Preface

vii

1

Genital Anatomy   Libby Edwards

1

Female Genitalia

1

Male Genitalia

7

2

Principles of Genital Diagnosis and Therapy   Pater J. Lynch

11

General Principles of Diagnosis

11

General Principles of Therapy

14

General Considerations

14

3

Diagnostic and Therapeutic Procedures   Libby Edwards

21

Diagnostic Procedures

21

Therapeutic Procedures

29

4

Genital Pruritus and the Eczematous Diseases   Peter J. Lynch

31

Idiopathic (“Essential”) Pruritus

31

Atopic Dermatitis and Lichen Simplex Chronicus

32

Irritant Contact Dermatitis

38

Allergic Contact Dermatitis

41

Seborrheic Dermatitis and Intertrigo

43

5

Genital Pain Syndromes   Libby Edwards

46

Causes of Genital Pain

46

6

Red Plaques and Patches Libby Edwards

57

Atopic Dermatitis, Eczema, and Lichen Simplex Chronicus

57

Contact Dermatitis

57

Seborrheic Dermatitis

60

Psoriasis

62

Tinea Cruris (Jock Itch)

67

Erythrasma

69

Candidiasis

70

Perianal Streptococcal Disease (Perianal Streptococcal Cellulitis)

73

Lichen Planus

73

Pityriasis Rosea

76

Pityriasis (Tinea) Versicolor

76

Plasma Cell Mucositis (Plasma Cell Vulvitis and Balanitis, Zoon Mucositis, Vulvitis, and Balanitis Circumscripta Plasmacellularis)

77

Vestibulodynia (Vulvar Vestibulitis Syndrome, Vestibular Adenitis)

79

Red Scrotum Syndrome

79

Extramammary Paget Disease

80

Intraepithelial Neoplasia (Bowen Disease, Squamous Cell Carcinoma in Situ, and Erythroplasia of Queyrat)

81

7

Red Papules and Nodules   Peter J. Lynch

84

Folliculitis

84

Keratosis Pilaris

84

Nodular Scabies

85

Miscellaneous Bites and Infestations

86

Cherry Angioma

87

Angiokeratoma

87

Prurigo Nodularis (Picker’s Nodule)

88

Pyogenic Granuloma

89

Urethral Caruncle

90

Urethral Prolapse

90

Vulvar Endometriosis

91

Hematoma

91

Hidradenoma Papilliferum (Mammary-Like Gland Adenoma)

92

Kaposi Sarcoma

92

Pseudowarts (Diaper Dermatitis of Jacquet, Granuloma Gluteale Infantum)

93

Furunculosis

93

Inflamed Cysts

94

Hidradenitis Suppurativa (Acne Inversa)

95

Miscellaneous Red Papules and Nodules

98

8

Yellow and Pustular Lesions   Libby Edwards

101

True Pustular Diseases

101

Solid Lesions that Sometimes Appear Pustular

114

Other Diseases that Can Appear Yellow or Produce Crusting

118

9

Erosive and Vesiculobullous Diseases   Libby Edwards

121

Noninfectious Inflammatory Dermatoses that Sometimes Erode

121

Primary Blistering or Pustular Infections

128

Noninfectious Blistering Eruptions

135

Pseudovesicular Conditions

149

Malignancies Presenting as Erosions

151

Genital Skin Fold Fissures

152

Posterior Fourchette Vulvar Fissures

154

10

Ulcers   Peter J. Lynch

158

Syphilis

158

Chancroid

160

Genital Herpes in Linmunosuppressed Individuals

162

Granuloma Inguinale (Donovanosis)

