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Disorders of the Female Genitalia

Nonneoplastic Epithelial Disorders of the Vulva
»	What is lichen sclerosus (also known as lichen sclerosus et atrophicus)?
»	Describe the clinical signs of lichen sclerosus of the vulva.
»	What are the symptoms of lichen sclerosus?
»	Is there a need to biopsy lichen sclerosus of the vulva?
»	How does one treat lichen sclerosus?
»	What is the differential diagnosis of lichen sclerosus of the vulva?
»	What is lichen planus?
»	Are there different variants of lichen planus that affect the vulva?
»	What are the clinical symptoms of vulval lichen planus?
»	Is lichen planus associated with malignancy?
»	How do you treat lichen planus of the vulva?
»	Describe lichen simplex chronicus of the vulva.
»	Psoriasis can be present on the vulva. How does it present?
»	How is psoriasis of the vulva treated?
»	What are other common causes of vulvar pruritus?
»	Name some common vulvovaginal infections associated with pruritus?
»	Compare and contrast condyloma accuminatum and molluscum contagiosum.
Vasculitic Disease of the Vulva
»	What is Behçet’s disease?
»	What is the treatment for Behçet’s disease?
Neoplastic Disorders of the Vulva
»	What is the most common cancer of the vulva?
»	Is squamous cell carcinoma of the vulva associated with a precancerous state?
»	How long does it take VIN to progress to squamous cell carcinoma of the vulva?
»	How does one treat VIN/SCC of the vulva?
»	What is the second most common vulvar malignancy?
»	How does melanoma of the vulva present?
»	Are melanomas of the vulva more aggressive than other cutaneous melanomas?
»	What is the treatment of melanoma of the vulva?
»	What is Paget’s disease of the vulva?
»	How does Paget’s disease of the vulva present?
»	What is the differential diagnosis of Paget’s disease?
»	How does one treat Paget’s disease of the vulva?

What is lichen sclerosus (also known as lichen sclerosus et atrophicus)?

Lichen sclerosus demonstrating typical ill-defined hypopigmentation with wrinkled atrophic appearance that is best visualized near the bottom of the lesion. (Courtesy of James E. Fitzpatrick, MD.)

Fig. 61.1 Lichen sclerosus demonstrating typical ill-defined hypopigmentation with wrinkled atrophic appearance that is best visualized near the bottom of the lesion. (Courtesy of James E. Fitzpatrick, MD.)

Lichen sclerosus (LS) (Fig. 61-1) is an inflammatory condition that primarily affects the superficial dermis. The disease process results in thinned or atrophic white papules and plaques of the skin. LS primarily affects the anogenital region, but it can also present on the trunk or extremities. Lichen sclerosus of the vulva most commonly affects postmenopausal women, but it can also develop in 7% to 15% of prepubertal females.