Whitish Genital Lesions
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Toward a Better Understanding of the Spectrum of Morphea
STUDY ONLINE FIRST High Frequency of Genital Lichen Sclerosus in a Prospective Series of 76 Patients With Morphea Toward a Better Understanding of the Spectrum of Morphea Virginie Lutz, MD; Camille Francès, MD, PhD; Didier Bessis, MD; Anne Cosnes, MD; Nicolas Kluger, MD; Julien Godet, PhD; Erik Sauleau, PhD; Dan Lipsker, MD, PhD Objective: To compare the frequency of genital lichen diagnosis was 54 (13-87) years. Forty-nine patients had sclerosus (LS) in patients with morphea with that of con- plaque morphea, 9 had generalized morphea, and 18 had trol patients. linear morphea. Three patients (3%) in the control group and 29 patients (38%) with morphea had LS (odds ra- Design: A prospective multicenter study. tio,19.8; 95% CI, 5.7-106.9; PϽ.001). Twenty-two pa- tients with plaque morphea (45%) and only 1 patient with Setting: Four French academic dermatology depart- linear morphea (6%) had associated genital LS. ments: Strasbourg, Montpellier, Tenon Hospital Paris, and Henri Mondor Hospital Cre´teil. Conclusions: Genital LS is significantly more frequent in patients with morphea than in unaffected individu- Patients: Patients were recruited from November 1, 2008, als. Forty-five percent of patients with plaque morphea through June 30, 2010. Seventy-six patients with mor- have associated LS. Complete clinical examination, in- phea and 101 age- and sex-matched controls, who un- cluding careful inspection of genital mucosa, should there- derwent complete clinical examination, were enrolled. fore be mandatory in patients with morphea because geni- tal LS bears a risk of evolution into squamous cell Interventions: A complete clinical examination and, if deemed necessary, a cutaneous biopsy. -
Prioritization of Health Services
PRIORITIZATION OF HEALTH SERVICES A Report to the Governor and the 74th Oregon Legislative Assembly Oregon Health Services Commission Office for Oregon Health Policy and Research Department of Administrative Services 2007 TABLE OF CONTENTS List of Figures . iii Health Services Commission and Staff . .v Acknowledgments . .vii Executive Summary . ix CHAPTER ONE: A HISTORY OF HEALTH SERVICES PRIORITIZATION UNDER THE OREGON HEALTH PLAN Enabling Legislatiion . 3 Early Prioritization Efforts . 3 Gaining Waiver Approval . 5 Impact . 6 CHAPTER TWO: PRIORITIZATION OF HEALTH SERVICES FOR 2008-09 Charge to the Health Services Commission . .. 25 Biennial Review of the Prioritized List . 26 A New Prioritization Methodology . 26 Public Input . 36 Next Steps . 36 Interim Modifications to the Prioritized List . 37 Technical Changes . 38 Advancements in Medical Technology . .42 CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES Practice Guidelines . 47 Age-Related Macular Degeneration (AMD) . 47 Chronic Anal Fissure . 48 Comfort Care . 48 Complicated Hernias . 49 Diagnostic Services Not Appearing on the Prioritized List . 49 Non-Prenatal Genetic Testing . 49 Tuberculosis Blood Test . 51 Early Childhood Mental Health . 52 Adjustment Reactions In Early Childhood . 52 Attention Deficit and Hyperactivity Disorders in Early Childhood . 53 Disruptive Behavior Disorders In Early Childhood . 54 Mental Health Problems In Early Childhood Related To Neglect Or Abuse . 54 Mood Disorders in Early Childhood . 55 Erythropoietin . 55 Mastocytosis . 56 Obesity . 56 Bariatric Surgery . 56 Non-Surgical Management of Obesity . 58 PET Scans . 58 Prenatal Screening for Down Syndrome . 59 Prophylactic Breast Removal . 59 Psoriasis . 59 Reabilitative Therapies . 60 i TABLE OF CONTENTS (Cont’d) CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES (CONT’D) Practice Guidelines (Cont’d) Sinus Surgery . -
Pruritus Vulvae
