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.


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)


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”


Lichen Sclerosis

Distinguishing Features


  • 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