Pseudoverrucous papules: an aspect of incontinence in children

Anogenital Papular Lesions in Children Five Year Old and Younger: Gender Differences

Introduction:

Anogenital area is a small compartment in the human body. Recognition of various dermatological conditions affecting this area in children is essential for any physician involved in pediatric examination and evaluation.

Aim:

To assess the nature, diagnoses, and gender differences of Anogenital lesions in pediatric patients presented to Royal Medical Services (RMS) general dermatology clinics, who were five year old and younger.

Methods:

The authors reviewed patients’ medical records in the period between September 2015 and September 2018. The inclusion criteria were children of both genders who were five year old or younger and presented with papular lesions in the Anogenital area. Those patients visited the general dermatology clinics of The Royal Medical Services Hospitals from the Eastern and Southern regions of Jordan.

Results:

Over a period of 3 years, a total of 514 patients were five year old or younger presented with various Anogenital papular lesions were evaluated and treated in general dermatology clinics. 35% of the patients presented with Perianal Psuedoverrucous Papules and nodules, 21% presented with Anogenital warts, 16% presented with Molluscum Contageosum. Moreover, 10% were presented with Epidermal nevi, 6% presented with Pearly Penile Papules, 7% presented with Infantile Perineal Pyramidal Protrusion, 4% presented with Vulvar Vestibular Papillomatosis, 0.2% presented with Juvenile Xanthogranuloma, 0.2% presented with lymphangioma Circumscriptum, and 0.2% presented with median raphe cyst. In addition, gender differences were noticed among Genital Warts, Mollascum Contageosum, Pearly Penile Papules, and Vulvar Vestibular Papillomatosis.

Conclusion:

Anogenital papules in children have variable clinical presentations and can be caused by multiple number of infectious and non-infectious factors. The presence of such lesions can be a source of a major concern for parents, and might be mistakenly assumed as a result of sexual assaults. Proper recognition of these papules is of paramount importance for all physicians involved in children examination, to appropriately reassure parents and avoid unnecessary investigations and psychological distress.

Vulvar pseudoverrucous papules and nodules secondary to a urethral--vaginal fistula

Irritant contact dermatitis is a common cause of genital eruptions representing at least one-fifth of presenting anogenital symptoms. A spectrum of inflammatory reactions have been identified, some of them with features severely mimicking more serious dermatoses, which may lead unnecessary workup and treatments. We report a case of a 10-year-old girl who presented at birth with cloacal atresia involving the rectum and the urethra. A diverting colostomy and a urethral-vaginal fistula were created to correct the deformity. Physical examination reveals numerous shiny, white-gray, pseudoverrucous papules and nodules coalescing into plaques over the vulva and its surrounding skin. Histological examination showed psoriasiform epidermal hyperplasia with a marked reactive acanthosis and altered cornification with parakeratosis, hypogranulosis, and pale keratinocytes in the upper reaches of the epidermis. The lesions regress when the irritating factor was removed. This case represents a peculiar form of presentation of perianal pseudoverrucous papules and nodules, usually secondary to urinary incontinence or encopresis (inability to control the elimination of stool) after surgery for Hirschsprung disease. Because similar findings have not been previously observed in patients with urethral-vaginal fistula, we attempt to extend the spectrum of presentations for a better knowledge of this condition.

Diaper dermatitis: a review and brief survey of eruptions of the diaper area

Eruptions in the diaper area are the most common dermatologic problem in infancy. Such eruptions can be subdivided into primary diaper dermatitis, an acute inflammation of the skin in the diaper area with an ill-defined and multifactorial etiology, and secondary diaper dermatitis, a term which encompasses eruptions in the diaper area with defined etiologies. The most important factors in the development of primary diaper dermatitis are: (i) water/moisture, (ii) friction, (iii) urine, (iv) feces, and (v) microorganisms (sometimes). Possible treatments include minimizing diaper use and using disposable diapers, barrier creams, mild topical cortisones, and antifungal agents. A variety of other inflammatory and infectious processes can occur in the diaper area and an awareness of these secondary types of diaper dermatitis aids in the accurate diagnosis and treatment of patients.