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Dip GUM > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is Lichen nitidus

A

rare skin condition
Appears as tiny, skin-colored, glistening bumps on the skin surface
Results from abnormal inflammatory activity
Cause is unknown

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2
Q

Aetiology of Lichen planus

A

chronic inflammatory disorder
affects skin / genital / oral mucous membranes
Unknown pathogenesis

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3
Q

Symptoms of vulval Lichen planus

A 
Itch/irritation
soreness
dyspareunia
urinary symptoms
vaginal discharge
Can be asymptomatic
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4
Q

Signs of vulval lichen planus

A

1) Classical = papules on the keratinised anogenital skin
+/- striae on the inner aspect of the vulva Hyperpigmentation

2) Hypertrophic = Thickened warty plaques - perineum / perianal areas - may become ulcerated / infected/ painful. Can mimic malignancy

3) Erosive = most common subtype to cause vulval symptoms.
mucosal surfaces eroded
Wickham’s striae
Can lead to scarring and complete stenosis

There may be loss of vulvar architecture.
Small risk of squamous cell carcinoma developing in women with lichen planus (< 3%).

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5
Q

Complications of vulval lichen planus

A

Scarring
vaginal synaechia
Development of SCC (up to 3%)

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6
Q

Diagnosis of vulval lichen planus

A

clinical appearance
vulval biopsy
Biopsy is a necessity if diagnosis is uncertain or coexistent VIN/SCC suspected

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7
Q

What investigations should be performed as part of management of vulval lichen planus

A

Investigate for autoimmune disease - esp thyroid
Skin swab - exclude secondary infection - esp excoriated lesions
Patch testing - if contact dermatitis suspected
Biopsy - if diagnosis uncertain / VIN or SCC suspected

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8
Q

Treatment of vulval lichen planus

A

Inform of small risk of neoplastic change

Ultra-potent topical steroids, e.g. Clobetasol
+/- Maintenance treatment with weaker steroid / less frequent potent steroids

Vaginal corticosteroids: hydrocortisone PV(Colifoam) / Prednisolone suppositories for more severe cases

An ultra-potent topical steroid with antibacterial and antifungal, e.g. Dermovate NN - short term to clear secondary infection

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9
Q

When is onward referral recommended for vulval lichen planus

A

Refer to a multidisciplinary vulval clinic if

  • erosive disease
  • recalcitrant cases
  • those in whom systemic therapy is considered
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10
Q

Systemic treatment options for lichen planus

A 
no consensus
Oral ciclosporin
retinoids
oral steroids
new biological agents m

supervised by a dermatologist in the context of a specialised clinic

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11
Q

Follow-up of patients with vulval lichen planus

A

review at 2–3 months
assess response to treatment
Stable disease should be reviewed annually - can be with GP

Erosive lichen planus needs long-term specialised follow-up

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12
Q

Aetiology of vulval eczema

A

Atopic = the ‘allergic’ type - often seen in people who also have hay fever or asthma

Allergic contact = skin contact to a substance to which the individual is sensitive

Irritant contact = skin contact with irritating chemicals, powders, cleaning agents, etc

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13
Q

symptoms of vulval eczema

A

Vulval itch and soreness

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14
Q

Signs of vulval eczema

A 
Erythema
Lichenification 
Excoriation
Fissuring
Pallor or hyperpigmentation
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15
Q

Complications of vulval eczema

A

Secondary infection.

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16
Q

Follow up for vulval eczema

A

As clinically required

psychological support may be needed

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17
Q

Diagnosis of vulval eczema

A

Clinical presentation.
General examination of the skin
+/- biopsy if diagnosis uncertain

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18
Q

further investigations of suspected of vulval eczema

A

Patch testing

Biopsy – only if atypical features (e.g. asymmetric, localised or eroded) or failure to respond to treatment

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19
Q

Treatment of vulval eczema

A

Avoid precipitating factor(s)
Use of emollient soap substitute
Topical corticosteroid – preparation depending on severity - 1% Hydrocortisone or betamethasone 0.025% or clobetasol 0.05%
Combined preparation - antifungal and/or antibiotic may be required for short-term use

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20
Q

Aetiology of vulval lichen simplex

A

A response to the skin being repeatedly scratched or rubbed over a long period of time

