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Localized epidermolytic hyperkeratosis of the female external genitalia
Michael H Swann1, John S Pujals, Jessica Pillow
1University of Arkansas for Medical Sciences, Dermatology, Little Rock, AR, USA.
Background:
Epidermolytic hyperkeratosis (EH) is most commonly associated with the diffuse involvement of congenital ichthyosiform erythroderma, but can also be found in a localized pattern. Localized EH is rare, but mucocutaneous lesions have been been identified, most commonly in the mouth.
Methods:
We observed a 58-year-old African-American female who noted spots on her genitalia for approximately 2 years. The lesions were increasing in size, darkening, and had become pruritic and sore over the past 6 months.
Results:
Physical examination revealed seven scattered, tan to brown, verrucoid papules on the labia and mons pubis, resembling condylomata acuminata or Bowenoid papulosis. Biopsy of a single labial papule revealed epidermal acanthosis, compact hyperkeratotic papillomatosis, perinuclear clear zones, granular keratohyalin clumping, hypergranulosis, and dyskeratosis resulting in intracellular eosinophilic globules, all characteristic of EH.
Conclusions:
Because of the rarity of localized genital EH and similar appearance to common diagnoses, clinical confusion may occur without biopsy.