A Practical Guide to Vulval Disease
Diagnosis and Management
1. Edition March 2017
240 Pages, Hardcover
Wiley & Sons Ltd
ISBN:
978-1-119-14605-6
John Wiley & Sons
Further versions
This book is a practical guide to the diagnosis and management of vulval disorders. It offers guidance for all those who are treating patients with vulval disease at trainee and specialist level, helping to improve management for the patient and prevent delays in diagnosis, including referrals to specialists.
It contains key information about diagnosis, investigation and basic management, with a section on signs and symptoms guides the reader to the correct chapter for the treatment of that disease. The experienced authors include updated classification and terminology of vulval disease with an explanation of how this should be useful in clinical practice and guidance as to when the patient should be referred on to a specialist.
As vulval diseases are different to those of the rest of the skin patients with vulval disease present a large unmet need, often with delays in diagnosis due to a lack of training from physicians. This practical guide provides the specialist knowledge required for diagnosis and treatment of these conditions.
Acknowledgements xvii
1 The Normal Vulva 1
Normal Vulval Anatomy 1
Normal Vulval and Vaginal Flora 4
Further Reading 4
Normal Anatomical Variants 4
Normal Changes Over the Lifetime 6
Further Reading 7
2 Taking a History and Examination 9
Taking a History 9
Examination of the Vulva 11
Further Reading 13
3 How to Take a Vulval Biopsy and the Importance of Clinico-Pathological Correlation 15
Incisional Biopsy 16
Fixation of the Biopsy 20
Further Reading 21
4 Basic Histology of the Vulva 23
Special Histological Stains 24
Immunohistochemical Stains 26
Other Tests 27
Further Reading 28
5 Investigations in Vulval Disease 29
Investigations for Infection 29
Investigations for Allergy 32
Investigations for Inflammatory Disease 33
Imaging Investigations 34
Useful Web Sites for Patient Information 34
Further Reading 34
6 Topical Treatment in Vulval Disease 35
Introduction 35
General Principles 35
Lotions 35
Gels 36
Ointments 36
Creams 36
Pastes 36
Topical Treatments Used for Vulval Disease 36
Antiseptics 41
Antibacterials 42
Antifungals 42
Barriers 42
Others 42
Practice Points 44
Further Reading 44
Useful Web Sites for Patient Information 44
7 Symptoms in Vulval Disease 45
Pruritis (Itch) 45
Causes of Vulval Pruritis 46
Soreness 46
Pain 47
Dyspareunia 48
Discharge 48
No Symptoms 49
Useful Web Site for Patient Information 49
8 Signs in Vulval Disease 51
Differential Diagnosis Based on Appearance 51
Algorithms 51
Further Reading 56
9 Eczema, Allergy and the Vulva 57
Seborrhoeic Eczema 57
Allergic Contact Eczema / Dermatitis 59
Clinical Features 60
Irritant Eczema / Dermatitis 62
Urticaria 64
Allergic Contact Urticaria 64
References 65
10 Psoriasis 67
Introduction 67
Incidence 67
Clinical Features 68
Basic Management 69
When to Refer 72
Practice Points 73
Further Reading 73
Useful Web Sites for Patient Information 73
11 Lichen Simplex 75
Introduction 75
Epidemiology 75
Incidence 75
Pathophysiology 75
Histological Features 76
Symptoms 76
Clinical Features 76
Basic Management 77
When to Refer 78
Practice Points 78
Further Reading 79
Useful Web Sites for Patient Information 79
12 Lichen Sclerosus 81
Introduction 81
Incidence 81
Pathophysiology 81
Histological Features 82
Symptoms 83