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21
Q

Symptoms of vulval lichen simplex

A

Vulval itch and soreness

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22
Q

investigation of suspected vulval lichen simplex

A

Biopsy - if diagnosis uncertain
Screening for infection (e.g. Staphylococcus aureus, Candida albicans)
Dermatological referral for consideration of patch testing –
Ferritin

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23
Q

Treatment of vulval lichen simplex

A

Avoid of precipitating factor(s)
Use emollient
Use soap substitute
Topical corticosteroid – potent steroids are required when treating lichenified areas, e.g. betamethasone or clobetasol
Combined preparation - antifungal and/or antibiotic may be required if secondary infection suspected
A graduated reduction in frequency of application of topical steroid helpful, over 3–4 months
Mildly anxiolytic antihistamine such as hydroxyzine or doxepin at night is helpful.
CBT may be helpful if co-existing mental health issues

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24
Q

Causes of lichen simplex

A
  • Underlying dermatoses, i.e. atopic dermatitis, allergic contact dermatitis, superficial fungal (tinea and candidiasis) infections.
  • Systemic conditions causing pruritus, i.e. renal failure, obstructive biliary disease, Hodgkin’s lymphoma, hyper- or hypothyroidism and polycythaemia rubra vera.
  • Environmental factors: heat, sweat, rubbing of clothing and other irritants
  • Psychiatric disorders: anxiety, depression, obsessive compulsive disorder and dissociative experiences
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25
Q

Appearance of vulval lichen simplex

A

Localised plaque of chronic eczematous inflammation
Lichenification / leathery appearance
Erosions and fissuring
Excoriations
Pubic hair may be lost in the area of scratching
or skin may be pale and wrinkled.

There may be labial swelling and erythema

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26
Q

Complications of vulval lichen simplex

A

Secondary infection.

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27
Q

Follow up for patients with vulval lichen simplex

A 
Mild disease – follow up as clinically required. 
Severe disease (i.e. when using potent topical steroids) – review at one month then as required
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28
Q

Aetiology of psoriasis

A

chronic inflammatory epidermal skin disease
Affects ~ 2% of general pop.

Genital psoriasis may present as part of plaque or flexural psoriasis

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29
Q

Symptoms of Genital psoriasis

A

vulval itch
soreness
burning sensation

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30
Q

Signs of Genital psoriasis

A

Well-demarcated brightly erythematous plaques
Often symmetrical
Frequently affects natal cleft
Usually lacks scaling due to maceration.
Fissuring.
Involvement of other sites, e.g. scalp, umbilicus

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31
Q

Complications of Genital psoriasis

A

May be worsened due to Koebner effect by irritation from urine, tight-fitting clothes or sexual intercourse

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32
Q

Diagnosis of Genital psoriasis

A

Clinical presentation.

General examination of the skin and nails to look for other signs of psoriasis

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33
Q

Further investigation of Genital psoriasis

A

Skin punch biopsy if the diagnosis is in doubt.

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34
Q

Treatment of Genital psoriasis

A

Avoid irritating factors.
Use of emollient soap substitute.
Topical corticosteroid – weak to moderate steroids preferred - if insufficient then intensive short-term potent steroids
Combined preparation with antifungal and/or antibiotic may be required if secondary infection suspected
Weak coal-tar preparations – used alone / combined / alternated with topical steroids.
Vitamin D analogues such as Talcalcitol – alone / combination with corticosteroid

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35
Q

When is onward referral recommended for genital psoriasis

A

If unresponsive to treatment
those in whom systemic therapy is considered

Systemic treatments: if required for severe and extensive psoriasis may help genital lesions but not recommended for isolated genital psoriasis

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36
Q

Follow up for genital psoriasis

A 
Mild disease – follow up as clinically required. 
Severe disease (i.e. when using potent topical steroids) – review at one month then as required
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37
Q

Aetiology of Vulval intrapeithelial neoplasia (VIN)

A

vulval pre-cancerous skin condition
May become cancerous if left untreated.

defined as low grade or high grade

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38
Q

Symptoms of Vulval intrapeithelial neoplasia (VIN)

A 
lumps
erosions
burning
itch/irritation
pain 
may be asymptomatic
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39
Q

2 types of Vulval intrapeithelial neoplasia (VIN)

A

Low-grade change - usually associated with HPV and may resolve

High-grade change - generally not HPV related - occurs in conjunction with lichen sclerosis or lichen planus
Known as differentiated type
much greater risk of progression to SCC

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40
Q

Diagnosis of Vulval intrapeithelial neoplasia (VIN)

A

histological diagnosis - biopsy

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41
Q

Signs of Vulval intrapeithelial neoplasia (VIN)

A

Clinical appearance is very variable
Raised white / erythematous / pigmented lesions
May be warty / moist / eroded
Multifocal lesions are common

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42
Q

Complications of Vulval intrapeithelial neoplasia (VIN)

A

Development of SCC
Recurrence common - progression to cancer can occur following previous treatment.
Psychosexual consequences

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43
Q

Diagnosis of Vulval intrapeithelial neoplasia (VIN)

A

Biopsy.

