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Vulval dermatoses (Lichen schlerosus (Diagnosis (History PC/HPC:…
Vulval dermatoses
Lichen
schlerosus
Clinical presentation
Anogenital area (figure of 8 appearance)
Burning, pain, itch
Problems with urination and intercourse
Diagnosis
History
PC/HPC: itching/burning genital area, no red flags
PMH: autoimmune disease
DH: current meds, allergies
FH: lichen schlerosus, autoimmune disease
SH: occupation, support, smoking, alcohol
Examination
White, shiny, wrinkly, atrophic skin
Purpura and telangiectasia
Excoriation, lichenification
Loss/fusion of labia minora, narrowed introitus
Investigations
Swabs: HVS, ECS (STIs, candida)
Bloods - FBC (anaemia), U+Es, TFTs (thyroid disease), autoimmune screen, vitamin B12/folate
Biopsy - if unclear diagnosis
Pathophysiology
Environment and genetics
Inflammation by lymphocytes, HLA-DQ7 association
Autoimmune association - thyroid, DM, pernicious anaemia
Epidemiology
Rare
Usually peri-menopausal
Definition
Itchy inflammatory skin condition
of the vulva
Management
Medical
Topical steroids
Indication: all patients
E.g. clobetasol 0.05% for 4 wks
MOA: reduces inflammation
Immunosuppressant
Indication: unresponsive to steroids
E.g. tacrolimus (specialist use)
MOA: reduces inflammation
SEs: pancytopenia, GIT disorder
Conservative
Information, advice, support
FU 3months
Vulval skin care
Advise to contact if ulcers, bleeding etc.
Lichen
planus
Clinical presentation
Painful, red, itchy, ulcerated lesions
Post-coital bleeding
Discharge
Purple papules and plaques with white streaks
Epidemiology
Rare
Diagnosis
History
PC/HPC: painful, itchy, red ulcers, PCB,
unusual discharge
PMH: current conditions
DH: meds, allergies
FH: vulval disorders
SH: occupation, smoking, alcohol
Examination
Erythematous ulcers, papules/pustules,
white streaks (Wickhams striae)
Investigations
Swabs (exclude herpes)
Bloods (syphilis)
Biopsy
Definition
Painful ulcerative skin condition of the vulva
Management
Conservative
Information, advice, support
FU 3months
Vulval skin care
Medical
Topical steroids
Indication: all patients
E.g. clobetasol 0.05% for 4 wks
MOA: reduces inflammation
Immunosuppressant
Indication: unresponsive to steroids
E.g. tacrolimus (specialist use)
MOA: reduces inflammation
SEs: pancytopenia, GIT disorder
Complications
Increased risk of vulval cancer
Vulval
dermatitis
Pathophysiology
Atopy association
Irritants e.g. soaps, shower gel, deodorants,
creams, condoms
Clinical presentation
Itch (secondary burning/pain)
Erythema
Dry, scaly skin
Definition
Dermatitis/eczema of the vulva
Diagnosis
History
PC/HPC: itching, red, dry vulva, no red flags
PMH: atopy
DH: current meds, allergies
FH: atopy (eczema)
SH: occupation, smoking, alcohol
Examination
Erythematous, dry, scaly skin
Investigations
Swabs (STIs, candida)
Management
Conservative
Information and advice
Avoid irritants
Skin care (soap substitutes, cotton underwear)
Referral for patch testing
Medical
Topical steroids
Indication: severe disease
E.g. clobetasol, betamethasone
MOA: redues inflammation
Emollient
Indication: all types
MOA; hydrating, reducing dryness and irritation
Soap substitute
Indication: all types
Antihistamine
Indication: itch
E.g. chlorphenamine
MOA: reduces histamine release,
also sedative to aid sleep at night
Vulval
psoriasis
Clinical presentation
Well-defined erythematous patches
Silver scaling
Diagnosis
:
Dermatological
Well defined erythematous patches
Silver scaling
History
PC/HPC: patches, arthropathy
PMH: other autoimmune disease
DH: meds, allergies
FH: psoriasis, autoimmune disease
SH: occupation, smoking, alcohol, stress
Definition
Psoriasis of the vulva
Management
Conservative
Information and advice
Good vulval skin care
Medical
Emollients
Indication: all
MOA: moisturise and reduce irritation
Topical steroids
Indication: all
E.g. hydrocortisone 1% cream
MOA: reduce inflammation