Genital DermatologyGenital Dermatology
“Hey doc…can I get some more
of that cream?”
LCDR Ron Perry, MSC, USN
ObjectivesObjectives
• Discuss the proper clinical evaluation of the
patient requesting “jock itch cream refills”
• Review...
Genital DermatologyGenital Dermatology
• You have just completed a new patient
evaluation on a 30 year-old male with
hyper...
Genital DermatologyGenital Dermatology
• Let’s review the ground rules
– Establish privacy and get a standby PRN
– Perform...
Genital DermatologyGenital Dermatology
• When patients refer to “genitalia” they may
be talking about:
– Upper medial thig...
Genital DermatologyGenital Dermatology
• Ask about pain, pruritis, other symptoms
• Is there any PMH of systemic disease?
...
Genital DermatologyGenital Dermatology
• Don’t forget allergies, meds, occupation, sex hx
• Anything affecting the genital...
Genital DermatologyGenital Dermatology
• Let’s take a at some genital
rashes and lesions
19 year-old male reports h/o “recurrent jock itch19 year-old male reports h/o “recurrent jock itch
since the beginning of ...
33 year-old male with h/o “groin rash” for last 433 year-old male with h/o “groin rash” for last 4
months. He states it wa...
40 year-old male reports h/o pruritic rash for the past40 year-old male reports h/o pruritic rash for the past
month. He h...
27 year-old desires eval for “red rash.” She states it27 year-old desires eval for “red rash.” She states it
has been ther...
42 year-old male with c/o non-tender, brown rash42 year-old male with c/o non-tender, brown rash
affecting groin and left ...
33 year-old male with a 2 week h/o intensely pruritic33 year-old male with a 2 week h/o intensely pruritic
scrotal rash. R...
18 year-old female with 2 year history of chronic18 year-old female with 2 year history of chronic
vulvar pruritis, rubbin...
30 year-old in for pap test and evaluation for groin rash30 year-old in for pap test and evaluation for groin rash
which “...
56 year-old female reports a 3 month h/o genital lesions56 year-old female reports a 3 month h/o genital lesions
and progr...
59 year-old female reports progressive vulvovaginal59 year-old female reports progressive vulvovaginal
pain, pruritis, and...
20 year-old obese female with chronic pelvic discomfort20 year-old obese female with chronic pelvic discomfort
and disabil...
21 year-old male with recent weight gain has noticed21 year-old male with recent weight gain has noticed
dark, thickened s...
25 year-old male reports hypopigmentation after using25 year-old male reports hypopigmentation after using
“some cream” pr...
22 year-old male and his newlywed wife are in your22 year-old male and his newlywed wife are in your
exam room. She is con...
44 year-old male with these “purple bumps” on44 year-old male with these “purple bumps” on
scrotum since he was in high sc...
21 year-old female with long h/o “bump down there”21 year-old female with long h/o “bump down there”
and would like it rem...
62 year-old male has had a penile ulceration for the past62 year-old male has had a penile ulceration for the past
7 days....
67 year-old female with long history of progressive67 year-old female with long history of progressive
vulvar discomfort, ...
50 year-old uncircumsized male with 4 year history of50 year-old uncircumsized male with 4 year history of
“sore” and rece...
Genital DermatologyGenital Dermatology
• Hang in there…we’re
almost done!
Genital DermatologyGenital Dermatology
• Don’t forget to examine other areas for clues to
the diagnosis
• Consider KOH, wo...
Genital DermatologyGenital Dermatology
• Get a biopsy PRN. I would refer for bx if
– Aggressive skin cancer
– A large lesi...
Genital DermatologyGenital Dermatology
• References
– Habif
– Fitzpatrick
– Dermatlas.org
– UpToDate.com
– Derm-Challenger...
Genital DermatologyGenital Dermatology
fleetadmiralron@hotmail.com
Thank
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"Genital Dermatology "

  1. 1. Genital DermatologyGenital Dermatology “Hey doc…can I get some more of that cream?”
  2. 2. LCDR Ron Perry, MSC, USN
  3. 3. ObjectivesObjectives • Discuss the proper clinical evaluation of the patient requesting “jock itch cream refills” • Review the differential diagnoses for genital rashes and lesions • Review the initial management of selected conditions
  4. 4. Genital DermatologyGenital Dermatology • You have just completed a new patient evaluation on a 30 year-old male with hypertension. As he is leaving your exam room, he turns around and asks you for “some of that jock itch cream.” • What do you do?