Multiple biopsies may be required as there is a risk of missing invasive disease.

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44
Q

Further investigations when Managing Vulval intrapeithelial neoplasia (VIN)

A

Ensure cervical cytology remains up-to-date – association with cervical intraepithelial neoplasia (CIN)
Refer for colposcopy to exclude CIN
For perianal lesions - referral for anoscopy is recommended

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45
Q

treatment of Vulval intrapeithelial neoplasia (VIN)

A

Local excision
Imiquimod cream 5% (not licensed in pregnancy) - unlicensed indication
Vulvectomy - Recurrence may occur, function + cosmesis will be impaired

Supervision – some lesions spontaneously regress, risk of progression

Local destruction - variety of techniques - carbon dioxide laser / ultrasonic surgical aspiration / photodynamic therapy /cryotherapy / laser - recurrence rates higher than for excision

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46
Q

Onward referral pathway for suspected or confirmed VIN

A

multidisciplinary vulval clinic

or input from gynaecology regarding assessment for surgical excision

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47
Q

Follow-up for Vulval intrapeithelial neoplasia (VIN)

A

Close follow-up is mandatory

Although resolution may occur VIN III has a significant rate of progression

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48
Q

biopsy features of lichen sclerosis

A

Initially a thickened epidermis
becomes atrophic with follicular hyperkeratosis

a band of dermal hyalinisation
with loss of the elastin fibres
perivascular lymphocytic infiltrate

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49
Q

Management of penile lichen sclerosus

A

Potent topical steroids - OD until remission, then gradually reduced, intermittent use may be required to maintain remission (e.g. clobetasol, betamethasone)

Treat secondary infection

Circumcision for phimosis

Surgery for meatal stenosis

50
Q

follow up of patients with penile lichen sclerosus

A

Regular follow up if requiring potent topical steroids
Frequency of follow up depends on disease
activity + symptoms
Recommend at least annual follow up - due to risk of malignant transformation

51
Q

What is Zoon’s balanitis

A

Zoon’s (plasma cell) balanitis
a disease of older uncircumcised men
thought to be due to irritation - partially caused by urine - within a ‘dysfunctional prepuce’

52
Q

Symptoms of Zoon’s (plasma cell) balanitis

A

Change in appearance

Rarely bloodstained discharge

53
Q

Signs of Zoon’s (plasma cell) balanitis

A

Clinical appearance variable
well­ circumscribed orange / ­red glazed areas on the glans
multiple pinpoint red spots ­ “cayenne pepper spots”

54
Q

Diagnosis of Zoon’s (plasma cell) balanitis

A

Clinical features

biopsy is advisable

55
Q

management of Zoon’s (plasma cell) balanitis

A

Circumcision ­- reported to lead to resolution of lesions
Topical steroids +/- ­ antibacterial agents
Hygiene measures

56
Q

Follow up of patients with Zoon’s (plasma cell) balanitis

A

Dependent on clinical course and treatment
Follow up recommended if topical steroids are used long
term

57
Q

Symptoms of penile psoriasis

A

change in appearance

Soreness or itching

58
Q

Signs of penile psoriasis

A

red scaly plaques - if circumcised

scaling is lost + patches appear red and glazed - if uncircumcised

59
Q

Diagnosis of penile psoriasis

A

Clinical
Look for psoriasis elsewhere
Biopsy may be necessary

60
Q

Management of penile psoriasis

A

· Emollients
· Mild to moderate topical steroids (+/- antibiotic or
antifungal)
· Topical calcitriol
· Avoid strong coal tar as it increases risk of genital
cancers

