the nonvenereal dermatoses can be classified into five groups based on pathogenesis : inflammatory diseases ( psoriasis , seborrheic dermatitis , lichen planus ) , infections and infestations ( scabies , dermatophytosis ) , congenital disorders ( median raphe cyst ) , benign abnormalities ( angiokeratoma of fordyce , sebaceous cyst ) , premalignant and malignant lesions ( eryrthroplasia of queyrat , squamous cell carcinoma ) .
as these groups includes various types of disorders , the identification of diseases is quite challenging .
these nonvenereal disorders are the cause of considerable concern to patients causing mental distress and guilt feeling in them .
nonvenereal dermatoses are quiet often a diagnostic dilemma to the treating physician , who has to effectively manage the condition and also allay the associated anxiety .
determining any causal or aggravating factor can save the patient from the agony of persistent discomfort and restrict social life , thereby considerably improving the dermatology - specific quality of life .
a comprehensive understanding of various presentation , there cause and appropriate management options is , therefore , essential .
the study was to find the pattern of nonvenereal dermatoses presenting with genital lesions and to correlate its various parameters .
a total of consecutive 100 male patients with genital lesions of nonvenereal origin , attending the dermatology opd at j a group of hospitals constituted the study group .
all male patients > 18 years of age who presented with genital complaints were screened for nonvenereal dermatoses .
a detailed history including demographic data , chief complaints related to skin , onset and duration of disease and associated medical or skin disorders was elicited and recorded .
the external genitalia was examined , and findings were noted . a detailed physical examination was done to see any associated lesions elsewhere in the body .
investigations such as gram - stain , koh mount , venereal disease research laboratory test , hiv test and histopathological examination were done as and when required establishing the diagnosis .
a proforma was prepared to record the relevant details of patient , examination , investigations and diagnosis .
a total of 100 male patients with nonvenereal dermatoses of external genitalia were included in the study .
the age of the patients ranged from 18 years to 65 years , with the mean age of 32.2 years .
most patients belong to the age group of 21 - 30 years ( 40% ) , followed by the age group of 31 - 40 years ( 20% ) .
seventy - four patients ( 74% ) were from the urban area while twenty - six patients ( 26% ) belong to rural background .
fifty - two ( 52% ) patients were married and the remaining forty - eight ( 48% ) patients were unmarried .
scrotum was involved in 60% and penis in 30% while both scrotum and penis were affected in 10% cases .
a total of sixteen types of nonvenereal dermatoses were noted in this study [ table 1 ] .
the most common disorder was vitiligo [ figure 1 ] present in 18 cases , followed by pearly penile papule [ figure 2 ] , which accounted for 16 cases .
the other disorder encountered included fixed drug eruption ( fde ) in 12 ; scabies [ figure 3 ] in 10 , scrotal dermatitis [ figure 4 ] and lichen planus [ figure 5 ] in 9 cases each etc . , [ table 1 ] .
genital vitiligo - depigmented macule over glans and prepuce pearly penile papule- asymptomatic discrete papules present over corona sulcus scabies - multiple nodules over glans lichen planus - violaceous annular plaques over glans penis the common presenting features were itchy genitalia , de - pigmentation .
other complaints were pain , burning sensation , redness , exfoliation of the skin , raised lesions over the skin , oozing , ulceration , erosions and thickening of the skin .
as venereal dermatoses are of primary concern to the patient and causes mental stress and guilt feeling among patients , it is , therefore , utmost important to distinguish between venereal and nonvenereal dermatoses .
male patients with nonvenereal dermatoses usually present to genitor - urinary experts or physicians , where the training and expertise are not oriented to adequate dermatological diagnosis and treatment .
disorders of genitalia have proved confusing to various specialists involved in the diagnosis and treatment .
the problem is confounded by the fact that the normal characteristics of common diseases at flexural sites are lost or modified , making the diagnosis difficult for even an experienced dermatologist .
the nonvenereal dermatoses of male external genitalia include wide spectrum of disease with varied etiology .
there are very few comprehensive study on the pattern of nonvenereal dermatoses in males from our country . also , our study is first of its kind from this part of the country .
had done a study on the pattern of nonvenereal dermatoses of male external genitalia from south india .
the age ranged from 18 to 65 years in the present study with the mean age of 32.2 years whereas the age ranged from 9 to 70 years with a mean age 33.7 years in a study by karthikeyan et al .
most of the patients belong to the age group of 2130 years ( 40% ) in the present study which is similar to karthikeyan et al .
a total of 16 different nonvenereal dermatoses were observed in this study [ table 1 ] .
the most common disorder was genital vitiligo [ figure 1 ] , which accounted for 18% , followed by pearly penile papule [ figure 2 ] in 16% and fde in 12% cases in the present study .
the study by acharya et al . reported infections as commonest disorder contributing 40% cases .
genital vitiligo as most common disorder ( 16% ) was observed in an another study , which is almost similar to our study .
khoo and cheong had 14.3% pearly penile papule as most common nonvenereal dermatoses , which are similar to this study ( 16% ) .
seventy - four patients ( 74% ) were from the urban area while twenty - six patients ( 26% ) belong to rural background .
fifty - two ( 52% ) patients were married and the remaining forty - eight ( 48% ) patients were unmarried .
scrotum was involved in 60% and penis in 30% while both scrotum and penis were affected in 10% cases in our study .
genital vitiligo could be an exclusive finding , or it can be associated with generalized vitiligo .
genital vitiligo [ figure 1 ] accounted for 18% cases as commonest disorder in our study and is seen in all age group from young adult to older age group .
this is in contrast with the study conducted by karthikeyan et al . , where the entire patients with vitiligo were in older age group .
ten patients in our study had associated vitiligo elsewhere while eight patients had only genital vitiligo .
they were present in 16% cases in our study [ figure 2 ] , which is almost similar to the study conducted by khoo and cheong they are frequently mistaken as warts and misdiagnosed as tyson 's gland or ectopic sebaceous gland of fordyce .
all the patients with pearly penile papule came to visit opd in apprehension of some venereal disease .
fixed drug eruptions were observed in 12% of cases in our study as third most common disorder .
