




Distinguishing Features



  • Asymptomatic 2 to 3 mm red-to-blue papules; solitary or multiple


  • They occur on the medial labia minora in women and the scrotum in men (Figs. 16-6 and 16-7)


  • The overlying surface may show slight scales (hyperkeratosis)



MALE AND FEMALE EXTERNAL GENITALIA


Molluscum Contagiosum



Distinguishing Features



  • Dome-shaped waxy or pearly papules with a central white core (umbilication)


  • Lesions generally 1 to 3 mm in diameter, but may coalesce into double or triple lesions and become “giant” mollusca


  • Generally asymptomatic; may itch and become inflamed (Fig. 16-8)




Pubic Lice (Pediculosis Pubis, “Crabs”)



Distinguishing Features



  • The primary symptom of infestation is pubic itching


  • Often, a sexual partner has “crabs”



Scabies














Lichen Sclerosis



Distinguishing Features


Females



  • Lesions consist of white plaques with epidermal atrophy. The vaginal mucosa may also become involved and display a whitish color with hemorrhages, telangiectasias, or bullae


  • LS can be quite pruritic and result in self-induced excoriations and erosions


  • Dyspareunia may come about as the vaginal mucosa becomes increasingly sclerotic and atrophic