Vulval Disorders

Question 1

Atopic dermatitis

Answer 1

Pruritic, chronic inflammatory dermatitis characterized by relapsing episodes or flares
Increased incidence of asthma, allergic rhinitis, allergic conjunctivitis

Question 2

Atopic dermatitis histo

Answer 2

Scale crusts in stratum corneum, spongiosis, microvesicular formation in epidermis, perivascular lymphocytic inflammatory infiltrate

Question 3

Allergic contact dermatitis

Answer 3

Inflammatory dermasosis where the tissue damage is rude to a type 4 T cell mediated delayed hypersensitivity reaction

Question 4

Allergic contact dermatitis histo

Answer 4

Parrakeratosis
Spongiosis
Irregular hyperkartosis of epidermis
Perivascular lymphcytic inflammatory infiltrate
More eosinophils

Question 5

Lichen simplex chronicus

Answer 5

Symptoms: chronic severe pruritic, worse at night; burning/soreness/dyspaerunia associated with erosions; exacerbated by heat

Signs: erythematous lichenified plaques, leathery feeling skin; erosions, ulcers, fissures, hyper or hypo pigmented skin areas

Histology: hyperkeratosis, irregular acanthodians with prominent superficial dermal inflammatory cell infiltrate, spongiosis

Question 6

Treatment of recurrent VVC

Answer 6

Control risk factors
Long term suppressive treatment
(Daily fluconazole 50-100mg)

Question 7

Risk factors for VVC

Answer 7

COCP, IUCD, Mirena
HRT
Obesity
DM
Immunosuppression
Abx
Steroids
Frequent sex
Poor hygiene

Question 8

Signs of lichen sclerosis

Answer 8

White sclerotic plaque with strophic wrinkled surface
Outputs
Fissuring
Erosions
Hyperkaratosis
Figure of 8 distribution
Loss of architecture (labial fusion, burying of clitoris, introital stenosis

Question 9

Histo LS

Answer 9

Lichenoid inflammatory pattern
Strophic epidermis
Hyperkeratosis
Basal hydropic degeneration +/- pigmentary incontinence
Lymphohistiocytic infiltrate in hyaline band with loss of elastic tissue in upper dermis; follicular plugging in hair bearing skin

Question 10

Treatment LS

Answer 10

Clobetasol proprionate 0.5%
Topical pimecrolimus and tacrolimus
Vulval skin care
Emollients
Surgery for division of labial adhesions, introital stenosis, malignancy
Long term follow up
Patient education

Question 11

Lichen planus types and definition

Answer 11

Autoimmune, mucocutaenous inflammatory disorder
Classical
Erosive
Hypertrophic

Question 12

Classical LP

Answer 12

Viola epis, plaques with overlying lacy white lines which usually affect the labia majora and surrounding skin

Question 13

Erosive LP

Answer 13

Most common
Labia Minora, vestibule, vagina
Glazed erythema or erosions symmetrically distributed at introital
Wickhams striae in surrounding skin

Question 14

Hypertrophic

Answer 14

Perinatal/perineal

Question 15

LP symptoms

Answer 15

Pain
Vaginal discharge
Soreness
Burning
Bleeding with sex
Vaginal stenosis
Dyspaerunia

Question 16

LP histo

Answer 16

Lichenoid reaction pattern
Irregular saw-toothed acanthodians
Increased granular layer
Basal cell liquefaction
Band-like dermal lymphocytic infiltrate

Question 17

Treatment

Answer 17

Little evidence
Steroids
Azathioprine
Vaginal dilators

Question 18

Causes of vulvar pain

Answer 18

Infectious
Inflammatory
Neoplastic
Neuro
Trauma
Iatrogenic
Hormonal deficiencies

Question 19

Vulvodynia

Answer 19

Vulvar pain of at least 3/12 without clear identifiable cause

Question 20

Descriptors of vulvar pain

Answer 20

Localized- generalized or mixed
Provoked, spontaneous or mixed
Onset
Temporal pattern (intermittent, persistent)

Question 21

Risk factors for vulvodynia

Answer 21

Co-morbidities and other pain syndromes
Genetics
Hormonal factors
Inflammation
MSK
Neurological mech
Psychological
Structural defects

Question 22

Treatment of vulvodynia

Answer 22

Patient education and reassurance
Pain modification
physical therapy
Psychological and psychosexual therapy