Benign vaginal and vulval conditions Flashcards
(46 cards)
Define lichen simplex chronicus.
An itch scratch cycle typically leads to chronic trauma from rubbing and scratches.
What are the clinical features of lichen sclerosus?
- Asymptomatic
- Anogenital pruritus that worsens at night
- Excoriations and thickening of vulvar skin
- Dyspaurenia
- White atrophic papules
- Distortion of vulvar anatomy: Labia minora regression, Clitoral concealment, Urethral obstruction, Introital stenosis
- Crinkling of the skin
- Formation of figure 8 due to involvement of perineum and anus
How is lichen simplex chronicus diagnosed?
Clinical
How is lichen simplex chronicus treated?
Treatment
Ellimination of provocative stimuli
Topical corticosteroid ointments
Lubricants: plain petrolatum, vegetable oil, cool sitz
To reduce scratching
Oral antihistamines
Trim finger nails
Cotton gloves worn at night
What are the clinical features of lichen simplex chronicus?
- Intense pruritus
- Excoriations within a background of erythema
- Lichenification
- Thickness of vulvar skin with exaggerated skin markings causing a leathery, gray appearance
- Functional and psychological distress
- Disruption of sleep
In which women is lichen sclerosus common?
Post-menopausal
What causes pruritis in lichen simplex chronicus?
- Irritation from clothing, heat or sweating
- Chemicals (hygiene products, topical medications, laundry product
- Food sensitivities
How is lichen planus treated?
Pharmacotherapy
Ultra potent topical corticosteroid ointments
Systemic corticosteroids
Topical tacrolimus ointment
Oral retinoids
Vaginal dilators
Give 2 suggested causes of lichen sclerosus.
Infections, hormonal, genetic and autoimmune
How is lichen sclerosus diagnosed?
Clinical and histology
Give 5 clinical features of lichen planus.
- Pruritus
- Superficial dyspaurenia
- Post coital bleeding
- Nail bed involvement: longitudinal ridging and sandpaper effect
- Genital lesions: Longitudinal, annular, ulcerative, hyperpigmented and bullous
- Mouth lesions: Reticular like cobwebs
- Skin lesions
What kind of condition is lichen planus?
Autoimmune
How is lichen sclerosus treated?
- Corticosteroids
- Oral antihistamines
- 2% lidocaine jelly
- Estrogen cream: indicated for menopausal atrophy, labial fusion and dyspaurenia
- Retinoids: severe non responsive cases of lichen sclerosus, or patients with intolerance for corticosteroids
- Topical calcineurin inhibitors (tacrolimus)
- Phototherapy
- Surgery
What the 3 forms that lichen planus can present in?
Erosive
Papulo-squamous
Hypertrophic
How do you differentiate irritant and allergic contact dermatitis?
Irritant- Immediate burning and stinging upon exposure to an offending agent
Allergic- Delayed onset and an intermittent course of pruritus and localized erythema, edema and vesicles/ bullae
How is contact dermatitis treated?
- Elimination of offending agent
- Restoration of the natural protective skin barrier
- Topical corticosteroids
- Scratch cessation
How does intertrigo come about?
Due to friction between moist skin surfaces
Give 5 clinical features of intertrigo.
- Erythema
- Erosions
- Fissuring
- Pruritus
- Hyperpigmentation
- Crusting
- Maceration
How is intertrigo treated?
Drying agents such as corn starch
Mild topical corticosteroids
Use of antibiotics if superinfected
Lightweight loose fitting clothing made of natural fibers
Improved ventilation
Thorough drying between skin folds after bathing
Define hidradenitis suppurativa.
Recurrent papular lesions that may lead to abscess, fistula formation, and scarring predominantly in apocrine gland bearing skin.
How is hidradenitis suppurativa treated?
- Local hygiene and weight reduction in obese patients
- Topical or oral antibiotics
- Warm compresses
- Non medical therapies: laser and phototherapy
- Surgical excision
What are apthous ulcers?
Self limited mucosal painful ulcers
What are potential triggers of apthous ulcers?
Stress, trauma, infection, hormonal fluctuation, and nutritional deficiencies of vitamin B12, folate, iron or zinc
How are apthous ulcers treated?
- High potency corticosteroids
- Colchine
- Dapsone
- Thalidomide
