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1. Foundations III > Vulvar disorders > Flashcards

Vulvar disorders Flashcards

1
Q

What are the etiologies of Lichen Sclerosis? Explain

A

Autoimmune
Genetic
Environmental

*You have an autoimmune predisposing factor and then you have an environmental factor -> leading to this condition

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2
Q

What are the environmental factors that contribute to causing Lichen Sclerosis?

A
  • incontinence
  • infection
  • contact dermatitis
  • trauma –> Koebner’s phenomenon
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3
Q

Who is Lichen Sclerosis MC in?

A

postmenopausal women

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4
Q

What are the common presenting sx of Lichen Sclerosis?

A

Pruritus= MC

Pain

  • dysuria
  • dyspareunia
  • anal discomfort
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5
Q

What area does Lichen Sclerosis involve?

A

diffuse involvement of vulva

usu. begins periclitorally, spreads to perineal

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6
Q

Describe the appearance of lichen sclerosis

A

sharply, well-demarcated, white plaques
“cellophane paper”
waxy

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7
Q

What is the hallmark of disease w/ lichen sclerosis?

A

fragility

-purpura, erosions, fissures

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8
Q

Severe cases of lichen sclerosis can cause what?

A

loss of normal anatomic landmarks

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9
Q

What are the RFs for squamous cell carcinoma from lichen sclerosis?

A

*hyperkeratotic lesions (pigment change)

elderly

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10
Q

How do you dx lichen sclerosis?

A

punch biopsy

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11
Q

How do you tx lichen sclerosis?

A

Topical super-high potency steroid ointment
=1st line if clobetasol (Temovate) 0.05% ointment

apply 2x daily, then 1-3x /week for maintenance once texture is normal

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12
Q

Is lichen sclerosis curable?

A

no :(

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13
Q

What are factors that contribute to causing Lichen simplex chronicus?

A
  • Hx of atopy
  • Emotional tensions (w/ hx of anxiety/depression)
  • Environmental triggers (sweating, excessive hygiene, panty-liners, topical meds, tight clothing)
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14
Q

What is the cycle of Lichen simplex chronicus?

A
  • Inflammatory cell infiltrate increases sensitivity
  • itching
  • scratching/rubbing
  • mechanical irritation
  • epidural thickening

REPEAT

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15
Q

What is the clinical presentation of Lichen simplex chronicus?

A

progressive vulvlar pruritus &/or burning x weeks-months

“itch that scratches”

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16
Q

Describe the PE findings for Lichen simplex chronicus?

A

poorly marginated
red
scaling papules & plaques

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17
Q

Initial signs of Lichen simplex chronicus?

Chronic signs?

A

Initial: weeping, excoriations, crusting

Chronic: Lichenification, hypo pigmentation w/ moisture

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18
Q

How do you dx Lichen simplex chronicus?

A

clinically

vulvar punch biopsy= definitive dx

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19
Q

Tx for Lichen simplex chronicus?

A

Identify underlying triggers (looser clothing, no panty liners, decrease stress)

-baths
-topical steroid cream (hydrocortisone 1-2%)
-antihistamine
SSRI

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20
Q

Who is lichen planes MC in?

A

women 50-60

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21
Q

Presentation of lichen planus?

A

Introital irritation= superficial dyspareunia

burning (less commonly pruritus)

vaginal discharge

22
Q

What will be seen on PE with lichen planus?

A
  • disruption of vulvar anatomy
  • can be seen on mucosal and/or keritonized surface
  • Non-erosive disease= lacy, white fern-like
  • Erosive disease= deep vaginal redness, vulvar erosions
23
Q

Tx for lichen planus?

A

1st line= topical steroid creams

Hydrocortisone acetate 25mg suppository if extends into vagina

24
Q

What is VIN?

A

Vulvar intraepithelial neoplasia=

neoplastic cells contained to squamous epithelium

25
Q

Which classes of VIN are precursors to vulvar cancer?

A

2 and 3

26
Q

What strains of HPV is VINu a/w and who is it MC seen in?

A

HPV 16, 18, 31

younger women

27
Q

RFs of VINu?

A

same are CIN

= smoking, immunosuppression, multiple sex partners

28
Q

Sx of VINu

A
  • asymptomatic

- vulvar burning in about 50%

29
Q

What diagnostic things must be done in VINu?

A

colposcopy/Pap smear

30
Q

What is the standard of care for VINu?

A

Surgical tx

CO2 laser vaporization, local wide exicsion, vulvectomy

31
Q

Is VINd related to HPV? Who is it seen in?

A

NO unrelated

women >70

32
Q

Does VINd involve the upper and lower epithelium?

A

No

only the lower 1/3

33
Q

An older women with untreated squamous cell hyperplasia (lichen sclerosis) is at risk of?

A

VINd

34
Q

Tx of VINd

A

surgical excision

35
Q

Women with VINu should receive what vaccine?

A

Gardasil

36
Q

What are common comorbidities a/w vulvar CA?

A

obesity, HTN

Type II DM

37
Q

What age is a/w vulvar CA?

A

bimodal peak
20-40 (VINu)
60-70 (VINd)

38
Q

Presentation of vulvar CA?

A

Asymptomatic
Pruritis= MC sx
vulvar bleeding
vulvar pain

39
Q

Tx of vulvar CA?

A

complete surgical removal of tumor w/ inguinal node dissection

40
Q

What is Bahcet’s disease and how is it caused?

A

autoimmune

Exposure to agent trimmest disease in pt w/ predisposition (bacterial/viral agents, heavy metals, chemicals)

41
Q

Clinical presentation of Bahcet’s disease?

A

oral ulcerations
urogenital lesions
skin lesions
ocular disease- uveitis

42
Q

Criteria to dx Behcets?

A 
Recurrent oral aphthae at least 3x in 1 year
\+ 2 of below:
-recurrent genital ulcers
-uveitis
-skin lesions
- (+) Pathergy test
43
Q

what is the pathergy test

A

needle insertion in the skin -> 2mm papule at injection site w/in 48 hrs

44
Q

1st line tx for Bahcet’s

A

Temovate 0.05% ointment

45
Q

Clinical presentation of Bartholin cyst/absess

A
  • acute, painful unilateral labial swelling
  • dyspareunia
  • pain w/ sitting or walking
  • drainage
46
Q

What is tx for Bartholin cyst/absess?

A

I&D w/ insertion of Word catheter

cultural purulent material

+/- empirical abx therapy

47
Q

Abx options for Bartholin cyst/absess

A
  • Bactrim
  • Augmentin
  • 2nd/3rd gen Cephalosporin + Doxy
48
Q

What are some potential causes of vulvodynia?

A
  • low estrogen (onset around menopause)
  • pelvic floor dysfunction
  • psych factors (mood/anxiety disorders 4x as likely)
  • neurologic sensitization
49
Q

MC complaint w/ vulvodynia?

what is seen on PE?

A

Vulvar BURNING

Absent clinical findings

50
Q

When you do an exam for vulvodynia, where should the pain be when palpating w/ a q-tip

A

pain limited to the vestibule

51
Q

Non-pharmacologic options for vulvodynia

A

Non-pharmacologic:

  • avoid scented products, tight clothing, panty liners
  • Sitz bath followed by petroleum jelly
  • couple counseling
  • pelvic floor therapy
52
Q

pharmacologic tx options for vulvodynia

A
  • topical lidocaine ointment
  • topical vaginal estrogen w/ testosterone
  • Amitriptyline or nortriptyline
  • SNRIs
  • Gabapentin

1. Foundations III (20 decks)

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