By Michèle Leibowitch, Richard Staughton, Sallie Neill, Simon Barton, Roger Marwood
This very hot atlas has been revised and up-to-date, with 60 new color illustrations highlighting key medical issues
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Extra resources for An Atlas of Vulval Diseases: A Combined Dermatological, Gynaecological and Venereological Approach
47 Distribution of psoriasis. Psoriasis should be checked for signs of psoriasis thimble pitting, subungual hyperkeratosis and onycholysis. However, anogenital lesions may be the only manifestations of the patient's psoriasis. Psoriasis is common—there is a genetic predisposition in some 5% of the population, expressed clinically by some 2% at any one time. Precipitating factors include recent streptococcal infection (usually guttate psoriasis), and lesions may appear at sites of trauma (the Koebner phenomenon).
58 Histology of vulval psoriasis. (a) There is papillomatosis, parakeratosis, neutrophil exocytosis and spongiform pustules (H & E, X40). (b) Enlargement shows neutrophil exocytosis and spongiform pustules in more detail (H & E, X83). (a) Neutrophil exocytosis and spongiform pustules 50 AN ATLAS OF VULVAL DISEASE Lichen planus (papular variety) Management Cutaneous papular lichen planus is an inflammatory skin condition causing intensely pruritic violaceous shiny papules distributed widely on the skin.
10 (a and b) Patient with lichen sclerosus showing progressive narrowing of the introitus, leaving only a tiny opening which leads to difficulties with micturition. 11 Lichen sclerosus may have an early erythematous phase and be mistaken for eczema. Biopsy, however, is helpful in this situation. 23). 12 Vulvectomy was once considered to be a treatment option for lichen sclerosus. In the authors' experience, relapse following vulvectomy is the rule, as seen in this patient 5 years later. 13 A 67-year-old woman with a 10-year history of severe pruritus vulvae despite Grade lll/IV topical corticosteroids.
An Atlas of Vulval Diseases: A Combined Dermatological, Gynaecological and Venereological Approach by Michèle Leibowitch, Richard Staughton, Sallie Neill, Simon Barton, Roger Marwood