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vulvar lichen simplex chronicus; vulvar squamous cell hyperplasia; hyperplastic vulvar dystrophy
Etiology:
- reaction to chronic irritation
- exacerbated by rubbing or scratching
- aggravating factors
- inability to maintain good hygiene
- candidiasis
- diabetes mellitus
Pathology:
- thickened lichenified epithelium
- excoriation & fissuring
- hyperkeratosis
- erythema on the labia majora
History:
- use of possible irritants
- incontinence pads
- cleansing products
- contact with unusual agent
Clinical manifestations:
- generalized vaginal irritation
- dysuria may be noted
- discomfort may interfere with social activities & sleep
- pruritus during the day may be minimal
- pain (occasional)
- no vaginal discharge
- thickened white or reddish patches involving
a) labia majora
b) outer aspects of labia minora
c) hood of clitoris
Laboratory:
- punch biopsy confirms diagnosis (several sites may be required)
Diagnostic criteria:
- diagnosis of exclusion
Differential diagnosis:
- lichen sclerosus
- psoriasis
- lichen planus
- eczema
- vulvar neoplasm
Management:
- remove offending agent(s)
- treat underlying conditions
- potent topical glucocorticoid
- ointment preferred over cream
- strings less
- tends to remain longer
- 4-6 week course
General
lichen simplex chronicus (LSC)
vulvar dystrophy (vulvar disorder)
sqaumous cell hyperplasia
References
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013