Ulcerative Dermatoses

  • Alberto Rosenblatt
  • Homero Gustavo de Campos Guidi
  • Walter BeldaJr.


Noninfectious ulcerative lesions involving the male genital may have distinct etiologies, including systemic diseases such as Behçet’s disease, as well as several traumatic lesions to the anogenital area. A detailed medical history, thorough clinical examination, and serologic tests to exclude sexually transmitted infections (See  Chap. 10) should be included in the investigation of the disorders detailed in this Chapter.


Pyoderma Gangrenosum Genital Ulcer Penile Fracture Topical Pimecrolimus Genital Skin 
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  1. Akkus E, Iscimen A, Tasli L, Hattat H (2006) Paraffinoma and ulcer of the external genitalia after self-injection of vaseline. J Sex Med 3:170–172PubMedCrossRefGoogle Scholar
  2. Alpsoy E, Er H, Durusoy C, Yilmaz E (1999) The use of sucralfate suspension in the treatment of oral and genital ulceration of Behcet disease: a randomized, placebo-controlled, double-blind study. Arch Dermatol 135:529–532PubMedCrossRefGoogle Scholar
  3. Alpsoy E, Durusoy C, Yilmaz E, Ozgurel Y, Ermis O, Yazar S, Basaran E (2002) Interferon alfa-2a in the treatment of Behcet disease: a randomized placebo-controlled and double-blind study. Arch Dermatol 138:467–471PubMedCrossRefGoogle Scholar
  4. Anchi T, Tamura K, Inoue K, Ashida S, Yasuda M, Kataoka S, Saito K, Kuriyama M, Hiroi M, Sasaguri S, Shuin T (2009) Localized Fournier’s gangrene of the penis: a case report. Hinyokika Kiyo 55:153–156PubMedGoogle Scholar
  5. Arrabal-Polo MA, Arias-Santiago SA, Giron-Prieto MS, Arrabal-Martin M (2009) Foreskin trapped by zipper: a case report. Cases J 2:6345PubMedCrossRefGoogle Scholar
  6. Badawy H, Soliman A, Ouf A, Hammad A, Orabi S, Hanno A (2010) Progressive hair coil penile tourniquet syndrome: multicenter experience with 25 cases. J Pediatr Surg 45:1514–1518PubMedCrossRefGoogle Scholar
  7. Balighi K, Farsinejad K, Naraghi ZS, Tamizifar B (2008) Paraffinoma and ulcer of the external genitalia after self-injection of nandrolone. Int J Dermatol 47:1092–1094PubMedCrossRefGoogle Scholar
  8. Bernstein KT, Stephens SC, Barry PM, Kohn R, Philip SS, Liska S, Klausner JD (2009) Chlamydia trachomatis and Neisseria gonorrhoeae transmission from the oropharynx to the urethra among men who have sex with men. Clin Infect Dis 49:1793–1797PubMedCrossRefGoogle Scholar
  9. Bertozzi M, Prestipino M, Nardi N, Falcone F, Appignani A (2009) Scrotal dog bite: unusual case and review of pediatric literature. Urology 74:595–597PubMedCrossRefGoogle Scholar
  10. Bode CO, Ikhisemojie S, Ademuyiwa AO (2010) Penile injuries from proximal migration of the Plastibell circumcision ring. J Pediatr Urol 6:23–27PubMedCrossRefGoogle Scholar
  11. Callen JP, Jackson JM (2007) Pyoderma gangrenosum: an update. Rheum Dis Clin North Am 33:787–802, viPubMedCrossRefGoogle Scholar
  12. Caputo R, Marzano AV, Di Benedetto A, Ramoni S, Cambiaghi S (2006) Juvenile gangrenous vasculitis of the scrotum: Is it a variant of pyoderma gangrenosum? J Am Acad Dermatol 55:S50–53Google Scholar
  13. Centers for Disease Control and Prevention (CDC) (2004) Transmission of primary and secondary syphilis by oral sex – Chicago, Illinois, 1998–2002. MMWR Morb Mortal Wkly Rep 53:966–968, Google Scholar
