vulvovaginal Flashcards
(47 cards)
what general advice can be given to pts with vulval conditions?
avoid contact with chemical irritants - soaps, lubricants
avoid tight fitting garments
lichen sclerosis aetiolgoy
autoantibodies to ECM protein 1
immunopathogenic mechanisms involved
features of lichen sclerosus
ithcy
sore
dyspareunia
dysuria
constipation - if perianal invovlement
what areas does lichen sclerosis affect?
labia majora/minora
clitoral hood
perianal skin
extragenital lesions in 10%
signs o/e in lichen sclerosis
allow
purpura
loss of architecture
erosions
lichenifcation, hyperkeratosis
figure of 8 distribution
complications of lichen sclerosus
SCC
clitroal pseudo-cyst
sexual dysfunction
urinary symptoms
vulvodynia
reactivation of latent HSV or HPV
how do you diagnose lichen sclerosus?
clinical
biopsy (younger women)
when is biopsy needed in lichen scelrosus
dx uncertain
atypical features
suspicion of VIN or SCC
failure to respond to first line tx
atypical pigmented areas
what is seen histologically in lichen sclerosu
epidermal atrophy
sub-epidermal hyalinisation of collagen
lymphocytic dermal infiltrate
tx lichen sclerosus
emollients
dermovate - clobetasone steroid with tapering regime
steroid + anti fungal
topical calcineurin inhibitors eg tacrolimus
oral retinoids in severe hyperkeratotic disease
UVA
how does lichen scelrosus affect pregnancy + breastfeeding?
improves in pregancy
no CI to vaginal delivery
steroids safe
tacrolimus CI
oral retinoids CI during breastfeeding + pregnancy, and for 2 yrs before
lichen planus aetiology
probably immunological response by activated T cells
weak circulating basement membrane antibodies present
what is lichen planus
inflammatory disorder of skin, oral and genital mucosa
may involve hair + nails, causing scarring alopecia + nail dystrophy
symptoms lichen planus
itch - hypertrophic
sore
dyspareunia
urinary symptoms
vaginal discharge
types of lichen planus
classic
hypertrophic
erosive
what is classical lichen planus
papule found on keratinised anogenital skin /- striae on inner vulva
hyperpigmentation following resolution, esp in darker skin
what is hypertrophic lichen planus
perineum + perianal area
thickened warty plaques
may become ulcerated, infected + painful
what is erosive lichen planus?
mucosal surfaces eroded with pale lilac lace network (Wickham’s striae)
consist of friable telangectasia with patchy erythema
cause post coital bleeding, dyspareunia, serosanguinus discharge
seen in oral mucosa
what is vulvo-vaginal gingival syndrome + symptoms
erosive disease n three sites
symptoms inc soreness, dyspareunia, blood-stained vaginal discharge
complications of lichen planus
scarring, vulval + vaginal adhesions
SCC in hypertrophic
how do you ix lichen planus
biopsy - if dx uncertain
autoimmune disease eg TFTs
skin swab
patch testing
Hep C
tx of lichen planus
dermovate - clobetasol steroid
topical calcineruin inhibitors eg tacrlimus
systemic eg oral sprednisolone, methotrexate, hydroxycholoriquine, mycophenolate
biologics in oral + cutaneous disease eg basiliximab
photodynamic therapy
sugary for severe adhesions
aetiology of vulval atopic eczema?
gene ,mutation in strucutral epidermal protein filaggrin leading to disturbance of the normal epidermal barrier function and increased epidermal susceptibility to allergens and microbes, resulting in chronic inflammation
what can cause irritation of genital skin?
urine, faeces, sweat
fragrances, preservatives
spices, peppermint
spermicides, lubricants
overzealous cleaning of genital skim, friction from exercise, tight synethetic underwear
