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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 |
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What are the types of red lesions? |
1 Candidiasis
2 Contact dermatitis 3 Systemic skin disorders 4 Vulvodynia 5 Folliculitis |
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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 |
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How is candidiasis treated? |
Nitroimidazoles
– Orally: fluconazole (Diflucan), itraconazole(Sporanox), ketoconazole (Nizoral) – Topically: clotrimazole etc. |
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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 |
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How does contact dermatitis present? |
Sudden onset of itch
Often new soap/toiletriesor clothes Red lesion on labia majora Demarcated |
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How is contact dermatitis treated? |
Saltwater Sitz baths and avoidance of the irritant NB - condom allergy presents the same |
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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 |
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What is vulvodynia? |
Painful vulva syndrome
Uncommon Disastrous Very symptomatic Pain is relentless |
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What are the major causes of vulvodynia? |
Post HPV
Dystrophies Vestibulitis Hypersensitivity postcandidiasis |
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How do we treat vulvodynia? |
Long term treatment Saltwater Sitz baths Behavior Pain management Topical steroids Sometimes surgery |
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What is folliculitis? |
Staph infection around the hair follicles Spreads to affect large areas of the vulva |
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How is folliculitis treated? |
Topical and sometimes systemic antibiotics Pain relief Meticulous hygiene |
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What are the types of white lesions? |
1 Lichen sclerosus
2 Hyperplastic dystrophy 3 Pigment deficiencies |
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What is Lichen Sclerosis? |
Uncommon but destructive Probably autoimmune disorder |
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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 |
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How is Lichen Sclerosis treated? |
Meticulous hygiene (esp. in young persons)
Potent topical corticoid Antipruritics Surgery may be required from time to time |
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What are the risks and prognosis of Lichen Sclerosis? |
Risks – Vulvar destruction, 2% risk of Ca Vulva
Prognosis – Good if life-long treatment |
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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 |
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How is vulvar hyperplasia treated? |
Biopsy
Hygiene Topical corticoids Surgery often needed as thickened skindoes not easily respond to medicaltreatment |
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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 |
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What are the types of dark lesions? |
1 Nevi 2 Neurofibromatosis |
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How are Nevi treated? |
Regard as premalignant Remove surgically |
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What are neurofibromatosis and how are they treated? |
Dark patches of skin No treatment |
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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 |
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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) |
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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 |
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How are condylomata treated? |
Small: imiquimod (Aldara), podophyllin
Medium: electrocautery Large: surgical excison |
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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! |
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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. |
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What are the types of large tumours? |
1 Lipomas
2 Fibromas 3 Cancers |
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What is a lipoma and how is it treated? |
Fatty tumours that grow in labia majora with few symptoms Remove if in the way |
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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 |
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What diverse conditions can affect the vulva? |
Vulvar oedema Valvar varicocities |
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What are the types of vulvar malignancies and premalignancies? |
1 VIN
2 Paget’s disease of the vulva 3 Carcinoma 4 Melanoma 5 Others |
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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 |
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What is the risk of VIN? |
Associated HPV/cancer May develope cancer |
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How do we treat VIN? |
Excision |
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How does Paget's disease present? |
Focal red itchy lesions
On biopsylooks like Paget cells in breast lesions |
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What is the risk of Paget's disease? |
Current or future malignancies |
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How is Paget's disease treated? |
Excision and follow up |
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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! |
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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 |
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How is vulvar carcinoma treated? |
Tests for metastasis and general condition Predominantly surgery - Radicalvulvectomy and groin node dissection If +ve nodesalso radiotherapy |
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What is the prognosis of vulvar cancer? |
Prognosis is good - 75% 5ys Recurrences treatedsurgically or radio/chemotherapy |
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What is vulvar melanoma? |
It exists, is rare and deadly
Same appearance and symptoms asmelanomas elsewhere |
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What is the treatment and prognosis of vulvar melanoma? |
Surgical approach in most casesPoor prognosis
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