  14. Chams-Davatchi C, Barikbin B, Shahram F, Nadji A, Moghaddassi M, Yousefi M, Davatchi F (2010) Pimecrolimus versus placebo in genital aphthous ulcers of Behcet’s disease: a randomized double-blind controlled trial. Int J Rheum Dis 13:253–258PubMedCrossRefGoogle Scholar
  15. Charlesworth P, Campbell A, Kamaledeen S, Joshi A (2011) Surgical repair of traumatic amputation of the glans. Urology 77:1472–1473PubMedCrossRefGoogle Scholar
  16. Cho YH, Jung J, Lee KH, Bang D, Lee ES, Lee S (2003) Clinical features of patients with Behcet’s disease and epididymitis. J Urol 170:1231–1233PubMedCrossRefGoogle Scholar
  17. Chou EK, Tai YT, Wu CI, Lin MS, Chen HH, Chang SC (2008) Penile replantation, complication management, and technique refinement. Microsurgery 28:153–156PubMedCrossRefGoogle Scholar
  18. Ciancio SJ, Coburn M (2000) Penile salvage for squamous cell carcinoma associated with mineral oil injection. J Urol 164:1650PubMedCrossRefGoogle Scholar
  19. Cohen PR (2009) Neutrophilic dermatoses: a review of current treatment options. Am J Clin Dermatol 10:301–312PubMedCrossRefGoogle Scholar
  20. Cohen JL, Keoleian CM, Krull EA (2002) Penile paraffinoma: self-injection with mineral oil. J Am Acad Dermatol 47:S251–S253PubMedCrossRefGoogle Scholar
  21. Davatchi F, Shahram F, Chams-Davatchi C, Shams H, Nadji A, Akhlaghi M, Faezi T, Sadeghi Abdollahi B (2010) How to deal with Behcet’s disease in daily practice. Int J Rheum Dis 13:105–116PubMedCrossRefGoogle Scholar
  22. Davatchi F, Chams-Davatchi C, Ghodsi Z, Shahram F, Nadji A, Shams H, Akhlaghi M, Larimi R, Sadeghi-Abdolahi B (2011) Diagnostic value of pathergy test in Behcet’s disease according to the change of incidence over the time. Clin Rheumatol 30:1151–1155PubMedCrossRefGoogle Scholar
  23. Edlin RS, Aaronson DS, Wu AK, Blaschko SD, Yang G, Erickson BA, McAninch JW (2010) Squamous cell carcinoma at the site of a Prince Albert’s piercing. J Sex Med 7:2280–2283PubMedCrossRefGoogle Scholar
  24. El-Bahnasawy MS, El-Sherbiny MT (2002) Paediatric penile trauma. BJU Int 90:92–96PubMedCrossRefGoogle Scholar
  25. Erdemir F, Gokce O, Sanli O, Kadioglu A, Parlaktas BS, Uluocak N, Kilicaslan I (2006) A rare complication after circumcision: keloid of the penis. Int Urol Nephrol 38:609–611PubMedCrossRefGoogle Scholar
  26. Evereklioglu C (2006) Diagnostic dilemma between intestinal Behcet disease and inflammatory bowel ­disease with pyoderma gangrenosum. World J Gastroenterol 12:5748–5751PubMedGoogle Scholar
  27. Farrell AM, Black MM, Bracka A, Bunker CB (1998) Pyoderma gangrenosum of the penis. Br J Dermatol 138:337–340PubMedCrossRefGoogle Scholar
  28. Ganem JP, Lucey DT, Janosko EO, Carson CC (1998) Unusual complications of the vacuum erection device. Urology 51:627–631PubMedCrossRefGoogle Scholar
  29. Georgala S, Georgala C, Nicolaidou E (2008) Pyoderma gangrenosum of the penis: a potentially dramatic skin disease. Urology 72:1185.e9–1185.e10CrossRefGoogle Scholar
  30. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA (1995) Newborn penile glans amputation during circumcision and successful reattachment. J Urol 153:778–779PubMedCrossRefGoogle Scholar
  31. Godwin J (2011) Neutropenia. In: Medscape reference. WebMD Health Professional Network, New YorkGoogle Scholar
  32. Gomes CM, Ribeiro-Filho L, Giron AM, Mitre AI, Figueira ER, Arap S (2001) Genital trauma due to animal bites. J Urol 165:80–83PubMedCrossRefGoogle Scholar
