By Michèle Leibowitch, Richard Staughton, Sallie Neill, Simon Barton, Roger Marwood
This very hot atlas has been revised and up-to-date, with 60 new color illustrations highlighting key medical issues
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Additional info for An Atlas of Vulval Diseases: A Combined Dermatological, Gynaecological and Venereological Approach
Psoriasis often emerges in areas of damaged skin, here in a surgical wound. 57 Evidence of psoriasis in the nails, with thimble pitting, onycholysis and dystrophy, should be sought. 58 Histology of vulval psoriasis. (a) There is papillomatosis, parakeratosis, neutrophil exocytosis and spongiform pustules (H & E, X40). (b) Enlargement shows neutrophil exocytosis and spongiform pustules in more detail (H & E, X83). (a) Neutrophil exocytosis and spongiform pustules 50 AN ATLAS OF VULVAL DISEASE Lichen planus (papular variety) Management Cutaneous papular lichen planus is an inflammatory skin condition causing intensely pruritic violaceous shiny papules distributed widely on the skin.
8 Advanced lichen sclerosus with loss of all normal architecture and the beginnings of introital narrowing. Note the glazed appearance of the atrophic skin. 9 Advanced lichen sclerosus, showing burying of clitoris and resorption of labia minora. Note the extensive loss of pigment and patchy postinflammatory hyperpigmentation giving this variegated patterning. 10 (a and b) Patient with lichen sclerosus showing progressive narrowing of the introitus, leaving only a tiny opening which leads to difficulties with micturition.
When scarring narrows the urethral orifice, the condition is referred to as balanitis xerotica obliterans. 19 Extragenital lichen sclerosus. The typical 'white spot disease' appearance is seen. There is follicular delling, which is another helpful physical sign. 20 Extragenital lichen sclerosus with 'cigarette-paper' wrinkling. 21 Extensive lichen sclerosus on the back, which is a common site for extra-genital disease. This patient had no involvement of genital skin. This is not unusual. Note also the purpura at an area where the dermo-epidermal junction has separated.