1. Vulval Dermatology Update from British Society for Study of Vulval Diseases Meeting Cardiff 2008

2. BSSVD Relief of patients suffering from vulval disease Relief of patients suffering from vulval disease Promotion of research into causes of vulval disease Promotion of research into causes of vulval disease Practice and art and science of diagnosis and treatment of vulval diseases Practice and art and science of diagnosis and treatment of vulval diseases www.bssvd.org www.bssvd.org

3. Cardiff 2008 Current Challenges in Vulval disease Current Challenges in Vulval disease Prospective Study to Determine Factors Leading to Delayed presentation of Patients with Vulval Lichen Sclerosis Prospective Study to Determine Factors Leading to Delayed presentation of Patients with Vulval Lichen Sclerosis AJ Mehta et al University Hospital Wales

4. Background LS is chronic,inflammatory condition LS is chronic,inflammatory condition Most commonly affects post-menopausal women but occurs at all ages Most commonly affects post-menopausal women but occurs at all ages Significant morbidity due to chronicity, scarring,psychosexual problems and SCC risk Significant morbidity due to chronicity, scarring,psychosexual problems and SCC risk

5. Prospective study of 28 post menopausal patients with LS in dermatology OPD Prospective study of 28 post menopausal patients with LS in dermatology OPD

6. Results Mean duration of symptoms 99 months Mean duration of symptoms 99 months Most common symptom itching in 96% Most common symptom itching in 96% Burning on micturition in 50% Burning on micturition in 50% 50% tried OTC treatments before seeing GP 50% tried OTC treatments before seeing GP

7. Results 60% waited >3/12 to report symptoms 60% waited >3/12 to report symptoms 21% waited 4-6/12 21% waited 4-6/12 14% 7-12/12 14% 7-12/12 25%>12/12 25%>12/12

8. Why did they wait? 42% patients thought symptoms were “normal for their age” 42% patients thought symptoms were “normal for their age” 21% too embarrassed 21% too embarrassed 71% pts would prefer female Dr 71% pts would prefer female Dr Other reasons:other health problems or family members took precedence Other reasons:other health problems or family members took precedence

9. 76% patients examined by GP 76% patients examined by GP 32% given definite diagnosis (7% candida) 32% given definite diagnosis (7% candida) Of those pts with no definite diagnosis Of those pts with no definite diagnosis 25% referred immediately to dermatology 25% referred immediately to dermatology 25% ref after 1-3/12 25% ref after 1-3/12 14% ref after 4-6/12 14% ref after 4-6/12 11% ref after7-12/12 11% ref after7-12/12

10. Conclusions Increased patient awareness required Increased patient awareness required Vulval Health Awareness Campaign Vulval Health Awareness Campaign www.vhac.org www.vhac.org www.vhac.org Education re self examination Education re self examination Increased clinician awareness Increased clinician awareness

11. Information Resources for Patients and Dr’s www.vahc.org www.vahc.org www.vahc.org www.bssvd.org www.bssvd.org www.bssvd.org www.vulvalpainsociety.org www.vulvalpainsociety.org www.vulvalpainsociety.org www.lichensclerosus.org www.lichensclerosus.org www.lichensclerosus.org www.UKLP.org.uk www.UKLP.org.uk www.UKLP.org.uk www.bashh www.bashh www.bashh

12. Clinical snippets Vulval ulceration secondary to nicorandil Vulval ulceration secondary to nicorandil May occur in pts on long standing treatment and after dosage increase May occur in pts on long standing treatment and after dosage increase

13. Clinical Snippets Increased auto-immunity in association with Lichen sclerosus and erosive Lichen planus Increased auto-immunity in association with Lichen sclerosus and erosive Lichen planus Thyroid disease most common (15% pts) Thyroid disease most common (15% pts) Coeliac disease associated with erosive LP Coeliac disease associated with erosive LP