  33. Graham JA, Hansen KK, Rabinowitz LG, Esterly NB (1994) Pyoderma gangrenosum in infants and children. Pediatr Dermatol 11:10–17PubMedCrossRefGoogle Scholar
  34. Gungor E, Karakayali G, Alli N, Artuz F, Lenk N (1999) Penile pyoderma gangrenosum. J Eur Acad Dermatol Venereol 12:59–62PubMedCrossRefGoogle Scholar
  35. Hawkins DA (2001) Oral sex and HIV transmission. Sex Transm Infect 77:307–308PubMedCrossRefGoogle Scholar
  36. Ho SA, Tan WP, Tan AW, Wong SN, Chua SH (2009) Scrotal pyoderma gangrenosum associated with Crohn’s disease. Singapore Med J 50:e397–e400PubMedGoogle Scholar
  37. Hounsfield V, Davies SC (2008) Genital piercing in association with gonorrhoea, chlamydia and warts. Int J STD AIDS 19:499–500PubMedCrossRefGoogle Scholar
  38. Ideguchi H, Suda A, Takeno M, Ueda A, Ohno S, Ishigatsubo Y (2011) Behcet disease: evolution of clinical manifestations. Medicine (Baltimore) 90:125–132CrossRefGoogle Scholar
  39. Imbert E, Milpied B, Jouary T, Versapuech J, Goussot JF, Taieb A, Ezzedine K (2010) Penile swelling and ulceration. Acta Derm Venereol 90:81–82PubMedCrossRefGoogle Scholar
  40. Ingram JR (2009) Nicotine: does it have a role in the treatment of skin disease? Postgrad Med J 85:196–201PubMedCrossRefGoogle Scholar
  41. International Study Group for Behcet’s Disease (1990) Criteria for diagnosis of Behcet’s disease. Lancet 335:1078–1080Google Scholar
  42. Jin F, Prestage GP, Mao L, Kippax SC, Pell CM, Donovan B, Templeton DJ, Taylor J, Mindel A, Kaldor JM, Grulich AE (2006) Transmission of herpes simplex virus types 1 and 2 in a prospective cohort of HIV-negative gay men: the health in men study. J Infect Dis 194:561–570PubMedCrossRefGoogle Scholar
  43. Jones R, Kingston A, Boag F (2007) Post-coital bleeding due to penile piercing. Int J STD AIDS 18:427–428PubMedCrossRefGoogle Scholar
  44. Jorizzo JL, Schmalstieg FC, Solomon AR Jr, Cavallo T, Taylor RS 3rd, Rudloff HB, Schmalstieg EJ, Daniels JC (1986) Thalidomide effects in Behcet’s syndrome and pustular vasculitis. Arch Intern Med 146:878–881PubMedCrossRefGoogle Scholar
  45. Kaplan GW (1983) Complications of circumcision. Urol Clin North Am 10:543–549PubMedGoogle Scholar
  46. Kienbaum S, Zouboulis CC, Waibel M, Orfanos CE (1993) Chemotactic neutrophilic vasculitis: a new histopathological pattern of vasculitis found in mucocutaneous lesions of patients with Adamantiades–Behçet’s disease. In: Wechsler B, Godeau P (eds) Behçet’s ­disease. Excerpta Medica, Amsterdam/London/New York/Tokyo, pp 337–341Google Scholar
  47. Kim TH, Oh SY, Myung SC (2009) Pyoderma gangranosum of the penis. J Korean Med Sci 24:1200–1202PubMedCrossRefGoogle Scholar
  48. Kimber RM, Mellon JK (2004) The role of special cutting equipment and corporeal aspiration in the treatment of penile incarceration with a barbell retaining collar. J Urol 172:975PubMedCrossRefGoogle Scholar
  49. Kohjimoto Y, Inagaki T, Iba A, Kikkawa K, Suzuki A, Uekado Y, Shinka T (2005) Pyoderma gangrenosum of the penis presenting as Fournier’s gangrene: a case report. Hinyokika Kiyo 51:411–415PubMedGoogle Scholar
  50. Lally A, Hollowood K, Bunker CB, Turner R (2005) Penile pyoderma gangrenosum treated with topical tacrolimus. Arch Dermatol 141:1175–1176PubMedCrossRefGoogle Scholar
  51. Lee T, Choi HR, Lee YT, Lee YH (1994) Paraffinoma of the penis. Yonsei Med J 35:344–348PubMedGoogle Scholar
