WBR0504
| Author | [[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]] |
|---|---|
| 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. She has been to her gynecologist several times with no solution. She says the lesion has not changed in appearance but the itching bothers her. She denies any vaginal bleeding or discharge. Physical examination reveals a raised white colored plaque on the vulva. There are excoriations adjacent to and overlying the lesion.
What is the most likely diagnosis in this patient?]] |
| Answer A | AnswerA::Lichen sclerosus |
| Answer A Explanation | AnswerAExp::Correct. This is a skin disorder commonly affecting post-menopausal women appearing as a whitish, wrinkled, itchy plaque on the vulva. Treatment is with steroid ointment to reduce the itching and inflammation. |
| Answer B | AnswerB::Lichen simplex chronicus |
| Answer B Explanation | [[AnswerBExp::Incorrect. Lichen simplex chronicus (LSC) refers to thickening of the skin secondary to repetitive scratching or rubbing which makes the skin thick, leathery, and brownish. Treatment is with topical steroids.]] |
| Answer C | AnswerC::Lichen planus |
| Answer C Explanation | [[AnswerCExp::Incorrect. Lichen planus is a chronic inflammatory disease that affects the skin and the mucous membrane. It commonly affects the middle aged groups. It may affect the skin, oral cavity, genitalia, scalp, nails, or esophagus. The clinical features of cutaneous lichen planus are described as the four P’s – pruritic, purple, polygonal papules or plaques. Diagnosis is by biopsy. Topical corticosteroids are the first line in treatment.]] |
| Answer D | AnswerD::Vulvar cancer |
| Answer D Explanation | [[AnswerDExp::Incorrect. Vulvar cancer is the fourth commonest gynecologic cancer. Common presentation is the appearance of vulvar plaque, ulcer or mass on frequently, the labia majora, although other areas may also be affected. Other symptoms may include: pruritus, vaginal bleeding, vaginal discharge, dysuria, lymphadenopathy in the groin. Diagnosis is by vulvar biopsy.]] |
| Answer E | AnswerE::Vitiligo |
| Answer E Explanation | [[AnswerEExp::Incorrect. Vitiligo is an autoimmune disorder against the melanocyte cells in the skin. It manifests as loss of pigment, resulting in irregular pale patches of skin. Treatment is with corticosteroid cream and phototherapy using PUVA.]] |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Lichen sclerosus is a skin disorder that mainly affects the vulva in women and the penis in men. The skin appears thin, whitish, and wrinkled. It appears to be commoner among post-menopausal women, although men, children, and premenopausal women may be affected. Common sites include: near the clitoris, labia, and in the anal region. Other skin surfaces affected include: thighs, breasts, wrists, shoulders, neck, and even the inside the mouth. Symptoms include itch, soreness, dyspareunia, and changes in the appearance of affected skin. The exact etiology is still unknown, although it has been postulated to have genetic, autoimmune and infectious origin. Diagnosis is by biopsy.
Treatment is with a steroid cream or ointment to reduce the itching and inflammation. Patients with lichen sclerosis have increased risk of developing squamous cell skin cancer. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Lichen sclerosus |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |