60
Anogenital Diseases
Introduction
• The anatomy (Fig. 60.1), normal cutaneous findings, and benign lesions of the anogenital area (Table 60.1) should be appreciated before addressing diseases in this area.
Table 60.1
Normal findings and benign lesions of the anogenital region.
Papules in the anogenital region can also result from HPV infection, in particular condylomata acuminata and common warts (see Ch. 66).
| Common | Less Common |
| Epidermoid cysts | Fox-Fordyce disease |
| Open comedones | Syringomas |
| Pearly penile papules (see Fig. 95.7) | Idiopathic calcinosis of the scrotum |
| Vestibular papillomatosis | Urethral caruncle |
| Angiokeratomas (see Fig. 87.11) | Hidradenoma papilliferum |
| Seborrheic keratoses and acrochordons | |
| Melanocytic nevi and genital lentigines | |
| Free sebaceous glands |
• A number of systemic diseases affect the anogenital area (Table 60.2).
Table 60.2
Systemic diseases with associated anogenital cutaneous findings.
EM, erythema multiforme; SJS, Stevens–Johnson syndrome; TEN, toxic epidermal necrolysis.
Courtesy, Susan M. Cooper, MD, and Fenella Wojnarowska, MD.
• A number of dermatologic conditions affect the anogenital region, including inflammatory (Table 60.3; Figs. 60.2–60.6), bullous (Table 60.4; Fig. 60.7), infectious (Table 60.5; see Chapter 69), and premalignant and malignant (Table 60.6; Figs. 60.8–60.11) conditions.
Table 60.3
Inflammatory dermatologic disorders with anogenital features.
Porokeratosis ptychotropica is a rare disorder and can mimic anogenital dermatitis or inverse psoriasis.
The DDx of these disorders includes the other entities listed in this table; consider infections, either primary or superimposed (see Table 60.5); less commonly bullous disorders (see Table 60.4); if nonhealing consider malignancy, most commonly SCC (see Table 60.6).
Fig. 60.2 Vulvar dermatitis. Lichenification is prominent. The underlying diagnosis was atopic dermatitis. Courtesy, Susan M. Cooper, MD, and Fenella Wojnarowska, MD.
Fig. 60.3 Psoriasis of the penile shaft. Well-demarcated erythematous plaque with slight scale. Similar lesions can be seen in patients with reactive arthritis (formerly Reiter’s disease). Courtesy, Jean L. Bolognia, MD.
Fig. 60.4 Lichen sclerosus (LS). Typical involvement of the vulva demonstrating marked architectural change with the loss of the labia minora and midline fusion (A) and purpura (B). Perianal LS (C) and involvement of the penis (D) with an erythematous and hypopigmented plaque on the glans. A, Courtesy, Susan M. Cooper, MD, and Fenella Wojnarowska, MD; B, Courtesy, Kalman Watsky, MD. C, Courtesy, Susan M. Cooper, MD, and Fenella Wojnarowska, MD; D, Courtesy, Ronald P. Rapini, MD.
Fig. 60.5 Anogenital lichen planus. A Involvement of the penis with an annular band on the glans, a typical finding. B
