Vulval disorders

Question 1

What are the causes of itchy vulva?

Answer 1

disorders causing general itchiness
skin disease e.g. psoriasis, lichen sclerosis
local causes

Question 2

What are local causes of itchy vulva?

Answer 2

• Infection
• Vaginal discharge e.g. candida
• Allergy e.g. washing powder
• Fabric dyes
• Infestation e.g. scabies, public lice, threadworms
• Vulval dystrophy - lichen sclerosis, leukoplakia, carcinoma

Question 3

What exacerbates pruritus vulvae?

Answer 3

obesity and incontinence

Question 4

What is surprisingly not a cause of itch

Answer 4

postmenopausal vaginal atrophy

Question 5

What are the investigations for pruritus vulvae?

Answer 5

−	Hx suggests cause
−	Examine vulva and genital tract 
−	Cervical smear
−	Vaginal and vulval swabs 
−	Tests for diabetes and thyroid disease

Question 6

What is lichen simplex also known as?

Answer 6

neurodermatitis

Question 7

What is lichen simplex?

Answer 7

Localised area of chronic, lichenified eczema/dermatitis w single or multiple plaques

Question 8

What is the cause of lichen simplex?

Answer 8

Follows repetitive scratching and rubbing, arising due to chronic localised itch.
itch can be due to eczema,
psoriasis
lichen planus
fungal infection

Question 9

What is the presentation of lichen simplex

Answer 9

chronic intractable itching esp. at night in those w sensitive skin or eczema

Question 10

what exacerbates lichen simplex

Answer 10

stress, sensitising chemicals, low body iron stores

Question 11

what is rx of lichen simplex

Answer 11

vulval care and steroids to break itch/scratch cycle

Question 12

what is leukoplakia

Answer 12

White vulval patches due to skin thickening and hypertrophy

Question 13

what are ix for leukoplakia and why

Answer 13

BIOPSY - can be pre-malignant lesion

Question 14

What is rx of leukoplakia

Answer 14

topical corticosteroids, psoralens w UV phototherapy, methotrexate, ciclosporin

Question 15

What is vulvovaginitis

Answer 15

Inflammation or infection of the vulva and vagina

Question 16

what can cause vulvovaginitis

Answer 16

drug reactions e.g. NSAIDs, statins

Question 17

what is rx of vulvovaginitis

Answer 17

Responds to 2-4 weeks of intravaginal clindamycin cream w hydrocortisone to the vulva

Question 18

What is lichen sclerosus?

Answer 18

Chronic skin disorder that most often affects genitals and perianal areas

Question 19

What can lichen sclerosus commonly occur w

Answer 19

other skin conditions e.g. lichen simplex, psoriasis

autoimmune conditions e.g. thyroid disease, vitiligo

Question 20

What popn of women are commonly affected w lichen sclerosus?

Answer 20

postmenopausal

Question 21

How does lichen sclerosus appear

Answer 21

pink-white papules which coalesce to form parchment like skin w fissures, vulva gradually becomes white, flat and shiny

Question 22

what are the clinical features of lichen sclerosus

Answer 22

1. Severe pruritus which may be worse at night
2. Scratching may cause trauma w bleeding and skin splitting then discomfort, pain
3. Dyspareunia
4. Dysuria - stinging
5. Introital stenosis - Inflammatory adhesions can form causing fusion of the labia and narrowing of the introitus

Question 23

what are the important investigations for lichen sclerosus and why

Answer 23

5% of cases can develop into vulval carcinoma so BIOPSY to exclude this

Question 24

What is the treatment of lichen sclerosus

Answer 24

Ultra-potent steroids - clobetasol propionate daily for 28 days

Question 25

What is lichen planus

Answer 25

skin rash triggered by the immune system, chronic and inflammatory

Question 26

Which bit of skin is most commonly affected in lichen planus?

Answer 26

mucosal surfaces

Question 27

What is the presentation of lichen planus

Answer 27

flat, papular purplish lesions

Question 28

What are the clinical features of lichen planus?

Answer 28

small number or many lesions on the skin and/or mucosal surfaces.
more pain than pruritis

Question 29

What is the treatment of lichen planus?

Answer 29

high-potency steroid creams