vulvar disorders Flashcards
Lichen Sclerosus etiology
- Autoimmune
- Genetics
- Environmental
Who does lichen sclerosis MCly occur in?
Postmenopausal women
MC sx in lichen sclerosis
Pruritus
Other sx’s in lichen sclerosis
- Dysuria
- Dyspareunia
- Anal discomfort
lichen sclerosis PEx findings
- Sharply, well-demarcated white plaques: “Cellophane paper”
- Fragility/thin skin: Hallmark
What risk/condition is associated with lichen sclerosis? Who is more likely to develop this?
Squamous cell carcinoma
Elderly, hyperkeratotic lesion
What autoimmune disorder is highly associated with lichen sclerosis?
Hypothyroidism
lichen sclerosis diagnosis
Punch biopsy
lichen sclerosis treatment
Topical high potency steroid OINTMENT: Clobetasol 0.05% ointment
Clobetasol SE’s
- Atrophy
- Dermatitis
- Rosacea
Lichen Simplex si/sx
- Vulvar pruritus and/or burning (wks-mos): “itch that rashes”.
- Anxiety/depression association
Lichen Simplex physical exam findings
Eczematous process:
Poorly marginated, red, scaling plaques
What are the initial signs in lichen simplex
- Weeping
- Excoriations
- Crusting
What are the chronic signs in lichen simplex
- Lichenification
2. Hypopigmentation with moisture
What is the definitive dx in lichen simplex
Vulvar punch biopsy
Lichen Simplex pharm treatment
- Topical steroid cream: Lower dose potency
- Hydrocortisone 1-2%
- Triamcinolone acetonide
- Betamethasone valerate - Antihistamines
- SSRI: if h/o anxiety/depression
Lichen planus clinical presentation
- Introital irritation
- Burning (less commonly pruritus)
- Vaginal discharge
Non-erosive disease in lichen planus
Lacy, white epithelium (fern-like appearance)
White striae
erosive disease in lichen planus
Deep vaginal redness
vulvar erosions
purulent vaginal secretions
1st line treatment in lichen planus
Topical steroid cream:
Hydrocortisone acetate 25mg suppository QHS
2nd treatment in lichen planus
- Topical Tacrolimus 0.1% ointment QOD - BID
2. Systemic corticosteroids
What is Vulvar Intraepithelial Neoplasia (VIN) U associated with?
HPV: 16, 18, 31
VINU risk factors
- Smoking: 50-80%
- Immunosuppression
- Multiple sex partners
VINU presentation
Burning and itching=50%
What is VINU highly associated with?
High grade CIN
VINU diagnostic procedure
Vulvar Colposcopy:
3-5% acetic acid
Sit for 3-5 minutes
Lesions gray-white-red/black
What is the standard of care in VINU?
Surgical treatment:
- CO2 laser vaporization-do not perform if invasion suspected
- Local wide excision
- Vulvectomy
What is the post-treatment recurrence rate in VINU?
30-50%
What population does VIND mainly effect?
Older population: >70
What is VIND associated with?
Squamous cell hyperplasia
lichen sclerosis that likely went untx
VIND prevention and treatment
Prevention: Proper tx of underling condition
Tx: Surgical excision
What is the ACOG/ASCCP position statement for VINU and VIND
Vaccination with Gardasil
What is the post-tx f/u in VINU/D?
Colposcopic vulvar inspection:
6 and 12 months
Annually thereafter
Vulvar CA common comorbidities
- Type 2 DM
- Obese
- HTN
What is the MC age in Vulvar CA?
Bimodal:
- 20-40yrs: HPV related (VINu)
- 60-70yrs: d/t chronic irritation
80% of women with vulvar CA have what untreated long-lasting conditions?
- lichen sclerosus
2. lichen simplex chronicus 3. squamous cell hyperplasia
Vulvar CA clinical presentation
- ASYMPTOMATIC
- Pruritus: MC sx
- Vulvar bleeding/pain
Vulvar CA treatment
- Complete surgical removal w/ inguinal node dissection
2. Radiation: indicated w/ lymph node spread
Behcets clinical presentation
- Oral ulcerations
- Urogenital lesions
- Skin lesions
- Ocular dz
Behcets diagnostic criteria
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 within 48h
Behcets treatment
- Temovate 0.05% ointment
- Intralesional Triamcinolone: 5 – 10mg/mL
- Systemic corticosteroids for refractory cases
Bartholin cyst/abscess treatment
- I&D w/ insertion of word catheter
- Culture purulent material:
Polymicrobial, E. coli, MRSA, STI - +/- empirical antibiotic therapy: Bactrim, Augmentin
Severe or recurring Bartholin cyst treatment
Marsupialization
Vulvodynia clinical presentation
- Vulvar “burning”*
- Absent clinical findings: Everything looks nl
- Introital pain with intercourse
Vulvodynia pharmacologic treatment
- Topical lidocaine ointment
- Topical vaginal estrogen w/ testosterone
- Amitriptyline or nortriptyline
- SNRIs
- Gabapentin