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47 Cards in this Set

  • Front
  • Back

How is vulvar disease classified?

Red lesions

White lesions


Dark lesions


Ulcers


Small tumours


Large tumours


Malignacies

What are the types of red lesions?

1 Candidiasis

2 Contact dermatitis


3 Systemic skin disorders


4 Vulvodynia


5 Folliculitis

How does candidiasis present?

Common, recurrent


Itch, white discharge, pain and swelling


Red lesions affecting labia majora and labia minora, also vagina, swelling and discharge

How is candidiasis treated?

Nitroimidazoles

– Orally: fluconazole (Diflucan), itraconazole(Sporanox), ketoconazole (Nizoral)


– Topically: clotrimazole etc.

Why do some patients have recurrent candidiasis and how is it managed?

Reasons for recurrence: antibiotics,steroids, DM, OCs, decreased immunity,other candida species



Strategy: meticulous hygiene, long termuse of anti-fungals, try to modify thecausative factor




95%+ success with first treatment

How does contact dermatitis present?

Sudden onset of itch

Often new soap/toiletriesor clothes


Red lesion on labia majora


Demarcated

How is contact dermatitis treated?

Saltwater Sitz baths and avoidance of the irritant




NB - condom allergy presents the same

How does systemic disease present and what are some causes?

Will see lesions on rest of body as well




Psoriasis and erythema of various causes

What is vulvodynia?

Painful vulva syndrome

Uncommon


Disastrous


Very symptomatic


Pain is relentless

What are the major causes of vulvodynia?

Post HPV

Dystrophies


Vestibulitis


Hypersensitivity postcandidiasis

How do we treat vulvodynia?

Long term treatment


Saltwater Sitz baths


Behavior


Pain management


Topical steroids


Sometimes surgery

What is folliculitis?

Staph infection around the hair follicles


Spreads to affect large areas of the vulva

How is folliculitis treated?

Topical and sometimes systemic antibiotics


Pain relief


Meticulous hygiene

What are the types of white lesions?

1 Lichen sclerosus

2 Hyperplastic dystrophy


3 Pigment deficiencies

What is Lichen Sclerosis?

Uncommon but destructive


Probably autoimmune disorder

How does Lichen Sclerosis present?

Itch, burn, narrowing of vagina, white figure of 8 lesion, skin thin andleathery, labia minora disappear, introitusnarrows, clitoris gets buried, sometimesulceration, always scratch marks

How is Lichen Sclerosis treated?

Meticulous hygiene (esp. in young persons)

Potent topical corticoid


Antipruritics


Surgery may be required from time to time

What are the risks and prognosis of Lichen Sclerosis?

Risks – Vulvar destruction, 2% risk of Ca Vulva

Prognosis – Good if life-long treatment

How does vulvar hyperplasia present?

Skin is swollen, thickened,hangs in folds

Hyperkeratotic thus grey-whitein appearance


Scratch marks


Disease of irritation, obesity


May becomeatypical (histologically) -> VIN

How is vulvar hyperplasia treated?

Biopsy

Hygiene


Topical corticoids


Surgery often needed as thickened skindoes not easily respond to medicaltreatment

What pigment deficiencies can affect the vulva and how are they treated?

Vitiligo: common, white skin patches withresidual hair pigmentation. No treatment

Albinism: congenital absence of melanin:skin and hairs depigmented. No treatment


Intertrigo: Skin fold whiteness associatedwith obesity and irritation: emollientcreams

What are the types of dark lesions?

1 Nevi


2 Neurofibromatosis

How are Nevi treated?

Regard as premalignant


Remove surgically



What are neurofibromatosis and how are they treated?

Dark patches of skin




No treatment

What are the types of ulcers and how are they treated?

Herpes: small ulcers + vesicles + fever

Syphilis: painless ulceration


HIV: deep painless ulceration


LGV: small genital ulcers with massivelymphadenopathy: chlamydial


GI: bacterial, same as LGV but largerulceration




Rx: hygiene, saltwater, AB/AVs

What are the types of small tumours?

1 Condylomata acuminata

2 Sebacious cysts


3 Inclusion cysts


4 Fibro-epithelial polyps


5 Bartholin cysts and abscesses


6 Carcinoma (discussed later)

How do condylomata present?

Caused by HPV types 6/11, sexuallyactive persons, causes irritation andsecondary infection, may get quite large



Recurrent in pregnancy, HIV, otherimmune suppression

How are condylomata treated?

Small: imiquimod (Aldara), podophyllin

Medium: electrocautery


Large: surgical excison

What are the types of cysts and how are they treated?

Sebacious: yellow cysts in hair growingareas, if not leaking no symptomsotherwise itch. Remove if it is in the way

Inclusion: central posterior, episiotomyrepairs


Bartholin: skin origins, chlamydia, gonococcal, swelling of gland and duct causes abscess. If redand sore - drain. Antibiotics play small role




Cyst to be removed in >40s: fear of Ca!

What are the types of polyps and how are they treated?

Fibro-epithelial polyps common andbenign; may have stalk and twist causing pain.Excise if problem.

Other small tumours include hemangiomas and postoperative skintags. Best left alone.

What are the types of large tumours?

1 Lipomas

2 Fibromas


3 Cancers

What is a lipoma and how is it treated?

Fatty tumours that grow in labia majora with few symptoms




Remove if in the way

What is a fibroma and how is it treated?

Grow in every part of the vulva but especially in the labia majora




Remove if in the way

What diverse conditions can affect the vulva?

Vulvar oedema


Valvar varicocities

What are the types of vulvar malignancies and premalignancies?

1 VIN

2 Paget’s disease of the vulva


3 Carcinoma


4 Melanoma


5 Others

How does VIN present?

Common, esp. in HIV+ persons

Starts asHPV infection (young/immune deficient) orchronic irritation (older persons)


Few symptoms: itch, burn, raised lesion, pigment changes: red/white/darklesions, multifocal

What is the risk of VIN?

Associated HPV/cancer


May develope cancer

How do we treat VIN?

Excision

How does Paget's disease present?

Focal red itchy lesions

On biopsylooks like Paget cells in breast lesions

What is the risk of Paget's disease?

Current or future malignancies

How is Paget's disease treated?

Excision and follow up

How does carcinoma of the vulva present?

Uncommon gynaecologic cancer

Mostly squamous carcinoma


Mostly caused by HPV 16/18, may followon long standing dystrophies


Few to many carcinomas, ulcer, exophytic growth,bleeding, pain


Must confirm withbiopsy!

How is vulvar carcinoma staged?

Stage I: confined to vulva, lesion <2cm

Stage II: Confined to vulva, >2cm


Stage III: any size but involvesthe introitus, urethra, clitoris


Stage IV: malignant groinnodes, vaginal or anal involvement

How is vulvar carcinoma treated?

Tests for metastasis and general condition


Predominantly surgery - Radicalvulvectomy and groin node dissection


If +ve nodesalso radiotherapy

What is the prognosis of vulvar cancer?

Prognosis is good - 75% 5ys


Recurrences treatedsurgically or radio/chemotherapy

What is vulvar melanoma?

It exists, is rare and deadly

Same appearance and symptoms asmelanomas elsewhere

What is the treatment and prognosis of vulvar melanoma?

Surgical approach in most casesPoor prognosis