Vulvar Pseudoverrucous Papules and Nodules Secondary to a Urethral–Vaginal Fistula

Abstract

Irritant contact dermatitis is a common cause of genital eruptions representing at least one-fifth of presenting anogenital symptoms. A spectrum of inflammatory reactions have been identified, some of them with features severely mimicking more serious dermatoses, which may lead unnecessary workup and treatments. We report a case of a 10-year-old girl who presented at birth with cloacal atresia involving the rectum and the urethra. A diverting colostomy and a urethral-vaginal fistula were created to correct the deformity. Physical examination reveals numerous shiny, white-gray, pseudoverrucous papules and nodules coalescing into plaques over the vulva and its surrounding skin. Histological examination showed psoriasiform epidermal hyperplasia with a marked reactive acanthosis and altered cornification with parakeratosis, hypogranulosis, and pale keratinocytes in the upper reaches of the epidermis. The lesions regress when the irritating factor was removed. This case represents a peculiar form of presentation of perianal pseudoverrucous papules and nodules, usually secondary to urinary incontinence or encopresis (inability to control the elimination of stool) after surgery for Hirschsprung disease. Because similar findings have not been previously observed in patients with urethral-vaginal fistula, we attempt to extend the spectrum of presentations for a better knowledge of this condition.

A vesicular variant of pseudoverrucous papules and nodules in the genital area of an incontinent 4-year-old

“…It occurs in approximately 20% of urostomy patients but has since been described in perianal, genital, suprapubic and peristomal areas, as well as on the buttocks on infants and adults . A similar case that presented with nodules was recently reported in another child with a urethrovaginal fistula . The diagnosis in our case was made by the striking clinical and pathological similarities to other cases in the literature.…”

“…The diagnosis in our case was made by the striking clinical and pathological similarities to other cases in the literature. The pathological changes, however, are not pathognomonic as they overlap the changes of necrolytic erythema, a point made by Concepcion et al …”

“…Overhydration and overheating result in maceration, which increases the permeability of the skin, allowing irritants to trigger inflammation. Ammonia from the urinary urea may also indirectly play a role . The histopathology in cases of pseudoverrucous papules and nodules shows a reactive acanthosis .…”

“…Ammonia from the urinary urea may also indirectly play a role . The histopathology in cases of pseudoverrucous papules and nodules shows a reactive acanthosis . The pathophysiology of vesiculation presumably relates to epidermal spongiosis and loss of epidermal intercellular cohesion.…”

Pseudoverrucous papules and nodules in an infant with penoscrotal hypospadiasis

“…[ 1 ] It presents as gray or erythematous, erosive/verrucous papules, plaques and nodules in the genital and peristomal sites of all ages. [ 2 ] Chronic urinary and stool incontinence secondary to urogenital anomalies, occult spinal dysraphism, and various urological and gastroenterological procedures lead to severe irritation of the diaper region causing PPN. [ 3 4 ]…”