A Practical Guide to Vulval Disease (eBook)

Diagnosis and Management

Fiona M. Lewis, Fabrizio Bogliatto, Marc van Beurden (Autoren)

eBook Download: PDF

2017
John Wiley & Sons (Verlag)
978-1-119-14606-3 (ISBN)

Infos

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.

Dr Fiona Lewis, Consultant Dermatologist, St John's Institute of Dermatology and Wexham Park Hospital (Frimley Health Foundation Trust), UK.

 Dr Fabrizio Bogliatto is Head of the Lower Female Genital Tract Disease Out-patient service in the Obstetrics and Gynaecology Department of the Chivasso Civic Hospital in Turin, Italy.

 Dr Marc van Beurden was trained in the Academic Medical Center in Amsterdam and did his fellowship in gynaecologic oncology in the Netherlands Cancer Institute, where he holds his current position as consultant since 1997.

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A PRACTICAL GUIDE TO VULVAL DISEASE DIAGNOSIS AND MANAGEMENT A PRACTICAL GUIDE TO VULVAL DISEASE DIAGNOSIS AND MANAGEMENT Patients with vulval disease frequently experience delays in diagnosis due to a lack of training for physicians. A Practical Guide to Vulval Disease: Diagnosis and Management offers practical, up-to-date and expert guidance on the diagnosis and management of vulval disorders. It provides the knowledge required for diagnosis and treatment of these conditions at both trainee and specialist level. Key information about diagnosis, investigation and basic management is included, with a section on signs and symptoms to direct the reader to the appropriate chapter for the particular disease. Current classification and terminology of vulval disease is featured, along with guidance on when a patient should be referred to a specialist. Well illustrated, with 185 high quality photographs, this user-friendly clinical guidebook integrates clinical and histological features of vulval disorders, so the reader can understand the disease from a microscopic to macroscopic level. Written by an experienced author team, A Practical Guide to Vulval Disease: Diagnosis and Management is essential reading for gynaecologists, dermatologists, genito-urinary physicians, general practitioners and nurses, both in practice and in training.

Autor

FIONA LEWIS, St John's Institute of Dermatology, Guy's & St Thomas' Hospital and Wexham Park Hospital (Frimley Health Foundation Trust), UK. FABRIZIO BOGLIATTO, Chivasso Civic Hospital in Turin, Italy. MARC VAN BEURDEN, Netherlands Cancer Institute.