628 BRITISH MEDICAL JOURNAL 17 MARCH 1973 may wronglly lead to the diagnosis of primary hyperaldo- 13 Mitchell, J. D., Baxter, T. J., Blair-West, J. R., and McCredie, D. A., Archives of Disease in Childhood, 1970, 45, 376. steronism and even to the excision of the wrong endocrine 14 Voute, P. A., Meer, J. van der, and Staugaard-Kloosterziel, W., Acta Endocrinologica, 1971, 67, 197. Br Med J: first published as 10.1136/bmj.1.5854.628 on 17 March 1973. Downloaded from gland. 15 Hudson, J. B., Chobanian, A. V., and Relman, A. S., New England The opposite clinical syndrome-primary lack of renin or J'ournal of Medicine, 1957, 257, 529. 16 Jacobs, D. R., and Posner, J. B., Metabolism, 1964, 13, 522. hyporeninism-has also been recognized recently. In this 17 Vagnucci, A. H., Journal of Clinical Endocrinology and Metabolism, 1969, disease primary lack of renin (and hence of its active pro- 29, 279. 18 Perez, G., Siegel, L., and Schreiner, G. E., Annals of Internal Medicine, duct angiotension II) apparently leads to selective deficiency 1972, 76, 757. of aldosterone associated with normal cortisol production. 19 Ferrara, E., Werk, E., Hanenson, I., Privirera, P., and Kenyon, C., Clinical Research, 1970, 18, 602. The literature contains reference to some 20 cases of isolated 20 Schambelan, M., Stockigt, J. R., and Biglieri, E. G., New England J ournal of Medicine, 1972, 287, 573. analdosteronism, the first a report by J. B. Hudson and his 21 Weidman, P., et Clinical Research, 1972, 20, 249. colleagues15 in 1957. Only recently however has the primary al., deficiency been recognized as renin lack in at least some of these patients. -
LICHEN SCLEROSUS Lichen Sclerosus (Sometimes Called Lichen
LICHEN SCLEROSUS Lichen Sclerosus (sometimes called lichen sclerosus at atrophicus, or LS&A) is a skin condition that is most common on the vulva of older women who have gone through menopause. However, lichen sclerosus sometimes affects girls before puberty, as well as young adult women, and the penis of uncircumcised males. In females, lichen sclerosus can affect rectal skin also. Only rarely does lichen sclerosus affect skin outside the genitalia, and this is usually the back, chest or abdomen. Lichen sclerosus almost never appears on the face or hands. The causes of lichen sclerosus are not completely understood, but a main cause is an over-active immune system. The immune system, that part of the body that fights off infection, becomes over-active and attacks the skin by mistake. Why this happens is not known. Lichen sclerosus typically appears as white skin that is very itchy. The skin is also fragile, so rubbing and scratching can cause breaks, cracks and bruises that hurt. Sexual activity is often painful or impossible. Untreated, lichen sclerosus can cause scarring and, occasionally, narrowing of the opening of the vagina in women. In boys and men, the foreskin can scar to the head of the penis. Untreated lichen sclerosus is also associated with skin cancer of the vulva in about one in thirty women. There is also an increased risk of skin cancer of the penis in men. These risks can be lowered when lichen sclerosus is well-controlled. Irritating creams, unnecessary medication, soaps and over washing should be avoided. Washing should be limited to once daily with clear water only. -
Vulvar Verruciform Xanthoma Ten Cases Associated with Lichen Sclerosus, Lichen Planus, Or Other Conditions
OBSERVATION ONLINE FIRST Vulvar Verruciform Xanthoma Ten Cases Associated With Lichen Sclerosus, Lichen Planus, or Other Conditions Charlotte Fite, MD; Franc¸oise Plantier, MD; Nicolas Dupin, MD, PhD; Marie-Franc¸oise Avril, MD; Micheline Moyal-Barracco, MD Background: Verruciform xanthoma (VX) is a rare be- acanthosis without atypia, and elongated rete ridges. nign tumor that usually involves the oral cavity. Since Xanthomatous cells were aggregated in the papillary the first report of this tumor in 1971, only 9 cases have dermis. been reported on the vulva, and 3 of these were associ- ated with another vulvar condition. We describe the clini- Conclusions: Vulvar VX is a benign tumor with mis- copathologic features of 10 patients with vulvar VX and leading clinical features. All 