Vulvar Dermatoses Flashcards
List 2 epidermal vulvar dermatoses
List 2 dermo-epidermal junction vulvar dermatoses
Epidermal
- Vulvar dermatitis
- Vulvar psoriasis
Dermo-epidermal junction
- Lichen sclerosus
- Lichen planus
What are characteristic features of vulvar dermatitis?
What are 2 management strategies?
- Outside > inside
- Pruritic
- Erythema
- Lichenification
- Possible superinfection with S. aureus, candida, Malassezia
- Care of vulval skin
- Avoid irritants
- Regular barrier emollient
- Soap substitute (cleanser)
- Topical steroid of adequate potenency
- Eumovate BID x 2/52, then daily x 2/52, then stop (clobetasol butyrate - class IV)
- Consider Fucibet (fucidic acid/betamethasone valerate) or Daktacort (2% miconazole/1%hydrocortisone) based on clinical appearances
- Consider
- Protopic 0.1% for maintenance
- Nizoral washes if seborrheic dermatitis tendency
What is the recommended treatment for genital psoriasis?
- Daktacort (2% miconazole/1%hydrocortisone) BID 2/52, then PRN
- Protopic 0.1% ointment
- Care of vulvar skin
Consider systemic/biologic treatment
What is a common early sign of lichen sclerosus?
When are the 2 peaks of presentation for lichen sclerosus?
What is an association that requires monitoring?
Tearing of the posterior fourchette with intercourse
- Prepubertal
- Peri/post menopausal
Increased incidence of squamous cell carcinoma (SCC) <5%
What is this dermatological diagnosis?
Vulvar dermatitis or psoriasis
What is this dermatological diagnosis?
Lichen sclerosus
What are clinical features of lichen sclerosus?
- Pruritus
- Tenderness/soreness
- Irritation of inner vulval skin
- White atrophic plaques (labia minora, perineum, perianal)
- Active disease: purpura, erosions, ulceration
- Architectural change
- Resorption of labia minora
- Burying of clitoral hood
- Shrinking of introitus
What is the recommended management of lichen sclerosus?
- Care of vulval skin
- Avoid irritants
- Regular barrier emollient
- Soap substitute (cleanser)
- Topical steroid
- Dermovate BID x 1/12, daily x 1/12, alternating days x 1/12 (clobetasol propionate - Class I)
- if flares, go back to beginning
- Aim for <30g in 6/12 = control
- Dermovate BID x 1/12, daily x 1/12, alternating days x 1/12 (clobetasol propionate - Class I)
- Surveillance due to increased risk of SCC
- Discussion regarding sexual function and childbirth
- consider physiotherapy
What is this dermatological diagnosis?
Vulvar lichen planus
What are clinical features of vulvar lichen planus?
What specialty may you need to consult?
- Reticulate white patches
- Painful erosions and ulcers
- Scarring leading to adhesions
- shiny erythema
- Erosive vaginitis
- Extravulvar signs
- Purple polygonal papules on volar wrist
- Reticulated buccal mucosa
- Scarring alopecia (lichen planopilaris)
Gynecology - assess vaginal involvement
What is the recommended management of vulvar lichen planus?
- Care of vulval skin
- Avoid irritants
- Regular barrier emollient
- Soap substitute (cleanser)
- Topical steroids +/- intralesional steroids
- Dermovate (clobetasol propionate)
- Systemic treatment may be warranted
- Acitretin/MTX/MMF
What is this dermatological diagnosis?
How does it present?
When should you consider biopsy?
What is it associated with?
Extramammary Paget Disease
- Red, scaly plaque
- Unilateral/asymmetrical
- Irregular poorly defined margins
If no response to treatment in 6 weeks
Adenocarcinoma of anogenital skin
What is this dermatological diagnosis?
What type of glands are involved?
Hidradenitis Suppurativa
Apocrine
What is this dermatological diagnosis?
List 3 clinical features
Genital Crohn’s disease
- Unilateral lymphedema
- Granulomatous rash
List 5 differentials to erythematous patches to vulvar area
- Atopic dermatitis
- Irritant contact dermatitis
- Psoriasis
- Allergic contact dermatitis
- Candidiasis
- Lichen planus
- Extramammary Paget disease
- Plasma cell vulvitis (Zoon’s vulvitis)
List 5 differentials to red papules and nodules to vulvar area
- Folliculitis/furuncles
- Hidradenitis suppurativa
- genital Crohn’s disease
- SCC
- Angiomas (angiokeratomas, hemangiomas)
- Epidermoid cysts
List 5 differentials to white patches and plaques to vulvar area
- Lichen sclerosus
- Vitiligo
- Lichen planus
- Candidiasis
- Lichen simplex chronicus
- Vulvar squamous intraepithelial lesions
- Low grade SIL: condylomata acuminata
- High grade SIL: HPV related precursor
- Differentiated: non HPV, associated with lichen sclerosus
List 5 differentials to white papules and nodules to vulvar area
- Fordyce spots
- Epidermoid cysts
- Molluscum contagiosum
- LSIL/HISL/dVIN
- SCC
- Scars (episiotomy)
- Milia
List 5 differentials to vesicles/bullae to vulvar area
- HSV
- VZV
- Bullous impetigo
- Autoimmune blistering conditions
- Bullous pemphigoid
- Pemphigus vulgaris
- Contact dermatitis (allergic or irritant)
- Hailey-Hailey disease
- Fixed drug eruption
- Lymphatic malformation
- Bullous lichen sclerosus
- Linear IgA
- Epidermolyisis bullosa aquisita
List 5 differentials to scarring ulcers to vulvar area
- Acute vulvar aphthous ulcers (Lipshütz ulcer)
- 30% associated with underlying infection (EBV)
- acute, painful, self-limiting
- Infection
- HSV
- Primary syphilis
- Trauma
- Malignancy (SCC, melanoma)
- Cutaneous Crohn’s disease
- Pyoderma gangrenosum
List 5 differentials to pigmented lesions to vulvar area
- Physiologic hyperpigmentation
- Postinflammatory hyperpigmentation
- SIL
- Melanocytic nevi
- Angiokeratoma
- Vulvar melanosis
- Lichen planus
- Vulvar melanoma
