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Bowen's disease

Presents as a persistent, well-demarcated, erythematous, scaly plaque, which requires a biopsy for confirmation unlike most inflammatory causes.

Candida

Characterized by beefy-red erythema with classic satellite pustules or papules, and a positive KOH preparation or fungal culture.

Eczema

Appears as ill-defined erythema with scaling and possible weeping or lichenification, often related to irritants or allergens.

Extramammary Paget's disease

Identified by a persistent, eczematous-appearing plaque that is unresponsive to topical steroids and requires biopsy showing Paget cells.

Lichen simplex

Distinguished by markedly thickened, leathery skin (lichenification) with exaggerated skin lines resulting from chronic scratching.

Perianal Streptococcus

Presents with sharply demarcated, bright red erythema, often with fissures and tenderness, and is confirmed by a positive bacterial swab.

Psoriasis

Shows well-demarcated, erythematous plaques with a silvery scale, often with evidence of psoriasis elsewhere on the body.

Pubic lice

Diagnosed by identifying nits (eggs) attached to pubic hairs or visualizing the lice themselves, a feature not present in other causes.

Scabies

Suspected with intense nocturnal itching and the presence of burrows, particularly if other family members are also affected.

Squamous cell carcinoma

Appears as a chronic, non-healing ulcer or a nodular, indurated lesion that requires a biopsy for definitive diagnosis.

Tinea

Features an annular plaque with a raised, active border and central clearing, confirmed by seeing hyphae on a KOH prep.

lichen sclerosus

Characterized by atrophic, white, 'cigarette paper'-like skin, often with purpura and architectural changes like effacement of the labia minora or phimosis.

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