10 cases were associated with focus on their associated conditions. a vulvar condition, mainly a lichen sclerosus. There- fore, VX might represent a reaction pattern induced by Observation: The mean age of the patients was 68 years different conditions, mainly characterized by damage to (range, 51-80 years). The VX lesions were asymptom- the dermoepidermal junction. When confronted with the atic, yellowish-orange verrucous plaques. The diagno- diagnosis of vulvar VX, clinicians may look for an asso- sis was clinically suspected in 2 cases; other suggested ciated vulvar condition. diagnoses were condyloma or squamous cell carci- noma. All of the patients had an associated vulvar con- dition: lichen sclerosus (6 patients), lichen planus (2 Arch Dermatol. 2011;147(9):1087-1092. patients), Paget disease, or radiodermatitis. Under mi- Published online May 16, 2011. croscopy, the VX lesions displayed parakeratosis, doi:10.1001/archdermatol.2011.113 ERRUCIFORM XANTHOMA location, histologic findings, history of dyslip- (VX) is a rare benign tu- idemia, treatment, follow-up, and associated mor which was first vulvar conditions. -
Diagnosing and Managing Vulvar Disease
Diagnosing and Managing Vulvar Disease John J. Willems, M.D. FRCSC, FACOG Chairman, Department of Obstetrics & Gynecology Scripps Clinic La Jolla, California Objectives: IdentifyIdentify thethe majormajor formsforms ofof vulvarvulvar pathologypathology DescribeDescribe thethe appropriateappropriate setupsetup forfor vulvarvulvar biopsybiopsy DescribeDescribe thethe mostmost appropriateappropriate managementmanagement forfor commonlycommonly seenseen vulvarvulvar conditionsconditions Faculty Disclosure Unlabeled Product Company Nature of Affiliation Usage Warner Chilcott Speakers Bureau None ClassificationClassification ofof VulvarVulvar DiseaseDisease byby ClinicalClinical CharacteristicCharacteristic • Red lesions • White lesions • Dark lesions •Ulcers • Small tumors • Large tumors RedRed LesionsLesions • Candida •Tinea • Reactive vulvitis • Seborrheic dermatitis • Psoriasis • Vulvar vestibulitis • Paget’s disease Candidal vulvitis Superficial grayish-white film is often present Thick film of candida gives pseudo-ulcerative appearance. Acute vulvitis from coital trauma Contact irritation from synthetic fabrics Nomenclature SubtypesSubtypes ofof VulvodyniaVulvodynia:: VulvarVulvar VestibulitisVestibulitis SyndromeSyndrome (VVS)(VVS) alsoalso knownknown asas:: • Vestibulodynia • localized vulvar dysesthesia DysestheticDysesthetic VulvodyniaVulvodynia alsoalso knownknown asas:: • “essential” vulvodynia • generalized vulvar dysesthesia Dysesthesia Unpleasant,Unpleasant, abnormalabnormal sensationsensation examplesexamples include:include: -
Lichen Sclerosus
Arch Dis Child: first published as 10.1136/adc.64.8.1204 on 1 August 1989. Downloaded from Archives of Disease in Childhood, 1989, 64, 1204-1206 Current topic Lichen sclerosus J BERTH-JONES, R A C GRAHAM-BROWN, AND D A BURNS Department of Dermatology, Leicester Royal Infirmary Lichen sclerosus, previously termed 'lichen sclerosus but the latter may be spared. When extragenital et atrophicus', is a uncommon disease that presents sites are affected there is usually anogenital disease to a wide variety of medical disciplines. It is a cause also. of much distress, not only because of its symptoms, The appearance of the vulva is usually diagnostic. but also, increasingly, because of a potential to be There are characteristic shiny white papules and misdiagnosed as sexual abuse.1-3 For those familiar plaques, with a semitranslucent appearance likened with lichen sclerosus in childhood it is usually to mother of pearl. The affected skin usually shows a possible to make a firm clinical diagnosis. tendency to fine wrinkling giving an appearance The incidence of lichen sclerosus is hard to termed 'cigarette paper skin'. In the more severe estimate as patients present to different specialties. cases purpura, excoriation, blistering (usually Mild cases may never come to receive medical haemorrhagic), telangiectasia, erosion, and bleeding attention, and others may remain misdiagnosed. may be present. When both the vulva and perianal The disease is much less common in children than in region are affected the disease often takes on ancopyright. adults: in a series of 290 cases only 20 developed the 'hour glass' or 'figure of eight' pattern. -
