This sexually active young adult presented with malaise, fever, sore throat and hoarseness together with the rash shown here. Does a concomitant HIV infection affect your management? If it does, explain how?
PPN is a form of chronic irritant contact dermatitis that occurs in the diaper and perianal areas in patients of any age with a predisposition to prolonged wetness (particularly chronic urinary incontinence/faecal soiling). Similar lesions have also been described in women who repeatedly apply the local anaesthetic benzocaine to the groin area. Moreover, they occur aroundurostomies (occurring in about 20% of urostomy patients) and occur less often around gastrointestinal stomas.
It is now thought that granuloma gluteale infantum (a misnomer because there are no granulomas), pseudoverrucous papules and nodules, and Jacquet’s erosive diaper dermatitis are parts of a disease spectrum that may be multifactorial in origin, but with a primary irritant aetiology.
The condition appears as 2 to 8 mm reddish to grey white (pseudoverrucous) flat-topped lesions. The lesions can coalesce into plaques. Histopathology shows reactive acanthosis or psoriasiform spongiotic dermatitis.
This entity may be mistaken for condylomata acuminata, condylomata lata, Langerhans cells histiocytosis and other conditions. Because it may mimic more serious conditions its recognition is important to avoid unnecessary investigations and sexual abuse consideration.
Protection of the skin helps eliminate them. If the lesions persist, they generally respond well to topical corticosteroids preparations.
PPN in a 10-year old child with chronic urinary incontinence
Most applicants to Dermatology training programme with its specialty exams and assessments will be physicians (MRCP holders). Other applicants are MRCPCH holders but in such circumstances additional specific clinical experience is needed.
Note that Genitourinary Medicine (Venereology) is a separate specialty that provides care for all aspects of sexual health and HIV medicine. Applicants to Genitourinary Medicine training programme with its specialty exams and assessments are MRCP holders (no longer MRCOG holders).
On reaching the consultant status, advancement from Membership to Fellowship (FRCP Status) might be achieved. Successful candidates must fulfil specific criteria employed by the Royal College Council.
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