Tuesday, 10 April 2012

Pseudoverrucous Papules and Nodules (PPN)

PPN is a form of chronic irritant contact dermatitis that occurs in the diaper and perianal areas in patients of any age with a predisposition to prolonged wetness (particularly chronic urinary incontinence/faecal soiling). Similar lesions have also been described in women who repeatedly apply the local anaesthetic benzocaine to the groin area. Moreover, they occur around urostomies (occurring in about 20% of urostomy patients) and occur less often around gastrointestinal stomas.

It is now thought that granuloma gluteale infantum (a misnomer because there are no granulomas), pseudoverrucous papules and nodules, and Jacquet’s erosive diaper dermatitis are parts of a disease spectrum that may be multifactorial in origin, but with a primary irritant aetiology.

The condition appears as 2 to 8 mm reddish to grey white (pseudoverrucous) flat-topped lesions. The lesions can coalesce into plaques.  Histopathology shows reactive acanthosis or psoriasiform spongiotic dermatitis.
This entity may be mistaken for condylomata acuminata, condylomata lata, Langerhans cells histiocytosis and other conditions. Because it may mimic more serious conditions its recognition is important to avoid unnecessary investigations and sexual abuse consideration.
Protection of the skin helps eliminate them. If the lesions persist, they generally respond well to topical corticosteroids preparations.

PPN in a 10-year old child with chronic urinary incontinence

This page was last updated in April 2012.

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology