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Re: Gyn: Perineal scarring From: Joanne Bulley, MD (islesannie@gmail.com) Tue Aug 26 19:43:51 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" Previous message: Efrain Ramirez: "Re: Gyn: Perineal scarring" In reply to: Garry E. Siegel, M.D.: "Gyn: Perineal scarring" Next in thread: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" The following link is a powerpoint presentation of Dr. Lynette Margesson. She writes chapters for derm texts and speaks on this and related subjects all the time. Sounds like Lichen Simplex Chronicus. She outlines the presentation, inpextion and histopathology as well as the treatments for LS(&A), LSC and Lichen Planus. I was at a talk of hers last fall for the NE OBGYN Society - she was great. I share patients with her (my hardest ones) and have a handout from her on vulvar care (make them STOP washing it ...) That is not in a computer / digital format (yet). I got this link from a google search last night (to send the info to a HS friend who is a FP in SW Harbor ME and had done a biopsy of vulva and somatic area with a diagnosis of L Planus. [PPT] THE ITCHY VULVA LICHEN SCLEROSUS (LS) File Format: Microsoft Powerpoint - View as HTML Boyd AS, Neldler KH: Lichen planus. J Amer Acad Dermatol 1991; 25(4): 593-619. Margesson LJ: Inflammatory diseases of the vulva. In Fisher BK, Margesson LJ ... http://www.asccp.org/pdfs/itchy_vulva.ppt - Hope this helps Joanne At Tue, 26 Aug 2008, Garry E. Siegel, M.D. wrote: > >51 YO menopausal 5005 who is S/P LAVH years ago, and subsequently had >pelvic reconstruction surgery with an academically based urogyn a few >years ago for a rectocele and lax perineum (no grafts). I did her LAVH >and haven't seen her since referral to the urogyn. > >She has seen another gyn who diagnosed lichen sclerosus without a biopsy >(per the patient) and clobetasol was "too strong" and didn't help. > >She has perineal discomfort and no sex drive, and is not on HRT. > >On exam, her perineum is whitened and scarred looking, like from >surgery, and is not reminiscent of LSA. The labia and clitoris are >normal. Her vagina is well estrogenized, the introitus admits two >fingers comfortably, and the length and depth are well preserved. > >The biopsy shows "Benign epithelial hyperplasia with overlying >keratosis." > >My instinct is to use medium potency steroids regularly, and address sex >drive, also. > >Any thoughts are welcome, and what dose/schedule of steroid would you >use? > >Garry > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- Joanne Bulley, MD solo gyn Keene, NH Next message: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" Previous message: Efrain Ramirez: "Re: Gyn: Perineal scarring" In reply to: Garry E. Siegel, M.D.: "Gyn: Perineal scarring" Next in thread: Joanne Bulley, MD: "Re: Gyn: Perineal scarring"

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