An Atlas of Vulval Diseases: A Combined Dermatological, by Michèle Leibowitch, Richard Staughton, Sallie Neill, Simon

By Michèle Leibowitch, Richard Staughton, Sallie Neill, Simon Barton, Roger Marwood

This extremely popular atlas has been revised and up to date, with 60 new color illustrations highlighting key scientific issues

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Nizoral cream) or zinc pyrithionecontaining shampoos. ii. Flexures—imidazole creams, sometimes in combination with topical corticosteroids: for example, 1 % clotrimazole with 1% hydrocortisone (Canesten HC) or 2% miconazole nitrate with 1 % hydrocortisone (Daktacort cream/Econacort ointment). b. g. g. g. 200 mg daily for a week) (nystatin, griseofulvin and terbinafine are not systemically active against P. ovale). 4 Most patients find a soap substitute helpful and should be advised to avoid irritants such as bubble-baths, shampoo in the bath and heavily fragranced soaps.

65 Lichen planus nail dystrophy. Nails showing longitudinal ridging. 66 Lichen planus nail dystrophy. A more advanced case showing scarring, with pterygium deformity. 67 Mucosal lichen planus. Mouth of a patient with lichen planus, showing the lace-like white streaks seen in the non-erosive phase. 68 Histology of lichen planus. There is basal cell liquefaction at the dermo-epidermal junction with a heavy band-like subepidermal lymphocytic infiltrate (H & E, X40). Basal cell liquefaction 55 INFLAMMATORY DISEASES Erosive vulvo-vagino-gingival lichen planus (Syndrome of Hewitt and Pelisse) Erosive vulvo-vagino-gingival lichen planus (Syndrome of Hewitt and Pelisse) is a rare condition.

Lichen planus is seen in some patients with other autoimmune conditions such as primary biliary cirrhosis. Similar histopathology and clinical lesions can be seen as part of chronic graftversus-host disease following bone marrow transplantation. Lichen planus is rare in childhood and old age and usually affects 25-40 year olds. Untreated papular lesions gradually resolve leaving pigmented tattoos over 12-24 months. Occasionally scarring occurs. Renewed cropping in later years may occur. Erosive lichen planus, a very rare condition, is discussed in the next section.

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