Flashcards in vulvar disorders Deck (45)
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1
Lichen Sclerosus etiology
1. Autoimmune
2. Genetics
3. Environmental
2
Who does lichen sclerosis MCly occur in?
Postmenopausal women
3
MC sx in lichen sclerosis
Pruritus
4
Other sx's in lichen sclerosis
1. Dysuria
2. Dyspareunia
3. Anal discomfort
5
lichen sclerosis PEx findings
1. Sharply, well-demarcated white plaques: "Cellophane paper"
2. Fragility/thin skin: Hallmark
6
What risk/condition is associated with lichen sclerosis? Who is more likely to develop this?
Squamous cell carcinoma
Elderly, hyperkeratotic lesion
7
What autoimmune disorder is highly associated with lichen sclerosis?
Hypothyroidism
8
lichen sclerosis diagnosis
Punch biopsy
9
lichen sclerosis treatment
Topical high potency steroid OINTMENT: Clobetasol 0.05% ointment
10
Clobetasol SE's
1. Atrophy
2. Dermatitis
3. Rosacea
11
Lichen Simplex si/sx
1. Vulvar pruritus and/or burning (wks-mos): "itch that rashes".
2. Anxiety/depression association
12
Lichen Simplex physical exam findings
Eczematous process:
Poorly marginated, red, scaling plaques
13
What are the initial signs in lichen simplex
1. Weeping
2. Excoriations
3. Crusting
14
What are the chronic signs in lichen simplex
1. Lichenification
2. Hypopigmentation with moisture
15
What is the definitive dx in lichen simplex
Vulvar punch biopsy
16
Lichen Simplex pharm treatment
1. Topical steroid cream: Lower dose potency
-Hydrocortisone 1-2%
-Triamcinolone acetonide
-Betamethasone valerate
2. Antihistamines
3. SSRI: if h/o anxiety/depression
17
Lichen planus clinical presentation
1. Introital irritation
2. Burning (less commonly pruritus)
3. Vaginal discharge
18
Non-erosive disease in lichen planus
Lacy, white epithelium (fern-like appearance)
White striae
19
erosive disease in lichen planus
Deep vaginal redness
vulvar erosions
purulent vaginal secretions
20
1st line treatment in lichen planus
Topical steroid cream:
Hydrocortisone acetate 25mg suppository QHS
21
2nd treatment in lichen planus
1. Topical Tacrolimus 0.1% ointment QOD - BID
2. Systemic corticosteroids
22
What is Vulvar Intraepithelial Neoplasia (VIN) U associated with?
HPV: 16, 18, 31
23
VINU risk factors
1. Smoking: 50-80%
2. Immunosuppression
3. Multiple sex partners
24
VINU presentation
Burning and itching=50%
25
What is VINU highly associated with?
High grade CIN
26
VINU diagnostic procedure
Vulvar Colposcopy:
3-5% acetic acid
Sit for 3-5 minutes
Lesions gray-white-red/black
27
What is the standard of care in VINU?
Surgical treatment:
1. CO2 laser vaporization-do not perform if invasion suspected
2. Local wide excision
3. Vulvectomy
28
What is the post-treatment recurrence rate in VINU?
30-50%
29
What population does VIND mainly effect?
Older population: >70
30
What is VIND associated with?
Squamous cell hyperplasia
(lichen sclerosis that likely went untx)
31
VIND prevention and treatment
Prevention: Proper tx of underling condition
Tx: Surgical excision
32
What is the ACOG/ASCCP position statement for VINU and VIND
Vaccination with Gardasil
33
What is the post-tx f/u in VINU/D?
Colposcopic vulvar inspection:
6 and 12 months
Annually thereafter
34
Vulvar CA common comorbidities
1. Type 2 DM
2. Obese
3. HTN
35
What is the MC age in Vulvar CA?
Bimodal:
1. 20-40yrs: HPV related (VINu)
2. 60-70yrs: d/t chronic irritation
36
80% of women with vulvar CA have what untreated long-lasting conditions?
1. lichen sclerosus
2. lichen simplex chronicus 3. squamous cell hyperplasia
37
Vulvar CA clinical presentation
1. ASYMPTOMATIC
2. Pruritus: MC sx
3. Vulvar bleeding/pain
38
Vulvar CA treatment
1. Complete surgical removal w/ inguinal node dissection
2. Radiation: indicated w/ lymph node spread
39
Behcets clinical presentation
1. Oral ulcerations
2. Urogenital lesions
3. Skin lesions
4. Ocular dz
40
Behcets diagnostic criteria
Recurrent oral aphthae at least 3 times in 1 year plus 2 of the following:
1. Recurrent genital ulcers
2. Uveitis
3. Skin lesions
4. (+) Pathergy test: 2mm papule at injection site within 48h
41
Behcets treatment
1. Temovate 0.05% ointment
2. Intralesional Triamcinolone: 5 – 10mg/mL
3. Systemic corticosteroids for refractory cases
42
Bartholin cyst/abscess treatment
1. I&D w/ insertion of word catheter
2. Culture purulent material:
Polymicrobial, E. coli, MRSA, STI
3. +/- empirical antibiotic therapy: Bactrim, Augmentin
43
Severe or recurring Bartholin cyst treatment
Marsupialization
44
Vulvodynia clinical presentation
1. Vulvar "burning"*
2. Absent clinical findings: Everything looks nl
3. Introital pain with intercourse
45