61
Q

What is Circinate balanitis

A

inflammatory condition
occurs in Reiter’s disease
post infective syndrome triggered by urethritis / enteritis
in genetically predisposed individuals

overlap with psoriasis in some cases
has been reported in association with HIV

62
Q

Appearance of Circinate balanitis

A

greyish white areas on the glans which coalesce to form “geographical” areas with a white margin

+/- associated with other features of Reiter’s syndrome but can occur without

63
Q

Diagnosis of Circinate balanitis

A

clinical appearance in association with other features of Reiter’s syndrome

Biopsy - spongiform pustules in upper epidermis
STI screening - including STS and HIV

64
Q

Management of Circinate balanitis

A

· Emollients
· Mild to moderate topical steroids (+/- antibiotic or
antifungal)
· Topical calcitriol
· Avoid strong coal tar as it increases risk of genital
cancers

+/- STI treatment

65
Q

Symptoms of irritant / allergic balanitis

A 
Symptoms associated with irritants e.g. soaps
history of atopy, 
itching
dry skin 
mild erythema 
oedema
66
Q

diagnosis of irritant / allergic balanitis

A

Patch tests + intradermal skin tests
referral to dermatologist
Biopsy - eczematous with spongiosis and non­specific
inflammation

67
Q

Management of irritant / allergic balanitis

A

Avoidance of precipitants ­- especially soaps
Emollients
Emollients ­as a soap substitute
Hydrocortisone 1% OD - BD until resolved
+/- antifungal / antibiotics

68
Q

What is a fixed drug eruption?

A

uncommon
distinctive type of cutaneous drug reaction
characteristically recurs in the same locations upon re-exposure
precipitants include tetracyclines, salicylates, paracetomol, phenolphthalein, some hypnotics.
the penis = one of the more commonly affected areas

Rarely can occur when sexual partner has taken the drug - assumed toxic component of drug passed through vaginal fluid

69
Q

signs of a fixed drug eruption

A

well demarcated erythematous lesions
can be bullous with subsequent ulceration
As inflammation settles - skin becomes brown

70
Q

Management of a fixed drug eruption

A

will settle without treatment
Topical steroids ­ e.g. mild to moderate BD until resolution
Rarely systemic steroids - if lesions severe

71
Q

What is Erythroplasia of Queyrat

A

a pre­malignant condition affecting the penis
usually glans / prepuce / meatus
estimated up to 30% progress to invasive cancer
suggested it is triggered by co­infection with multiple types of HPV

72
Q

Signs of Erythroplasia of Queyrat

A

red / velvety / well­ circumscribed area on the glans
May have raised white areas
BUT induration would suggest frank squamous cell carcinoma

73
Q

Diagnosis of Erythroplasia of Queyrat

A

Biopsy

essential to exclude­ squamous carcinoma in situ

74
Q

Management of Erythroplasia of Queyrat

A

Recommended = Surgical excision ­

  • Local excision
  • Mohs’ surgery
Alternative Regimens
· Fluorouracil cream 5%
· Cryotherapy
· Imiquimod 5% cream (unlicensed)
 · Photodynamic therapy
75
Q

Follow up of Erythroplasia of Queyrat

A

Obligatory Follow up
because of risk of recurrence
Minimum annual appointments

76
Q

What is Bowen’s disease

A

cutaneous carcinoma in situ

77
Q

Signs of Bowens disease

A

Scaly
discrete
erythematous
plaque

78
Q

Complications of Bowens disease

A

20 % develop frank squamous carcinoma

79
Q

Diagnosis of Bowens disease

A

Biopsy - essential - appearance can be variable

80
Q

Management

A

Recommended = Local excision

Alternative regimens
· Imiquimod cream (unlicenced) 
· Photodynamic therapy
· Laser resection
· 5 Fluorouracil cream
81
Q

Follow up for Bowens disease

A

Obligatory - possibility of recurrence

Minimum of annual appointments

82
Q

What is bowenoid papulosis

A

A form of carcinoma in situ

linked to HPV infection - particularly type 18

83
Q

Signs of bowenoid papulosis

A

Lesions range from discrete papules to plaques

often pigmented

84
Q

Complications of bowenoid papulosis

A

Development of squamous cell carcinoma

85
Q

Diagnosis of bowenoid papulosis

A

Biopsy is essential

86
Q

Management of bowenoid papulosis

A

Recommended = Local excision

Alternative regimens
· Imiquimod cream (unlicensed)
· Cryotherapy 
· laser resection 
· 5 Fluorouracil cream 
· Some lesions regress spontaneously
87
Q

