Vulval Disease Flashcards

1
Q

What is lichen sclerosis?

A

autoimmune condition - elastic tissue turns to collagen

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2
Q

How does lichen sclerosis present?

A

usually after middle age
intensely itchy vulva
‘bruised’ red purpuric signs
bullae, erosions and ulcerations

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3
Q

What eventually happens to the vulva in lichen sclerosis?

A

becomes white, flat, shiny

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4
Q

In lichen sclerosis, why is there long term surveillance if its unresponsive to treatment?

A

can be premalignant

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5
Q

What is the treatment of lichen sclerosis?

A

topical steroid - clobetasol proporionate

vulval ablation - to relieve itch

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6
Q

What is leukoplakia?

A

white vulval patches due to skin thickening and hypertrophy

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7
Q

How does leukoplakia present?

A

itch

white patches

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8
Q

How is leukoplakia diagnosed?

A

biopsy - as may be premalignant

clinical

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9
Q

How is leukoplakia diagnosed?

A

topical corticosteroid
PUVA
methotrexate, ciclosporin

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10
Q

How does lichen planus present?

A

pain
itch - less likely than pain
in mouth and genital areas
can be erosive - well demarcated glazed appearance around introitus

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11
Q

How is lichen planus treated?

A

vulval care

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12
Q

What is lichen simplex?

A

non specific inflammation of the vulva

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13
Q

What can exacerbate lichen simplex?

A

stress
sensitising chemicals
low iron

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14
Q

How does lichen simplex present?

A

chronic itching
worse at night
history of sensitive skin or eczema

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15
Q

What is the treatment of lichen simplex?

A

vulval care
steroids to break itch/scratch cycle
antihistamines can help

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16
Q

What is vulval care?

A
soap substitute for washing 
clean vulva once daily with hand 
loose fitting cotton underwear 
sleep without pants 
avoid soaps, bubble bath, shower gels 
regular emollient use
17
Q

What is vulval intraepithelial neoplasia? (VIN)

A

pre invasive phase of vulval malignant

18
Q

What drives VIN?

A

usually HPV (esp type 16)

19
Q

What is VIN like in younger people?

A

often multifocal, recurrent and persistent causing treatment problems

20
Q

What is VIN like in older people?

A

greater risk of progression to invasive squamous carcinoma

21
Q

How is VIN diagnosed?

A

biopsy

5% acetic acid stains affected areas

22
Q

How is VIN treated?

A

wide local excision

with access to reconstructive surgery afterwards

23
Q

What are 90% of vulval carcinomas?

A

vulvar invasive squamous carcinoma

24
Q

Who usually gets vulvar invasive squamous carcinoma?

A

elderly women

25
How does vulvar invasive squamous carcinoma present?
vulval lump | indurated ulcer - bleeding, pain
26
How is vulvar invasive squamous carcinoma treated?
wide local excision and ipsilateral groin node biopsy | more advanced disease: radical vulvectomy, inguinal lymphadenectomy
27
What causes vulval/genital warts?
HPV types 6 and 11 usually spread by sexual contact
28
How are genital warts treated?
diathermy, cryocautery, laser | self application of podophyllotoxin cream
29
What is a bartholins cyst?
Bartholin's glands lie under labia minora - secrete thin mucus duct blocks - painless cyst
30
What is a Bartholin's abscess?
if Bartholin's cyst becomes infected
31
How does a Bartholin's abscess present?
hugely painful - can't sit down (Maddie) hugely swollen, hot, red labia big swelling
32
How is a Bartholin's abscess treated?
incision and drainage