  5. 5. Genital DermatologyGenital Dermatology • Let’s review the ground rules – Establish privacy and get a standby PRN – Perform a H & P – Labs PRN – R/O DDx, Dx and tx – Failure to respond to tx • Re-eval patient…wrong dx, wrong tx…or both? • Biopsy
  6. 6. Genital DermatologyGenital Dermatology • When patients refer to “genitalia” they may be talking about: – Upper medial thighs – Crural folds – Penis – Scrotum – Vulva – Perineal – Perianal – Intergluteal
  7. 7. Genital DermatologyGenital Dermatology • Ask about pain, pruritis, other symptoms • Is there any PMH of systemic disease? • Is there a PMH of similar rash or lesion? • FHx of something similar, or atopy? • What are they currently/prev. using for tx? – Where did they get it? – Does it help or make condition worse? – Has the morphology changed? – How long have they been treating condition?
  8. 8. Genital DermatologyGenital Dermatology • Don’t forget allergies, meds, occupation, sex hx • Anything affecting the genitalia leads to great concern by the patient…patient’s partner • Skin in this region is thin, moist, easily damaged • Scale may not form in this region, which can make things challenging • STDs and staph infections in your ddx, but covered by other speakers
  9. 9. Genital DermatologyGenital Dermatology • Let’s take a at some genital rashes and lesions
  10. 10. 19 year-old male reports h/o “recurrent jock itch19 year-old male reports h/o “recurrent jock itch since the beginning of football season”since the beginning of football season” What do you think? A. Erythrasma B. Tinea cruris C. Candida intertrigo Treatment options?
  11. 11. 33 year-old male with h/o “groin rash” for last 433 year-old male with h/o “groin rash” for last 4 months. He states it was improving with use of OTCmonths. He states it was improving with use of OTC hydrocortisone, but he ran out and now wantshydrocortisone, but he ran out and now wants “something stronger”“something stronger” What do you think? A. Tinea cruris B. Tinea incognito C. Candida intertrigo Treatment options?
  12. 12. 40 year-old male reports h/o pruritic rash for the past40 year-old male reports h/o pruritic rash for the past month. He has h/o same and was given “some cream”month. He has h/o same and was given “some cream” which worked well last timewhich worked well last time What do you think? A. Erythrasma B. Tinea cruris C. Candida intertrigo Treatment options?
  13. 13. 27 year-old desires eval for “red rash.” She states it27 year-old desires eval for “red rash.” She states it has been there “for some time” and is often pruritic athas been there “for some time” and is often pruritic at night. She states heat and friction make conditionnight. She states heat and friction make condition worse. FHx positive for “red scaly rashes”worse. FHx positive for “red scaly rashes” What do you think? A. Vestibulitis B. Inverse psoriasis C. Candida intertrigo Treatment options?
  14. 14. 42 year-old male with c/o non-tender, brown rash42 year-old male with c/o non-tender, brown rash affecting groin and left foot (4affecting groin and left foot (4thth toe interspace). He statestoe interspace). He states he has had this for about 3 months and using OTChe has had this for about 3 months and using OTC “antifungal cream” with no change“antifungal cream” with no change What do you think? A. Tinea cruris B. Erythrasma C. Candida intertrigo Treatment options?
  15. 15. 33 year-old male with a 2 week h/o intensely pruritic33 year-old male with a 2 week h/o intensely pruritic scrotal rash. Recalls using an antibiotic ointment onscrotal rash. Recalls using an antibiotic ointment on scrotum approximately 3 weeks ago for tx of “ingrownscrotum approximately 3 weeks ago for tx of “ingrown hair”hair” What do you think? A. Atopic dermatitis B. Irritant contact dermatitis C. Allergic contact dermatitis Treatment options?
  16. 16. 18 year-old female with 2 year history of chronic18 year-old female with 2 year history of chronic vulvar pruritis, rubbing and scratching. Her PMH andvulvar pruritis, rubbing and scratching. Her PMH and FHx are significant for asthmaFHx are significant for asthma What do you think? A. Lichen planus B. Atopic dermatitis C. Lichen simplex chronicus Treatment options?
  17. 17. 30 year-old in for pap test and evaluation for groin rash30 year-old in for pap test and evaluation for groin rash which “comes and goes” over the past 15 years. Shewhich “comes and goes” over the past 15 years. She also has chronic dandruffalso has chronic dandruff What do you think? A. Psoriasis B. Atopic dermatitis C. Seborrheic dermatitis Treatment options?
  18. 18. 56 year-old female reports a 3 month h/o genital lesions56 year-old female reports a 3 month h/o genital lesions and progressive dyspareunia. She also has painful oraland progressive dyspareunia. She also has painful oral lesions. Denies prior h/o samelesions. Denies prior h/o same What do you think? A. Lichen planus B. Lichen sclerosis C. Behcet’s syndrome Treatment options?
