ABSTRACT
BACKGROUND: Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterized clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two cases to be reported. OBJECTIVES: To determine the clinical and histological characteristics of cases of PEKMB, and evaluate treatments used and clinical course. METHODS: This monocentric case series was conducted at the University College London Hospitals tertiary male genital dermatology clinic between April 2018 and August 2020. Eight patients with PEKMB were evaluated. Data were collected on demographics, clinical presentation, histological features, presence of human papilloma virus (HPV), history of lichen sclerosus, treatment of PEKMB and subsequent response, and presence or development of squamous cell carcinoma (SCC) or penile intraepithelial neoplasia (PeIN) during follow-up. RESULTS: Eight Caucasian males presented with clinical and histological evidence of PEKMB. Seven had a background of lichen sclerosus; two had failed treatment with superpotent topical steroids and four had symptoms for three or more years prior to circumcision. There was no clinical or histological relationship with HPV infection, and p16 staining was negative. HPV PCR, performed in two cases, was negative. Basal atypia, insufficient to amount to PeIN, was present in six patients. One patient progressed to PeIN during follow-up, and no patient progressed to invasive malignancy. Five patients were treated successfully with glans resurfacing and split skin graft reconstruction. CONCLUSIONS: Our observations demonstrate that PEKMB represents a form of chronic, undiagnosed or misdiagnosed, inadequately treated or treatment refractory, unstable lichen sclerosus. The significant potential for squamous carcinogenesis (differentiated PeIN and verrucous carcinoma) can be mitigated by timely diagnosis and treatment. Glans resurfacing and split skin graft reconstruction appears to be a successful treatment modality in patients with refractory disease.
Subject(s)
Balanitis , Carcinoma in Situ , Keratosis , Lichen Sclerosus et Atrophicus , Papillomavirus Infections , Penile Neoplasms , Skin Neoplasms , Balanitis/diagnosis , Carcinoma in Situ/pathology , Humans , Keratosis/pathology , Lichen Sclerosus et Atrophicus/complications , Lichen Sclerosus et Atrophicus/pathology , Male , Papillomaviridae , Penile Neoplasms/diagnosis , Penile Neoplasms/pathology , Penile Neoplasms/surgeryABSTRACT
Male genital lichen sclerosus (MGLSc) is a chronic inflammatory dermatosis that predominantly affects uncircumcised males. Several aetiological factors have been described, with growing evidence supporting chronic urine exposure of susceptible epithelium being crucial to its pathogenesis. We describe a 45-year-old man with a 2-year history of MGLSc at the site of a urethrocutaneous fistula secondary to a penile piercing. To our knowledge, this is the first documented case of MGLSc occurring at the site of a genital piercing.
Subject(s)
Cutaneous Fistula/complications , Dermatitis , Lichen Sclerosus et Atrophicus/etiology , Penis/pathology , Cutaneous Fistula/pathology , Humans , Lichen Sclerosus et Atrophicus/pathology , Male , Middle Aged , Penis/surgeryABSTRACT
Our study shows that treatment recommendations provided through social media are based on evidence of variable quality. However, on Youtube®, there was no significant difference between viewership numbers between physicians and nonphysicians. Therefore, Dermatologists with expertise in alopecia should consider utilizing social media to promote evidence-based treatment options for all alopecia subtypes.
Subject(s)
Social Media , Alopecia/therapy , Cross-Sectional Studies , Humans , Video RecordingSubject(s)
Dermatologists/statistics & numerical data , Keratoacanthoma/therapy , Practice Patterns, Physicians'/statistics & numerical data , Surgeons/statistics & numerical data , Attitude of Health Personnel , Dermatologists/psychology , Ear Diseases/therapy , Humans , Leg , Referral and Consultation , Surgeons/psychology , Surveys and Questionnaires , Watchful WaitingSubject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/pathology , Antibodies, Antineutrophil Cytoplasmic/analysis , Myeloblastin/immunology , Aged , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy , Biomarkers/analysis , Biopsy , Dapsone/adverse effects , Dapsone/therapeutic use , Female , Humans , Skin/pathologySubject(s)
Hand Dermatoses/pathology , Hematoma/pathology , Skin/pathology , Female , Hand/pathology , Hand Dermatoses/etiology , Humans , Middle AgedABSTRACT
The association of linear IgA disease (LAD) with ulcerative colitis (UC) is well documented. One hypothesis for the association proposes immune exposure to autoantigens present in the colon, and subsequent targeting of these autoantigens in the skin. There are variable reports on the effect of bowel surgery on skin disease in such patients. We report a patient with LAD and UC who required colectomy to control her UC, but whose skin disease failed to resolve following surgery. A literature review revealed that in reported cases of this association, proctocolectomy has resulted in remission of skin disease in all cases where it has been performed, in contrast to variable results seen in cases where colectomy alone was performed.
