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Background: Dysaesthetic penoscrotodynia (DPSD) is a poorly understood disorder, in which men experience distressing symptoms such as burning pain in their genital skin. Drugs for neuropathic pain are often used, but with little success., Aim: To review a series of patients with DPSD to highlight common themes and response to treatment., Methods: Ten consecutive patients with DPSD were identified from specialist male genital dermatology and psychodermatology clinics at two centres. Clinical details, including psychiatric history, were reviewed retrospectively. Patients with no previously diagnosed psychiatric illness completed either the Generalized Anxiety Disorder (GAD)-7 scale and the Patient Health Questionnaire (PHQ)-9 depression scale, or the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI)., Results: Of the 10 patients, 9 had known or newly diagnosed psychopathology. All patients were offered psychodermatological treatment, of which 7 of 10 accepted. All of those who accepted psychodermatological treatment experienced an improvement in their genital symptoms. When post-treatment scores were collected, improvement in psychiatric symptoms accompanied improvement in genital symptoms., Conclusions: Psychopathology is almost invariably present in individuals with DPSD, yet these patients rarely volunteer such information. DPSD is most likely to constitute a functional somatic symptom disorder, hence psychodermatological treatment is indicated for its management. This concept reflects a significant change in the approach to this condition., (© 2016 British Association of Dermatologists.)

Bullous pemphigoid (BP) is one of the most common acquired immunobullous diseases. Rarely, the development of BP is attributed to drug exposure. We present two cases of BP, one triggered by intravenous iodine, and one associated with etanercept treatment in a patient with psoriasis; the first time, to our knowledge, that either of these associations has been reported. The recognition of occasional cases of drug-induced BP such as ours, with timely cessation of the offending agent, may produce rapid clinical improvement with decreased exposure to potent immunosuppressive therapy., (© The Author(s). CED © 2011 British Association of Dermatologists.)

Background: Male erectile dysfunction (ED) is common, frequently caused by pelvic arterial atherosclerosis, and is a predictor of future cardiovascular disease. There is an emerging association between psoriasis, the metabolic syndrome and atherosclerotic disease. We hypothesized that ED occurs more commonly in patients with psoriasis, at least in part due to incipient atherosclerosis, which may offer an opportunity for early intervention., Objectives: To determine the prevalence of, and risk factors for, ED in patients with psoriasis in comparison with a heterogeneous dermatology outpatient control group., Methods: We conducted a pilot study with a prospective observational cross-sectional design, recruiting consecutive adult male dermatology outpatients diagnosed with psoriasis or any other skin condition. Sexually active participants completed a questionnaire, a Dermatology Life Quality Index and the validated five-item version of the International Index of Erectile Function (IIEF-5)., Results: Fifty-three of 92 (58%) patients with psoriasis recorded an IIEF-5 score indicative of ED, compared with 64 of 130 (49%) control patients, reflecting an age-adjusted odds ratio of 2·007 (95% confidence interval 1·088-3·701; P = 0·026). A multivariable logistic regression model indicated that increasing age and hypertension, but not a diagnosis of psoriasis, were independent risk factors for ED in our study population., Conclusions: We present the largest survey of ED in patients with skin disease, and the first to posit the potential link between psoriasis, ED and atherosclerosis. We suggest that an assessment of sexual function should be part of the routine holistic care provided for dermatology outpatients, and highlight the need to screen for cardiovascular risk factors in those with documented ED., (© 2010 The Authors. BJD © 2010 British Association of Dermatologists 2010.)

We report a case of eruptive disseminated superficial porokeratosis occurring in a 63-year-old man with no history of excessive sun exposure. Unlike disseminated superficial actinic porokeratosis, this condition resolved rapidly with minimal topical treatment. This is most likely to have represented a drug-induced phenomenon, which is very rarely reported in the dermatological literature.

Background: Dermatological surgery is carried out by a variety of practitioners in primary and secondary care., Objectives: To explore the activity and histopathological outcomes among different groups of dermatological surgeons dealing with skin cancers., Methods: Reports for all new skin tumour specimens processed by our histopathology department over a continuous 3-month period were reviewed retrospectively., Results: One thousand, one hundred and eleven new skin tumour specimens were identified. General practitioners (GPs) were least accurate in clinical diagnosis, with 42.8% (59/138) of their request forms including the eventual histological diagnosis, compared with 69.5% (328/472) for dermatologists (odds ratio, OR 0.33, 95% confidence interval, CI 0.22-0.48). Inappropriate procedures were most often performed by plastic surgeons, usually involving large excision biopsies for benign lesions in elderly patients [6.6% (20/305) of their specimens vs. 0% for dermatologists, exact P < 0.001]. Excision biopsies performed by GPs had the highest rate of margin involvement by tumour of any specialty [68% (15/22) of such specimens vs. 8% (9/116) for dermatologists; OR 25.47, 95% CI 8.26-78.53]. As per National Institute for Health and Clinical Excellence guidance, 13.8% (19/138) of tumours operated on by GPs should instead have been referred to secondary care for initial surgical management., Conclusions: This study presents a strong case for dermatologists to continue to provide the lead in diagnosis of skin lesions, and in selection and execution of dermatological surgical procedures.

We report a case of follicular porokeratosis of Mibelli affecting the natal cleft in a 42-year-old white man. To our knowledge, this is the first report in the English-language literature of follicular porokeratosis of Mibelli limited to the genitogluteal area.