••• CHAPTER 31^ Benign Vulvar and Vaginal Lesions^299
❍ What is second-line therapy for severe lichen sclerosis?
Surgical lysis of adhesion/scar tissue with possible laser or cavitary ultrasonic surgical ablation (CUSA) ablation.
❍ What is intertrigo?
Inflammatory condition of two closely opposed skin surfaces.
❍ In which patients is intertrigo of the vulva commonly found?
Obese or diabetic women.
❍ What other skin discoloration causing darkened macular areas at the vulva is seen in diabetic women?
Acanthosis nigricans.
❍ What is the common distribution of intertrigo?
Axilla, inframammary folds, groin, perineum, intergluteal folds, toe webs, interlabial and intercrural folds.
❍ What causes labial agglutination?
Chronic vulvar inflammation from any cause.
❍ What is the treatment of labial agglutination?
If it is asymptomatic, no treatment is needed and often a girl’s natural estrogen at the time of puberty will resolve
the agglutination; if symptomatic, 2 to 4 weeks of topical estrogen may be used with manual separation.
❍ What symptom of labial agglutination requires prompt treatment of the agglutination?
Inability to urinate.
❍ What is the most common cause of papillary lesions on the vulva?
HPV.
❍ What characteristic of HPV explains the high rate of clinical relapse of treated warts?
Viral latency.
❍ Which types of HPV are most commonly associated with malignancy?
16 and 18.
❍ What cytotoxic agents are used in the treatment of HPV of the vulva?
Podophyllin (mitotic poison), TCA (caustic agent), 5-FU (antimetabolite), Imiquimod (immune modulator),
interferon alpha (immune modulator), and adefovir (nucleoside analog).
❍ What other techniques may be used in the treatment of HPV?
Liquid nitrogen, electrocauterization, surgical excision, carbon dioxide laser, and CUSA.