Vulvular Lesions (Dermatoses)

Question 1

IS SVD-

Answer 1

1. Dermatoses
   - Lichen Sclerosus
2. Precancer
3. Cancer
4. Vulval Pain

Question 2

Dermatoses

What is Lichen Sclerosus?

Answer 2

-Chronic inflammatory dermatosis

(dermatosis is defined as a disorder involving lesions or eruptions of the skin that can be acute or chronic)

• that causes an ivory-white and atrophic looking vulva and perianal skin
• Underlying fibrosis causes resorption

-Can lead to introital stenosis and
dyspareunia

Question 3

What is the aetiology of Lichen Sclerosus?

Answer 3

• Unknown

- Possible autoimmune origin.

Question 4

Lichen Sclerosus presents in post-menopausal and pre-pubertal age groups:

True or False

Answer 4

True

Question 5

How do pt present with Lichen Sclerosus?

Answer 5

1. Vulval pruritis
2. Dyspareunia (if sexually acctive)
3. Burning pain

Question 6

How does Lichen Sclerosus lesion look like?

Answer 6

-The classic lesion is:
Ivory-white and
Atrophic looking

• It involves the vulval and perianal skin
• it is in a figure 8 looking distribution.
• Causes resorption of labia (loss of normal anatomy)

Question 7

How is the diagnosis of Lichen Sclerosus made?

Answer 7

1. It is made clinically
   - presence of characteristic clinical manifestations
2. Dx can be confirmed by a punch biopsy

Question 8

What is the treatment of Lichen Sclerosus?

Answer 8

1. Inform the patient-
   treatable but not curable.

2.Drug Rx:
-Treat with potent Topical Steroid
*Clobetasol
(Dermovate)

-Give maintenance therapy
*Lower potency steroid,
Topical emmollient

3. For superficial dyspareunia and vaginal dryness
   * Glycerine can help.
4. Regular follow-up required
   - to detect any suspicious areas
5. Adipose-derived stem cells can be used for regeneration of vulval skin

Question 9

What does Lichen Sclerosus put a pt at risk of?

Answer 9

-Squamous Carcinoma

risk of malignant transformation +/- 4%

Question 10

What is Lichen Simplex Chronicus?

Answer 10

-this condition is caused by chronic scratching.
-is a chronic
endogenous eczema.

-It is a common cause of vulvar pruritis that often manifests with nightly itching.

Question 11

Hx of Lichen Simplex Chronicus:

Answer 11

• Pruritis of the vulva
• often manifests with nightly itching
• may result in itch-scratch-itch cycle, can be uncontrollable

Question 12

What do you see in vulvar exam of Lichen Simplex chronicus?

Answer 12

-Lichenified,
grayish,
excoriated lesion,
usually over labia Majora.

• Excoriation may result in ulcer.
• Scale is present (with whitening from chronic moisture)

Question 13

What is the treatment for Lichen Simplex Chronicus?

Answer 13

• Break the itch-scratch-itch cycle
• Steroid cream
• Removal of irritant.

Question 14

What is Lichen Planus?

Answer 14

-Occurs as red, sharply
marginated,
flat topped
papule/ plaques.

-Lesions occur in a lacy/network pattern.