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Simple cases
Case 61
A 37 -year-old woman presents with marked vulvar pruritus.
History
Do you have a regular sexual partner?
Yes, I have had a steady boy friend for the past 6 months.
The sexual history can give valuable information when dealing with genital dermatoses.
How long have you been having problems?
The itching has been really bad for about a week.
The time course of a disease often helps narrow the differential diagnostic considerations.
Do you have allergies, hay fever or asthma?
Yes, I had have had hay fever since I was a kid, but in recent years, it has become milder and milder.
This question helps establish an atopic diathesis.
Does it burn when you urinate?
Yes.
Dysuria is an important additional symptom in this clinical setting.
Have you noticed a vaginal discharge?
Yes, for a few days and it has an unpleasant odor.
Vaginal discharge is an important additional symptom in this clinical setting.
When did you last have sexual intercourse?
Three days ago.
The sexual history can give valuable information when dealing with genital dermatoses.
Do you take any medications?
No
Always an important question, but not likely to help in this clinical setting.
Are you pregnant?
No, not that I know.
In view of the differential diagnostic considerations and therapeutic choices, an important question.
Lesion
Choose the right efflorescences:
Erosions are epidermal defects.
No scales are seen.
A fissure is a fine split or tearnot seen here.
Correct. No primary lesion is seen here; the patient has symptoms. Actually the patient's vulvar is erythematous, but this not considered a primary lesion.
Lichenification is the result of chronic rubbing, producing exaggerated skin markings.
Diagnosis
Choose the right diagnosis:
The vulvitis associated with atopic dermatitis is chronic with lichenification and scales.
Correct.
Pediculosis pubis is pruritic but not associated with vaginal discharge.
Vaginal discharge is not psychogenic.
Primary genital herpes simplex can cause a very painful inflamed vulvovaginitis.
Therapy
Choose the right therapy(ies):
False. The treatment for candidal vulvovaginitis.
False. Treatment for some helminthic infestations.
Correctthe treatment of choice.
Proton pump blocker which plays no role for this clinical problem.
