Vulval disorders Flashcards
What are the causes of itchy vulva?
disorders causing general itchiness
skin disease e.g. psoriasis, lichen sclerosis
local causes
What are local causes of itchy vulva?
- Infection
- Vaginal discharge e.g. candida
- Allergy e.g. washing powder
- Fabric dyes
- Infestation e.g. scabies, public lice, threadworms
- Vulval dystrophy - lichen sclerosis, leukoplakia, carcinoma
What exacerbates pruritus vulvae?
obesity and incontinence
What is surprisingly not a cause of itch
postmenopausal vaginal atrophy
What are the investigations for pruritus vulvae?
− Hx suggests cause − Examine vulva and genital tract − Cervical smear − Vaginal and vulval swabs − Tests for diabetes and thyroid disease
What is lichen simplex also known as?
neurodermatitis
What is lichen simplex?
Localised area of chronic, lichenified eczema/dermatitis w single or multiple plaques
What is the cause of lichen simplex?
Follows repetitive scratching and rubbing, arising due to chronic localised itch. itch can be due to eczema, psoriasis lichen planus fungal infection
What is the presentation of lichen simplex
chronic intractable itching esp. at night in those w sensitive skin or eczema
what exacerbates lichen simplex
stress, sensitising chemicals, low body iron stores
what is rx of lichen simplex
vulval care and steroids to break itch/scratch cycle
what is leukoplakia
White vulval patches due to skin thickening and hypertrophy
what are ix for leukoplakia and why
BIOPSY - can be pre-malignant lesion
What is rx of leukoplakia
topical corticosteroids, psoralens w UV phototherapy, methotrexate, ciclosporin
What is vulvovaginitis
Inflammation or infection of the vulva and vagina
what can cause vulvovaginitis
drug reactions e.g. NSAIDs, statins
what is rx of vulvovaginitis
Responds to 2-4 weeks of intravaginal clindamycin cream w hydrocortisone to the vulva
What is lichen sclerosus?
Chronic skin disorder that most often affects genitals and perianal areas
What can lichen sclerosus commonly occur w
other skin conditions e.g. lichen simplex, psoriasis
autoimmune conditions e.g. thyroid disease, vitiligo
What popn of women are commonly affected w lichen sclerosus?
postmenopausal
How does lichen sclerosus appear
pink-white papules which coalesce to form parchment like skin w fissures, vulva gradually becomes white, flat and shiny
what are the clinical features of lichen sclerosus
- Severe pruritus which may be worse at night
- Scratching may cause trauma w bleeding and skin splitting then discomfort, pain
- Dyspareunia
- Dysuria - stinging
- Introital stenosis - Inflammatory adhesions can form causing fusion of the labia and narrowing of the introitus
what are the important investigations for lichen sclerosus and why
5% of cases can develop into vulval carcinoma so BIOPSY to exclude this
What is the treatment of lichen sclerosus
Ultra-potent steroids - clobetasol propionate daily for 28 days
