Vulvar Disorders Flashcards
What is Lichen Sclerosus?
Autoimmune: autoantibodies attack extracellular matrix and basement membrane. Immune dysfunction affecting all levels of skin.
Lymphocytic infiltrate of skin. Assoc w/ thyroid disorder and HLA.
What Koebner’s phenomenon? How does this effect Lichen Sclerosus
Trauma to an area makes the condition worse
Who is Lichen Lichen Sclerosus mostly seen in?
Post menopausal women
What is the most common symptom seen in Lichen Sclerosus
Pruritus*
Also pain and pyspareunia
What are physical exam findings in Lichen Sclerosus
Sharp well demarcated white plaques, figure 8
Cellophane paper appearance (waxy and hyperkaerototic
What is a hallmark findings in Lichen Sclerosus ?
What is a seen in severe cases
Fragility
Loss of anatomical landmarks
How is Lichen scleorosus diagnosed
Vulvar biopsy
Treatment for Lichen Sclerosus
- Topical ultrapotent steroid OINTMENT
Known as Clobetasol (Temovate)
What is important to know when applying treatment towards Lichen sclerosus
Educate patient to apply only to affected area
What can occur if Lichen sclerosus is left untreated?
Squamous cell cancers
RF: elderly and hyperkeratotic lesions
Does lichen sclerorus go away?
no, chronic condition
Who is likely to aquire Lichen Simplex Chronicus
Patients with hx of atropy
What is a precipitating factor that will trigger Lichen Simplex chornicus
Vulvar pruritis
How does Lichen Simplex chronicus typically present
Initially poorly marginated red, scaling papules and plaques
Chronic:
Lichenification (callus)
Hypopigementation with moisture
What is first line treatment for Lichen simplex complex
Identify underlying triggers
Causes of Lichen planus?
autoimminue disorder
Clinical presentation of Lichen planus
Introital irritation-superficial dyspareunia
Burning and /or pruritis
Vaginal dis harge
Slide 23
slide 23
Treatment for Lichen planus
Topical steroids - Hydrocortione (like lichen simplex complex)
Definition of Vulvar Intraepithelial Neoplasia
neoplastic cells confined to squamous epithelium
Which types/grades of Vulvar Intraepithelial neoplasia are most concerning that lead to cancer?
How are they further differentiated
VIN 2
VIN 3
VINu or VINd
Which HPV types are VINu associated with?
type 16, 18, 31
Clinical presentation for VINu?
Most are asymptomatic
Vulvar burning and pruritus in 50% of cases
Associated often with high grade CIN therefore colposcopy / Pap smear is mandatory
Biopsy all pigmented lesions
How is VINu diagnosed?
Vulvar Colposcopy
Physcial exam findings for VINu?
Hypo and Hyperpigmentation
Treatment for VINu?
None provided are guaranteed due to failure to include all lesions
What is the standard care for VINu
Surgical- CO2 laster vaporization
Who is VINd seen mos commonly in?
Is it related to HPV
Seen in older women (70 or older)
No relation to HPV
How is VINd caused?
− Associated with squamous cell hyperplasia (Lichen Sclerosis)
− Unidentified carcinogenic agents combined with local environment of chronically irritated/inflamed skin lead to dysplastic cell
How is VINd treated?
Prevention- proper treatment of underlying conditions
Treatment: surgical exision of lesions
How is VINu prevented during follow up?
Vaccination- Gardasil
What are post treatment follow up recommendation for VINu and VINd
colposcopic vulvar inspection at 6 and 12 months and then annually thereafter
The incidence of vulvar cancer has ________ what type of peak?
Bimodal peak
Women 20-40 years is HPV related (VINu)
Women 60-70 years is due to chronic irritation and poorly understood co-factor (VINd)
What are clinical presentations for Vulvar cancer?
ASYMPTOMATIC is MC
Pruritus is the second most common condition
Vulvar bleeding
Vulvar pain
Need to inspect the vulva
Treatment for Vulvar Cancers?
Staging based on FIGO
Surgical removal of tumor with inguinal node dissection
What is the MCC type of vulvar cancer?
Squamous cell carcinomas
What are clinical presentations of Behcet’s disease?
Genital ulcers
What is the criteria to diagnose Behcet’s disease?
o Recurrent oral aphthae at least 3 times in 1 year plus 2 of the following:
" Recurrent genital ulcers " Uveitis " Skin lesions " (+) Pathergy test " 2mm papule at injection site w/in 48hr
Treatment for Behcet’s disease?
High dose steroid
Temovate 0.05% ointment
What are Bartholin Cysts?
Bilateral glands found at the 4 and 8 clock positions
How do Batholin cysts present?
Acute, painful unilateral labial swelling - less pain with cyst
Dyspareunia
Pain with sitting or walking
Drainage
Different between Batholin Cysts and abscess?
slide 52
Treatment for Bartholin Cysts
Incision and drainage and instertion of Word catheter
Cultures and empirical antibiotic therapy
Sitz baths 2-3 days after I&D
No intercourse until cather is removed
What is the cause of Vuvlodynia?
Unknown
but onset usually is around menopause
Clinical presentation of Vulvodynia?
Absent clinical findings
Vulvar “burning”
Raw or stabbing sensation
On physical exam how can you differentiate and diagnose Vulvodynia
Use a q-tip to palpate the vestibule where we expect the pain
Treatment for Vulvodynia
slide 62 and slide 63
