Perianal pseudoverrucous papules and nodules
A 14-year-old girl inmate of an orphanage with spina bifida at L3 level presented with complaints of multiple asymptomatic whitish-raised lesions on the inner aspect of thighs and labia majora since infancy. She had incontinence stool and urine excretion since birth. She had a history of using diapers since childhood, due to incontinency. She did not have any rash or constitutional symptoms. The patient was not sexually active. In the past, she had received topical antifungals, corticosteroids, and systemic antibiotics, without any improvement.\nSystemic examination, blood, and biochemical investigations were normal.\nCutaneous examination revealed multiple, flat-topped moist papules, 3-12 mm in size, few verrucous nodules; some of these lesions coalescing to form plaques at the perianal area, extending up to the labia majora [Figures and ]. Enzyme-linked immunosorbent assay (ELISA) for HIV, Venereal Disease Research Laboratory Test, and Treponema pallidum hemagglutination (TPHA) tests were negative/non-reactive. Polymerase chain reaction did not detect human papillomavirus.\nThe histopathological examination of a papule revealed irregular epidermal hyperplasia. There was marked acanthosis with pale keratinocytes in the upper epidermis. A mild lymphocytic infiltrate can be seen in upper dermis [].