Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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Year : 2018  |  Volume : 39  |  Issue : 2  |  Page : 141-142
 

Multiple pruritic plaques on scrotum-what is your diagnosis?


Government Medical College Baroda, SSG Hospital, Vadodara, Gujarat, India

Date of Web Publication7-Dec-2018

Correspondence Address:
Dr. Ashma Surani
OPD-1, Medical College Baroda, SSG Hospital, Vadodara - 390 001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijstd.IJSTD_82_18

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   Abstract 

Differential diagnosis of genital lesions must include venereal and nonvenereal dermatosis. Atypical manifestations of common dermatosis exclusively over scrotum pose diagnostic challenge and histopathology plays a crucial role in such cases.


Keywords: Plaque, pruritus, scrotal skin


How to cite this article:
Surani A, Marfatia Y, Bavariya R. Multiple pruritic plaques on scrotum-what is your diagnosis?. Indian J Sex Transm Dis 2018;39:141-2

How to cite this URL:
Surani A, Marfatia Y, Bavariya R. Multiple pruritic plaques on scrotum-what is your diagnosis?. Indian J Sex Transm Dis [serial online] 2018 [cited 2019 May 21];39:141-2. Available from: http://www.ijstd.org/text.asp?2018/39/2/141/247089



   Present Case Top


A 57-year-old male presented to the dermatology outpatient department with multiple pruritic skin lesions on scrotum for 2 years. The itching was moderate in intensity without diurnal variation. There was no history of extramarital sexual exposure. No history of any dermatosis. History of application of various topical over-the-counter products was present without significant improvement.

Cutaneous examination revealed multiple well-defined warty plaques with central ulceration having erythematous base and raised depigmented margins on the right side of scrotum [Figure 1]. Regional lymph nodes were not palpable. Hair, nail, and oral mucosa were normal. No significant changes were seen in the perianal region. Differential diagnosis of lichen simplex chronicus, chronic plaque psoriasis, and keratoacanthoma was considered.
Figure 1: Clinical appearance

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Investigations

Serum venereal disease research laboratory and HIV tests were negative. Complete blood count and urine routine reports were within normal limit. Biopsy was sent for histopathological examination.

Histopathological examination

Histopathological examination revealed moderately dense superficial perivascular infiltrate along with irregular epidermal hyperplasia centered around follicular infundibula and acrosyringia infiltrate which was denser around hyperplastic appendages and encroaching on them obscuring dermoepidermal (DE) junction. DE junction at those spots showed colloid bodies. Wedge-shaped hypergranulosis was seen within hyperplastic appendages. Follicular infundibula were dilated and plugged by compact orthokeratosis and corneocytes [Figure 2]a and [Figure 2]b.
Figure 2: (a and b) Histopathology

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   Final Diagnosis-Hypertrophic Lichen Planus Top


Treatment given

In this case, intralesional steroid (triamcinolone 10 mg/ml) was given fortnightly.


   Discussion Top


In the case discussed, lesions were suggestive of venereal disease, but there was no history of exposure, no other markers of STI and serology for HIV and syphilis were also nonreactive.

Nonveneral condition like lichen simplex chronicus, chronic plaque psoriasis, and keratoacanthoma was considered. Surprisingly, biopsy suggested hypertrophic lichen planus (LP).

LP is inflammatory, papulosquamous disorder affecting either or all of the skin, mucous membrane, hair, and nail. Hypertrophic LP is subacute or chronic variant of LP commonly affecting the pretibial region. Isolated hypertrophic lesions on the scrotum are rare phenomenon.[1] Although very rare, malignant transformation is possible. Majority of reported neoplasms have been histologically well-differentiated squamous cell carcinomas.[2] Two cases of keratoacanthoma in association with final diagnosis-hypertrophic LP have been reported.[3]

Potent corticosteroid ointments are the mainstay of therapy for localized lesions of LP. In hypertrophic LP, intralesional injections of long-acting steroid (triamcinolone acetonide) are effective. Calcineurin inhibitors such as cyclosporine, tacrolimus, and pimecrolimus have also been used in the treatment of LP.[4]

LP runs the chronic course, and relapse is seen in 15%–20% of cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Menon DS, Marfatia YS. Perigenital warty lesions-what is your diagnosis? Indian J Sex Transm Dis 2017;38:194-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sengupta S, Das JK, Gangopadhyay A. Malignant transformation of hypertrophic lichen planus. Indian J Dermatol Venereol Leprol 2006;72:470.  Back to cited text no. 2
  [Full text]  
3.
Bhat RM, Chathra N, Dandekeri S, Devaraju S. Verrucous growth arising over hypertrophic lichen planus. Indian J Dermatol Venereol Leprol 2013;79:711-3.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Pigatto PD, Chiappino G, Bigardi A, Mozzanica N, Finzi AF. Cyclosporin A for treatment of severe lichen planus. Br J Dermatol 1990;122:121-3.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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