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: |
| Approved | Approved::No |
| Keyword | WBRKeyword::Lichen sclerosus |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |