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At the heart of general practice since 1960

Managing anogenital conditions

Interesting presentations photographed in GP surgeries

This 89-year-old mentioned in passing

that for a number of months she had piles that

bled regularly, although they were painless, writes

Dr Nigel Stollery. Examination revealed, not piles as she had thought, but

a large rectal polyp. This was successfully removed under general anaesthetic a few months later.

This 50-year-old woman had intractable itching around her vulva and anus, writes Dr Michael Lacey. She had non-indurated ivory white, shiny atrophic macules with follicular plugging in a figure-of-eight pattern around her vulva and anus.

She has lichen sclerosus. The condition is an uncommon one. Females predominate. Extragenital involvement occurs in 20 per cent of cases.

Premalignant and frankly malignant changes can occur in patients with lichen sclerosus. About three-quarters of female patients will have one or more organ specific autoantibodies.

There is no effective treatment for extragenital lesions and they should be left alone. For genital lesions there is evidence that the use of potent topical steroids give both symptomatic relief and prevent scarring. Patients with genital lesions should be seen at intervals to facilitate the early detection of carcinoma.

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