Lichen sclerosis, amenorrhea Flashcards
What is lichen sclerosis?
Benign chronic dermatologic scarring skin condition characterized. by inflammation, epithelial thinning and dermal changes causing pain and vulvar itching
What group of patients are affected by lichen sclerosis?
Postmenopausal
Prepubertal
What causes lichen sclerosis?
Unknown thought to be Multifactorial
How do you diagnose lichen sclerosis?
Clinical or vulvar biopsy
How can you diagnose lichen sclerosis clinically?
Classic clinical symptoms and physical exam findings
What are the classic clinical exam findings for lichen sclerosis?
White thin crinkling skin of the anogenital region
Porcelain white papule/plaques
Introital narrowing; fusion of labia
loss of vulvar architecture
Hypopigmentation; atrophy
When should you recommend vulvar biopsy for lichen sclerosis?
Suspicious vulvar lesion
lesion in immunocompromised patient
Un resolved/persistent vulvar lesion
unclear diagnosis
worsening of disease with therapy
How do you counsel patient on lichen sclerosis?
Start with explaining chronic condition that can have relapse of symptoms
Vulvar care to help manage symptoms
Discuss treatment with maintenance therapy
Risk of cancer
follow up and when to return if no scheduled follow up
What are vulvar care options for patients with vulvar skin conditions?
Cotton underwear; no underwear at night while sleeping
Avoid tight fitting clothes
Avoid soap in affected area; pat dry after bathing
Avoid fragrance spray/soaps in vulvar area
peribottle with urination
adequate lubrication with intercourse
What is the recommended management for lichen sclerosis?
clobetasol 0.05% cream nightly for 4 weeks then alternate nights for 4 weeks then 2x weekly for 4 weeks followed by maintenance therapy with lowest dose needed to control symptoms.
What is the risk of vulvar cancer with lichen sclerosis?
<5%
Where does lichen sclerosis occur?
Typically the anogenital region but can be any skin surface
What type of cancer are patient with lichen sclerosis at increased risk for?
Vulvar squamous cell carcinoma
What is lichen planus?
Inflammatory dermatologic condition that can affect the skin, mucosa, nails and scalp
What is vulvar lichen planus?
Inflammatory condition that causes erosive, papular or hypertrophic lesions on the vulva with or without vaginal involvement
What age group is lichen planus typically seen in?
Perimenopause or postmenopausal
What are symptoms of lichen planus?
Vaginal discharge, vulvar itching, burning or dyspaurenia
What do the lesions look like for lichen planus?
Well demarcated, glazed, brightly erythematous patches or erosions
What is the treatment for lichen planus?
Clobetasol nightly for 8-12 weeks
Maintenance therapy 1-4times per week
Systemic steroids if topical not effective
What size biopsy should you get for lichen planus or lichen sclerosis?
4mm punch biopsy
When is biopsy indicated for lichen planus?
Uncertain diagnosis
with erosive or hypertrophic forms of lichen planus
what are second line options for lichen planus and refractory options?
Topical tacrolimus
Intralesional steroids
Definition of amenorrhea?
Absence of menses
Causes of amenorrhea?
Can be due to hypothalamus, pituitary, ovaries, uterus or vagina
Definition of secondary amenorrhea?
Absence of menses for 3 months in women with history of regular cycles and 6 months in women with irregular cycles
Definition of primary amenorrhea?
Absence of menses by age 15 in girls with normal growth and secondary sexual characteristics
Absence of menses by age 13 in girls without secondary sexual characteristics
What should you think of for girls presenting before age 15 with secondary sexual characteristics with amenorrhea and cyclic pelvic pain?
Outflow obstruction
What are causes of primary amenorrhea
Usually a genetic or anatomic abnormality
- GnRH deficiency -associated with kallman syndrome
- Functional hypothalamic amenorrhea (anorexia)
- Constitutional delay of puberty
- Hyperprolactinemia
- systemic illness leading to decreased GnRH
- Gonadal dysgenesis/primary ovarian insufficiency
- PCOS
- Outflow tract disorders
- Imperforate hymen
- Transverse septum
- Mullerian agenesis
- Complete androgen insensitivity
- 5 alpha reductase deficiency
- CAH
What is a abnormal prolactin level
15-20
What are some normal things that can raise prolactin level?
Stress
sleep
Sex
Exercise
What is the most common cause of primary amenorrhea?
Gonadal dysgenesis
What condition is associated with gonadal dysgenesis?
Turners syndrome
What are causes of secondary amenorrhea?
- Pregnancy
- Functional hypothalamic amenorrhea
- PCOS
- Hyperprolactinemia
- Thyroid disease
