Download Papule/nodule

Papule/nodule
A wide spectrum of benign,
premalignant, and
malignant lesions may
involve the vulva
NEOPLASIA
Vulvar intraepithelial
neoplasia
Most vulvar intraepithelial
neoplasia lesions are multifocal
and located in the nonhairbearing parts of the vulva
cancer:
Most patients with vulvar cancer
present with a unifocal vulvar
plaque, ulcer, or mass (fleshy,
nodular, or warty) on the labia.
Lichen sclerosus and erosive lichen
planus
may
vulvar to
predispose
cancers
Squamous cell cancer and lichen sclerosus
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FLESH COLORED
PAPULE/NODULE
Vestibular papillae
discrete, small papules located
symmetrically around the edge
of vestibule
benign and usually asymptomatic
do not require treatment confused
with condyloma acuminata except
condyloma tend to fuse together
and are not confined to the
vestibule.
P

Acroc hordon
: (skin tag,
fibroepithelial polyp, soft fibroma)
a benign outgrowth of normal skin
appear as pedunculated lesions on narrow
stalks and tend to be more numerous in
patients with diabetes or obesity and in
areas of chronic friction.
Removal is indicated when the
patient is symptomatic
Cysts :
Bartholin gland ,pilonidal,
epidermoid ,dermoid, Gartner, and
mucous cysts are benign lesions,
but can be associated with
bothersome symptoms
treatment is often requested by the
patient.
Genital warts (condyloma
acuminata)
Genital warts, caused by (HPV), may be of flat,
filliform, verrucous, pedunculated, or giant
morphology. They may be flesh colored or
pigmented.
Lesions of secondary syphilis may
have a wart-like appearance, but
are not true warts.
Molluscum contagiosum :
umbilicated translucent or pearly
papules due to infection from a
member of the poxvirus family.
in healthy adult woman may indicate an
underlying immunosuppressive
disorder.
Treatment :
destructive (eg, cantharidin,
cryotherapy) or immunomodulating
(eg, imiquimod)
Syringoma :
benign neoplasms of the eccrine sweat glands.
multiple, 1 to 2 mm, flesh-colored to yellow
papules arranged symmetrically on the labia
majora., heat and sweating, menstruation,
or pregnancy may provoke pruritus in
vulvar syringomas.
Excision or ablation is curative. In some
patients, topical atropin or tretinoin
WHITE PATCH/PLAQUE
Hyperkeratosis or lichen
simplex chronicus :
Raised white or dark colored plaques on the
vulva are associated with hyperkeratosis
secondary to chronic rubbing or scratching.
Erosions and/or excoriations may also be
evident..
Biopsy of affected skin may be indicated if the
underlying disorder is uncertain.
Lichen sclerosus (white, finely wrink&
atrophic patches )
May develop with minor trauma, hemorrhage
may be present.
Vulvar itching and have typical clinical
findings that suggest the diagnosis.
A biopsy may be indicated to exclude
malignancy if unresponsive to therapy or if
lesional skin demonstrates morphologic
changes.
Be treated medically with a potent topical
corticosteroid ointment, such as
clobetasol 0.05 percent ointment and
followed closely
Papule/nodule
Dermatofibroma
usually present as firm, hyperpigmented
papules that invaginate (dimple sign) with
lateral pressure.
It is hypothesized that they arise after trauma.
Ectopic breast
Present as a hyperpigmented nodule on the
vulva on the milk line, which extends from
the axilla to the groin. Symptoms may
develop with pregnancy or menstruation'
Kaposi's sarcoma
Consists of dusky erythematous to violaceous
papules that may ulcerate and become
painful.
Extra-genital skin, in particular the oral
mucosa, should be examined (HIV)infection
should be ruled out
Compound melanocytic nevi:
Darker than intradermal nevi; both are often
well circumscribed, dark-colored, soft
papules.
Definitive diagnosis is made with a biopsy
Fox-Fordyce:
Disease is an extremely pruritic,
monotonous eruption of minute,
dark papules involving apocrine
glands
Red macule/patch/plaque
Dermatitis :
Atopic, irritant, and allergic dermatitis, and
neurodermatitis of the vulva erythematous
lesions.
Long-standing dermatitis hyperpigmentation
and thickening of the skin with
lichenification.
Avoidance of offending agents is the mainstay
of treatment of contact and allergic
dermatitis.
Psoriasis :
Psoriasis is characterized by erythematous
plaques with micaceous scale on the scalp,
elbow, knees, palms, and soles. It is often
associated with nail changes
Lichen planus
violaceous, flat-topped papules with lacy,
white scales the characteristic lesions.
Involved areas of the vestibule or vagina
often appear as erythematous erosions and
patients may develop shortening and
narrowing of the vagina.
Atrophic vulvitis
Is a manifestation of
hypoestrogenism; although the
vagina is much more sensitive to
estrogen deprivation than the
vulva.
Infection :
The differential diagnosis of erythematous
vulvar lesions should also include infections.
Candida infection presents as moist
erythema with satellite lesions
Excessive vaginal discharge from bacterial
vaginosis or trichomoniasis may contribute
to erythema and maceration of vulvar skin.
Cherry angioma :
Discrete benign red papules; they are often
present on the trunk and rarely occur on the
vulva
Treatment by destructive modalities (eg
surgery, cautery)
Urethral lesions :
A midline polypoid lesion may be a urethral
caruncle or urethral prolapse.
Satisfactory treatment may be achieved with
topical estrogen cream alone.
Endometriosis :
Develops after vulvar implantation of
endometrial tissue following a surgical
procedure.
PUSTULES, VESICLES,
AND EROSION
Folliculitis:
Develop in any hair-bearing surface;
Staphylococcus aureus can be cultured from
the skin lesions.
Furunculosis :
Furunculosis and carbuncles may develop
with long-standing, severe folliculitis.
Hidradenitis suppurativa :
Manifests with pruritus, erythema, and local
hyperhidrosis.
As the area heals, it becomes fibrotic and new
nodules develop inflammatory masses.
Hyperpigmentation, scars, and pitting are
seen on the skin.
Candida
Herpes simplex virus (HSV) :
Multiple, painful vesicles or ulcerating
lesions
It also often appears as grouped
(herpetiform distribution(
Evident due to the moisture and friction
in this area.
Fever, malaise, and lymphadenopathy
Scabies and insect bites
Fixed drug reaction :
Usually demonstrate discrete, hyperpigmented
bullae or erosions that recur in the exact
same
Location with repeat medication
administration
Herbal supplements, phenolphthalein,
tetracycline,NSAIDS, and sulfonamides
Improvement should occur within two weeks
of stopping the causative drug.
ULCER/FISSURE
Infection
HSV
Syphilitic chancre
Chancroid ulcer
Lymphogranuloma venereum
Granuloma inguinale
Malignancy
Systemic disease
Drug
TREATMENT:
Vulvar skin care
Soaks
Lubricants
Topical analgesics and oral
antihistamines
Estrogen
Antimicrobial drugs
Antiinflammatory agents (oral or
topical)
Combination topical antimicrobial and
anti-inflammatory agents
Surgery
Geriatric
vulvar lesions in
postmenopausal women are atrophy due to
hypoestrogenemia and cancer. These lesions
can be asymptomatic or have nonspecific
symptoms such as itching. ".)
Immunocompromise
at risk for severe manifestations of common
infections, as well as atypical infections
prone to development of certain types of
premalignant and malignant disease.