Essentials Of Obstetrics And Gynecology Fifth Edition – Neville F Hacker

Topical and systemic steroids are recommended for treatment. The epithelium of the vulva is susceptible to dermatologic disorders found elsewhere on the body surface, although the clinical manifestations of those disorders may be slightly different because of the vulva’s moist environment. A correct diagnosis is critical, and tissue punch biopsy may be required (Figure 18-6). Psoriasis generally appears velvety but may lack the characteristic scaly patches found on the flexor surfaces (e.g., knees and elbows). Eczema has a more erythematous presentation and may be difficult to diagnose unless lesions that are more characteristic can be found on the scalp, umbilicus, or extremities.

Even in these circumstances, diagnostic biopsy may be needed to rule out conditions that are more serious. Pemphigus is an autoimmune blistering disease involving the vulvovaginal and conjunctival areas. Behçet’s syndrome classically involves ulcerations in the genital and oral areas, as well as superficial ocular lesions.

The genital lesions are distinctive and can result over time in a scarred, fenestrated vulva. The etiology is unknown, as is an effective treatment. Diagnosis is based on the concurrence of vulvar, oral, and ocular involvement, the recurrent nature of the disease, and the exclusion of other conditions, such as syphilis and Crohn disease.

FIGURE 18-6 A disposable cutaneous punch biopsy instrument. Crohn disease is primarily a gastrointestinal (GI) disorder, but vulvar ulcers can precede the development of GI ulcerations. The vulvar ulcers are slit-like or “knife-cut” ulcers with prominent edema. Draining sinuses and fistulas to the rectum may occur. Aphthous ulcers, which are superficial and painful, can be found not only on the labia but also in the mouth. Decubitus ulcers can develop in frail women over the bony prominences of their ischial tuberosities or sacrococcygeal region or in areas susceptible to friction from indwelling catheters.

Acanthosis nigricans is most commonly found in the intertriginous area, in the axilla or on the nape of the neck (see Chapter 32, Figure 32-4). It is recognizable by its darkly pigmented velvety or warty surface. Acanthosis nigricans is related most closely to insulin resistance but can be linked less commonly to other benign conditions and malignancy. The labia are exposed to a wide range of chemicals and other foreign materials that can induce contact dermatitis (erythema and burning) or irritative changes.

Neville F. Hacker, MD Professor of Gynaecologic Oncology Conjoint, University of New South Wales Director, Gynaecological Cancer Centre Royal Hospital for Women Sydney, Australia Joseph C. Gambone, DO, MPH, Executive Editor Professor Emeritus of Obstetrics and Gynecology David Geffen School of Medicine at UCLA Attending Physician, Ronald Reagan UCLA Medical Center Clinical Professor of Obstetrics and Gynecology Western University of Health Sciences College of Osteopathic Medicine of the Pacific Residency Education Consultant Arrowhead Regional Medical Center San Bernardino, California Calvin J. Hobel, MD Miriam Jacobs Chair in Maternal-Fetal Medicine Cedars-Sinai Medical Center Professor of Obstetrics and Gynecology Professor of Pediatrics David Geffen School of Medicine at UCLA Los Angeles, California SAUNDERS OceanofPDF.com Front Matter Hacker and Moore’s Essentials of Obstetrics and Gynecology 5th Edition Neville F.

Hacker, MD Professor of Gynaecologic Oncology, Conjoint, University of New South Wales Director, Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, Australia Joseph C. Gambone, DO, MPH, Executive Editor Professor Emeritus of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA Attending Physician, Ronald Reagan UCLA Medical Center, Clinical Professor of Obstetrics and Gynecology, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific Residency Education Consultant, Arrowhead Regional Medical Center, San Bernardino, California Calvin J.

Hobel, MD Miriam Jacobs Chair in Maternal-Fetal Medicine, Cedars-Sinai Medical Center, Professor of Obstetrics and Gynecology, Professor of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California OceanofPDF.com Copyright 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 HACKER AND MOORE’S ESSENTIALS OF OBSTETRICS AND GYNECOLOGY ISBN: 978-1-4160-5940-0 International Edition ISBN: 978-0-8089-2416-6 Copyright © 2010, 2004, 1998, 1992, 1986 by Saunders, an imprint of Elsevier Inc.

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