Some Aspects of Œstrogenic Therapy
Edinburgh Medical Journal February 1942 SOME ASPECTS OF (ESTROGENIC THERAPY * By W. F. T. HAULTAIN, O.B.E., M.C., B.A., M.B., F.R.C.S.Ed., F.R.C.O.G. I HAVE chosen the subject of cestrogenic therapy for this lectui e for several reasons. The first is that the discovery of the female sex hormones is of comparatively recent origin and, though no doubt there is still much to be discovered with regard to sexual physiology, the work on the natural and synthetic oestrogens has advanced rapidly, with the result that various preparations are even now of the greatest use to the clinician. Secondly, cestrogenic therapy has always been of particular interest to me, even long before I had heard of such a name, and in 1928 I 1 wrote a paper on the administration of ovarian extract for the artificial menopause, gleaned from work which I had been carrying out clinically for five years previously. Since that time I have continued my clinical observations with the various natural and synthetic oestrogenic products which have been introduced, and in this lecture I intend to include my further observations in their appropriate place. Thirdly, special work in the clinical use of has oestrogens been carried out during the last three years in my obstetrical and gynaecological wards. That being so, I intend to deal chiefly in this lecture with conditions with which I have had some clinical experience in regard to the value of oestrogens, and will do no more than refer to other conditions for which have oestrogens been recommended, of which I have no personal experience. -
Clinical Spectrum of Lyme Disease
European Journal of Clinical Microbiology & Infectious Diseases (2019) 38:201–208 https://doi.org/10.1007/s10096-018-3417-1 REVIEW Clinical spectrum of Lyme disease Jesus Alberto Cardenas-de la Garza1 & Estephania De la Cruz-Valadez1 & Jorge Ocampo-Candiani 1 & Oliverio Welsh1 Received: 4 September 2018 /Accepted: 30 October 2018 /Published online: 19 November 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Lyme disease (borreliosis) is one of the most common vector-borne diseases worldwide. Its incidence and geographic expansion has been steadily increasing in the last decades. Lyme disease is caused by Borrelia burgdorferi sensu lato, a heterogeneous group of which three genospecies have been systematically associated to Lyme disease: B. burgdorferi sensu stricto Borrelia afzelii and Borrelia garinii. Geographical distribution and clinical manifestations vary according to the species involved. Lyme disease clinical manifestations may be divided into three stages. Early localized stage is characterized by erythema migrans in the tick bite site. Early disseminated stage may present multiple erythema migrans lesions, borrelial lymphocytoma, lyme neuroborreliosis, carditis, or arthritis. The late disseminated stage manifests with acordermatitis chronica atrophicans, lyme arthritis, and neurological symptoms. Diagnosis is challenging due to the varied clinical manifestations it may present and usually involves a two-step serological approach. In the current review, we present a thorough revision of the clinical manifestations Lyme disease may present. Additionally, history, microbiology, diagnosis, post-treatment Lyme disease syndrome, treatment, and prognosis are discussed. Keywords Lyme disease . Borrelia burgdorferi . Tick-borne diseases . Ixodes . Erythema migrans . Lyme neuroborreliosis History posteriorly meningitis, establishing a link between both mani- festations. -
Is There Any Reason of Irritating Vulvar Itching?