What is penile intraepithelial neoplasia? (PIN)

A

a rare pre-cancerous disease of the epidermis of the penis

Includes:
Erythroplasia of Queyrat
Bowens disease
squamous cell carcinoma in-situ

88
Q

According to the BASHH guidelines when should a biopsy be performed for persistent balanitis

A

Biopsy when balanitis persists >6 weeks despite simple

treatment

89
Q

factors presdisposing to candidal balanitis

A

systemic illness

diabetes

90
Q

Treatment of candidal balanitis

A

1% clotrimazole cream

+/- HC

91
Q

what is tinea cruris

A

dermatophyte fungus
appearance similar to ring worm
very itchy

92
Q

treatment of tinea cruris

A

clotrimazole 1% cream BD for 14/7

93
Q

differential diagnosis for Kaposi sarcoma

A

hard to distinguish from - Bacillary angiomatosis
biopsy to confirm diagnosis

haematoma
haemangioma
dermatofibroma
pyogenic granuloma
purpura
94
Q

what virus is associated with Kaposi sarcoma

A

human herpes virus 8

95
Q

What causes seborrheic eczema

A

hypersensitivity to malassezia fur fur
inflammatory condition
more common in HIV +ve patients

Treatment = clotrimazole HC
or ketoconazole shampoo for scalp

96
Q

most common cause of vulval itching

A

Contact dermatitis = inflammatory reaction

  • itch
  • lichenification
  • hyperpigmentation

can be caused by:

  • Proprietary creams (esp containing local anaesthetics)
  • Topical antibiotic preparations (e.g. neomycin)
  • Barrier contraceptives or lubricants.
  • Perfumes, soaps, bubble baths, wet wipes.
  • Detergents, fabric conditioners, bleaches, or dyes.
97
Q

why does genital psoriasis have a different appearance to classical psoriasis

A

due to the moisture and friction of skin folds
the classic psoriatic lesion (well-demarcated border, with erythematous plaques and silvery scale) is replaced with

a poorly demarcated
erythematous plaque
with minimal scale
shiny texture.

Look for typical psoriasis lesions elsewhere on the body (elbows, knees, scalp)

98
Q

What is lichen sclerosus

A

An inflammatory skin condition
Affects the anogenital area more often than other cutaneous surfaces.

Most often diagnosed in women > 50 years

Any area from the clitoral hood to the perianal area can be affected, but the vagina is not affected

99
Q

Appearance of lichen sclerosus

A

Hypopigmented-to-white,
crinkled,
fragile plaques
classically distributed in a figure eight pattern around the vulva, perineal body, and perianal skin.

Bruises, blood blisters or ulcers may appear after scratching, or from minimal friction.
Purpura (ecchymosis) is common.

Scarring may cause loss of vulvar architecture,
resorption of the labia minora,
fusing in the midline with burying,
but not loss of the clitoris.

Small risk of squamous cell carcinoma developing in women with lichen sclerosus (< 5%).

100
Q

What is Fox–Fordyce disease

A

very rare — small dome-shaped flesh-coloured to reddish papules which affect all hair follicles in the area.

Intensely itchy
often presenting as lichenification

Mainly occurs in women aged 13–35 years
sometimes affects men and children

101
Q

what is Hailey–Hailey disease

A

very rare — blistering disease.
Inherited autosomal dominant condition
Also known as ‘familial benign chronic pemphigus’

Mainly affecting the skin folds
Moist, fissured, malodorous plaques and blisters.

Vesicles erupt causing pruritus
+/- involvement of the axillae and sides of the neck

102
Q

what is Darier disease

A

very rare

persistent
greasy / scaly papules
which are firm and may feel like sandpaper.

If papules coalesce they form warty plaques - may be macerated and malodorous.

Sites affected include seborrhoeic areas of the trunk, flank, face and skin folds

103
Q

what is symptomatic dermographism

A

a form of localized urticaria
triggered by a direct firm touch, scratching, or rubbing.

5% of women with pruritus vulvae are affected by dermographism

104
Q

Which infections and infestations can cause pruritus vulvae?

A 
Candidiasis 
Trichomoniasis 
Bacterial vaginosis 
Genital herpes simplex 
Pubic lice (Pediculus pubis)
Scabies (Sarcoptes scabiei)
105
Q

Which malignant conditions may cause pruritus vulvae?

