Gynecologic Dermatology: Symptoms, Signs and Clinical Management Gudula Kirtschig, Susan M Cooper
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1GYNECOLOGIC DERMATOLOGY SYMPTOMS, SIGNS AND CLINICAL MANAGEMENT2
3GYNECOLOGIC DERMATOLOGY SYMPTOMS, SIGNS AND CLINICAL MANAGEMENT
GUDULA KIRTSCHIG, MD, PhD Consultant Dermatologist University of Tübingen Tübingen Germany SUSAN M COOPER, MD, FRCP Consultant Dermatologist Department of Dermatology Oxford University Hospitals NHS Foundation Trust Honorary Senior Clinical Lecturer University of Oxford Oxford UK
4© 2016 JP Medical Ltd.
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The rights of Gudula Kirtschig and Susan M Cooper to be identified as editors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication (with the exception of Figure 5.2, which is intended to be copied as required) may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission in writing of the publishers. Permissions may be sought directly from JP Medical Ltd at the address printed above.
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9781909836013
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A catalog record for this book is available from the Library of Congress
Publisher:
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Associate Publisher:
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5Preface
Vulvar medicine spans the disciplines of dermatology, gynecology and sexual health. Many conditions affecting the vulva also affect the skin elsewhere, but their appearance may be modified by the vulvar environment, which is prone to heat, friction and occlusion. However, some conditions are unique to the vulvar site, influenced by hormonal and microbiological factors. Vulvar disorders may present, for example, as infections, inflammatory rashes or pigmented lesions, or simply cause pain. Time spent taking a careful history and carrying out a full examination is time well spent, increasing the chance of the correct diagnosis being made. The subsequent management of some vulvar conditions is complex and a multidisciplinary approach is often required.
Vulvar dermatology is still a developing discipline, and training and expertise is very variable amongst physicians. It is often difficult for practitioners to obtain practical help to deal with some of the problems they encounter in the clinic. There is a paucity of practical texts, with enough depth to satisfy the specialist but also be an aid to the generalist.
Gynecologic Dermatology: Symptoms, Signs and Clinical Management has been written to serve the specialist but also lead the generalist in a stepwise manner, offering basic knowledge about important vulvar conditions. The book has been written from a clinical perspective, and aims to assist the reader by providing a practical symptom- and sign-based approach. Features of the normal vulva are discussed in section one; section two covers diseases by symptoms such as itch and pain as well as by physical signs such as redness and white skin. In section three, individual diseases are each discussed in separate chapters written by experts in the field. Many tables and illustrations have been included to illuminate the text, highlight key points, and help the reader retain important information.
Many women still suffer in silence from irritating and often distressing vulvar symptoms, either because of embarrassment or because they believe that nothing can be done to help them. It is vital women receive the correct diagnosis and management when they seek professional help. The editors hope that Gynecologic Dermatology: Symptoms, Signs and Clinical Management supports the delivery of high quality care for patients with vulvar conditions and that, for some patients, it may help to change their lives for the better.
Gudula Kirtschig
Susan M Cooper
February 20166
7Acknowledgements
We would like firstly to acknowledge our debt to Professor Fenella Wojnarowska who led the Oxford vulvar service for many years. She inspired both of us to work in vulvar dermatology and we are grateful for her enthusiastic support.
We are grateful to the colleagues who made this book possible by contributing chapters. Many more of our colleagues were also helpful during the preparation of Gynecologic Dermatology. We would particularly like to mention Professor Dr Theo M Starink and Dr Remco van Doorn of Leiden University Medical Center, and Dr Juliette Hoefnagel of Sint Lucas Andreas Ziekenhuis, Amsterdam, the Netherlands for their reviews and constructive criticism throughout the development of the book.
Dr Yves Bogaerts from Blankenberge in Belgium kindly provided the drawing of a ‘normal vulva’ (Figure 5.2) – a piece of artwork that is intended to serve as a master copy when taking notes in clinics and which may be copied freely.
Finally, we owe an enormous debt to our families for their understanding.