Clinical Features 83
Associated Disease 90
Risk of Malignancy 90
Basic Management 92
Follow Up 92
When to Refer 92
Practice Points 93
Further Reading 93
Useful Web Sites for Patient Information 93
13 Lichen Planus 95
Introduction 95
Epidemiology 95
Incidence 95
Pathophysiology 95
Histological Features 96
Clinical Features of Lichen Planus 96
Vulval Lichen Planus 98
Risk of Malignancy 99
Basic Management 100
When to Refer 101
Practice Points 102
Further Reading 102
Useful Web Sites for Patient Information 102
14 Hidradenitis Suppurativa and Crohn's Disease 103
Hidradenitis Suppurativa 103
Further Reading 110
Useful Web Sites for Patient Information 110
15 Disorders of Pigmentation on the Vulva 111
Introduction 111
Postinflammatory Pigmentation 111
Post-Traumatic Pigmentation 111
Acanthosis Nigricans 111
Melanosis 114
Pigmented Lesions 115
Lentigines 116
Benign Naevi 116
Atypical Genital Naevi 117
Seborrhoeic Keratoses 117
Pigmented Basal Cell Carcinoma (see Chapter 22) 118
Hypopigmentation 118
Vitiligo 118
When to Refer 119
Practice Points 119
Further Reading 119
Useful Web Sites for Patient Information 120
16 Other Dermatoses 121
Genetic Disorders 121
Auto-Immune Bullous Disease 123
Drug Eruptions 126
Further Reading 126
Useful Web Sites for Patient Information 126
Stevens-Johnson Syndrome 127
Toxic Epidermal Necrolysis 127
Manifestations of Underlying Disease 128
Further Reading 129
Acrodermatitis Enteropathica 129
Practice Point 130
Further Reading 130
Inflammatory Ulcers 130
Practice Point 130
Behcet's Syndrome 130
Further Reading 132
Useful Resources 132
Lipschutz Ulceration 132
Further Reading 133
Others 133
Further Reading 135
Vulvovaginal Adenosis 135
Further Reading 135
Langerhans Cell Histiocytosis 136
Further Reading 136
17 Vulval Infection - Sexually Transmitted 137
Normal Flora 137
Trichomoniasis 137
Lymphogranuloma Venereum 139
Gonorrhoea 140
Clinical Features 140
Syphilis 141
Chancroid 142
Donovanosis (Granuloma Inguinale) 143
Herpes Simplex Infection 144
Human Papillomavirus Infection 147
Molluscum Contagiosum 150
Scabies 152
Pubic Lice 153
18 Vulval Infection - Nonsexually Transmitted 155
Bacterial Infections 155
Bacterial Vaginosis 155
Erythrasma 157
Staphylococcal and Streptococcal Infections 158
Folliculitis 159
Bartholin Abscess 159
Other Staphylococcal Infections 161
Cellulitis 161
Other Streptococcal Infections 161
Vulvovaginal Candidiasis 162
Tinea Cruris 165
Viral Infections 166
19 Vulval Intraepithelial Neoplasia 167
Introduction 167
Epidemiology 167
Aetiology 168
Prevention 168
Histological Features 168
Symptoms 169
Clinical Features 169
Management 173
Progression 174
Melanoma In Situ 176
When to Refer 176
Practice Points 176
Further Reading 177
Useful Web Site for Patient Information 177
20 Extramammary Paget's Disease 179
Introduction 179
Epidemiology 179
Histological Features 179
Classification 180
Symptoms 181
Clinical Features 181
Management 183
Recurrences 185
Progression 185
Follow Up 186
When to Refer 186
Practice Points 186
Further Reading 186
Useful Web Site for Patient Information 187
21 Vulval Squamous Cell Carcinoma 189
Introduction 189
Epidemiology 189
Aetiology / Histology 189
Symptoms and Clinical Features 190
Management 191
Surgery 191
Complications 192
Radiotherapy 193
Follow Up 193
Prognosis 193
When to Refer 194
Practice Points 194
Further Reading 194
Useful Web Site for Patient Information 195
22 Other Vulval Cancers 197
