Read more
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.
List of contents
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 9
About the author
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. 
