๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Vesiculobullous conditions
Vesiculobullous conditions
Subepidermal (bullous pemphigoid and mucous membrane pemphigoid) and intra-epidermal (pemphigus vulgaris) autoimmune blistering diseases are discussed elsewhere. Pemphigus can involve the penis (the glans is the usual site) but very rarely in isolation. Pemphigus vegetans presenting with a 4-year history of indolent tender balanitis, where the glans penis was involved with a moist vegetative plaque with beefy red erosions separating irregular hyperkeratotic mounds, has been reported.1 Involvement of the penis in mucous membrane pemphigoid is very uncommon and may cause blisters, erosions, ulcers, transcoronal adhesions, scarring, and phimosis.2
Clinical features Lesions in females are rare and affect the vestibule and the labia minora.2,3 Few lesions have been described on the clitoris. The condition probably is not a single entity but a pattern of inflammation that is seen on a mucosal surface in other chronic dermatoses, particularly LP.4 The lesions are bright red with a varnished appearance, and sometimes there is cayenne pepper-like speckling. There may also be areas of purpura and hemosiderin pigmentation (Fig. 12.66).
Alternative names proposed for these inflammatory changes include chronic vulval purpura5 and persistent purpuric dermatitis.6 Similar lesions have been described in the oral cavity and other mucosal surfaces, including the epiglottis, under names such as plasma cell orificial mucositis and atypical gingivostomatitis.7
In the female, mucous membrane pemphigoid can lead to architectural change and is the main differential diagnosis for erosive LP. Vulval involvement in linear IgA disease in children (bullous dermatosis of childhood) can be seen in 80% patients and may present with genital lesions.3
The histology of bullous disorders in genital skin is the same as that seen in lesions presenting elsewhere.
Fig. 12.66 Zoon vulvitis (plasma cell vulvitis): purpuric change at vestibule.