GK
SMC89101112
13Contributors
  • Ruth Asher, MB, ChB, FRCPath, DipRCPath(Derm)
  • Consultant Dermatopathologist
  • Department of Cellular Pathology
  • John Radcliffe Hospital
  • Oxford
  • UK
  • Tanja Gizela Bohl, MBBS, Dip RACOG, FACD
  • Jean Hailes Medical Centre for Women
  • Monash
  • Melbourne
  • Australia
  • Jan Brockie, SRN, NMP
  • Advanced Nurse Practitioner
  • Menopause Service
  • Women's Centre
  • John Radcliffe Hospital
  • Oxford
  • UK
  • Katherine Brown, MBBS, Dip RACOG, Dip Venereology, MSc
  • M Forensic Medicine, FAChSHM, FFCFM
  • Medical Director, Ambulatory and Primary Health Care
  • Illawarra Shoalhaven Local Health District
  • Sydney Medical School
  • University of Sydney
  • Graduate School of Medicine
  • University of Wollongong
  • NSW
  • Australia
  • Fanny Camus, MD
  • Dermatologist and Venerologist
  • Department of Dermatology Venerology
  • Université Libre de Bruxelles (ULB)
  • Brussels
  • Belgium
  • Iskander H Chaudhry, MBChB, FRCPath
  • Consultant Pathologist
  • Department of Histopathology
  • St James's University Hospital
  • Leeds
  • UK
  • Susan M Cooper, MD, FRCP
  • Consultant Dermatologist
  • Department of Dermatology
  • Oxford University Hospitals NHS Foundation Trust
  • Honorary Senior Clinical Lecturer
  • University of Oxford
  • Oxford
  • UK
  • Christa De Cuyper, MD
  • Dermatologist
  • Department of Dermatology
  • AZ Sint-Jan Brugge-Oostende AV
  • Belgium
  • Joanne de Hullu, MD, PhD
  • Associate Professor
  • Gynecologic Oncologist
  • Radboud University Nijmegen Medical Centre
  • Nijmegen
  • The Netherlands
  • Marianne GR De Maeseneer, MD, PhD
  • Vascular Surgeon
  • Department of Dermatology, Phlebology Section
  • Erasmus University Medical Center
  • Rotterdam
  • The Netherlands
  • Barbara Eberz, MD
  • Specialist in Gynaecology and Obstetrics
  • Reference Center for Vulvar Diseases
  • Vice President, Interdisciplinary Interest Group for Vulvar Diseases
  • Mürzzuschlag
  • Austria
  • Sylvie M Franken, MD
  • Dermatologist
  • Department of Dermatology
  • VU Medical Centre
  • Amsterdam
  • The Netherlands
  • Karen L Gibbon, MB ChB, FRCP
  • Consultant Dermatologist
  • Department of Dermatology
  • Whipps Cross University Hospital
  • Barts Health NHS Trust
  • London
  • UK
  • Andreas R Günthert, MD
  • Professor of Gynecology and Obstetrics
  • Department of Gynecology and Obstetrics
  • Cantonal Hospital of Lucerne
  • Lucerne
  • Switzerland
  • 14Michael A Hambardzumyan, MD
  • Research Associate
  • Medical Scientific Centre of Dermatology and STI
  • Yerevan State Medical University
  • Armenia
  • Anne Lise Ording Helgesen, MD
  • Senior Consultant
  • Norwegian National Advisory Unit on Women's Health
  • Department of Dermatology and Faculty of Medicine
  • University of Oslo
  • Oslo
  • Norway
  • Aysha Javed, MBChB, MRCP(UK)
  • Consultant Dermatologist
  • Department of Dermatology
  • Lancashire Teaching Hospitals NHS Trust
  • Warrington
  • UK
  • Gregor B E Jemec, MD, DMedSc
  • Professor of Dermatology
  • Chairman, Department of Dermatology
  • Roskilde Hospital
  • Roskilde
  • Health Sciences Faculty
  • University of Copenhagen
  • Copenhagen
  • Denmark
  • Gudula Kirtschig, MD, PhD
  • Consultant Dermatologist
  • University of Tübingen
  • Tübingen
  • Germany
  • Claudia E Marchitelli, MD
  • Chief of Vulvar Disease and Surgery
  • President, International Society for the Study of Vulvovaginal Diseases
  • Department of Gynecology
  • Hospital Italiano de Buenos Aires
  • Buenos Aires
  • Argentina
  • Janet McLelland, BSc, MBBS(Hons), MD, FRCP
  • Consultant Dermatologist
  • Dermatology Department
  • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Newcastle upon Tyne
  • UK
  • George Meligonis, MBBCh, FCPath(SA)
  • Consultant Histopathologist
  • Department of Histopathology
  • Addenbrooke's Hospital
  • Cambridge
  • UK
  • William James Merchant, MD, ChB, FRCPath
  • Consultant Histopathologist
  • St James's Hospital
  • Leeds
