298 Obstetrics and Gynecology Board Review •••
❍ How are episodes of hidradenitis suppurativa treated?
Short courses of antibiotic treatment with doxycycline are first line, antiandrogens, and surgery for more severe
cases.
❍ Why does hyperkeratosis occur?
By disordered epithelial growth and nutrition that can be a result of chronic irritation, chronic inflammation,
cancer, or precancer.
❍ What is the treatment of squamous cell hyperplasia without atypia?
Episodic mid to high potency topical corticosteroids.
❍ What is lichen sclerosus characterized by histologically?
Hyperkeratosis, thinning of the epidermis with acanthosis and elongation/flattening of the rete pegs; upper dermis
is hyalinized with a band of lymphocytes below this region.
❍ What is lichen sclerosis thought to increase the risk for?
Squamous cell cancer of the vulva.
❍ What other skin disease can also lead to white “patches” on the vulva?
Vitiligo.
❍ What is the appearance of vulvar lichen sclerosus?
Thin white wrinkled skin classically characterized as “paper-like” with possible obliteration of normal anatomy
including labia minora, clitoris, or urethra with scar tissue introitus may have yellow, waxy appearance.
❍ What two vulvar diseases can obliterate normal vulvar anatomy?
Lichen sclerosis and lichen planus.
❍ When a lesion suspicious for lichen sclerosis is found what is the best first step in management?
Biopsy.
❍ What other lesions appear white on the vulva?
Squamous cell cancer of the vulva.
❍ How is lichen sclerosus treated in a child?
It usually regresses, but tiny amounts of clobetasol (topical corticosteroid) for a longer period of time appear
successful in young girls and maintenance therapy not always required; topical corticosteroids can arrest
the process and the symptoms.
❍ How is lichen sclerosus treated in the adult?
High potency topical steroid, usually clobetasol 0.05% ointment or cream. The treatment is tapered over 4 to
6 weeks from initial BID/TID applications to a maintenance application of 1 to 3 times weekly. This is a chronic
condition that usually requires indefinite therapy.