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April 2013

Nodular Lesions in the Diaper Area—Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

JAMA Dermatol. 2013;149(4):475-480. doi:10.1001/jamadermatol.2013.1172a

An 83-year-old woman with urinary incontinence was referred to our clinic with a 2-year history of pruritic and painful lesions in the genital and suprapubic area. Repeated cycles of topical corticosteroid therapy resulted in a minimal and transitory response. The patient also reported a constant burning sensation that she treated with several daily applications of topical benzocaine. Dermatologic examination of the vulva, mons pubis, inner thighs, and suprapubic area revealed multiple, flesh-colored to erythematous violaceous papules, nodules, and plaques, some of which displayed superficial erosions (Figure 1). Culture of the lesional tissue did not demonstrate clinically significant bacterial or fungal pathogens. A skin biopsy specimen was obtained for histologic analysis (Figure 2).

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