Skin Anomalies Pathological Noninfective

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LICHEN SCLEROSIS

Lichen sclerosis is an inflammatory condition of unknown aetiology that most commonly occurs in the anogenital skin of both men and women. The main symptoms are itchiness and soreness; however, lichen sclerosis can occur without symptoms. Lichen sclerosis causes typical white plaques on the skin of the genitalia. Characteristic features in women are whitening and scarring atrophy, causing gradual destruction of normal vulval architecture, with burying of the clitoris and reabsorption of the labia minora. Eventual narrowing of the introitus is also known to occur. Lichen sclerosis may occur in skin already scarred or damaged (the Koebner phenomenon), so that trauma, injury, and sexual abuse have been suggested as possible triggers of symptoms in predisposed people. There is a small risk of developing squamous cell carcinoma on a background of lichen sclerosis, and biopsy of suspicious lesions is common.

LICHEN PLANUS

Lichen planus is an inflammatory eruption of the skin and mucous membranes of unknown aetiology. In the reticular (lacy) pattern there may be mild to severe pruritus, and the erosive and ulcerative form presents with pain and burning. On examination there may be small purple papules with a lacy or reticulated surface. In erosive disease there may be a glazed erythema with tenderness to touch or frank almost ulcerated erosions, often with a lacy or slightly greyish edge.

LICHEN SIMPLEX

Classically this condition is the end-result of intense, chronic pruritus that results from repetitive rubbing or scratching. The skin responds by thickening and the increase in skin markings is referred to as lichenification. This occurs mostly in individuals with a history of allergies, eczema, hay fever or asthma. They have sensitive and easily irritated skin.

VITILIGO

Vitiligo is thought to be an autoimmune disease in which the melanocytes at the border of the dermis and epidermis are destroyed. It tends to occur around orifices, and genital skin involvement sometimes occurs before involvement of other parts of the body. It is characterised by patches of sharply demarcated milk white skin with no signs of texture change.

ECZEMA

Eczema is a non-infectious condition that may develop following skin irritation or via an immune pathway. Eczema is a collection of clinical findings rather than a particular disease. Patients may present with papules, vesicles, erythema, fissures, weeping and oedema in an acute stage. Itching is often present, and angular and linear erosions produced by finger nails are common. Scaling and lichenification are common in the chronic stage. When lichenification occurs on the mucous membrane of the vulva the skin frequently becomes white.

PSORIASIS

Psoriasis often affects the genital area and typically presents as a well-demarcated pink plaque. The glans penis is a common site, and psoriasis of the vulva can present as discomfort. Other mucosal sites are rarely affected. Because of the moist nature of the genitalia the scaly nature of psoriasis is not readily obvious in psoriasis of the genitalia compared with that of other parts of the body.

CONTACT DERMATITIS

Contact dermatitis of the genital skin falls into two categories: irritant contact dermatitis and allergic contact dermatitis. Irritant contact dermatitis is a response to contact with an irritating substance. This is considered a mild chemical burn, and the appearance is erythematous, with oedema and exudation in more severe cases. It occurs rapidly, and is treated by elimination of the irritant. Allergic contact dermatitis occurs more slowly following contact with an allergen, and appears more like eczema, though allergic and irritant contact dermatitis are frequently indistinguishable.

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