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Additional info for An Atlas of Vulval Diseases: A Combined Dermatological, Gynaecological and Venereological Approach
However, anogenital lesions may be the only manifestations of the patient's psoriasis. Psoriasis is common—there is a genetic predisposition in some 5% of the population, expressed clinically by some 2% at any one time. Precipitating factors include recent streptococcal infection (usually guttate psoriasis), and lesions may appear at sites of trauma (the Koebner phenomenon). A characteristic psoriasis-like eruption is seen in Reiter's syndrome (see page 118). Psoriasis is notoriously chronic, and patients understandably fear this diagnosis.
16 The same patient at 1 -year follow-up. She had been treated with our standard regimen of nightly grade I topical corticosteroid for 2 months and had used less than 30 g over the year. Scarring is not reversed but symptoms are abolished and progression is halted. 17 Lichen sclerosus is occasionally confined to the ridge of skin separating the vulva from the perianal area. Such patients often complain of dyspareunia, as they may tear at this site during sexual intercourse. 18 Lichen sclerosus affecting the male foreskin and glans.
Patients should understand that their 'itch-scratch' cycle may recur at times of stress. 43 Lichen simplex chronicus. Well-demarcated patch of lichenification on the right interlabial sulcus. 44 More extensive lichen simplex chronicus. Patients may deny scratching. 45 Histology of lichen simplex chronicus. There is marked thickening of the epidermis (acanthosis) with epidermal ridges projecting deep down into the dermis with rounded, burgeoning tips. No nuclear atypia is seen. There are occasional patches of spongiosis and overlying parakeratosis (H & E, X40).