Photo gallery: diseases of the anogenital skin and mucosa in males

Diseases affecting the anogenital skin and mucosa represent a relevant and complex interdisciplinary clinical problem. The spectrum of conditions affecting this anatomical region is extremely broad and diverse. This creates substantial difficulties for practicing clinicians in performing differential diagnosis and establishing a definitive diagnosis. Moreover, the clinical manifestations and disease course of certain conditions may vary depending on patient sex. This article presents a case series involving HIV-positive men from the author’s archive. The photo gallery includes anogenital diseases of various etiologies, including conditions confined exclusively to this region as well as manifestations representing just some of the more widespread dermatoses. The presented conditions include multiple scrotal epidermoid cysts, angiokeratoma of Fordyce, herpes zoster, molluscum contagiosum, scabies, microsporia, Stevens–Johnson syndrome, and gonococcal infection. An epidermoid cyst is a cystic tumor with low malignant potential. In addition to the external genitalia, it may occur on the scalp, face, or trunk. Lesions are often multiple and may reach up to 6 cm in diameter. Angiokeratoma is a vascular lesion characterized by persistent dilation of subepidermal capillaries and postcapillary venules in combination with epidermal hyperkeratosis and acanthosis. Several clinical forms are distinguished depending on lesion localization and number, one of which is angiokeratoma of Fordyce (genital angiokeratoma), presenting on the scrotum in men or the vulvar region in women. Genital herpes zoster in men involves dermatomes innervated by the sacral spinal nerves S2–S4. Such cases account for no more than 5% of all herpes zoster presentations and may be accompanied by urinary dysfunction. In adults, molluscum contagiosum most commonly affects the pubic region, external genitalia, lower abdomen, and perianal area. Multiple lesions are typically observed in immunocompromised individuals. Genital involvement in scabies often remains unrecognized, as specific features of skin structure, increased humidity and temperature, and mechanical friction may alter the clinical presentation of the dermatosis. Dermatophytosis of the male external genitalia is rare and primarily affects young individuals. Microsporum canis is the most common causative agent. Although diagnosis of typical skin and hair involvement caused by Microsporum species usually presents little difficulty, atypical clinical presentations and/or unusual localization may complicate recognition. In Stevens–Johnson syndrome, anogenital involvement accounts for 44%–78% of cases. Resulting bullae rapidly rupture, forming painful, extensive erosions covered with fibrinous exudate. The presented case of gonococcal urethritis serves as a reminder of gonococcal infection, the incidence of which has been steadily declining in the Russian Federation. The photographs in the gallery are accompanied by descriptions of the pathological process. Cases of syphilis and sexually transmitted infections caused by human papillomavirus and herpes simplex virus types 1 and 2 were not included, as these conditions were addressed in previous issues of the journal.