CF: 56-60 Flashcards
51 yo woman p/w 4 yr hx of pruritic vulva. Genital tissue is atrophic. thin, white and excoriated with retraction of the clitoris and constriction of the introitus with some bruising.
Dx?
Next step?
Most likely therapy?
- Lichen sclerosis
- Bx of affected areas
- Corticosteroid ointment
What does Bx of lichen sclerosis show?
Thinned epidermis, hyperkeratosis, elongation of the rete pegs
Why are postmenopausal women at lower risk of candidal vaginitis?
Decr estrogen–> incr pH–> not amenable to candida
Silver scaly lesions on vagina and extensor surfaces?
Psoriasis
Why is it important to Bx lichen sclerosis?
Bc vulvar cancer and VIN can both present similarly and are assoc w/ LS, so you must rule them out.
Which tends to involve the vagina: lichen sclerosis or lichen planus?
Planus
What structures comprise the vulva?
Mons pubis, labia majora and minora, clitoris, vaginal vestibule and glands, opening of urethra and of vagina, hymen.
What two ages does lichen sclerosis peak?
Prepubertal and postmenopausal
What percent of lichen sclerosis has extragenital disease?
15-20%
MC CC with lichen sclerosis?
“Vaginal” (really vulvar) itching that’s worst at night
Name 4 things in the Ddx of lichen sclerosis
- Lichen planus
- VIN/cancer
- Vitiligo
- Psoriasis
How does closure of the vaginal introitus occur in lichen sclerosis?
Scratching or intercourse–> tears–>scarring–>narrowing/closure
How does dyschezia occur in lichen sclerosis?
Scratching–>scarring–>constriction of anus
3 major lifestyle modifications for lichen sclerosis?
- All white, cotton underwear
- No irritants to skin
- No scratching!
Medical treatment of lichen sclerosis? Followup?
Corticosteroids- start with potent ointment (clobetasol) and taper down once Sx abate. Continue maintenance dose to ppx relapses of pruritis.
Yearly surveillance to monitor for cancer
What glands are at the 5 and 7 o clock locations of labia majora?
Bartholin (greater vestibular) glands
How do you treat bartholin gland abscess (2 options)? What is the goal of either of these options?
- Incision and placement of small balloon catheter into gland
- Marsupialization
Purpose of both is to allow drainage of infection over several weeks
Typical etiology of bartholin gland abscess?
Polymicrobial
45 yo woman comes in with bartholin gland abscess. Whatcha do?
She’s over 40, and BG abscesses in the >40 age group are often assoc w/ cancer. Get her a Bx.
What’s a major RF for developing vulvar cancer as a younger woman?
HPV
Name 3 big RF for vulvar CA?
HPV
Lichen sclerosis
Smoking
Next step after diagnosing vulvar CA on Bx?
Surgical staging w/ removal of primary lesion and ipsilateral inguinal LNs
MC type of vulvar CA? Name 2 other types?
MC: SCC
Basal cell, melanoma
How do you treat symptomatic vaginal atrophy in post-menopausal woman?
Estrogen cream
