Vulva Flashcards
What are causes for vulval pruritus?
Local: infection, vaignal discharge (e.g. candida), allergy, infestation (scabies, pubic lice, threadworms), or vulval dystrophy (lichen sclerosis, leukoplakia, carincoma)
Take swabs and biopsy if suspicion
What is management for vulval pruritus?
Treat cause
Avoid sensitisers
Reassurance
Short course of topical steroids - betamethasone validate may help
What is lichen sclerosis?
Chronic inflammatory skin disease, thought to be autoimmune, of anogenital region in women
Elastic tissue turns to collagen
Causes atrophy producing thin stratified squamous epithelium
What is risk of lichen sclerosis?
Risk of progressing to squamous cell carcinoma
What are risk factors for lichen sclerosis?
Genetics - FHx
Other autoimmune disorders
What are clinical features of lichen sclerosis?
White atrophic patches on the skin
Hourglass shape around vulva and anus
Itching - skin may undergo fissuring or erosions which can cause pain
Dyspareunia
Clitoral hood fusion
Fusion of labia minor to the labia majora
Posterior fusion resulting in loss of vaginal opening
What are ddx for lichen sclerosis?
Lichen simplex
Vitiligo
Vulvae cancer or intraepithelial neoplasia
Candidiasis
What is management for lichen slcerosis
Clobetasol propionate cream daily for 28 days, alternate days for 4 weeks then twice weekly for 8 weeks then as needed
Topical tacrolimus in steroid unresponsive
What is leukoplakia? Management?
White vulval patches due to skin thickening and hypertrophy
Itchy
Biopsy as it may be pre-malignant
Topical corticosteroids
Psoralens with UV phototherapy
Methotrexate
Ciclosporin
What is lichen planus?
Pain>pruritis
Mouth and genital area can be eroseappearting with a well demarcated glazed appearance around introitus
What is lichen simplex?
Chronic intractable itching especially at night in those with sensitive skin or eczema
Non-specific inflammation of the vulva ± mons pubis and inner thighs
Stress, sensitising chemical and low body iron stores can exacerbate symptoms
Treat with vulval care
Antihitamines
Steroids
What is vulvovaginitis?
Fixed drug reactions (NSAIDs, statins)
Intravaginal clindamicina cream
What is vulval intraepithelial neoplasia?
Pre-invasive phase of vulval malignancy
May be itchy
What causes vulval intrepithelial neoplasia?
Often HPV
If found, examination cervix and anal canal, natal cleft skin and breasts
How is vulval intraepithelial neoplasia treated?
Surveillance with biopsy of suspicious lesions
Painful or irritating lesions can be removed by vulvectomy or laser ablation is not recommended due to high recurrence
Imiquimod cream - stimulates monocytes and macrophages which secrete cytokines resulting in T-helper cell coordination of a cell-mediated immune response
