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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

Vulvodynia pharmacologic treatment

1. Topical lidocaine ointment
2. Topical vaginal estrogen w/ testosterone
3. Amitriptyline or nortriptyline
4. SNRIs
5. Gabapentin