Miscellaneous Perianal Afflictions

Abstract

This article provides an overview of hidradenitis suppurativa, lichen planus, lichen sclerosis, calcinosis cuti, pyogenic granuloma, intertrigo, and seborrheic keratosis. This article also focuses on recognition and management of these pleomorphic afflictions of the perianal region.

Keywords: calcinosis cuti; hidradenitis suppurativa; intertrigo and seborrheic keratosis; lichen planus; lichen sclerosis; pyogenic granuloma.

Fig. 1

Squamous cell carcinoma transformation in the setting of chronic hidradenitis suppurativa—an example of a Marjolin's ulcer phenomenon (Photo—A. Ortega).

Fig. 2

Characteristic features of hidradenitis suppurativa are in evidence including ( A ) diffuse interconnecting tracts with abscesses and pyogenic granuloma; ( B ) demonstrates greater disease extension, scarring, and deformity (Photos—A. Ortega).

Fig. 3

Representative photographs in three stages of advanced hidradenitis treated by serial unroofing procedures: ( A ) An aggressive initial incision and debridement; ( B ) fewer lesions are encountered at second interventions; and ( C ) burned out hidradenitis following multiple unroofing procedures (Photos—A. Ortega).

Fig. 4

Perianal lichen planus confluent at the anal verge associated with peripheral satellite lesions (Photo—A. Ortega).

Fig. 5

Perianal lichen sclerosis resembles vitiligo (Photo—A. Ortega).

Fig. 6

Perianal calcinosis cuti observed in two asymptomatic individuals without identified autoimmune disorders (Photo ( A )—A. Ortega; Photo ( B )—J.M. Parker).

Fig. 7

Pyogenic granulomas associated with the external opening(s) of cryptoglandular fistulas: ( A ) solitary, ( B ) double, ( C ) and ( D ) multiple. (Photos—A. Ortega)

Fig. 8

Perianal intertrigo with its characteristic pustules, papules, and superficial ulcerations (Photo—VisualDx.com—with permission).

Fig. 9

Seborrheic keratosis outside the anal margin in evidence (Photo—Genital & Perianal Diseases—A Color Handbook. Mroczkowski TF, Millikan LE, Parish LC, editors. 2014 © Boca Raton, FL: CRC Press. Reproduced by permission of Taylor & Francis Books UK).