GYN

Question 1

Lichen Sclerosis

etiology and s/sxs

Answer 1

autoimmune disorder- immune dysfunction affecting all levels of the skin but more common in genital area

associated w thyroid d/o and HLA (human leukocyte antigen)

MC seen in postmenopausal women

Sxs: 
#1  pruritis, dysuria, dyspareunia,anal discomfort

Question 2

Lichen Sclerosis

physical exam

Answer 2

sharply demarcated white plaques (diffuse usually begins periclitorally w spread to perineal skin)

“cellophane paper” - waxy and/or hyperkeratotic appearance

purpura, erosions, fissures

in severe cases- loss of anatomic landmarks

Question 3

what is Koebner’s phenomenon

Answer 3

associated w lichen sclerosis

trauma makes condition worse

Question 4

Lichen Sclerosis co-morbid conditions

Answer 4

SCC
squamous cell carcinoma occurs in ~5%

atypical nevi and melanoma

higher incidence of associated hypothyroidism

Question 5

Lichen Sclerosis

diagnosis and treatment

Answer 5

Dx biopsy
Tx:
topical super high potent steroid OINTMENT

1st line Clobestasol 0.05% ointment, applied BID until texture normal then 1-3 x/week for maintenance

lichen sclerosis never goes away, but can taper down dose and increase as needed

Question 6

Lichen Simplex Chronicus is associated with what genetic tendency?

Answer 6

Atopy
(asthma, rhinitis, dermatitis)

emotions may trigger or make pruritis worse

Question 7

Lichen Simplex Chronicus

clinical presentation and physical exam

Answer 7

the itch that rashes
pts likely to have underlying anxiety/depression

color tends to be more red and may develop scaling papules and plaques

more chronic presentation: lichenification, hypo pigmentation

Question 8

Lichen Simplex Chronicus

diagnosis and treatment

Answer 8

clinical dx based on PE
vulvar punch biopsy for definitive dx

Tx: tx underlying triggers ( looser clothing, hygiene products, decrease stress), bath tub soaks, low dose hydrocortisol, antihistamine qhs, SSRI