Skin diseases of the aged.
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Most common groin lesions are caused by fungi, bacteria, psychogenic factors, viruses, parasites, or tumors. The workup of all patients with an inguinal skin disorder should include a history, physical examination, microscopic examination and culture of scrapings from the eruption, and examination of the eruption by Wood's light. Agents useful in treating groin lesions include topical and systemic corticosteroids and antibiotics, antipruritic agents, Burow's solution, and lindane. Prolonged use of high-potency topical corticosteroids can be deleterious.
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Five patients developed pruritic, keratotic, perforating follicular papules and nodules within 2 months of starting maintenance hemodialysis. Clinically and histologically, the papules and nodules showed the features of perforating folliculitis with superimposed prurigo nodularis, a condition not previously described in patients on maintenance dialysis. The patients with perforating folliculitis constituted 10% of our patients on dialysis during the period of this study. Notably, all five patients were black and had chronic renal failure secondary to diabetic nephropathy. The precise pathogenesis of perforating folliculitis in these patients is unclear at this time.
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Vulvar vestibular biopsy specimens from 31 women with clinical and pathologic findings of vulvar vestibulitis were studied using polymerase chain reaction (PCR) for the identification of human papilloma virus (HPV). The PCR technique specifically probed for HPV types 6, 11, 16, and 18. Of the 31 subjects, three were found to have HPV within the biopsy specimens; two had HPV type 11 and one had HPV 16. Five of the 31 cases had histopathologic features of koilocytosis consistent with HPV effect; three of these five were found to have HPV. The findings support the hypothesis that HPV types 6, 11, 16, and 18 are rarely associated with vulvar vestibulitis. The frequencies identified were similar to those seen with control patients. True koilocytosis is the most useful pathologic feature distinguishing HPV-related cases; it is rarely identified in typical vulvar vestibulitis. Nonspecific changes in the vestibular epithelium associated with glycogen effect should not be interpreted as koilocytosis.
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Psychosocial dysfunction in dermatologic disorders is more frequent than commonly recognized. This review discusses skin changes that may suggest a psychological problem and a screening survey (the Pediatric Symptom Checklist) that facilitates office assessment of the degree of psychosocial dysfunction present.