Basal Cell Carcinoma 197
Malignant Melanoma 199
Other Malignant Tumours and the Vulva 202
Further Reading 202
23 Vulvodynia 203
Definition 203
Epidemiology 203
Pathophysiology 205
Psychological Aspects of Vulvodynia 205
Histology 206
Symptoms 206
Signs 206
Diagnosis 207
Management 207
Further Reading 209
Useful Web Sites for Patient Information 209
24 Psychosexual Aspects of Vulval Disease 211
Clinical Psychological Assessment 212
Further Reading 212
25 Benign Lesions 213
Epidermoid Cysts 213
Comedones 213
Syringomata 213
Hidradenoma Papilliferum 215
Lymphangioma / Lymphangiectasia 216
Further Reading 216
Index 000
1 The Normal Vulva 1
Normal Vulval Anatomy 1
Normal Vulval and Vaginal Flora 4
Further Reading 4
Normal Anatomical Variants 4
Normal Changes Over the Lifetime 6
Further Reading 7
2 Taking a History and Examination 9
Taking a History 9
Examination of the Vulva 11
Further Reading 13
3 How to Take a Vulval Biopsy and the Importance of Clinico-Pathological Correlation 15
Incisional Biopsy 16
Fixation of the Biopsy 20
Further Reading 21
4 Basic Histology of the Vulva 23
Special Histological Stains 24
Immunohistochemical Stains 26
Other Tests 27
Further Reading 28
5 Investigations in Vulval Disease 29
Investigations for Infection 29
Investigations for Allergy 32
Investigations for Inflammatory Disease 33
Imaging Investigations 34
Useful Web Sites for Patient Information 34
Further Reading 34
6 Topical Treatment in Vulval Disease 35
Introduction 35
General Principles 35
Lotions 35
Gels 36
Ointments 36
Creams 36
Pastes 36
Topical Treatments Used for Vulval Disease 36
Antiseptics 41
Antibacterials 42
Antifungals 42
Barriers 42
Others 42
Practice Points 44
Further Reading 44
Useful Web Sites for Patient Information 44
7 Symptoms in Vulval Disease 45
Pruritis (Itch) 45
Causes of Vulval Pruritis 46
Soreness 46
Pain 47
Dyspareunia 48
Discharge 48
No Symptoms 49
Useful Web Site for Patient Information 49
8 Signs in Vulval Disease 51
Differential Diagnosis Based on Appearance 51
Algorithms 51
Further Reading 56
9 Eczema, Allergy and the Vulva 57
Seborrhoeic Eczema 57
Allergic Contact Eczema / Dermatitis 59
Clinical Features 60
Irritant Eczema / Dermatitis 62
Urticaria 64
Allergic Contact Urticaria 64
References 65
10 Psoriasis 67
Introduction 67
Incidence 67
Clinical Features 68
Basic Management 69
When to Refer 72
Practice Points 73
Further Reading 73
Useful Web Sites for Patient Information 73
11 Lichen Simplex 75
Introduction 75
Epidemiology 75
Incidence 75
Pathophysiology 75
Histological Features 76
Symptoms 76
Clinical Features 76
Basic Management 77
When to Refer 78
Practice Points 78
Further Reading 79
Useful Web Sites for Patient Information 79
12 Lichen Sclerosus 81
Introduction 81
Incidence 81
Pathophysiology 81
Histological Features 82
Symptoms 83
Clinical Features 83
Associated Disease 90
Risk of Malignancy 90
Basic Management 92
Follow Up 92
When to Refer 92
Practice Points 93
Further Reading 93
Useful Web Sites for Patient Information 93
13 Lichen Planus 95
Introduction 95
Epidemiology 95
Incidence 95
Pathophysiology 95
Histological Features 96
Clinical Features of Lichen Planus 96
Vulval Lichen Planus 98
Risk of Malignancy 99
Basic Management 100
When to Refer 101
Practice Points 102
Further Reading 102
Useful Web Sites for Patient Information 102
14 Hidradenitis Suppurativa and Crohn's Disease 103
Hidradenitis Suppurativa 103
Further Reading 110
