GYN Dermatology (incomplete)

Question 1

Lichen simplex chronicus

Answer 1

Presentation: leathery skin appearance with accentuated cutaneous markings. Hyper/hypo-pigmentations. Can have erosions/ulcers from scratching. Occurs primarily mid-late adult life.

Symptoms: primarily intense itching (sometimes affecting sleep) and burning

Cause/associated factors: recurrent vaginal infections, irritants/long standing eczema. Essentially localized atopic dermatitis.

Can coexist with other disorders like lichen planus or sclerosis.

Diagnosis: clinical exam (dont need biopsy unless loss of architectural landmarks or worried about something else). Wet mount to r/o yeast and tinea.
Treatment: remove irritant/allergens if discovered, topical mid-high potency steroids.

Question 2

Lichen sclerosus

Answer 2

Presentation: May involve labia minora, clitoris, interracial sulcus, inner portion of labia majora, and perianal areas. Depigmentation of vaginal introitus and adjacent perianal region (keyhole distribution), loss of mucocutaneous markings, submucosal hemorrhage

Symptoms

Cause: unknown

Diagnosis: ***need to biopsy

Treatment: clobetasol, increase exam frequency because of vulvar carcinoma risk

Question 3

Lichen planus

Answer 3

Inflammatory disorder, probably immune regulated

2 presentations: a) classic: sharply demarcated, flat-topped plaques on oral and genital membranes, white lacy/fernlike striae b) erosive: erosive, erythematous lesion originating in vestibule and variably extending into vaginal canal

Dysparunia, vaginal discharge

Biopsy needed for erosive lichen planus

Most difficult of lichens to treat (topical or systemic steroids, topical and oral cyclosporine, topical tacrolimus, hydroxychloroquine, oral retinoids, methotrexate, azathioprine, and cyclophosphamide). May also be associated with risk of malignancy.

Question 4

Psoriasis

Answer 4

Pink/red plaques

Treatment: topical mid-high potency steroids, injectable corticosteroids, topical tacrolimus

Question 5

Pemphigus

Answer 5

Autoimmune flaccid blistering and superficial erosions most commonly involving mucosal surfaces of post menopausal women. Later stages = hyperkeratotic skin. Pap may show LSIL

Diagnosis: biopsy

Treatment: systemic steroids

Question 6

What should you biopsy?

Answer 6

Hyperpigmented or exophytic lesions, lesions with changes in vascular patterns, or unresolving lesions is particularly important and should be performed to rule out carcinoma.

Differential dx: erosive lichen planus

Any lesions, nodules, erosions, or ulcerations suspicious for vulvar intraepithelial neo- plasia (VIN, which is precancer) or vulvar cancer.

No biopsy if the skin appears normal

Question 7

Basal Cell Carcinoma

Answer 7

5% of genital cancers
Increased incidence in fair-skinned, older
Itching
Rolled edges, telangiectasias
Local invasion and necrosis
Rare metastases

Diagnosis: biopsy

Treat: local excision