Some genital ulcers are innocent
Oct 06, 2002
Sexually transmitted diseases are on the increase as we all know — so is the world population. There is an understandable tendency for people to attribute a sexually transmissible disease to any rash or ulcer which appears at or near the genital organs
Sexually transmitted diseases are on the increase as we all know — so is the world population. There is an understandable tendency for people to attribute a sexually transmissible disease to any rash or ulcer which appears at or near the genital organs.
Many skin conditions involve the genital area in both sexes. I will only deal with some of the common ones.
First, not all unusual skin appearances are due to a ‘disease.’ Prominent ‘fat producing’ glands on the penile shaft or inside the vulva sometimes worry patients unduly. However, many of these conditions require no treatment other than firm reassurance.
Individuals occasionally insist on surgical removal of these minor blemishes in which case there is often an underlying psychoneurosis.
Genital drug rashes present a common diagnostic pitfall. Flat pinkish areas appear anywhere on the penis or vulva, often quite suddenly. They are non irritative. The most usual culprit drugs are the tetracyclines, sulphonamides and the very useful, but now difficult to obtain, barbiturates.
The two most commonest skin diseases, which frequently involve the genitals, are psoriasis and eczema. Typically psoriasis produces non-iritative crusts and eczema irritative, sometimes lesions. It is very important to examine the whole patient and search for other evidence of skin involvement. Some doctors are woefully inept at doing this. You only find what you look for!
Psoriasis usually produces crusted plaques on the elbows, knees and scalp and sometimes pitting of the finger and toenails. Eczema tends to go for the body flexures, such as the groin and armpits, the area beneath female breasts, the nose, ears and eyelids. Both conditions may have a familial basis. Either disease when restricted to the genitals can be difficult to diagnose and if the lesions persist or enlarge a biopsy is justified.
Lichen planus is less commonly seen on the genitals and typically presents as mauve hexagonal plaques. Generalised lichen planus is very itchy, but the genital eruption in isolation is not. Syphilis can produce a somewhat similar rash. Beware of undiagnosed, non-itchy genital rashes. A blood test is called for.
Vitiligo not uncommonly, occurs on the penis or vulva, especially in dark skinned people, where the condition can hardly be missed since the dark skin completely loses its pigment although the texture of the skin remains normal. There is a peak incidence in the teens and twenties and the more generalised type is commoner in women although when confined to the genitals, I think it is probably more common in men.
Generalised vitiligo is rarely accompanied by visual disturbance and deafness, but the ‘genital’ type is always benign although the de-pigmented area may increase in size. Treatment such as photochemotherapy may be indicated for cosmetic reasons, but this is not usually appropriate for the areas under discussion.
Cancers of the genitals are not frequently seen outside specialist centres and penile cancer is almost never seen in circumcised men. Hence it is very rare in Hebrews and Muslims. There are a number of ‘pre-malignant’ conditions such as Bowen’s disease, which may present as persistent shiny plaques. Again, when doubt exists, biopsy should be undertaken.
Hydrocortisone cream or ointment, available worldwide is the treatment of choice for most of the above conditions. One word of caution — it is desirable to try to exclude candida (fungus infection), which is sometimes sexually transmitted, requires different treatment and is usually made worse by steroids. The first duty of a diligent physician is not to aggravate the patient’s conditions.
From the Internet
Many skin conditions involve the genital area in both sexes. I will only deal with some of the common ones.
First, not all unusual skin appearances are due to a ‘disease.’ Prominent ‘fat producing’ glands on the penile shaft or inside the vulva sometimes worry patients unduly. However, many of these conditions require no treatment other than firm reassurance.
Individuals occasionally insist on surgical removal of these minor blemishes in which case there is often an underlying psychoneurosis.
Genital drug rashes present a common diagnostic pitfall. Flat pinkish areas appear anywhere on the penis or vulva, often quite suddenly. They are non irritative. The most usual culprit drugs are the tetracyclines, sulphonamides and the very useful, but now difficult to obtain, barbiturates.
The two most commonest skin diseases, which frequently involve the genitals, are psoriasis and eczema. Typically psoriasis produces non-iritative crusts and eczema irritative, sometimes lesions. It is very important to examine the whole patient and search for other evidence of skin involvement. Some doctors are woefully inept at doing this. You only find what you look for!
Psoriasis usually produces crusted plaques on the elbows, knees and scalp and sometimes pitting of the finger and toenails. Eczema tends to go for the body flexures, such as the groin and armpits, the area beneath female breasts, the nose, ears and eyelids. Both conditions may have a familial basis. Either disease when restricted to the genitals can be difficult to diagnose and if the lesions persist or enlarge a biopsy is justified.
Lichen planus is less commonly seen on the genitals and typically presents as mauve hexagonal plaques. Generalised lichen planus is very itchy, but the genital eruption in isolation is not. Syphilis can produce a somewhat similar rash. Beware of undiagnosed, non-itchy genital rashes. A blood test is called for.
Vitiligo not uncommonly, occurs on the penis or vulva, especially in dark skinned people, where the condition can hardly be missed since the dark skin completely loses its pigment although the texture of the skin remains normal. There is a peak incidence in the teens and twenties and the more generalised type is commoner in women although when confined to the genitals, I think it is probably more common in men.
Generalised vitiligo is rarely accompanied by visual disturbance and deafness, but the ‘genital’ type is always benign although the de-pigmented area may increase in size. Treatment such as photochemotherapy may be indicated for cosmetic reasons, but this is not usually appropriate for the areas under discussion.
Cancers of the genitals are not frequently seen outside specialist centres and penile cancer is almost never seen in circumcised men. Hence it is very rare in Hebrews and Muslims. There are a number of ‘pre-malignant’ conditions such as Bowen’s disease, which may present as persistent shiny plaques. Again, when doubt exists, biopsy should be undertaken.
Hydrocortisone cream or ointment, available worldwide is the treatment of choice for most of the above conditions. One word of caution — it is desirable to try to exclude candida (fungus infection), which is sometimes sexually transmitted, requires different treatment and is usually made worse by steroids. The first duty of a diligent physician is not to aggravate the patient’s conditions.
From the Internet