WBR0504

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Dermatology
Prompt	[[Prompt::A 62-year-old woman presents to the dermatology clinic with a white plaque on her vulva. She reports history of recurrent itching in the area for several years and has been to her gynecologist several times with no solution. She says the lesion has not changed in appearance and denies any vaginal bleeding or discharge. Physical examination reveals a raised white colored plaque on the vulva with excoriations adjacent to and overlying the lesion. Which of the following diagnoses is most likely in this patient?]]
Answer A	AnswerA::Lichen sclerosus
Answer A Explanation	AnswerAExp::See explanation
Answer B	AnswerB::Lichen simplex chronicus
Answer B Explanation	[[AnswerBExp::Lichen simplex chronicus (LSC) refers to thick, leathery, and brown skin secondary to repetitive scratching or rubbing. Lichen simplex chronicus can be treated with topical steroids.]]
Answer C	AnswerC::Lichen planus
Answer C Explanation	[[AnswerCExp::Lichen planus is a chronic inflammatory disease commonly seen in middle-aged individuals that affects the skin and the mucous membrane. It may present in the skin, oral cavity, genitalia, scalp, nails, or esophagus. The clinical features of lichen planus are described as the four P’s – Pruritic, Purple, Polygonal, and Papule. Topical corticosteroids are often the first line of treatment.]]
Answer D	AnswerD::Vulvar cancer
Answer D Explanation	[[AnswerDExp::Vulvar cancer is the fourth most common gynecologic cancer. Frequently on the labia majora, vulvar cancer often manifests as a plaque, ulcer or mass. Symptoms commonly assosiated with vulvar cancer are pruritus, vaginal bleeding, vaginal discharge, dysuria, and lymphadenopathy in the groin.]]
Answer E	AnswerE::Vitiligo
Answer E Explanation	[[AnswerEExp::Vitiligo is an autoimmune disorder that depletes epidermal melanocytes. Vitiligo manifests as irregular pale patches of skin, secondary to depigmentation. Vitiligo is often treated with corticosteroid cream and phototherapy using PUVA.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Lichen sclerosus is a disorder mainly affecting the skin of the vulva and the foreskin of the penis. The lesion presents as thin, whitish, and wrinkled. Areas impacted by lichen sclerosus are often sore and pruritic. Although the exact etiology is still unknown, it is postulated to have genetic, autoimmune, and infectious origin. Post-menopausal women are at highest risk for developing lichen sclerosus. Treatment with a steroid cream or ointment can help reduce the itching and inflammation. Patients with lichen sclerosis have increased chance of developing squamous cell skin cancer. Educational Objective: Lichen sclerosus is a disorder mainly affecting the skin of the vulva and the foreskin of the penis. The lesion presents as thin, whitish, and wrinkled. Areas impacted by lichen sclerosus are often sore and pruritic. Patients with lichen sclerosis have increased chance of developing squamous cell skin cancer. References: First Aid 2014 page 437]]
Approved	Approved::No
Keyword	WBRKeyword::Lichen sclerosus, WBRKeyword::dermatology, WBRKeyword::skin, WBRKeyword::lesion, WBRKeyword::treatment, WBRKeyword::steroid
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::