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Nick Van Wagoner, MD PhD Department of Infectious Diseases University of Alabama at Birmingham By the end of the lecture, the participant should be familiar with: Commonly used dermatological terms Common dermatological conditions seen in STD Clinics Dematology language Genital anatomy Categories of lesions Dermatological conditions seen in the STD clinic Not all individuals presenting to STD Clinics have STDs. Consider other causes for symptoms. History and examination are important in diagnosing non-STD genital findings. How long has it been present? What have you been doing to the skin in that area? Do you have any skin trouble anywhere else? Does this this look like an STD? Has this person been treated for STDs? Did it help? Know your limitations: Ask and Refer Symptoms perceived to be an STD Drips Discharge Dysuria Pain Redness Ulcers Bumps “I have spots on my head where hair won’t grow.” “I have a bump on my arm that hurts.” “I have painful sores on my back. I was told it was herpes.” History Exam Treat STD Reassure Not an STD Treat Refer Macule Patch area of color change area of color change <1.5cm, nonpalpable >1.5cm, nonpalpable From: www.acponline.org From: www.merck.com From: www.dermatology.cdlib.org From: www/missinglink.ucsf.edu From: www.visualdxhealth.com From: www.dermubc.ca From: www.dermubc.ca Papule Plaque area of elevation area of elevation <1.0cm, palpable >1.0cm, palpable elevated From: www.dermatology,about.com From: www.mycology.adelaide.edu/au/gallery From: www/missinglink.ucsf.edu www.dermatology.about.com CDC Susan Lindsey From: www.dermatology,about.com Nodule papule/plaque with deeper extension into the skin From: www.asnom.org Vesicle Pustule Bulla blister <1.0cm pus-filled vesicle blister >1.0cm From: www.meded.ucsd.edu From: www.afpmb.org From: www.ars.usda.gov From: www.missinglink.ucsf.edu From: www.acponline.org From: www.missinglink.ucsf.edu Erosion Ulcer shallow skin defect deep skin defect From: mdconsult.com From: www.missinglink.ucsf.edu From: www.missinglink.ucsf.edu Crust Scale amorphous accumulation of abnormal shedding or dried serum, blood or pus accumulation of cornified cells From: www.missinglink.ucsf.edu From: www.missinglink.ucsf.edu From: www.missinglink.ucsf.edu From www.glowm.com Michael Hughey, MD. 1. Testicles 2. Epididymis 3. Corpus cavernosa 4. Foreskin 5. Frenulum 6. Urethral opening 7. Glans penis 8. Corpus spongiosum 9. Penis/Shaft 10. Scrotum Red Plaques and Patches Red Papules and Nodules Yellow and Pustular Lesions Erosive and Vesiculobullous Diseases Ulcers White Lesions Skin-Colored Lesions Brown Lesions Atopic Dermatitis, Eczema, and Lichen Angiokeratoma Simplex Chronicus Cherry Angioma Irritant Contact Dermatitis Varicosity Allergic Contact Dermatitis Cutaneous Vulvar endometriosis Seborrheic Dermatitis Hematoma Psoriasis Hedradenoma Papilliferum Tinea Cruris Pyogenic Granuloma Erythrasma Kaposi’s Sarcoma Candidiasis Urethral Caruncle Perianal Streptococcal Disease Urethral Prolapse Lichen Planus Prurigo Nodularis (Picker’s Nodules) Plasma Cell Mucositis Pseudowarts Extramammary Page’s Disease Folliculitis and Furunculosis Bowen’s Disease Chigger Bites Vulvar Vistibulitis Nodules Scabies Dysesthetic Vulvodynia Inflamed Cysts Red Scrotum Syndrome Hydradenitis Suppurativa Crohn’s Disease Secondarily Red Skin-Colored Tumors Papulosquamous Diseases Lichen Planus Folliculitis Plasma cell (Zoon’s) vulvitis/balanitis Furunculosis Lichen Sclerosis Hidradenitis Suppurativa Reiter’s Disease Mucocutaneous Candidiasis Lichen Simplex Chronicus Pustular Psoriasis Necrolytic migratory erythema Reiter’s Syndrome Impetigo Sneddon-Wilson Disease Pemphigus Bullous Impetigo Bullous pemphigoid Cicatricial pemphigoid Linear IgA Disease Epidermolysis bullosa acquisita Apthae Pemphigoid gestationis Behcet’s Disease Dermatitis herpetiformis Ulcus Vulvae Acutum Benign familial pemphigus Pyoderma Gangrenosum Erythema multiforme Crohn’s Diseas Fixed drug eruption Factitial Ulcerations Contact Dermatitis Diseases that secondarily ulcerate Basal cell carcinoma Lichen Planus Squamous cell carcinoma Tumor Vulvar intraepithelial neoplasia Hidradenitis Suppurativa Extramammary Paget’s disease Genital Warts Vitiligo Moluscum Cantagiosum Postinflammatory Hypopigmentation and Condyloma lata Depigmentation Cysts Lichen Sclerosus (Lichen Sclerosus et Atrophicus) Epidermal Cysts Lichen Planus Vestibular Cysts Lichen Simplex Chronicus Cyst of the Median Raphe Candidiasis Bartholin’s Gland Duct Cysts Intraeptithelial Neoplasia Acrochorda (Skin tag) White Spongy Nevus Intradrmal Nevi Epidermal Cysts and Milia Neurofibromas Verrucous Carcinoma (SCC) Lipomas Pearly Penile Papules Vestibular papillae Physiologic Nigricans Forcye’s spots (pilosebacious units) Post-Inflammatory Hyperpigmentation Tyson’s Glands Genital Melanosis Fox Fordyce Disease Melanocytic Nevus Keratosis Pilaris Atypical Nevus Hidradenoma Papilliferum Melanoma Lichen Nitidus Dermatofibroma Sclerosing Lymphangitis Seborrheic Keratosis Squamous Cell Carcinoma Pigmented Condylomata acuminata Squamous Intraepithelia Neoplasia Intraepithelial neoplasia (bowenoid Papulosis, Boweln’s Disease) Invasive Squamous Cell Carcinoma Basal Cell Carcinoma Kaposi’s Sarcoma Elephantiasis Nostra Verrucosa Angiokeratoma Recent sex with a new partner, “I thought he was the one.” No condoms Spermicide “I think he gave me an STD” Used feminine hygiene product Used depilatory agent Chlorox bath Contact Itching with Inflammation Stinging substance Erythema Irritant Allergic direct effects of irritating specific immunologic substance response (Type IV) Occurs days to weeks Occurs 2-4 days TCA Topical medications Liquid nitrogen Spermicide Extreme heat Personal hygiene products Bleach Nail polish Feces/Urine Sanitary napkins Water Condoms Deodorant Alcohol History of allergies Self- perpetuating Rubbing Atopic Dermatitis = Scratching Widespread Precipitant Lichen Simplex Chronicus = Irritant Localized Scaling plaques Allergen Itching Excoriations Chronic itching or Anxiety Drainage scratching Perspiration Lichenified lesions Urine overlying a thickened, well- circumscribed plaque Perpetuating Factors Predilection for scrotum Cleaning and vulva Scrubbing Creams Source: AAFP: O’Connell. AAFP 2008. Improvement Steroids Sitz baths Remove irritant Sedation Stop rubbing Avoid irritating substances Good History or scratching Gentle cleanser and Exam Hyperproliferation of the epidermis Red, sharply demarcated plaques with silver scale Preferentially affects Scalp Elbows Knees Gluteal cleft Umbilicus Diagnosis: History, Exam, Histology Treatment: Dermatologist www.dermatology.about.com www.psorialess.com Often precipitated by: Warmth Perspiration Urine Friction Genital location: Over the hair-bearing skin of the vulva Glans Shaft Scale may be inaparent because of the moisture of the genital area www.afp.com Dermatophyte fungal Infection Occurs on drier keratinized skin www.dermimages.med.jhmi.edu Scaling well-demarcated plaques Does not affect scrotum or penis Unless immunocompromised Look for fungal elements Topical Antifungals www.womenshealthapta.org Characteristics Small Purplish Sharply demarcated papules Cutaneous blood vessels Genetically predisposed May have innumerable lesions Reassurance Characteristics Small Bright red Sharply demarcated papules Very common in older white persons Usually over trunk, but can occur in the perineum Reassurance From: www2.kumc.edu/coa/Education/ AMED900/Dermatology.htm Folliculitis Furunculosis Inflammation around the Deeper, perifollicular abscess hair follicle Characteristics Itch Painful Erythematous papules/nodules Location Hair bearing areas /www.skininfection.com/image S aureus Treatment: Antibacterial cleansers Topical antibiotics Oral antibiotics missinglink.ucsf.edu/.../folliculitis.html www.atlasdermatologico.com Can occur in Epidermal cysts Median raphe cysts Vestibular cysts Bartholins duct cysts Characteristics Red Tender www.meridiamedical.com/images Nodular Caused by Friction Trauma Occasionally infection Antibiotics Steroid Injection Drainage with a catheter Marsupialization Cystic Acne Not infection Apocrine and pilosebacious units with follicles distended by keratin/apocrine secretions Location Axillae www.mayoclinic.com/health/medica Genital Area Doesn’t remit after teenage years www.derm101.com Characteristics Comedones and nodules Painful as they enlarge May rupture Can form tracts draining to the surface 18 year old male MSM Recently became sexually active “My boyfriend told me I have warts.” Caused by HPV Usually asymptomatic Number and size dependent on host immune status Many shapes and sizes Round Acuminate (pointed) Filiform (long and slender) Raised Flat Images Courtesy of the CDC Characteristics Skin-colored Monomorphous Dome-shaped In rows around the corona Most common in uncircumcised men Asymptomatic Reassurance Characteristics Soft Monomorphous Discrete base Occur in patches or lines Bilaterally symmetrical Rounded tips (rather than acuminate) Occur at the introitus and medial labia minora Present in ~1/2 of premenopausal women Reassurance Pin-point yellowish papules Occur over labia minora/mucosal surfaces Enlarged sebaceous glands Reassurance Characteristics 2-5 mm Flesh-colored Smooth Domed Centrally
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