Vulval Conditions

Question 1

History that should be included in work up for vulval skin conditions

Answer 1

Symptoms at other skin sites
Medical hx
Drug hx
Fam hx (autoimmune conditions)
History of atopic conditions
Symptoms of urinary and faecal incontinence

Examine rest of body for presence of other skin disorder sites

Question 2

Investigations

Answer 2

TFTs
STIS
HbA1c
Biopsy if failure to respond to treatment or suspicion of VIN or cancer
Ferritin

Question 3

Clobetasol proprionate 0.05% cream application

Answer 3

Once daily for 1/12
Alternate days for 1/12
Twice a week for 1/12
Once a week for 1/12
Gradually reduce this until you can use it occasionally or not at all

Use every night for flare ups for two weeks then reduce frequency
If frequent flare ups, can use long term once or twice a week

Question 4

Second line treatment for LS that don’t improve with steroids

Answer 4

Tacroliimus - need supervision of specialist clinic

Question 5

Lifetime risk of women developing invasive vulval cancer with LS and LP

Answer 5

2-4%

Question 6

Lichen planus definition

Answer 6

Chronic inflammatory skin condition affecting skin and mucosal surfaces

Question 7

Lichen planus pathophysiology

Answer 7

Autoimmune disorder

Inflammatory cells attack an unknown protein within the skin and mucosal keratinocytes

Question 8

Lichen planus appearance

Answer 8

Papules and polygonal plaques that are shiny, flat-topped and firm on palpation
Plaques crossed by firm white lines called wickam striae
Painless white streaks in a lacy or fern-like pattern
Painful and persistent erosions and ulcers
Scarring
Mucky vaginal discharge
Overlap with LS

Question 9

Clinical features of lichen sclerosis

Answer 9

White crinkled or thickened patches of skin that tend to scar
Non-hair bearing areas of the vulva
Never involves the vaginal mucosa

Question 10

Lichen simplex

Answer 10

Worse during times of stress
Pruritic form of dermatitis in which excesssive scratching or rubbing leads to lichenfication
Well-dermarcated, erythematous or hyperpigmented, thickened plagues affection one or both sides of the vulva
Typically secondary to an underlying skin condition or neuropathy

Question 11

Lichen sclerosis pathophysiology

Answer 11

T-cell mediated chronic inflammatory dermatitis with predilection for vulva