Perianal pseudoverrucous papules and nodules (PPPN) is an uncommon form of irritant contact dermatitis that can be easily confused with other conditions, leading to frequent misdiagnosis. The common inciting factor in all reported cases of PPPN is exposure to a persistent moist environment. A reactive epidermal hyperplasia resulting from moisture, heat, and chronic irritation is the most commonly proposed and likely pathogenic mechanism. Ammonia from urine may also play a contributing role.
PPPN has been described in patients with urostomies, colostomies, chronic urinary incontinence requiring diapers, encopresis, severe intractable diarrhea or chronic fecal incontinence secondary to spinal dysraphism, spina bifida, and spinal cord injury. PPPN typically occurs in infants or in patients with any of the above predisposing scenarios.
Perianal pseudoverrucous papules and nodules - Anogenital in
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Synopsis
Codes
ICD10CM:
R23.8 – Other skin changes
SNOMEDCT:
271757001 – Papular eruption
400037008 – Disorder of perianal skin
R23.8 – Other skin changes
SNOMEDCT:
271757001 – Papular eruption
400037008 – Disorder of perianal skin
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Human papillomavirus infection / condyloma acuminata – Consider in sexually active patients or pediatric patients where sexual abuse is a possibility. Although skin biopsy is not necessary for the diagnosis of genital warts, it can help differentiate genital warts from PPPN.
- Condylomata lata of secondary syphilis – Take a sexual history and ask about a recent primary chancre.
- Bacterial infections
- Granuloma gluteale infantum / adultorum – Appears as oval-shaped, red to violaceous nodules in areas of maceration and/or occlusion.
- Candidiasis – Appears as beefy red plaques with satellite papules and superficial pustules, with or without scale.
- Langerhans cell histiocytosis – Crusted papules in a seborrheic distribution involving the scalp, ears, abdomen, and intertriginous areas.
- Cutaneous lymphoma
- Pemphigus vegetans – Look for crusted erosions elsewhere, as well as oral involvement.
- Papular acantholytic dermatosis
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Therapy
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References
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Last Updated:02/20/2018
Perianal pseudoverrucous papules and nodules - Anogenital in