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According to studies, that is because tobacco smoke impairs the immune system

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While it is important to be alert to suspicious anogenital lesions, it is also important to perform a correct differential diagnosis, with consideration of conditions including lichen sclerosus et atrophicus, localized vulvar pemphigoid, pinworm infection, scabies, inverse psoriasis, atopic and contact dermatitis, perianal streptococcal dermatitis, and candidiasis