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Sometimes scarring can occur without any preceding symptoms Refer to the related chapter Mucous membrane pemphigoid Anogenital erosions / bullae / scarring Drug eruptions Refer to the notes below on Various sites Lichen sclerosus Causes white patches, scarring and architectural changes, bullae are rare Refer to the chapter Lichen sclerosus Erosive lichen planus Refer to the chapter Lichen planus Mucous membrane pemphigoid (figure 59) Painful blisters and erosions on the clitoris and labia can lead to architectural changes similar to those seen in lichen sclerosis Penile involvement can lead to adhesions between the prepuce and glans penis Linear IgA disease In children, blisters have a predilection for the lower abdomen and anogenital regions Lesions are often and annular / polycyclic lesions with blistering around the edge known as the 'string of pearls' sign Refer to the notes in the section above on trunk / wider distribution Pemphigus vulgaris and paraneoplastic pemphigus can affect the genitalia Epidermolysis bullosa can also affect the genitalia Various sites Drug eruptions - fixed drug eruptions (figure 60) Symptoms occur within 48 hours of commencing the medication Clinical features Distribution - lips, face, distal limbs, hands & feet, glans penis and perianal skin

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Epitrix hirtipennis (Melsheimer) Epitrix fasciata (Blatchley) Southern tobacco Author: David Riley, Professor, University of Georgia, 2019 Description Immature stages: Tobacco flea beetles have three larval instars, or developmental stages, that are all whitish with darker heads, and all feed on fine roots near the soil surface or occasionally tunnel into larger roots

A common progression might look like: 20mg 10mg 6mg 3mg 0mg This gradual approach allows users to adjust at their own pace

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