Lichen sclerosis, atrophic vaginitis, vulval cancer Flashcards
What is lichen sclerosis?
Lichen sclerosus is a chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin.
AI condition
What does lichen sclerosis commonly affect?
labia, perineum and perianal skin in women. It can affect other areas, such as the axilla and thighs. It can also affect men, typically on the foreskin and glans of the penis.
interlabial sulci
labia minora
clitoral hood
clitoris
perineal body
What is lichen sclerosis commonly associated with?
autoimmune diseases, such as type 1 diabetes, alopecia, hypothyroid and vitiligo.
How is lichen sclerosis usually diagnosed?
The diagnosis of lichen sclerosus is usually made clinically, based on the history and examination findings. Where there is doubt, a vulval biopsy can confirm the diagnosis.
What is lichen simplex?
chronic inflammation and irritation caused by repeated scratching and rubbing of an area of skin. This presents with excoriations, plaques, scaling and thickened skin.
What is lichen planus?
autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.
Presentation / S+S of Lichen sclerosis?
typical presentation in your exams is a woman aged 45 – 60 years complaining of vulval itching and skin changes in the vulva. The condition may be asymptomatic
Itching
Soreness and pain possibly worse at night
Skin tightness
Painful sex (superficial dyspareunia)
Erosions
Fissures
What is the appearance of lichen sclerosis?
There can be associated fissures, cracks, erosions or haemorrhages under the skin. The affected skin appears:
“Porcelain-white” in colour
Shiny
Tight
Thin
Slightly raised
There may be papules or plaques
What is the koebner phenomenon?
refers to when the signs and symptoms are made worse by friction to the skin. This occurs with lichen sclerosus. It can be made worse by tight underwear that rubs the skin, urinary incontinence and scratching.
What is the management of lichen sclerosis?
Lichen sclerosis cannot be cured, but the symptoms can be effectively controlled. Lichen sclerosus is usually managed and followed up every 3 – 6 months by an experienced gynaecologist or dermatologist.
Potent topical steroids are the mainstay of treatment. The typical choice is clobetasol propionate 0.05% (dermovate). Steroids are used long term to control the symptoms of the condition.
Steroids are initially used once a day for four weeks, then gradually reduced in frequency every four weeks to alternate days, then twice weekly. When the condition flares patients can go back to using topical steroids daily until they achieve good control. A 30g tube should last at least three months.
Emollients should be used regularly, both with steroids initially and then as part of maintenance.
Complications of lichen sclerosis?
The critical complication to remember is a 5% risk of developing squamous cell carcinoma of the vulva.
Other complications include:
Pain and discomfort
Sexual dysfunction
Bleeding
Narrowing of the vaginal or urethral openings
What cant be done for women and can be done for men with lichen sclerosis?
In females:
vulvectomy is contraindicated as recurrences following surgery are common.
In males:
circumcision may be necessary if severe constriction
What is atrophic vaginitis?
dryness and atrophy of the vaginal mucosa related to a lack of oestrogen. Atrophic vaginitis can also be referred to as genitourinary syndrome of menopause. It occurs in women entering the menopause.
What happens to the epithelial lining of the vagina when there is oestrogen?