A 
Squamous cell carcinomas - 90% of malignant disease of the vulva. 
Perianal intraepithelial neoplasia
Basal cell carcinoma
Melanoma 
Carcinoma of Bartholin's gland

Vulval cancer can affect women of all ages
Most frequent in women aged 65–75 years

Human papillomavirus (HPV) is responsible for about 60% of squamous cell carcinomas of the vulva

106
Q

Which pre-malignant conditions may cause pruritus vulvae?

A

VIN = pre-malignant skin lesion of the vulva.

Types
= bowenoid papulosis - low grade VIN - spontaneously regresses

= High grade squamous intraepithelial lesion (usual-type)

= Extramammary Paget disease (very rare)

107
Q

Squamous cell carcinomas commonly arise from what

A

Squamous cell carcinomas often arise from pre-existing background disease.
e.g Vulval lichen sclerosus or lichen planus

108
Q

Presentation of VIN

A

VIN may be completely symptom-free

Most women present with:

  • Mild to severe vulval itching.
  • Mild to severe vulvar burning.
  • One or more slightly raised, well-defined skin lesions that may be pink, red, brown, or white.
109
Q

VIN progress to cancer

A

If left untreated VIN may:

  • resolve spontaneously (especially the low-grade VIN - aka ‘Bowenoid papulosis’
  • or develop into an invasive cancer

On average, it takes > 10 years for VIN to progress to cancer

110
Q

presentation of squamous cell carcinomas

A

rarely itchy
usually present as a lump or ulcer
usually tender

111
Q

What % of SCC of the vulva is caused by HPV

A

about 60%

112
Q

Average age of presentation of VIN

A

May occur in women of all ages

Average age is 45–50 years

113
Q

Types of VIN

A

Low grade VIN = bowenoid papulosis

High grade squamous intraepithelial lesion (usual-type)

Intraepithelial neoplasia (differentiated-type) — associated with lichen sclerosus.

114
Q

Risk factors for high grade squamous intraepithelial VIN

A

often caused by HPV

RF incude:
Smoking
Immunosuppression

115
Q

What is extramammary Paget disease

A

very rare

a cutaneous neoplasm
with a chronic eczema-like rash
affects the anogenital region and vulva.

116
Q

features of extramammary paget disease

A

mild to intense itching of a lesion found around the groin, genitalia, perineum, or perianal area.

Pain and bleeding may occur from scratching

Thickened plaques may form
can become red, scaly, and crusty.

Plaques are fixed (unchanging over a few weeks)
with sharply demarcated margins
Usually asymmetric

Fail to clear up with topical steroid creams

117
Q

What hormonal changes can cause pruritus vulvae?

Atrophic vulvovaginitis

A

Atrophic vulvovaginitis
- peri- and postmenopausal women - declining oestrogen contribute to vulvovaginal itching, dryness, and burning.

Pregnancy
- Increased hormone levels are associated with
increased physiological vaginal discharge
and increased risk of candidal vulvovaginitis

118
Q

What gastrointestinal conditions can cause pruritus vulvae?

A

Gastrointestinal disease — irritable bowel syndrome, Crohn’s disease, ulcerative colitis, other inflammatory bowel disease, anal fissures - may lead to prolonged contact of stool with the vulval skin due to faecal incontinence or poor perianal hygiene.

Urinary and faecal incontinence — this can result in vulvar inflammation

119
Q

What systemic conditions may cause pruritus vulvae?

A

Drug reactions - e.g. doxycycline and NSAIDs

Systemic diseases - e.g. renal or hepatic disease, diabetes, iron deficiency anaemia, lymphoma, other haematological abnormalities and thyroid dysfunction.

Psychological problems — occasionally present as pruritus vulvae

Stress — may be a cause of itch, or an exacerbating factor causing prolongation of symptoms or a flare-up

120
Q

why is corticosteroid ointment preferred over cream for vulvo-vaginal dermatoses

A

Corticosteroid ointments are preferred as they have a reduced need for preservatives, which may cause secondary contact allergy.

Creams also have more water content than ointments and may sting when applied.

121
Q

Management of CIN

A

CIN 1 - most regress within 18m - repeat cytology in 12m

CIN 2 - as per CIN 3
CIN 3 - LLETZ / cone biopsy / ablative techniques

Women treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for ‘test of cure’ repeat cytology

Hysterectomy considered if repeated treatment fails

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