Vulval Disease Flashcards
What is lichen sclerosis?
autoimmune condition - elastic tissue turns to collagen
How does lichen sclerosis present?
usually after middle age
intensely itchy vulva
‘bruised’ red purpuric signs
bullae, erosions and ulcerations
What eventually happens to the vulva in lichen sclerosis?
becomes white, flat, shiny
In lichen sclerosis, why is there long term surveillance if its unresponsive to treatment?
can be premalignant
What is the treatment of lichen sclerosis?
topical steroid - clobetasol proporionate
vulval ablation - to relieve itch
What is leukoplakia?
white vulval patches due to skin thickening and hypertrophy
How does leukoplakia present?
itch
white patches
How is leukoplakia diagnosed?
biopsy - as may be premalignant
clinical
How is leukoplakia diagnosed?
topical corticosteroid
PUVA
methotrexate, ciclosporin
How does lichen planus present?
pain
itch - less likely than pain
in mouth and genital areas
can be erosive - well demarcated glazed appearance around introitus
How is lichen planus treated?
vulval care
What is lichen simplex?
non specific inflammation of the vulva
What can exacerbate lichen simplex?
stress
sensitising chemicals
low iron
How does lichen simplex present?
chronic itching
worse at night
history of sensitive skin or eczema
What is the treatment of lichen simplex?
vulval care
steroids to break itch/scratch cycle
antihistamines can help
What is vulval care?
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
What is vulval intraepithelial neoplasia? (VIN)
pre invasive phase of vulval malignant
What drives VIN?
usually HPV (esp type 16)
What is VIN like in younger people?
often multifocal, recurrent and persistent causing treatment problems
What is VIN like in older people?
greater risk of progression to invasive squamous carcinoma
How is VIN diagnosed?
biopsy
5% acetic acid stains affected areas
How is VIN treated?
wide local excision
with access to reconstructive surgery afterwards
What are 90% of vulval carcinomas?
vulvar invasive squamous carcinoma
Who usually gets vulvar invasive squamous carcinoma?
elderly women
How does vulvar invasive squamous carcinoma present?
vulval lump
indurated ulcer - bleeding, pain
How is vulvar invasive squamous carcinoma treated?
wide local excision and ipsilateral groin node biopsy
more advanced disease: radical vulvectomy, inguinal lymphadenectomy
What causes vulval/genital warts?
HPV
types 6 and 11
usually spread by sexual contact
How are genital warts treated?
diathermy, cryocautery, laser
self application of podophyllotoxin cream
What is a bartholins cyst?
Bartholin’s glands lie under labia minora - secrete thin mucus
duct blocks - painless cyst
What is a Bartholin’s abscess?
if Bartholin’s cyst becomes infected
How does a Bartholin’s abscess present?
hugely painful - can’t sit down (Maddie)
hugely swollen, hot, red labia
big swelling
How is a Bartholin’s abscess treated?
incision and drainage
