Vulvar disorders Flashcards
Lichen Sclerosus is associated with what?
- Autoimmune (thought to be)
- Hypothyroidism*
- Koebner’s phenomenon: trauma makes it worse
Lichen sclerosus: clinical presentation
- post menapausal women
- Pruritus**
Lichen sclerosus: physical exam
-sharp, well-demarcated white plaques “cellophane paper”
- fragility is hallmark of disease
- usually starts around the clitorus
Lichen sclerosus: Tx
Clobestasol ointment (super-high potency steroid)
-will need to use as maintenance 1-3x a week since lichen sclerosis does not go away :(
Lichen simplex chronicus: etiology
- atopic patient
- anxiety/depression may induce sensation of pruritis*
- excessive hygiene
Lichen simplex chronicus: clinical presentation
‘itch that rashes’
-patient’s likely to have underlying anxiety/depression
Lichen simplex chronicus: physical exam
- poorly marginated
- red, scaling papules and plaques
- weeping, excoriations, crusting
- (chronic signs): lichenification, hypopigmentation
Lichen simplex chronicus: treatment
- Topical steroid (ex. hydrocortisone 1-2%, or triamcinolone)
- Antihistamine QHS
- SSRI
Lichen planus: etiology
autoimmune
Lichen planus: clinical presentation
- women 50-60
- Introital irritation
- Burning**
- Vaginal discharge
Lichen planus: physical exam
Non-erosive disease: lacy, white epithelium (fern-like appearance), white striae
Erosive disease: deep vaginal redness, vulvar erosions, purulent vaginal secretions
Lichen planus: tx
1st line: topical steroid - ex. hydrocortisone acetate 25mg suppository QHS
2nd line: Topical Tacrolimus (Protopic) 0.1% ointment
3rd line: oral steroid
VIN U (usual type) risk factors
- HPV 16, 18, 31
- Young women
- Smoking
- Multiple sex partners
VIN U presentation
-burning and pruritis (50% of cases)
VIN U: pigmented lesion
biopsy all pigmented lesions
VIN U: diagnosis
vulvar colposcopy with acetic acid (vinegar)
VIN U: tx
ALL medical therapies are off-label:
- 5FU cream
- Interferon
- Imiquiod (Aldara) cream
Surgery is standard of care****
VIN D (differentiated type): etiology
- NOT related to HPV
- older women (70+)
- Lower 1/3 of epithelium
VIN D: pathogenesis
-association with squamous cell hyperplasia (so, also assoc with Lichen Sclerosis)
VIN D: tx
surgical excision
Vulvar cancer: etiology/background
- Uncommon
- Bimodal peak:
- –20-40 is HPV related (VIN u)
- –60-70 is due to chronic irritation (VIN d)
Vulvar cancer: clinical presentation
Asymptomatic
-Pruritis* (MC symptom)
Vulvar cancer: Tx
complete surgical removal + inguinal node dissection
radiation therapy if lymph node spread
Behcet’s disease: clinical presentation
- oral ulcerations (aphthous ulcers)
- Urogenital lesions
- Skin lesions
- Uveitis
Behcet’s disease: diagnosis
oral aphthae 3 or more times in the last year +:
- recurrent genital ulcers
- uveitis
- skin lesions
- (+) pathergy test: 2mm papule at injection site within 48 hrs.
Behcet’s disease: tx
Clobetasol 0.05% ointment
Bartholin cyst: clinical presentation
- acute, painful unilateral labial swelling
- dyspareunia
- pain with sitting or walking
Bartholin cyst: treatment
- Incision and drainage
- Placement of Word catheter
- Culture
- Empiric ABO treatment: Bactrim (TMP/SMX)
- Sitz bath 2-3 days after I&D
What is the treatment if a bartholin cyst is severe or keeps happening?
marsupialization
Vulvodynia: key points
- onset around menopause
- increased pain sensitivity***
- mood and anxiety disorders
Vulvodynia: most common presentation
vulvar burning
Vulvodynia: tx non-pharmacologic
- Sitz bath BID followed by thin petroleum jelly
- Pelvic floor PT for spasms
Vulvodynia: tx
- topical lidocaine ointment
- Topical vaginal estrogen with testosterone
- Amitriptyline (or nortriptyline)*
- SNRIs
- Gabapentin 1200mg TID
