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1. Foundations III > Vulvar disorders > Flashcards

Vulvar disorders Flashcards

1
Q

What are the etiologies of Lichen Sclerosis? Explain

A

Autoimmune
Genetic
Environmental

*You have an autoimmune predisposing factor and then you have an environmental factor -> leading to this condition

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2
Q

What are the environmental factors that contribute to causing Lichen Sclerosis?

A
  • incontinence
  • infection
  • contact dermatitis
  • trauma –> Koebner’s phenomenon
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3
Q

Who is Lichen Sclerosis MC in?

A

postmenopausal women

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4
Q

What are the common presenting sx of Lichen Sclerosis?

A

Pruritus= MC

Pain

  • dysuria
  • dyspareunia
  • anal discomfort
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5
Q

What area does Lichen Sclerosis involve?

A

diffuse involvement of vulva

usu. begins periclitorally, spreads to perineal

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6
Q

Describe the appearance of lichen sclerosis

A

sharply, well-demarcated, white plaques
“cellophane paper”
waxy

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7
Q

What is the hallmark of disease w/ lichen sclerosis?

A

fragility

-purpura, erosions, fissures

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8
Q

Severe cases of lichen sclerosis can cause what?

A

loss of normal anatomic landmarks

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9
Q

What are the RFs for squamous cell carcinoma from lichen sclerosis?

A

*hyperkeratotic lesions (pigment change)

elderly

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10
Q

How do you dx lichen sclerosis?

A

punch biopsy

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11
Q

How do you tx lichen sclerosis?

A

Topical super-high potency steroid ointment
=1st line if clobetasol (Temovate) 0.05% ointment

apply 2x daily, then 1-3x /week for maintenance once texture is normal

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12
Q

Is lichen sclerosis curable?

A

no :(

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13
Q

What are factors that contribute to causing Lichen simplex chronicus?

A
  • Hx of atopy
  • Emotional tensions (w/ hx of anxiety/depression)
  • Environmental triggers (sweating, excessive hygiene, panty-liners, topical meds, tight clothing)
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14
Q

What is the cycle of Lichen simplex chronicus?

A
  • Inflammatory cell infiltrate increases sensitivity
  • itching
  • scratching/rubbing
  • mechanical irritation
  • epidural thickening

REPEAT

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15
Q

What is the clinical presentation of Lichen simplex chronicus?

A

progressive vulvlar pruritus &/or burning x weeks-months

“itch that scratches”

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16
Q

Describe the PE findings for Lichen simplex chronicus?

A

poorly marginated
red
scaling papules & plaques

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17
Q

Initial signs of Lichen simplex chronicus?

Chronic signs?

A

Initial: weeping, excoriations, crusting

Chronic: Lichenification, hypo pigmentation w/ moisture

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18
Q

How do you dx Lichen simplex chronicus?

A

clinically

vulvar punch biopsy= definitive dx

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19
Q

Tx for Lichen simplex chronicus?

A

Identify underlying triggers (looser clothing, no panty liners, decrease stress)

-baths
-topical steroid cream (hydrocortisone 1-2%)
-antihistamine
SSRI

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20
Q

Who is lichen planes MC in?

A

women 50-60

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21
Q

Presentation of lichen planus?

A

Introital irritation= superficial dyspareunia

burning (less commonly pruritus)

vaginal discharge

22
Q

What will be seen on PE with lichen planus?

A
  • disruption of vulvar anatomy
  • can be seen on mucosal and/or keritonized surface
  • Non-erosive disease= lacy, white fern-like
  • Erosive disease= deep vaginal redness, vulvar erosions
23
Q

Tx for lichen planus?

A

1st line= topical steroid creams

Hydrocortisone acetate 25mg suppository if extends into vagina

24
Q

What is VIN?

A

Vulvar intraepithelial neoplasia=

neoplastic cells contained to squamous epithelium

25
Which classes of VIN are precursors to vulvar cancer?
2 and 3
26
What strains of HPV is VINu a/w and who is it MC seen in?
HPV 16, 18, 31 | younger women
27
RFs of VINu?
same are CIN | = smoking, immunosuppression, multiple sex partners
28
Sx of VINu
- asymptomatic | - vulvar burning in about 50%
29
What diagnostic things must be done in VINu?
colposcopy/Pap smear
30
What is the standard of care for VINu?
Surgical tx | CO2 laser vaporization, local wide exicsion, vulvectomy
31
Is VINd related to HPV? Who is it seen in?
NO unrelated women >70
32
Does VINd involve the upper and lower epithelium?
No | only the lower 1/3
33
An older women with untreated squamous cell hyperplasia (lichen sclerosis) is at risk of?
VINd
34
Tx of VINd
surgical excision
35
Women with VINu should receive what vaccine?
Gardasil
36
What are common comorbidities a/w vulvar CA?
obesity, HTN | Type II DM
37
What age is a/w vulvar CA?
bimodal peak 20-40 (VINu) 60-70 (VINd)
38
Presentation of vulvar CA?
**Asymptomatic** **Pruritis= MC sx** vulvar bleeding vulvar pain
39
Tx of vulvar CA?
complete surgical removal of tumor w/ inguinal node dissection
40
What is Bahcet's disease and how is it caused?
autoimmune Exposure to agent trimmest disease in pt w/ predisposition (bacterial/viral agents, heavy metals, chemicals)
41
Clinical presentation of Bahcet's disease?
oral ulcerations urogenital lesions skin lesions ocular disease- uveitis
42
Criteria to dx Behcets?
``` Recurrent oral aphthae at least 3x in 1 year + 2 of below: -recurrent genital ulcers -uveitis -skin lesions - (+) Pathergy test ```
43
what is the pathergy test
needle insertion in the skin -> 2mm papule at injection site w/in 48 hrs
44
1st line tx for Bahcet's
Temovate 0.05% ointment
45
Clinical presentation of Bartholin cyst/absess
- acute, painful unilateral labial swelling - dyspareunia - pain w/ sitting or walking - drainage
46
What is tx for Bartholin cyst/absess?
I&D w/ insertion of Word catheter cultural purulent material +/- empirical abx therapy
47
Abx options for Bartholin cyst/absess
- Bactrim - Augmentin - 2nd/3rd gen Cephalosporin + Doxy
48
What are some potential causes of vulvodynia?
- low estrogen (onset around menopause) - pelvic floor dysfunction - psych factors (mood/anxiety disorders 4x as likely) - neurologic sensitization
49
MC complaint w/ vulvodynia? | what is seen on PE?
Vulvar BURNING Absent clinical findings
50
When you do an exam for vulvodynia, where should the pain be when palpating w/ a q-tip
pain limited to the vestibule
51
Non-pharmacologic options for vulvodynia
Non-pharmacologic: - avoid scented products, tight clothing, panty liners - Sitz bath followed by petroleum jelly - couple counseling - pelvic floor therapy
52
pharmacologic tx options for vulvodynia
- topical lidocaine ointment - topical vaginal estrogen w/ testosterone - Amitriptyline or nortriptyline - SNRIs - Gabapentin

1. Foundations III (20 decks)

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