Inhalt

Title Page 5
Copyright Page 6
Contents 7
Acknowledgements 19
Chapter 1 The Normal Vulva 21
Normal vulval anatomy 21
Normal vulval and vaginal flora 24
Further reading 24
Normal anatomical variants 24
Normal changes over the lifetime 26
Childhood 26
Pregnancy 26
Menopause 26
Further reading 27
Chapter 2 Taking a History and Examination 29
Taking a history 29
General medical history 29
Gynaecological history 30
Dermatological history 30
Vulval history 30
Examination of the vulva 31
Further reading 33
Chapter 3 How to Take a Vulval Biopsy and the Importance of Clinico?Pathological Correlation 35
Incisional biopsy 36
Fixation of the biopsy 40
Further reading 41
Chapter 4 Basic Histology of the Vulva 43
Special histological stains 44
Immunohistochemical stains 46
Other tests 47
Further reading 48
Chapter 5 Investigations in Vulval Disease 49
Investigations for infection 49
Bacterial swabs 49
Viral swabs 49
Fungal scrapings 49
Wood’s light examination 52
Serological Tests 52
Investigations for allergy 52
RAST tests 52
Prick tests 52
Patch tests (see Chapter 9) 52
Investigations for inflammatory disease 53
Direct immunofluorescence 53
Indirect immunofluorescence 54
Imaging investigations 54
Useful web sites for patient information 54
Further reading 54
Chapter 6 Topical Treatment in Vulval Disease 55
Introduction 55
General principles 55
Lotions 55
Gels 56
Ointments 56
Creams 56
Pastes 56
Topical treatments used for vulval disease 56
Emollients 57
Topical steroids 58
Adverse effects 58
Topical steroids in pregnancy 61
Antiseptics 61
Antibacterials 62
Antifungals 62
Barriers 62
Others 62
Podophyllotoxin 62
Imiquimod 62
Calcineurin inhibitors 63
Tar 64
EMLA® 64
Practice points 64
Further reading 64
Useful web sites for patient information 64
Chapter 7 Symptoms in Vulval Disease 65
Pruritis (Itch) 65
Causes of vulval pruritis 66
Soreness 66
Pain 67
Dyspareunia 68
Discharge 68
No symptoms 69
Useful web site for patient information 69
Chapter 8 Signs in Vulval Disease 71
Differential Diagnosis Based on Appearance 71
Algorithms 71
Further reading 76
Chapter 9 Eczema, Allergy and the Vulva 77
Seborrhoeic eczema 77
Incidence 77
Pathophysiology 77
Symptoms 78
Clinical features 78
Basic Management 78
When to Refer 78
Practice points 79
Further reading 79
Useful Web Sites for Patient Information 79
Allergic Contact Eczema?/?Dermatitis 79
Introduction 79
Incidence 79
Pathophysiology 80
Patch testing (see Chapter 5) 80
Symptoms 80
Clinical features 80
Basic management 80
Who to Refer for Patch Testing 80
Practice Points 81
Further Reading 81
Useful Web Sites for Patient Information 82
Irritant Eczema?/?Dermatitis 82
Introduction 82
Incidence 82
Pathophysiology 83
Histological features 83
Symptoms 83
Clinical features 83
Basic management 84
When to refer 84
Practice points 84
Further reading 84
Urticaria 84
Allergic Contact Urticaria 84
Clinical features 85
Management 85
References 85
Chapter 10 Psoriasis 87
Introduction 87
Incidence 87
Pathophysiology 87
Histological features 87
Symptoms 88
Clinical features 88
Basic management 89
When to refer 92
Practice points 93
Further reading 93
Useful Web Sites for Patient Information 93
Chapter 11 Lichen Simplex 95
Introduction 95
Epidemiology 95
Incidence 95
Pathophysiology 95
Histological features 96
Symptoms 96
Clinical features 96
Basic management 97
When to refer 98
Practice points 98
Further reading 99
Useful Web Sites for Patient Information 99
Chapter 12 Lichen Sclerosus 101
Introduction 101
Incidence 101
Pathophysiology 101
Genetic 102
Epigenetics 102
Autoimmunity 102
Hormonal factors 102
Infection 102
Trauma 102
Role of the Skin Immune System 102
Histological features 102
Symptoms 103
Clinical features 103
Associated disease 110
Risk of malignancy 110
Basic Management 112
Follow Up 112
When to Refer 112
Practice points 113
Further reading 113
Useful Web Sites for Patient Information 113
Chapter 13 Lichen Planus 115
Introduction 115
Epidemiology 115
Incidence 115
Pathophysiology 115
Histological Features 116
Clinical Features of Lichen Planus 116
Vulval Lichen Planus 118
Classic LP 118
Hypertrophic LP 118
Erosive LP 118
Risk of Malignancy 119
Basic management 120
When to refer 121
Practice points 122
Further reading 122
Useful Web Sites for Patient Information 122
Chapter 14 Hidradenitis Suppurativa and Crohn’s Disease 123
