CMN 572 DeCherney Ch. 39-Benign Disorders of Vulva & Vagina
1. Most common nonneoplastic
epithelial vulvar disorder
2. Intense pruritus usually in women older than 60
y. Rare in adolescent, with spontaneous
resolution. Vulvar skin is thin, wrinkled,
What are the s/s of Lichen white with areas of lichenification and
Sclerosus?
hyperkeratosis
3. Anterior parts of the labia minora
of both sides agglutinate to cover
clitoris and create phimosis
4. Erosions, fissures, subepithelial
hemorrhages, and ulcerations
result from scratching
1. Biopsy all new lesions d/t high rate of squamous cell carcinoma.
2. Stop the itch scratch cycle and minimize inflammation=avoid
tight undergarments, cleanse daily with mild soap, and dry the
vulvar skin with a hair dryer.
3. Oral antihistamine taken at bedtime
4. Clobetasole dipropionate (Dermovate) is recommended at
What is the treatment for Lichen the start to obtain immediate relief. (minimize SE, apply in small
Sclerosus? amount, twice daily for 2 weeks, then once daily for 2 weeks, then
twice weekly for 2 weeks, and then prn for the rest of her life. Or
taper to a lower potency topical steroid for maintenance.
5. If no response, tacrolimus cream, retinoid, antimalarial agents
or photodynamic therpy is prescribed.
6. If nothing relieves itch, intralesional injection of steroids or
surgical undermining of affected skin without excision. (Mering
procedure).
7. It is a chronic condition.
1. Benign epithelial thickening and
What are the s/s of vulvar lichen hyperkeratosis resulting from chronic
simplex chronicus? irritation such as from perfumed pads
or chronic vulvovaginal infections.
2. Pruritus, rubbing and scratching, maceration
, What is required to diagnose vulvar Biopsy to exclude intraepithelial neoplasia and tumor.
lichen simplex chronicus?
1. Sitz baths and lubricants to restore moisture to cells and
reconstruct epithelial barrier.
2. Oral antihistamines
What is the treatment for
3. Topical application of medium potency steroids twice
vulvar lichen simplex
daily to decrease inflammation and pruritus.
chronicus? 4. Takes 6 weeks to heal
5. For intractable cases, antidepressants or SQ intralesional injection of steroids.
1. Rarely affects vulva.
2. flat topped papules and less sharply
marginated white plaques.
What are the s/s of genital lichen 3. classic leukoplastic lesions or
planus? erosive lesions may be present.
4. erosive lichen planus is similiar to
inflammatory vaginitis.
1. Topical hydrocortisone foam for vagina (Colifoam).
2. If unsuccessful,topical fluorinated corticosteriods, ultra potent
What is the treatment for genital
corticosteriods, or topical treatment with tacrolimus
Lichen Planus?
3. Frequent f/u of vaginal for formation of adhesions is important.
4. For severe pruritus, and intensive involvement, systemic steroids
chronic relapsing dermatosis that
affects the scalp,extensor surfaces of
Define Psoriasis.
extremities, the trunk, and vulva..
What is the treatment for Psoriasis? Topical corticosteriods.
benign darkly pigmented flat lesion that
may be mistake for melanoma.
Define Melanosis or Lentigo.
Multiple small dark blue,
asymptomatic papules that are
Define capillary hemangioma
discovered incidentally during exam of
the older patient.
Excisional biopsy is needed only if they bleed repeatedly.
What is the treatment for capillary
childhood hemangiomas regress or become static after age 18 months.
hemangioma.
Larger ones may require cryosurgery, argon laser, or sclerosing solutions to
remove.
What is the most common Herpes Genitalis
cause of ulcerative lesion
on the vulva?
Viral culture
Then glycoprotein-G-based specific serology and PCR.
What is the gold standard to A smear scraped from the lesion and stained by PPanicolau stain is
diagnose Herpes Genitalis? fast, but is less sensitive and less specific than a culture.
Cytologic characteristics-Giant cells, multiple nulei, molding of the
nuclei (compression of one into another), and ground-glass
appearance.
