This document discusses benign and malignant vulval and vaginal conditions. It begins by describing vulval anatomy and then discusses several non-neoplastic epithelial disorders of the vulva including lichen sclerosus, lichen planus, psoriasis, squamous cell hyperplasia, and lichen simplex chronicus. It also mentions several benign vulval lumps that can occur. The document then discusses vulval intraepithelial neoplasia (VIN) and vulval carcinoma, including clinical staging. Finally, it briefly discusses benign vaginal lesions such as atrophic vaginitis.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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gynaecology.Vulval and vaginal benign and malignant conditions.(dr.mahabat)
1. Vulval and vaginal benign
and malignant conditions
Dr. Muhabat Salih Saeid- MRCOG- London, UK.
2. Vulval anatomy
The vulva (external genitalia ) includes:
Mons pubis
clitoris
labia majora and minora
Perineum: a less hairy skin & subcutaneous tissue
area lying between the vaginal orifice & the anus &
covering the perineal body. Its length is 2-5 cm or
more. The urethra opens on to it.
Vestibule: a forecourt or a hall next to the
entrance. It is the area of smooth skin lying within
the L. minora & in front of the vaginal orifice.
Hymen.
13. Squamous Cell Hyperplasia
(Atopic Eczema/Neurodermatitis)
Physical Appearance
Benign epithelial thickening and hyperkeratosis
◦ Acute phase with red/moist lesions
◦ Causing pruritus leading to rubbing &
scratching
◦ Circumscribed, single or unifocal
◦ Raised white lesions on vulva or labia
majora and clitoris
Treatment: Sitz baths, lubricants, oral
antihistamines, Medium potency
topical steroid twice daily
14.
15. Lichen Simplex Chronicus
Physical Appearance
◦ Thickened white epithelium on
vulva
◦ Generally unilateral and localized
Treatment: Medium potency
steroid twice daily prn
16.
17. Benign Vulval lumps
Bartholin’s cyst.
Epidermal inclusion cyst.
Skene’s duct cyst.
Congenital mucous cysts: arise from mesonephric ducts
remnants.
Cyst of the canal of Nuck: can give rise to hydrocele in
labia maqjora.
Sebaceous cyst.
Papillomatosis (solid).
Fibroma (solid).
Lipoma (solid).
Condylomata (solid).
Cysts are either congenital or arise from obstructed glands.
Manifestations arise from the cysts (cosmotic) or from
infection.
18. Bartholin glands
Two in number.
Lie posteriolaterally to the
vaginal orifice, one on
either side
Normally not seen nor felt.
If enlarged, can be a
painless cyst or painful
abscess
19. Bartholin Duct Cyst
Most common Vulval cyst.
usually unilateral, on the
posterio-lateral side of the
introitus.
usually about 2 cm &
contains sterile mucus.
Usually asymptomatic.
secondary infections →
Bartholin's abscess.
Rx: excision or
Marsupialization.
22. Skene's Gland
• are found on each side
of urethra
• Normally neither seen
nor felt
23. Skenitis
May become swollen
and tender, particularly
with
GC or chlamydia
Rx: drainage.
Culture for GC, Chlamydia
24. Inclusion Cysts of the Vulva
Contain creamy, yellow
debris & lined with
stratified epithelium.
Found in the perineum,
posterior V. wall & other
parts of the vulva.
Arise from perineal skin
buried at obstetrical
injuries.
Usually symptomless.
Rx: excision.
25. (vulval intraepithelial neoplasia) VIN
Classification
VIN I - mild dysplasia with
hyperplastic vulvar
dystrophy with mild atypia
VIN II - Moderate dysplasia,
hyperplastic vulvar
dystrophy with moderate
atypia
VIN III - Severe dysplasia;
hyperplastic vulvar
dystrophy with severe atypia
(it replaces the term
Carcinoma in situ
carcinoma in situ, Bowen’s
disease).
28. • Introduction
• Vulval cancer is uncommon and accounts
for approximately 1-4% of all gynecological
cancer
y incidence : 1.8 /100.000, It is predominantly
seen in postmenopausal and old women
(mean age 65 years ) ,and only 2% were
less than 30 years.
r In countries such as south Africa where
sexually transmitted diseases are common,
the mean age of presentation is 59 years.
