Gynecology - Benign and malignant vulvar disorders Flashcards
The most common cause of vulvar pruritus?
Contact/Allergic dermatitis
Epidermal thickening (lichenification) due to excessive itching, usually secondary to some kind of irritation (allergic or contact dermatitis, vulvar eczema, psoriasis). Vulvar itching is typically the chief complaint.
Lichen Simplex Chronicus
What does Lichen Simplex Chronicus look like?
Symmetric lichenification, vulva usually appears discolored (gray), leathery and thick, excoriations from frequent itching may be noted.
How do you treat Lichen Simplex Chronicus?
- Topical corticosteroid ointments (e.g betamethasone)
- Non-irritative lubricants
- Size baths
- PO antihistamines
- Clip nails
Vulvar and/or anogenital pruritus that’s usually worse at night, may be a burning sensation or dyspareunia. (Chronic inflammatory disease affecting the labiae and perianal skin, usually presents in postmenopausal women)
Lichen Sclerosus
What does Lichen Sclerosus look like?
Affected areas are thin appearing, crinkled, often described as “cigarette paper”, there may be distortion of the external anatomy including introital stenosis.
Diagnosing Lichen Sclerosus
Can be presumed clinically. Biopsy is useful to exclude neoplasia.
How do you treat Lichen Sclerosus?
No curative options. The mainstay of therapy is short-term high potency steroid ointments (e.g clobetasol).
- Estrogen creams may be used for concurrent atrophic vaginitis
- Tacrolimus may be used for concurrent vulvar eczema
- Surgery is reserved for severe cases unresponsive to steroids, particularly those causing sexual dysfunction.
How many % of Lichen Sclerosus go on to develop vulvar cancer (SCC) ?
4-6 %
Atrophic inflammatory condition causing vulvar pruritus -> characterized by shiny white-purple papules especially on labiae minorae which may be eroded and inflamed (is also a systemic condition, and can have manifestations elsewhere)
Lichen Planus
Causes of Lichen Planus
Assoc. w/certain drugs, but may also be spontaneous. May be exacerbated w/stress. Usually seen in middle-aged women.
How does Lichen Planus look like?
Shiny, purple papules on affected areas which may be painful and are invariable itchy. There may be whitish discoloration of the skin. Adhesions may be present,resulting in stenosis. May be mild exudate.
How do you diagnose Lichen Planus?
Clinical. Biopsy is useful if diagnosis is uncertain or to establish an initial diagnosis.
How do you treat Lichen Planus?
- Vaginal hydrocortisone suppositories
- Discontinue irritants
- May manage adhesions w/vaginal dilators/surgery
Vulvar eczema - the classical patient
young girls in the first 5 years of life. Often have eczema elsewhere, may have atopic diseases. Presents with relapsing and remitting vulvar itching.
How do you treat Vulvar Eczema?
Similar to lichen simplex chronicus;
- Mild-medium potency topical corticosteroids (e.g bethamethasone)
- PO antihistamines at night
Vulvar pruritus w/lesions, thick, red plaques w/silvery scales found on the vulva and often elsewhere. Autoimmunologic dermatological condition of varying severity.
Vulvar psoriasis
How do you treat vulvar psoriasis?
Short-term, high potency corticosteroids (e.g clobetasol).