  52. Letsinger JA, McCarty MA, Jorizzo JL (2005) Complex aphthosis: a large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide. J Am Acad Dermatol 52:500–508PubMedCrossRefGoogle Scholar
  53. Maruschke M, Seiter H (2004) Total infarction of the penis caused by entrapment in a plastic bottle. Urologe A 43:843–844PubMedCrossRefGoogle Scholar
  54. Masarani M, Dinneen M (2007) Penile fracture: diagnosis and management. Trends Urol Gynaecol Sex Health 12:20–24CrossRefGoogle Scholar
  55. May M, Gunia S, Helke C, Kheyri R, Hoschke B (2006) Penile entrapment in a plastic bottle – a case for using an oscillating splint saw. Int Urol Nephrol 38:93–95PubMedCrossRefGoogle Scholar
  56. Messahel A, Musgrove B (2009) Infective complications of tattooing and skin piercing. J Infect Public Health 2:7–13PubMedCrossRefGoogle Scholar
  57. Morand JJ, Lightburn E, Richard MA, Hesse-Bonerandi S, Carsuzaa F, Grob JJ (2001) Skin manifestations associated with myelodysplastic syndromes. Rev Med Interne 22:845–853PubMedCrossRefGoogle Scholar
  58. Murty OP (2008) Male genital ornaments: penis pearls. J Forensic Leg Med 15:96–100PubMedCrossRefGoogle Scholar
  59. Nakamura T, Yagi H, Kurachi K, Suzuki S, Konno H (2006) Intestinal Behcet’s disease with pyoderma gangrenosum: a case report. World J Gastroenterol 12:979–981PubMedGoogle Scholar
  60. Norton SA (1993) Fijian penis marbles: an example of artificial penile nodules. Cutis 51:295–297PubMedGoogle Scholar
  61. Park HJ, Kim YC, Cinn YW, Yoon TY (2000) Granulomatous pyoderma gangrenosum: two unusual cases showing necrotizing granulomatous inflammation. Clin Exp Dermatol 25:617–620PubMedCrossRefGoogle Scholar
  62. Parren LJ, Nellen RG, van Marion AM, Henquet CJ, Frank J, Poblete-Gutierrez P (2008) Penile pyoderma gangrenosum: successful treatment with colchicine. Int J Dermatol 47(Suppl 1):7–9PubMedCrossRefGoogle Scholar
  63. Perez-Cotapos ML, Cossio ML (2006) Tattooing and piercing in teenagers. Rev Med Chil 134:1322–1329PubMedGoogle Scholar
  64. Pieretti RV, Goldstein AM, Pieretti-Vanmarcke R (2010) Late complications of newborn circumcision: a ­common and avoidable problem. Pediatr Surg Int 26:515–518PubMedCrossRefGoogle Scholar
  65. Presutti RJ (1997) Bite wounds. Early treatment and prophylaxis against infectious complications. Postgrad Med 101:243–244, 246–252, 254PubMedCrossRefGoogle Scholar
  66. Reichrath J, Bens G, Bonowitz A, Tilgen W (2005) Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol 53:273–283PubMedCrossRefGoogle Scholar
  67. Robinson AM, Chapple CR (2003) Pyoderma gangrenosum of the penis: an interesting penile lesion. BJU Int 92(Suppl 3):e62PubMedGoogle Scholar
  68. Rosen T (2005) Penile ulcer from traumatic orogenital contact. Dermatol Online J 11:18PubMedGoogle Scholar
  69. Rosen T, Conrad N (1999) Genital ulcer caused by human bite to the penis. Sex Transm Dis 26:527–530PubMedCrossRefGoogle Scholar
  70. Rosenberg E, Romanowsky I, Asali M, Kaneti J (2007) Three cases of penile paraffinoma: a conservative approach. Urology 70:372.e9–372.e10CrossRefGoogle Scholar
  71. Rosenblatt A, Campos Guidi H (2009) Human papillomavirus history and epidemiology. In: Rosenblatt A, Campos Guidi H (eds) Human papillomavirus – a practical guide for urologists. Springer, Heidelberg, p 12Google Scholar