  19. 19. 59 year-old female reports progressive vulvovaginal59 year-old female reports progressive vulvovaginal pain, pruritis, and dyspareunia. She also notes a slightpain, pruritis, and dyspareunia. She also notes a slight watery discharge and admits to habitual vulvarwatery discharge and admits to habitual vulvar scratchingscratching What do you think? A. Lichen planus B. Lichen sclerosis C. Squamous cell carcinoma Treatment options?
  20. 20. 20 year-old obese female with chronic pelvic discomfort20 year-old obese female with chronic pelvic discomfort and disability related to recurrent cystic masses,and disability related to recurrent cystic masses, nodules, and sinus tract drainagenodules, and sinus tract drainage What do you think? A. Folliculitis B. Keratosis pilaris C. Hidradenitis suppurativa Treatment options?
  21. 21. 21 year-old male with recent weight gain has noticed21 year-old male with recent weight gain has noticed dark, thickened skin in the groin and axillaedark, thickened skin in the groin and axillae What do you think? A. Lentigo B. Candida intertrigo C. Acanthosis nigricans Treatment options?
  22. 22. 25 year-old male reports hypopigmentation after using25 year-old male reports hypopigmentation after using “some cream” prescribed at another clinic several weeks“some cream” prescribed at another clinic several weeks agoago What do you think? A. Vitiligo B. Nevus anemicus C. Chemical-induced leukoderma Treatment options?
  23. 23. 22 year-old male and his newlywed wife are in your22 year-old male and his newlywed wife are in your exam room. She is concerned he has been involved withexam room. She is concerned he has been involved with extracurricular activitiesextracurricular activities What do you think? A. Warts B. Bowenoid papulosis C. Pearly penile papules Treatment options?
  24. 24. 44 year-old male with these “purple bumps” on44 year-old male with these “purple bumps” on scrotum since he was in high school. States may bleedscrotum since he was in high school. States may bleed if traumatizedif traumatized What do you think? A. Scrotal cysts B. Lichen planus C. Angiokeratomas Treatment options?
  25. 25. 21 year-old female with long h/o “bump down there”21 year-old female with long h/o “bump down there” and would like it removed. She states embarrassmentand would like it removed. She states embarrassment regarding possibility of STD and being “contagious”regarding possibility of STD and being “contagious” What do you think? A. Wart B. Skin tag C. Vulvar cancer Treatment options?
  26. 26. 62 year-old male has had a penile ulceration for the past62 year-old male has had a penile ulceration for the past 7 days. He has a h/o chronic bacterial prostatitis and is7 days. He has a h/o chronic bacterial prostatitis and is taking trimethoprim sulfamethoxazoletaking trimethoprim sulfamethoxazole What do you think? A. Candida balanitis B. Fixed drug eruption C. Erythroplasia of queyrat Treatment options?
  27. 27. 67 year-old female with long history of progressive67 year-old female with long history of progressive vulvar discomfort, dyspareunia, intermittent bleedingvulvar discomfort, dyspareunia, intermittent bleeding and “growing bump”and “growing bump” What do you think? A. Vulvar cancer B. Lichen sclerosis C. Bartholin’s cyst Treatment options?
  28. 28. 50 year-old uncircumsized male with 4 year history of50 year-old uncircumsized male with 4 year history of “sore” and recent onset of weight loss and inguinal“sore” and recent onset of weight loss and inguinal swellingswelling What do you think? A. Psoriasis B. Penile cancer C. Candida balanitis Treatment options?
  29. 29. Genital DermatologyGenital Dermatology • Hang in there…we’re almost done!
  30. 30. Genital DermatologyGenital Dermatology • Don’t forget to examine other areas for clues to the diagnosis • Consider KOH, wood’s lamp, dermatoscope, culture, bloodwork • Do not tx unless you know the dx • If give steroid rx, don’t give refills • Patient ed is important. Reinforce tx compliance and need for patient to keep an eye on things • Ensure f/up
  31. 31. Genital DermatologyGenital Dermatology • Get a biopsy PRN. I would refer for bx if – Aggressive skin cancer – A large lesion – A lesion located in sensitive area – A lesion that is beyond scope of your skills – The patient has a higher chance of having a complication or may require close monitoring during or after surgery
  32. 32. Genital DermatologyGenital Dermatology • References – Habif – Fitzpatrick – Dermatlas.org – UpToDate.com – Derm-Challenger PA – eMedicine.com – Dermnet.com – Dermnet.org.nz
  33. 33. Genital DermatologyGenital Dermatology fleetadmiralron@hotmail.com Thank
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