Genital dermatology: What biopsies tell us that the patient may not.
ESC Congress Library. Jones N. May 10, 2018; 208070
Naomi Jones
Naomi Jones
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Abstract
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Objectives: Genitourinary medicine clinics allow self-referrals for genital specific dermatological complaints to be seen by senior, specialist clinicians in an ‘open access' setting. The rapid and easily accessible clinics known to offer confidential, non-judgemental advice result in first presentations of many genital dermatoses including those of a non-sexually transmitted nature. Recent changes to the National Service Specifications for sexual health services do not outline a need for dermatological services. This project looked to see the diagnostic biopsies undertaken in a 2 year period prior to these changes in a level 3 Complex service provision. One dermatological presentation of a penile lesion resulted in the underlying diagnosis of HIV being made. Design and methods: A retrospective observation of diagnostic biopsies from October 2014 to November 2016. A total of 18 diagnostic genital biopsies were undertaken.  11 from male patients and 7 female. Results: The following diagnoses were made: Female:  Psoriasis vulgaris, three cases of high grade/VIN3, lichen sclerosis and erythrasma, benign seborrheic keratosis, plasma cell vulvitis. Males: Two cases of Lichen sclerosis, granulation polyp, lichen planus, SCC, lichenoid inflammation, two cases of bullous balanitis xerotica obliterans, PeIN3 (HIV+ve), viral wart, fixed drug eruption. The PeIN3 diagnosis was the presenting complaint of a HIV positive patient. He had been reluctant to present to his general practitioner given the stigma associated with genital complaints and given then sexual health setting was screened for infectious causes of genital lesions. Conclusions: Across the 2 year period there is an interesting variety of genital presentations including 5 requiring urgent follow-up via the cancer pathway. The crossover between the two specialities highlights areas for further educational development and interdisciplinary discussions. Consideration of the differential diagnoses in genital dermatological presentation will ensure that patients access the correct care pathways and in a timely manner. As service specifications change in genitourinary medicine it is an interesting point to highlight to dermatological specialists the non-sexually transmitted genital complaints presenting via the open-access GUM service.
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