Mini Review ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2021.33.005347 Is there Any Reason of Irritating Vulvar Itching? Magdalena Bizoń Szpernalowska* and Włodzimierz Sawicki Chair and Department of Obstetrics, Medical University of Warsaw, Poland *Corresponding author: Magdalena Bizoń Szpernalowska, Chair and Department of Obstetrics, Gynecology and Gynecological Oncology, ul. Kondratowicza 8, 03-242 Warsaw, Poland ARTICLE INFO ABSTRACT Received: Published: December 27, 2020 Vulvar complains like itching, burning and pain are reported mainly by women in peri- and postmenopuasal age. Severity of symptoms influence on well-being. The most January 11, 2021 frequent reason of vulvar symptoms is lichen sclerosus. Diagnose is given after vulvar Citation: biopsy, which is crucial in exact diagnosis. Sometimes histological result can also reveal hypertrophy of epithelium, acanthosis, lichen planus, vulvar intraepithalial neoplasia or Magdalena Bizoń S, Włodzimierz even vulvar cancer. Lichen sclerosus cause leucoplacia, vulvar atrophy and narrowing of S. Is there Any Reason of Irritating Vulvar the vagina. Delay of diagnosis cause quicker progression of disease and intensification Itching?. Biomed J Sci & Tech Res 33(1)- of vulvar symptoms. The first line of treatment is based on ointments according to 2021.Abbreviations: BJSTR. MS.ID.005347. glicocorticosteroids. If there is no response on this method, the alternative way is photodynamic therapy (PDT). The aim of the treatment is to protect against progression LS: Lichen Sclerosus; PDT: ofKeywords: lichen sclerosus and decrease vulvar symptoms. Photodynamic Therapy; VIN: Vulvar In- traepithelial Neoplasia lichen sclerosus; itching; photodynamic therapy Mini Review weissflechen dermatose and white spot disease [5]. Nomenclature Clinical vulvar symptoms like itching, burning and pain are include also term of lichen sclerosus and atrophicus [6]. -
Necrobiosis Lipoidica
IMAGES Necrobiosis Lipoidica A 13-year-old girl with type 1 diabetes mellitus presented with diabetic ketoacidosis. She was on regular insulin thrice a day with poorly controlled blood sugars. On examination, the girl had a well-defined, circular, indurated red plaque, measuring 5×5 cm, over the left leg (Fig.1). The lesion started as painless, reddish papules that slowly enlarged to a plaque over a period of 3 years. Analysis of the biopsy specimen confirmed the diagnosis of necrobiosis lipoidica (NL) diabeticorum. Laboratory investigations revealed an elevated glycosylated hemoglobin (12.5%), normal thyroid function, normal complete blood count, unremarkable liver and renal functions, and normal serum cholesterol and FIG. 1 Necrobiosis lipoidica plaque with erythematous margins triglycerides. She was able to achieve good glucose in the pretibial area. control and resume her normal life; however, the complication on skin persisted despite an intensive agents, cryotherapy and potent topical glucocorticoid insulin treatment and topical steroids. agents for early lesions, and intralesional corticosteroids NL is an extremely rare finding in childhood diabetes injected into the active borders of established lesions. and typically presents at 30-40 years of age. The most Systemic glucocorticoid therapy may also be effective, commonly affected site is the leg; 85% of cases affect that but can be associated with adverse effects in patients site exclusively. Differential diagnoses include granuloma with diabetes. annulare (typically found on the dorsa of hands, fingers *SELIM DERECI AND OZGUR PIRGON and feet), sarcoidosis, necrobiotic xanthogranuloma, Süleyman Demirel University, Faculty of Medicine, lichen sclerosus, and erythema induratum. First-line Department of Pediatrics, Isparta, Turkey. -
Vulvar Lichen Sclerosus Et Atrophicus Pragya Ashok Nair
[Downloaded free from http://www.jmidlifehealth.org on Friday, June 16, 2017, IP: 201.13.5.108] Review Article Vulvar Lichen Sclerosus et Atrophicus Pragya Ashok Nair Department of Dermatology Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis characterized and Venereology, by ivory‑white plaques or patches with glistening surface commonly affecting the Pramukshwami Medical College, Karamsad, Gujarat, vulva and anus. Common symptoms are irritation, soreness, dyspareunia, dysuria, and India urinary or fecal incontinence. Anogenital lichen sclerosus (LS) is characterized by Abstract porcelain‑white atrophic plaques, which may become confluent extending around the vulval and perianal skin in a figure of eight configuration. Thinning and shrinkage of the genital area make coitus, urination, and defecation painful. LS is not uncommon in India and present as an itchy vulvar dermatosis which a gynecologist may mistake for candidal vulvovaginitis. There is often a delay in diagnosis of VLS due to its asymptomatic nature and lack of awareness in patients as well as physicians. Embarrassment of patients due to private nature of the disease and failure to examine the genital skin properly are the other reasons for delay in diagnosis. There is no curative treatment for LS. Various medications available only relieve the symptoms. Chronic nature of the disease affects the quality of life. Proper and regular follow‑up is required as there are chances of the development of squamous cell carcinoma. Keywords: Dermatosis, lichen sclerosus et atrophicus, vulva Introduction old.[3] Women are more commonly affected than men ulva is the most visible female genital structure, with 10:1 ratio, particularly during menopausal age V but it has received the least attention in the medical group, but younger women or girls may also be affected.