  72. Sams HH, Kiripolsky MG, Boyd AS, King LE Jr (2003) Crohn’s disease of the penis masquerading as pyoderma gangrenosum: a case report and review of the literature. Cutis 72:432–437PubMedGoogle Scholar
  73. Santos P, Chaveiro A, Nunes G, Fonseca J, Cardoso J (2003) Penile paraffinoma. J Eur Acad Dermatol Venereol 17:583–584PubMedCrossRefGoogle Scholar
  74. Sanusi ID, Gonzalez E, Venable DD (1982) Pyoderma gangrenosum of penile and scrotal skin. J Urol 127:547–549PubMedGoogle Scholar
  75. Sathesh-Kumar T, Hanna-Jumma S, De Zoysa N, Saleemi A (2009) Genitalia strangulation – fireman to the ­rescue! Ann R Coll Surg Engl 91:W15–W16PubMedCrossRefGoogle Scholar
  76. Shah M, Lewis FM, Harrington CI (1996) Scrotal pyoderma gangrenosum associated with dermatomyositis. Clin Exp Dermatol 21:151–153PubMedCrossRefGoogle Scholar
  77. Silberstein J, Grabowski J, Lakin C, Goldstein I (2008) Penile constriction devices: case report, review of the literature, and recommendations for extrication. J Sex Med 5:1747–1757PubMedCrossRefGoogle Scholar
  78. Singh I, Joshi MK, Jaura MS (2010) Strangulation of penis by a ball bearing device. J Sex Med 7:3793–3797PubMedCrossRefGoogle Scholar
  79. Strimling BS (1996) Partial amputation of glans penis during Mogen clamp circumcision. Pediatrics 97:906–907PubMedGoogle Scholar
  80. Stunell H, Power RE, Floyd M Jr, Quinlan DM (2006) Genital self-mutilation. Int J Urol 13:1358–1360PubMedCrossRefGoogle Scholar
  81. Suzuki Kurokawa M, Suzuki N (2004) Behcet’s disease. Clin Exp Med 4:10–20PubMedCrossRefGoogle Scholar
  82. Thomsen SF, Sorensen LT (2010) Smoking and skin ­disease. Skin Therapy Lett 15:4–7PubMedGoogle Scholar
  83. Thomson N, Sutcliffe CG, Sirirojn B, Sintupat K, Aramrattana A, Samuels A, Celentano DD (2008) Penile modification in young Thai men: risk environments, procedures and widespread implications for HIV and sexually transmitted infections. Sex Transm Infect 84:195–197PubMedCrossRefGoogle Scholar
  84. Voegeli TA, Effert PJ (2005) Pentaethylene-terephthalate (PET) bottles: a new device for autoerotic strangulation of the penis causing serious injury. Arch Sex Behav 34:469–470PubMedCrossRefGoogle Scholar
  85. Wahba A, Cohen HA (1979) Herpes simplex virus isolation from pyoderma gangrenosum lesions in a patient with chronic lymphatic leukemia. Dermatologica 158:373–378PubMedCrossRefGoogle Scholar
  86. Wessells H, Long L (2006) Penile and genital injuries. Urol Clin North Am 33:117–126, viiPubMedCrossRefGoogle Scholar
  87. Wilcher G (2006) Artificial penile nodules – a forensic pathosociology perspective: four case reports. Med Sci Law 46:349–356PubMedCrossRefGoogle Scholar
  88. Yip A, Ng SK, Wong WC, Li MK, Lam KH (1989) Injury to the prepuce. Br J Urol 63:535–538PubMedCrossRefGoogle Scholar
  89. Yousefi M, Lee S, Bang D (2010) Dermatologic aspects of Behcet disease. In: eMedicine. Medscape. Available at: Updated: 23 Dec 2010
  90. Zouboulis CC (1999) Epidemiology of Adamantiades-Behcet’s disease. Ann Med Interne (Paris) 150:488–498Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Alberto Rosenblatt
    • 1
  • Homero Gustavo de Campos Guidi
    • 2
  • Walter BeldaJr.
    • 3
  1. 1.Albert Einstein Jewish Hospital (HIAE)São PauloBrazil
  2. 2.University of São Paulo Medical SchoolSão PauloBrazil
  3. 3.Department of DermatologyUniversity of São Paulo Medical SchoolSão PauloBrazil

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