, where only 3 cases had fde and all of them because of cotrimoxazole . in our study , various drugs were implicated such as , nonsteroidal antiinflammatory drugs , sulphonamides , ornidazole , fluconazole , ampicillin , etc . , half of our patients with fde had oral involvement also .
recorded scabies as most common nonvenereal dermatoses accounting for 30 cases ( 15% ) , while it was present in only 10% cases in our study [ figure 3 ] .
lichen planus was present in 9% cases in our study that is in contrast [ figure 5 ] with puri and puri where it was seen in only 6.6% ( 3 ) cases and karthikeyan et al . where it was seen in only 1 case .
contributory factors include , tight clothing , friction , maceration , atopy , over - washing , use of various toiletries , topical medicaments and indigenous preparations .
scrotal dermatitis [ figure 4 ] accounted for 9% cases in our study inclusive of allergic contact dermatitis , irritant contact dermatitis .
sebaceous cysts of scrotum [ figure 6 ] were observed in 7% cases in our study , while it was second most common finding ( 14% ) by karthikeyan et al .
they were observed in only 3.7% cases by khoo and cheong all of our cases were asymptomatic and from younger age group .
multiple sebaceous cysts scrotum dermatophytic infection was present in 5% cases in our study as scaly pruritic plaques over scrotum .
lichen sclerosus ( ls ) is chronic inflammatory dermatoses which are associated with substantial discomfort and morbidity with an unknown etiology .
ls was observed in 3 cases in our study [ figure 7 ] , while it was seen in only 2 cases by karthikeyan et al .
clinical findings in cases of ls in this study were found to be in concordance with the literature review .
lichen sclerosus - sclerosus and de - pigmentation of prepuce and glans with phimosis around 2% of the world population have psoriasis , but it is possible that many more could have ano - genital psoriasis at some time .
genital appearance could be challenging to interpret , especially in uncircunscribed individuals because a mucosal site is affected rather than keratinized skin .
reported a solitary case of psoriasis of glans penis while acharya et al . reported 5 cases of psoriasis over genitalia
zoon 's balanitis or plasma cell balanitis [ figure 8 ] was observed in 2% cases in this study that had not been reported by acharya et al . ,
it is a disorder of middle and older age in uncircumcised male , the etiology remains unknown .
zoon 's balanitis or plasma cell balanitis lymphangiectasia of scrotum [ figure 9 ] was seen in 2 cases .
one case each of lichen nitidus , granuloma annulare , papulo - necrotid tuberculid and squamous cell carcinoma [ figure 10 ] were also observed in our study .
it is very important to distinguish between venereal and nonvenereal genital dermatoses , as these nonvenereal disorders are a considerable concern to patients causing mental distress and feeling of guilt .
also , these nonvenereal disorders are quiet difficult in making a diagnosis by the treating physicians . a comprehensive understanding of the various presentations , their etiology is , therefore , essential .
this study was quiet useful in understanding the epidemiological , clinical and etiological characteristics of various nonvenereal genital dermatoses .
 background : nonvenereal dermatoses tend to create confusion from venereal dermatoses . 
 this may be responsible for considerable concern to the patient as well as may cause diagnostic dilemma to the physicians . 
 nonvenereal dermatoses may not be restricted to genitalia alone ; it may affect skin and mucous membrane also . 
 most of the patients with genital lesions had apprehension of suffering from some venereal disorders.aim:the aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia.materials and methods : this was a descriptive study of 100 consecutive adult male patients with nonvenereal genital dermatoses attending skin and std opd at j a group of hospitals , gwalior . 
 cases having any venereal dermatoses were excluded from this study.results:the study included 100 male patients with nonvenereal genital lesions . 
 a total of sixteen nonvenereal genital dermatoses were noted . 
 the most common nonvenereal genital dermatoses were vitiligo ( 18% ) , pearly penile papule ( 16% ) , fixed drug eruptions ( 12% ) , scabies ( 10% ) , scrotal dermatitis ( 9% ) and lichen planus ( 9% ) . 
 other dermatoses included sebaceous cyst , psoriasis , lichen sclerosus , plasma cell balanitis or zoon 's balanitis , granuloma annulare , lichen nitidus , lymphangioma circumscriptum , papulo - necrotic tuberculid , squamous cell carcinoma and tinea infections . 
 the age ranged from 18 years to 65 years with majority in the age group of 21 - 30 years ( 40%).conclusion : this study highlights the importance of diagnosing common nonvenereal genital dermatoses . 
 it also helps in avoiding the general misconception that all genital lesions are sexually transmitted . 