WBR0504

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Dermatology
Prompt	[[Prompt::A 58-year-old woman presents to the dermatology clinic for vaginal irritation. She reports a long history of recurrent pruritus and vulvar tenderness. The patient explains that she has been to her gynecologist several times but the antifungal creams he has prescribed have not helped. She denies any vaginal bleeding or discharge. She reports having significant dyspareunia particularly in the past 2 months. Physical examination reveals a raised ivory-white plaque on the vulva with 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::Lichen sclerosus is a disorder mainly affecting the skin of the vulva, perineum, anus, and the foreskin of the penis. It presents as a thin, whitish, and wrinkled plaquethis is often sore and pruritic.]]
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.]]
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.]]
Answer D	AnswerD::Vulvar cancer
Answer D Explanation	[[AnswerDExp::Vulvar cancer is the fourth most common gynecologic cancer. Frequently in 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 (LS) is a chronic dermatitis that mainly affects the skin of the vulva, perineum, anus, and the foreskin of the penis. LS lesions present as thin, whitish, and wrinkled plaques with areas involved being sore and pruritic. Although the exact etiology is still unknown, LS is a lymphocyte-mediated skin disease with postulated genetic, autoimmune, and infectious origins. Caucasian peri- or postmenopausal women are at the highest risk of developing LS. Treatment with a ultra-potent topical corticosteroid cream or ointment can help reduce the itching and inflammation, however relapses are commmon and chronic treatment is often necessary. Patients with lichen sclerosis have increased chance (4-7%) of developing squamous cell carcinoma of the involved skin. Educational Objective: Lichen sclerosus is a disorder mainly affecting the skin of the vulva, perineum, anus, and the foreskin of the penis. It presents as a thin, whitish, and wrinkled plaquethis is often sore and pruritic. References: Pugliese JM, Morey AF, Peterson AC. Lichen sclerosus: review of the literature and current recommendations for management. J Urol. 2007;178(6):2268-76. First Aid 2014 page 437]]
Approved	Approved::Yes
Keyword	WBRKeyword::Lichen sclerosus, WBRKeyword::Skin lesion, WBRKeyword::Vulva, WBRKeyword::Pruritus
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::