Hidradenitis Suppurativa 123
Introduction 123
Epidemiology 123
Incidence 123
Pathophysiology 123
Histological features 123
Symptoms 124
Clinical features 124
Basic management 125
Medical management 125
Surgery 125
When to refer 125
Practice points 126
Further reading 126
Useful Web Sites for Patient Information 126
Crohn’s disease 126
Introduction 126
Epidemiology 126
Pathophysiology 127
Histological features 127
Symptoms 127
Clinical features 127
Basic management 129
When to refer 129
Practice points 129
Further reading 130
Useful Web Sites for Patient Information 130
Chapter 15 Disorders of Pigmentation on the Vulva 131
Introduction 131
Postinflammatory Pigmentation 131
Post-Traumatic Pigmentation 131
Acanthosis Nigricans 131
Management 133
Melanosis 134
Pigmented lesions 135
History and examination 135
Other techniques 136
Lentigines 136
Benign naevi 136
Atypical Genital Naevi 137
Seborrhoeic Keratoses 137
Pigmented Basal Cell Carcinoma (see Chapter 22) 138
Hypopigmentation 138
Vitiligo 138
When to Refer 139
Practice points 139
Further reading 139
Useful Web Sites for Patient Information 140
Chapter 16 Other Dermatoses 141
Genetic disorders 141
Hailey–Hailey Disease (Familial Benign Chronic Pemphigus) 141
Management 141
When to refer 141
Practice points 141
Further reading 142
Useful Web Site for Patient Information 142
Auto-Immune Bullous Disease 143
Practice points 146
Further Reading 146
Drug Eruptions 146
Fixed Drug Eruption 146
Common Drugs Causing a Fixed Drug Eruption 146
Further Reading 146
Useful Web Site for Patient Information 146
Stevens–Johnson syndrome 147
Symptoms 147
Clinical features 147
Toxic Epidermal Necrolysis 147
Symptoms 147
Clinical features 147
Basic management 147
Furtherreading 148
Useful Web Site for Patient Information 148
Manifestations of Underlying Disease 148
Necrolytic Migratory Erythema 148
Symptoms 149
Clinical features 149
Basic management 149
Further reading 149
Acrodermatitis Enteropathica 149
Clinical Features 149
Basic management 149
Practice point 150
Further reading 150
Inflammatory ulcers 150
Aphthous Ulcers 150
Clinical Features 150
Management 150
Practice Point 150
Behcet’s Syndrome 150
Further Reading 152
Useful resources 152
Lipschutz ulceration 152
Clinical Features 152
Basic management 153
Further reading 153
Others 153
Graft-Versus-Host Disease 153
Further reading 154
Zoon’s Vulvitis (Plasma Cell Vulvitis) 154
Histology 154
Symptoms 154
Clinical Features 155
Basic Management 155
Further Reading 155
Vulvovaginal Adenosis 155
Further Reading 155
Langerhans Cell Histiocytosis 156
Further Reading 156
Chapter 17 Vulval Infection – Sexually Transmitted 157
Normal flora 157
Trichomoniasis 157
Pathophysiology 157
Clinical features 158
Diagnosis 158
Basic management 158
Further reading 158
Useful Web Site for Patient Information 158
Chlamydia 159
Clinical Features 159
Diagnosis 159
Treatment 159
Further reading 159
Useful Web Site for Patient Information 159
Lymphogranuloma Venereum 159
Clinical features 160
Diagnosis 160
Treatment 160
Further reading 160
Useful Web Site for Patient Information 160
Gonorrhoea 160
Clinical features 160
Diagnosis 160
Treatment 161
Further reading 161
Useful Web Sites for Patient Information 161
Syphilis 161
Pathophysiology 161
Clinical features 161
Treatment 162
Further reading 162
Useful Web Site for Patient Information 162
Chancroid 162
Pathophysiology 162
Clinical features 163
Treatment 163
Further reading 163
Useful Web Sites for Patient Information 163
Donovanosis (Granuloma Inguinale) 163
Clinical Features 163
Diagnosis 163
Treatment 163
Further reading 164
Useful Web Site for Patient Information 164
Herpes Simplex Infection 164
Incidence 164
Pathophysiology 164
Clinical Features 164
Differential diagnosis 165
Diagnosis 166
Basic management 166
HSV Infection and Pregnancy 166
Further reading 167
Useful Web Sites for Patient Information 167
Human Papillomavirus Infection 167
Epidemiology 167
Pathophysiology 168
The Concept of Vulval Subclinical Lesion 168
Histology 168
Clinical features 169
Diagnosis 169
Treatment 170
HPV vaccine 170
Genital Warts in Children 170
Further reading 170
Useful Web Sites for Patient Information 170
Molluscum contagiosum 170
Symptoms 171
Clinical appearance 171
Diagnosis 171
Treatment 171
Further reading 172