29. AETHIOLOGY:
Little is known
A viral factor has been suggested by
the detection of antigens induced by
Herpes simplex virus type (HSV2)
Type 16/18 human papilloma virus
(HPV) , in vulval intraepithelial
neoplasia.
30. PATHOLOGY
Primary Tumor
90% of lesions are of squamous in origin.
3-5 of lesions are melanoma.
2% of lesions is basal cell carcinoma.
Less than 1% is sarcoma.
Secondary Tumors
It is occasionly found in vulva
Most commonly the primary lesion is from the
cervix or the endometrium .
31. Vulval Carcinoma
Clinical Staging (F.I.G.O.):
Stage I :
1a: confined to vulva with <1mm invasion.
1b: confined to vulva with a diameter < 2 cm & no inguinal
lymph nodes affection.
Stage II : limited to vulva with diameter > 2 cm) & no
inguinal lymph nodes affection.
Stage III : adjacent spread to the lower urethra and/or
vagina and/or anus and/or unilateral lymph nodes affection.
Stage IV :
H. Bilateral inguinal nodes metastases, involvement of mucosa
of rectum, urinary bladder, upper urethra or pelvic bones.
I. Distant metastasis.
32. A new FIGO staging based on surgical
findings in 1988, it is more accurate
as the involvement of groin nodes is
missed on clinical examination in up to
30% of cases and over diagnosis in 5%.
33. NEW FIGO STAGING OF
VULVA CARCINOMA
Stage 1 cm lesion 2 Confined to the vulva or perineum nodes
size Or less .histo-Logically negative
Stage 2 2cm lesion < Confined to the vulva or perineum nodes
size .histo-Logically negative
Stage 3 Tumor of any size spread to lower urethra
vagina anus +/- Unilateral metastasis
Stage 4 A : Involvement of
Upper urethra
Bladder mucosa
Rectal mucosa
Pelvic bone
Bilateral L.N.metastasis
B Distant metastases and / or pelvic nodes
34. SQUAMOUS CELL CARCINOMA
Are usually seen in the anterior part of the vulva.
2/3 of cases in the labia majora.
1/3 of cases in the clitoris ,labia minora,fourchitte,
and perineum.
Spread:-
5. LYMPHATIC > 50%
6. Direct spread occurs in 25% to the urethra, vagina
and rectum
7. Hematogenous spread to bone or lung is rare
The lymph nodes are arranged in 5 groups in each
groin:
35. Clinical Features & Diagnosis
Most patients with invasive disease
complain of:
Irritation or purities in 70% of cases
Vulvar mass or ulcer in 55% of cases
Bleeding in 28% of cases
Discharge in 2-3% of cases
36. The major problem in invasive vulvar cancer
is delay between the first appearance of the
symptoms and referral to the gynecological
opinion due to :
1. The doctor fails to recognize the gravity
of the lesion and prescribes topical
therapy.
2. Older women are often embarrassed and
shy.
37. On Examination
2. Lesion can take any form from flat white lesion
to large ulcer.the size of the tumor ,involvement
of the urethra and anus should be noted
3. Inspection of the cervix and cervical cytology.
4. Needle aspiration of any suspicious groin node.
diagnosis is made on histology from full thickness
generous biopsy.
38. Treatment of Vulval Carcinoma
Stage I & II :
Radical local excision with 1cm disease–free margin.
Stage III & IV :
- According to the general health.
- Chemotherapy & radiotherapy to shrink the tumour
to permit surgery which may preserve the urethral &
anal sphincter function.
- radical vulvectomy + inguinal L. nodes dissection.
- reconstructive surgery with skin grafts or
myocutaneous flaps for healing.
44. Treatment for Atrophic Vaginitis
Treated with estrogen replacement (vaginal/oral)
Oral BCP (ethinyl estradiol up to 50ug)
Conjugated estrogen up to 1.25mg in combo
w/medroxyprogesterone acetate to prevent
endometrial hyperplasia
Vaginal cream 1g daily qhs x1m then ½ dose 2X/
week (1g vaginal cream=.625mg conjugated
estrogen)
◦ should give w/ 2.5mg medrxyprogesterone
x14d
Estrogen vaginal ring (change q3m) (Estring)
delivers 6-9ug estrodiol daily
Vagifem 1tab intravaginally x2w then 3x/w for
3-6m
45. Vaginal Carcinoma
Incidence: 1-2% of all gyn. Cancer.