164

Lymphogranuloma Venereum

166

Epstein—Barr Virus and Cytomegalovirus-Associated Ulcers

166

Aphthous Ulcer and Complex Aphthosis

166

Behcet Disease

169

Aphthous-Like Ulcers Associated with Viral Infections

170

Aphthous-Like Ulcers Associated with Medications

170

Crohn Disease

171

Pyoderma Gangrenosum

173

Ulcers Due to External Trauma

174

Miscellaneous Ulcers

176

11

White Lesions   Sailie M. Neill

178

White Patches and Plaques

178

White Papules and Nodules

194

12

Skin-Colored Lesions   Peter J.Lynch

197

Genital Warts

197

Molluscum Contagiosum

202

Condyloma Latum

205

Lymphogranuloma Venereum

206

Epidermal Cysts (Epidermoid Cysts)

206

Mucinous Vestibular Cysts

207

Cysts of the Median Raphe

208

Pilonidal Sinus (Pilonidal Cyst)

208

Bartholin Cysts and Abscesses

208

Skin Tag (Acrochordon, Fibroepithelial Polyp)

209

Intradermal Nevi (Dermal Nevi)

210

Neurofibroma

210

Lipoma

210

Pearly Penile Papules

210

Vulvar Vestibular Papillomatosis

211

Fordyce Spots and Sebaceous Gland Hyperplasia

211

Tyson Glands

212

Fox-Fordyce Disease

212

Hidradenoma Papilliferum (Mammary-Like Gland Adenoma)

213

Lichen Nitidus

213

Sclerosing Lymphangitis of the Penis

214

Squamous Carcinoma in Men

214

Squamous Cell Carcinoma in Women

217

Basal Cell Carcinoma

220

Genital Edema

222

13

Pigmented Disorders   Peter J. Lynch

228

Physiologic Hyperpigmentation

228

Acanthosis Nigricans

228

Postinflammatory Hyperpigmentation

229

Seborrheic Keratoses

231

Pigmented Warts

231

Genital Intraepithelial Neoplasia

232

Pigmented Basal Cell Carcinoma

232

Angiokeratomas

232

Kaposi Sarcoma

233

Genital Varicosities

233

Genital Melanosis (Lentiginosis)

234

Melanocytic Nevus (Mole, Pigmented Nevus)

236

Melanoma

240

14

Pediatric Genital Disease   Libby Edwards

245

Normal Genitalia

245

Congenital Abnormalities

246

Red Plaques and Papules

249

Skin-Colored Lesions

263

White Lesions

264

15

Vaginitis and Balanitis   Libby Edwards

268

Vaginitis

268

Balanitis

283

16

Special Issues in Genital Dermatology: Psychosexual Matters, Concerns of Immunosuppression, and Aging   Peter Lynch and Libby Edwards

289

Psychological Issues

289

Psychosocial Dysfunction May Cause Disease

289

Psychosocial Dysfunction Influences the Course of Disease

291

Psychosocial Dysfunction Occurs as a Result of Disease

292

Immunosuppression

293

Infections

293

Noninfectious Inflammatory Diseases Associated with HIV

300

Neoplastic Diseases

303

Geriatric Issues

305

Appendix A

Classification of Genital Disorders   Peter J. Lynch

311

The Rationale for Classification

311

Approaches Used for Classification

311

Our Preferred Approach for Classification

311

Alternative Classifications

312

ISSVD Classification of Vulvodynia (2003)

312

ISSVD Classification of Squamous Cell Vulvar Intraepithelial Neoplasia (2004)

312

ISSVD Classification of Vulvar Dermatoses (2006)

313

Appendix B

Patient Education Handouts   Libby Edwards

315

Atrophic Vagina and Atrophic Vaginitis

315

Candida (Yeast) Vaginitis 316

Desquamative Inflammatory Vaginitis

317

Hidradenitis Suppurativa

318

Lichen Planus

319

Lichen Sclerosus

320

Genital Lichen Simplex Chronicus (Eczema, Neurodermatitis, and Dermatitis)

322

Physiologic Vaginal Secretions (Physiologic Vaginal Discharge)

323

Vulvar Care

324

Vulvodynia/Vestibulodynia/Vestibulitis

325

Index

327