Useful Web Site for Patient Information 172
Scabies 172
Clinical features 172
Diagnosis 172
Treatment 173
Further reading 173
Useful Web Site for Patient Information 173
Pubic lice 173
Clinical features 173
Treatment 173
Useful Web Site for Patient Information 173
Chapter 18 Vulval Infection – Nonsexually Transmitted 175
Bacterial Infections 175
Bacterial Vaginosis 175
Clinical features 175
Diagnosis 175
Treatment 175
Further reading 177
Useful Web Sites for Patient Information 177
Erythrasma 177
Clinical features 177
Differential diagnosis 177
Diagnosis 178
Basic Management 178
Useful Web Site for Patient Information 178
Staphylococcal and Streptococcal Infections 178
Folliculitis 179
Pathophysiology 179
Clinical Features 179
Diagnosis 179
Basic management 179
Further reading 179
Bartholin abscess 179
Clinical features 180
Differential diagnosis 180
Basic management 180
Drainage of the Abscess 180
Marsupialization 180
Further reading 180
Other Staphylococcal Infections 181
Toxic Shock Syndrome 181
Staphylococcal Scalded Skin Syndrome 181
Cellulitis 181
Clinical Features 181
Diagnosis 181
Differential Diagnosis 181
Other Streptococcal Infections 181
Further reading 182
Vulvovaginal Candidiasis 182
Pathophysiology 182
Clinical features 183
Differential diagnosis 183
Diagnosis 184
Treatment 184
Further reading 184
Useful Web Sites for Patient Information 184
Tinea cruris 185
Pathophysiology 185
Clinical features 185
Differential diagnosis 185
Diagnosis 186
Basic Management 186
Further Reading 186
Useful Web Site for Patient Information 186
Viral infections 186
Varicella Zoster (Shingles) 186
Chapter 19 Vulval Intraepithelial Neoplasia 187
Introduction 187
Epidemiology 187
Aetiology 188
Prevention 188
Histological features 188
Symptoms 189
Clinical features 189
Management 193
Progression 194
Melanoma in situ 196
When to refer 196
Practice points 196
Further reading 197
Useful Web Site for Patient Information 197
Chapter 20 Extramammary Paget’s Disease 199
Introduction 199
Epidemiology 199
Histological features 199
Classification 200
Symptoms 201
Clinical features 201
Management 203
Recurrences 205
Progression 205
Follow up 206
When to refer 206
Practice points 206
Further reading 206
Useful Web Site for Patient Information 207
Chapter 21 Vulval Squamous Cell Carcinoma 209
Introduction 209
Epidemiology 209
Aetiology?/?histology 209
Symptoms and Clinical Features 210
Management 210
Surgery 210
Complications 211
Radiotherapy 212
Follow up 213
Prognosis 213
When to refer 213
Practice points 213
Further reading 214
Useful Web Site for Patient Information 214
Chapter 22 Other Vulval Cancers 215
Basal Cell Carcinoma 215
Epidemiology 215
Incidence 215
Pathophysiology 215
Histological features 215
Symptoms 216
Clinical features 216
Basic Management 216
When to Refer 216
Practice Points 217
Further Reading 217
Useful Web Site for Patient Information 217
Malignant melanoma 217
Epidemiology 218
Pathophysiology 218
Histological Features 218
Symptoms 218
Clinical Features 218
Basic Management 218
Further reading 219
Other Malignant Tumours and the Vulva 220
Further reading 220
Chapter 23 Vulvodynia 221
Definition 221
Epidemiology 221
Pathophysiology 223
Psychological Aspects of Vulvodynia 223
Histology 224
Symptoms 224
Signs 224
Diagnosis 225
Management 225
Local Topical Pain Modifiers 225
Systemic Pain Modifiers 225
Physical therapy 226
Psychosexual therapy 227
Surgical Treatment 227
Further reading 227
Useful Web Sites for Patient Information 227
Chapter 24 Psychosexual Aspects of Vulval Disease 229
Clinical Psychological Assessment 230
Further reading 230
Chapter 25 Benign Lesions 231
Epidermoid cysts 231
Comedones 231
Syringomata 231
Hidradenoma Papilliferum 233
Lymphangioma?/?Lymphangiectasia 234
Further reading 234
Index 235
EULA 240

Produkt-Details

• Erscheint lt. Verlag: 8.5.2017
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Gynäkologie / Geburtshilfe
• Themenwelt: Studium ► Querschnittsbereiche ► Prävention / Gesundheitsförderung
• Schlagworte: Dermatologie • Dermatology • Female Sexual Disorders • Gynaecology, Gynecology, Vulval, Vulvar, Dermatologist, Vulval Disease, Genito-Urinary. • Gynäkologie • gynecology • Medical Science • Medizin • Störungen der weiblichen Sexualität
• ISBN-10: 1-119-14606-2 / 1119146062
• ISBN-13: 978-1-119-14606-3 / 9781119146063