1. Most common nonneoplastic
epithelial vulvar disorder
2. Intense pruritus usually in women older than 60
y. Rare in adolescent, with spontaneous
resolution. Vulvar skin is thin, wrinkled,
What are the s/s of Lichen white with areas of lichenification and
Sclerosus?
hyperkeratosis
3. Anterior parts of the labia minora
of both sides agglutinate to cover
clitoris and create phimosis
4. Erosions, fissures, subepithelial
hemorrhages, and ulcerations
result from scratching
1. Biopsy all new lesions d/t high rate of squamous cell carcinoma.
2. Stop the itch scratch cycle and minimize inflammation=avoid
tight undergarments, cleanse daily with mild soap, and dry the
vulvar skin with a hair dryer.
3. Oral antihistamine taken at bedtime
4. Clobetasole dipropionate (Dermovate) is recommended at
What is the treatment for Lichen the start to obtain immediate relief. (minimize SE, apply in small
Sclerosus? amount, twice daily for 2 weeks, then once daily for 2 weeks, then
twice weekly for 2 weeks, and then prn for the rest of her life. Or
taper to a lower potency topical steroid for maintenance.
5. If no response, tacrolimus cream, retinoid, antimalarial agents
or photodynamic therpy is prescribed.
6. If nothing relieves itch, intralesional injection of steroids or
surgical undermining of affected skin without excision. (Mering
procedure).
7. It is a chronic condition.
1. Benign epithelial thickening and
What are the s/s of vulvar lichen hyperkeratosis resulting from chronic
simplex chronicus? irritation such as from perfumed pads
or chronic vulvovaginal infections.
2. Pruritus, rubbing and scratching, maceration
, What is required to diagnose vulvar Biopsy to exclude intraepithelial neoplasia and tumor.
lichen simplex chronicus?
1. Sitz baths and lubricants to restore moisture to cells and
reconstruct epithelial barrier.
2. Oral antihistamines
What is the treatment for
3. Topical application of medium potency steroids twice
vulvar lichen simplex
daily to decrease inflammation and pruritus.
chronicus? 4. Takes 6 weeks to heal
5. For intractable cases, antidepressants or SQ intralesional injection of steroids.
1. Rarely affects vulva.
2. flat topped papules and less sharply
marginated white plaques.
What are the s/s of genital lichen 3. classic leukoplastic lesions or
planus? erosive lesions may be present.
4. erosive lichen planus is similiar to
inflammatory vaginitis.
1. Topical hydrocortisone foam for vagina (Colifoam).
2. If unsuccessful,topical fluorinated corticosteriods, ultra potent
What is the treatment for genital
corticosteriods, or topical treatment with tacrolimus
Lichen Planus?
3. Frequent f/u of vaginal for formation of adhesions is important.
4. For severe pruritus, and intensive involvement, systemic steroids
chronic relapsing dermatosis that
affects the scalp,extensor surfaces of
Define Psoriasis.
extremities, the trunk, and vulva..
What is the treatment for Psoriasis? Topical corticosteriods.
benign darkly pigmented flat lesion that
may be mistake for melanoma.
Define Melanosis or Lentigo.
Multiple small dark blue,
asymptomatic papules that are
Define capillary hemangioma
discovered incidentally during exam of
the older patient.
Excisional biopsy is needed only if they bleed repeatedly.
What is the treatment for capillary
childhood hemangiomas regress or become static after age 18 months.
hemangioma.
Larger ones may require cryosurgery, argon laser, or sclerosing solutions to
remove.
What is the most common Herpes Genitalis
cause of ulcerative lesion
on the vulva?
Viral culture
Then glycoprotein-G-based specific serology and PCR.
What is the gold standard to A smear scraped from the lesion and stained by PPanicolau stain is
diagnose Herpes Genitalis? fast, but is less sensitive and less specific than a culture.
Cytologic characteristics-Giant cells, multiple nulei, molding of the
nuclei (compression of one into another), and ground-glass
appearance.