Classification:
1. primary: squamous (common, 85%), adenocarcinoma (17-21
years of age, metastasis to L.Ns), clear cell adenocarcinoma
(DES).
2. secondary: metastasis from the cervix, endometrium,
…..others.
50% in the upper 3rd, 30% in lower 3rd & 19% in middle 3rd.
Posterior V. lesions more common than anterior & the anterior
are more common than lateral lesions.
Spread: direct & lymphatic.
46. Vaginal Carcinoma
Clinical Staging (F.I.G.O.):
Stage I: tumour confined to vagina.
Stage II : tumour invades paravaginal tissue but not
to pelvic sidewall.
Stage III : tumour extends to pelvic sidewall.
Stage IV :
a) tumour invades mucosa of bladder or rectum
and/or beyond the true pelvis.
b) Distant metastasis.
47. TREATMENT
Stage 1:
1. Tumour < 0.5 cm deep:
a. surgery: local excision or total vaginectomy with reconstruction.
b. radiotherapy.
2. Tumour > 0.5 cm deep: (a) wide vaginectomy, pelvic
lymphadenectomy + reconstruction of vagina. (b) radiotherapy
stage 2: (a) radical vaginectomy, lymphadenectomy (b)
radiotherapy
Stage 3: radiotherapy.
Editor's Notes
This condition believed to be an autoimmune disease. This condition affects the Pts are usually treating self for chronic yeast infections SKIN/NAILS/MUCOUS MEMBRANES:MOUTH ESOPHAGUS CUNJUNCTIVAE, BLADDER, NOSE, LARYNX, STOMACH, AND ANUS. Papulosquamous LP are usually intense papules with a violaceous hue. Hypertrophic LP is difficult to diagnose resembling squamous cell carcinoma.
Vulvar psoriasis may be the only site affected. Or may have scalp/extensor surfaces of extremities/ trunck affected Other treatments if severe and involving other sites: emollients, tar, methotrexate, ultraviolet light etc.
Vulvar psoriasis
SSRI’s may help alleviate pruritus Treatment : AVOID causative factors PADS/SOAPS-avoid
Very similar to squamous cell hyperplasia and needs biopsy for diagnosis
Lichenification from lichen simplex chronicus
Marsupializationof Bartholin duct cyst. A vertical incision is made over the center of the cyst to dissect it free of mucosa. The cyst wall is everted and approximated to the edge of the vestibular mucosa with interrupted sutures.
The degree to which these symptoms are present depends upon the extent of inflammation
pH 5-7 d/t reduction in lactic acid production and decrease in lactobacilli decreasing h2o2 Normal vaginal pH 4-4.5 >4.5 BV/contaminant-sperm/lubricants Prepubertal small tear (treat with Vaseline/KY) R/O use of Perfumes, powders, soaps, deodorants, panty liners, spermicides and lubricants often contain irritant compounds. 6 In addition, tight-fitting clothing and long-term use of perineal pads or synthetic materials can worsen atrophic symptoms
External genitalia of a 67-year-old woman who is naturally menopausal for two years and is not on estrogen replacement therapy. Note loss of labial and vulvar fullness, pallor of urethral and vaginal epithelium, and decreased vaginal moisture.
Treatment w/ ½ applicator nightly for 1-2weeks usually resolves symptoms Treat with estrogen if not contraindicated (breast CA/endometrial CA etc…) 1/2g cream given 3x/w x6months had normal ultz, biopsy showed thickening. ESTRING= preferred local delivery. (is 1/10 th the amount of estrogen secreted by premenopausal women. Only 10% absorbed systemically (may still consider opposing progesterone Oral meds may be 25days or more if needed but will reoccur of D/C’d If no uterus then no progesterone is needed ½ the dose for the vaginal cream may be effective Consider progesterone w/any vaginal treatments 1g vag=100ug estrodiol (max 4g) 1g=.625mg conjugated estrogen