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Live Blog: Red Where the Sun Don’t Shine – Faculty: Misha Miller, MD

In this live blog from the Annual Summer SDPA Conference in Las Vegas, Misha Miller, MD, presented a lecture on “Red Where the Sun Don’t Shine.” Here are some of the highlights.

Dr. Misha Miller, a dermatologist and an OB/GYN, shared diagnostic pearls and tips for treatment on a number of conditions that plague our patients’ privates.

Irritant Dermatitis

In genital dermatology, Dr. Miller says that the most common thing she sees is irritant dermatitis. She explained that this is the direct effect of a caustic agent and typically won’t take a few days to appear like an allergic dermatitis would. Once the irritant is removed, the skin tends to get better. If the individual has itched the area to the point of abrasion, then they are at risk for developing lichen simplex chronicus.

Lichen Simplex Chronicus

“This is something that develops from a chronic itch,” explained Miller. “You have to have the itch to develop LSC, but sometimes it’s hard to find out how it was caused exactly.” Miller suggests patch testing in this case. It’s also important to check for candida and bacterial infections in order form a treatment that will best suit the patient. LCS appears mainly on the labia majora and the scrotum as a well-defined, thickened plaque.

Dr. Miller teaches that this is a clinical diagnosis, though a biopsy can sometimes be helpful to help delineate it. The best way to ensure positive treatment response will be to keep the area cool and ventilated. Miller also added that it would be worth convincing patients to stop using antibacterial soaps.

Lichen Sclerosus

Lichen sclerosus (LS) is a condition that is seen in women more than men – typically before puberty or after menopause. Clinicians will notice a figure-eight formation stretching from the clitoral hood down to the anus. Patients will likely be expressing great discomfort, itching, and difficulty using the bathroom – causing dysuria and constipation. If a male patient does present with this condition, it is important to treat it quickly as untreated LS can grow to obstruct the urethral meatus.

Dr. Miller added, “When you do see a patient with LS, they may have other autoimmune diseases that they should be tested for. Test their thyroid and ask about patchy hair loss.” Have these patients visit every month and then every 4-6 months. It may be important to see these patients throughout their lifetime.

Image: Mike and Annabel Beales

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