Vulval disorders Flashcards
List 4 symptoms of vulval dermatitis
dermatitis - DIE Pain
D - discharge
I - itch
E - erythema
Pain
List 4 signs of vulval dermatitis
Dermatitis - DEE DIES
Dry skin
Erosions
Erythema
Dry skin
Itch
Erythema
Symmetrical
DEE = signs DIES = symptoms
List 3 symptoms of vulval psoriasis
Itchy ASS
I - itch
A - arthritis
S - Scaly Skin
list 2 signs of vulval psoriasis
- red, scaly, well demarcated patches
- asymmetrical patches
List 4 symptoms of lichen sclerosis
Itch Dry skin Dyspaerunia pain May be asymptomatic
List 6 signs of lichen sclerosis
- loss of vulval architecture
- pale vulva/anogenital area
- figure of 8 sign - pale skin around Introits and anus
- hair loss
- spares vagina
- fusion of labia
List 4 signs of lichen planus
The vagina P’s
May involve vagina
Purple
Papules or plaques
Appears inflamed or sore
List 6 contributing factors to vulval dermatitis
- sweat
- recurrent candidiasis
- synthetic underwear
- douching
- use of chemical on vulva
- laundry detergents
- spermacides
List 4 macroscopic features that are consistent with lichen sclerosis
PAVLOva
P - pale skin around anus/introitus A - asymmetry V - vaginal stenosis L - labial fusion/Loss of architecture O - obliteration of clitoral hood
What advice would you give someone about lichen sclerosis as a condition?
- autoimmune condition
- causes chronic inflammation of the vulva
- associated with an increased risk of vulval cancer
What management options are available for lichen sclerosis?
- conservative - cotton underwear, sleep without underwear, avoid vulval irritants/douching
- medical - treat with potent steroids lifelong
- surgical - occasionally labioplasty is required for restoration of anatomy and for sexual/urinary function
List 5 conditions that present with vulval itch and rash?
Vulval dermatitis Lichen sclerosis Lichen planus VIN lichen simplex chronicus
Describe the medical management of vulval dermatitis
- avoiding causative agents is first line
- cream/emollient
- Anti-histamine
- consider course of low potency steroid
What is the differential diagnosis for vulval itch?
THIINN Trauma hormonal infection inflammatory Neoplastic neurological
What can cause traumatic vaginal itch
- obstetric trauma
- FGM
What are the causes of infective vaginal itch?
- candidiasis
- HSV
What are the causes of inflammatory vaginal itch?
- eczema
- contact dermatitis
- psoriasis
- lichen simplex chronicus
- lichen planus
- lichen scelorosis
- desquamative inflammatory vaginitis
What are the causes of neoplastic vaginal itch?
VIN/VAIN
Extra-mammary pagets disease
What are the causes of neurological vaginal itch?
post-herpetic neuralgia
nerve injury
What are the hormonal causes of vaginal itch?
atrophy
What are 3 characteristics that can help you differentiate Lichen sclerosis from lichen planus?
- Lichen sclerosis occurs on the vulva only, whereas LP affects vagina also
- LS is white and is not primarily erosive, whereas LP is red/erythematous and primary erosive
- LS occurs in children while LP rarely occurs in childhood
- LS is associated with malignancy while LP only rarely associated with malignancy