  • UK
  • Maja Mockenhaupt, MD, PhD
  • Senior Dermatologist; Head of German Registry on Severe Skin Reactions (dZh); Coordinator of the International RegiSCAR-Study Group
  • Medical Center, University of Freiburg
  • Department of Dermatology
  • Documentation Center for Severe Skin Reactions
  • Freiburg
  • Germany
  • Ruth Murphy, MbChB, MMEdSci (Med Ed), PhD, FRCP
  • Consultant in Paediatiric and Adult Dermatology
  • Sheffield University Teaching Hospitals
  • Sheffield Childrens' Hospital
  • Sheffield
  • Honorary Associate Clinical Professor
  • Nottingham University
  • Nottingham
  • UK
  • David Nunns, MD, FRCOG
  • Consultant Gynaecological Oncologist
  • Department of Gynaecological Oncology
  • Nottingham University Hospitals NHS Trust
  • Nottingham
  • UK
  • Dominique Parent, MD, PhD
  • Professor of Dermatology and Venerology
  • School of Medicine and Dentistry
  • School of Pharmacy
  • Université Libre de Bruxelles (ULB)
  • Brussels
  • Belgium
  • Mariola Pawlaczyk, MD, PhD
  • Assistant Professor of Dermatology and Venereology
  • Department of Skin Diseases Prophylaxis
  • Poznan University of Medical Sciences
  • Poznan
  • Poland
  • Michał Pawlaczyk, MD, PhD
  • Assistant Professor of Gynaecology and Obstetrics
  • Department of Gynaecology and Obstetrics
  • Szamotuły District Hospital
  • Szamotuły
  • Poland
  • Christiane Pfeiffer, MD, PhD
  • Department of Dermatology and Allergology
  • Ulm University
  • Ulm
  • Germany
  • 15Marjo J Ramakers, MD
  • Registered Sexologist NVVS/Fellow ECSM
  • CenSeRe (Center for Psychological, Relational and Sexual Health)
  • Voorschoten
  • The Netherlands
  • Sigrid Regauer, MD
  • Professor of Pathology
  • Institute of Pathology
  • Medical University Graz
  • Graz
  • Austria
  • Thomas Rustemeyer, MD, PhD
  • Professor of Dermato-Allergology and Occupational Dermatology
  • VU University Medical Centre
  • Amsterdam
  • The Netherlands
  • Ditte M Saunte, MD, PhD
  • Associate Professor and Consultant
  • Department of Dermatology
  • Roskilde Hospital
  • Roskilde
  • Denmark
  • Mirte Siemerink, MD
  • Dermatologist
  • Department of Dermatology
  • Erasmus University Medical Center
  • Rotterdam
  • The Netherlands
  • Michael Sticherling, MD
  • Professor of Dermatology
  • Skin Clinic, University Hospital Erlangen
  • Erlangen
  • Germany
  • Tom J Stoof, MD, PhD
  • Dermatologist
  • Department of Obstetrics and Gynaecology
  • VU Medical Centre
  • Amsterdam
  • The Netherlands
  • Kathy Taghipour, MD(Res), MRCP
  • Consultant Dermatologist
  • Department of Dermatology
  • Whittington Health
  • London
  • UK
  • Ad A van Bodegraven, MD, PhD
  • Departments of Gastroenterology, Geriatrics, Intensive Care Medicine, and Internal Medicine
  • Zuyderland Medical Centre
  • Heerlen-Sittard-Geleen
  • Department of Gastroenterology and Hepatology
  • VU University Medical Centre
  • Amsterdam
  • The Netherlands
  • Hedwig van de Nieuwenhof, MD, PhD
  • Resident in Obstetrics and Gynaecology
  • Radboud University Nijmegen Medical Centre
  • Nijmegen
  • The Netherlands
  • Irene A M van der Avoort, MD, PhD
  • Gynaecologist
  • Department of Obstetrics and Gynaecology
  • Ikazia Hospital
  • Rotterdam
  • The Netherlands
  • Laura T H Wang, MD
  • Assistant Professor of Clinical Obstetrics and Gynecology
  • University of South Carolina School of Medicine – Greenville
  • Department of Obstetrics and Gynecology
  • Greenville Health System
  • Greenville, South Carolina
  • USA
  • Jennifer Anne Yell, MBChB, FRCP, MD
  • Consultant Dermatologist
  • Central Manchester University Hospitals NHS Foundation Trust
  • Manchester
  • UK
  • Mirjana Ziemer, MD, PD Dr. Med. Habil.
  • University of Leipzig
  • Department of Dermatology, Venereology and Allergology
  • Leipzig
  • Germany
  • Martin Zikeli, MD
  • Consultant Dermatologist
  • Department of Dermatology
  • State Hospital Wiener Neustadt
  • Wiener Neustadt
  • Austria
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