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A 52-year-old female presents to you with a history of intractable itching in the vulvar area and soreness during intercourse. She claims that this has been going on for about three months. She has tried several over the counter medications, but none has made a difference in her condition. Upon examination, you notice that the vulva is red and appears dry with scaly patches. No lesion is palpated. Biopsy is done and the results are pending. The most appropriate treatment is:
C. Topical steroids
The answer is C. According to the signs and symptoms, it looks like Lichen sclerosis. However, before the biopsy result coming out, we can't be 100% sure it IS Lichen sclerosis. So when the biopsy is pending, why can't we just wait for the biopsy result? Lichen sclerosis is not that emergent to have to treat immediately. Well, in case the final biopsy show that the disease is not Lichen sclerosis, but another unknown diz and using steroid is contraindication. How can we do by then?
the biopsy is done to rule out cancer which can also present in the same way and not to make a diagnosis of lichen sclerosis, which can be and is diagnosed clinically. but a biopsy is always indicated when yu suspect lichen sclerosis to rule out the possibility of cancer. the other pruritic condition in which we must always do the biopsy to rule out cancer is hypertrophic vaginitis. and so steriods are indicated when yu suspect lichen sclerosis. hope this helps.
So if we give steroid to the patient with vulvar cancer, what's the result?
well i get a bit confused with lichen sclerosis and senile changes
can anyone help
they are testing our epidemiology knowledge. since Lichen sclerosis is far more common than the other options, to give tretment to the most likely cause while waiting for results is fair game. there are exceptions but here I can find none.
so topical steriods is a good choice
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