Vulval Dermatology

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Vulval Dermatology

• Update from
• British Society for Study of Vulval Diseases
  Meeting
• Cardiff 2008

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BSSVD

• Relief of patients suffering from vulval disease
• Promotion of research into causes of vulval
  disease
• Practice and art and science of diagnosis and
  treatment of vulval diseases
• www.bssvd.org

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Cardiff 2008

• Current Challenges in Vulval disease
• Prospective Study to Determine Factors Leading to
  Delayed presentation of Patients with Vulval
  Lichen Sclerosis
• AJ Mehta et al
• University Hospital Wales

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Background

• LS is chronic ,inflammatory condition
• Most commonly affects post-menopausal women but
  occurs at all ages
• Significant morbidity due to chronicity,
  scarring,psychosexual problems and SCC risk

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(No Transcript)
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• Prospective study of 28 post menopausal patients
  with LS in dermatology OPD

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Results

• Mean duration of symptoms 99 months
• Most common symptom itching in 96
• Burning on micturition in 50
• 50 tried OTC treatments before seeing GP

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Results

• 60 waited gt3/12 to report symptoms
• 21 waited 4-6/12
• 14 7-12/12
• 25gt12/12

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Why did they wait?

• 42 patients thought symptoms were normal for
  their age
• 21 too embarrassed
• 71 pts would prefer female Dr
• Other reasonsother health problems or family
  members took precedence

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• 76 patients examined by GP
• 32 given definite diagnosis (7 candida)
• Of those pts with no definite diagnosis
• 25 referred immediately to dermatology
• 25 ref after 1-3/12
• 14 ref after 4-6/12
• 11 ref after7-12/12

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Conclusions

• Increased patient awareness required
• Vulval Health Awareness Campaign
• www.vhac.org
• Education re self examination
• Increased clinician awareness

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Information Resources for Patients and Drs

• www.vahc.org
• www.bssvd.org
• www.vulvalpainsociety.org
• www.lichensclerosus.org
• www.UKLP.org.uk
• www.bashh

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Clinical snippets

• Vulval ulceration secondary to nicorandil
• May occur in pts on long standing treatment and
  after dosage increase

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Clinical Snippets

• Increased auto-immunity in association with
  Lichen sclerosus and erosive Lichen planus
• Thyroid disease most common (15 pts)
• Coeliac disease associated with erosive LP