Useful Web Sites for Patient Information 110
15 Disorders of Pigmentation on the Vulva 111
Introduction 111
Postinflammatory Pigmentation 111
Post-Traumatic Pigmentation 111
Acanthosis Nigricans 111
Melanosis 114
Pigmented Lesions 115
Lentigines 116
Benign Naevi 116
Atypical Genital Naevi 117
Seborrhoeic Keratoses 117
Pigmented Basal Cell Carcinoma (see Chapter 22) 118
Hypopigmentation 118
Vitiligo 118
When to Refer 119
Practice Points 119
Further Reading 119
Useful Web Sites for Patient Information 120
16 Other Dermatoses 121
Genetic Disorders 121
Auto-Immune Bullous Disease 123
Drug Eruptions 126
Further Reading 126
Useful Web Sites for Patient Information 126
Stevens-Johnson Syndrome 127
Toxic Epidermal Necrolysis 127
Manifestations of Underlying Disease 128
Further Reading 129
Acrodermatitis Enteropathica 129
Practice Point 130
Further Reading 130
Inflammatory Ulcers 130
Practice Point 130
Behcet's Syndrome 130
Further Reading 132
Useful Resources 132
Lipschutz Ulceration 132
Further Reading 133
Others 133
Further Reading 135
Vulvovaginal Adenosis 135
Further Reading 135
Langerhans Cell Histiocytosis 136
Further Reading 136
17 Vulval Infection - Sexually Transmitted 137
Normal Flora 137
Trichomoniasis 137
Lymphogranuloma Venereum 139
Gonorrhoea 140
Clinical Features 140
Syphilis 141
Chancroid 142
Donovanosis (Granuloma Inguinale) 143
Herpes Simplex Infection 144
Human Papillomavirus Infection 147
Molluscum Contagiosum 150
Scabies 152
Pubic Lice 153
18 Vulval Infection - Nonsexually Transmitted 155
Bacterial Infections 155
Bacterial Vaginosis 155
Erythrasma 157
Staphylococcal and Streptococcal Infections 158
Folliculitis 159
Bartholin Abscess 159
Other Staphylococcal Infections 161
Cellulitis 161
Other Streptococcal Infections 161
Vulvovaginal Candidiasis 162
Tinea Cruris 165
Viral Infections 166
19 Vulval Intraepithelial Neoplasia 167
Introduction 167
Epidemiology 167
Aetiology 168
Prevention 168
Histological Features 168
Symptoms 169
Clinical Features 169
Management 173
Progression 174
Melanoma In Situ 176
When to Refer 176
Practice Points 176
Further Reading 177
Useful Web Site for Patient Information 177
20 Extramammary Paget's Disease 179
Introduction 179
Epidemiology 179
Histological Features 179
Classification 180
Symptoms 181
Clinical Features 181
Management 183
Recurrences 185
Progression 185
Follow Up 186
When to Refer 186
Practice Points 186
Further Reading 186
Useful Web Site for Patient Information 187
21 Vulval Squamous Cell Carcinoma 189
Introduction 189
Epidemiology 189
Aetiology / Histology 189
Symptoms and Clinical Features 190
Management 191
Surgery 191
Complications 192
Radiotherapy 193
Follow Up 193
Prognosis 193
When to Refer 194
Practice Points 194
Further Reading 194
Useful Web Site for Patient Information 195
22 Other Vulval Cancers 197
Basal Cell Carcinoma 197
Malignant Melanoma 199
Other Malignant Tumours and the Vulva 202
Further Reading 202
23 Vulvodynia 203
Definition 203
Epidemiology 203
Pathophysiology 205
Psychological Aspects of Vulvodynia 205
Histology 206
Symptoms 206
Signs 206
Diagnosis 207
Management 207
Further Reading 209
Useful Web Sites for Patient Information 209
24 Psychosexual Aspects of Vulval Disease 211
Clinical Psychological Assessment 212
Further Reading 212
25 Benign Lesions 213
Epidermoid Cysts 213
Comedones 213
Syringomata 213
Hidradenoma Papilliferum 215
Lymphangioma / Lymphangiectasia 216
Further Reading 216
Index 000
