The scrotum, vulva, and perianal area are common sites of involvement with lichen simplex chronicus. Clinically, lichenification, hyperpigmentation, and excoriation are prominent features (Fig,,240-3). Treatment is the same as for LSC in other areas except low-potency corticosteroid (hydrocortisone 2.5% or desonide) ointments should be used. In cases of perianal LSC, patients should be instructed to cleanse the perianal area thoroughly to remove fecal debris and tissue paper that may be irritating. Witch hazel pads are recommended for cleansing.
FIG. 240-3. Lichen simplex chronicus. Pronounced lichenification and hyperpigmentation is typical of lichen simplex chronicus. The scrotum is a common site of involvement.
Hidradenitis suppurativa is a chronic scarring inflammatory disorder of the apocrine gland-bearing areas of the body. These glands are located predominantly in the groin, intergluteal cleft, vulva, and axilla. Hidradenitis suppurativa begins after puberty and is seen slightly more frequently in women. It is more likely seen in obese patients. Hidradenitis suppurativa may be seen in association with acne conglobata, dissecting cellulitis of the scalp, and pilonidal cysts (the follicular occlusion syndrome).
The initiating event in hidradenitis suppurativa is occlusion of the apocrine gland and pilosebaceous follicular unit. The exact mechanism resulting in this occlusion is unknown. This occlusion results in the development of inflammatory nodules and abscesses. Bacterial infection is only a secondary process and not the cause of this disorder.
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