An Atlas of Vulval Diseases: A Combined Dermatological, Gynaecological and Venereological Approach PDF
Preview An Atlas of Vulval Diseases: A Combined Dermatological, Gynaecological and Venereological Approach
AN ATLAS OF VULVAL DISEASE An Atlas of Vulval Disease A Combined Dermatológica!, Gynaecological and Venereological Approach Michèle Leibowitch MD Professor of Dermatology Hôpital Tarnier, Paris, France Richard Staughton MA, FRCP Consultant Dermatologist Chelsea and Westminster Hospital, London, UK Sallie Neill MRCP Consultant Dermatologist St Peter's Hospital, Chertsey, Surrey; and St John's Dermatology Centre, St Thomas's Hospital, London, UK Simon Barton BSC, MD, MRCOG Consultant Physician in Genito-Urinary Medicine Chelsea and Westminster Hospital, London, UK Roger Marwood MSC, FRCOG Consultant Gynaecologist and Obstetrician Chelsea and Westminster Hospital, London, UK informa healthcare New York London CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 1997 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130828 International Standard Book Number-13: 978-1-84184-935-5 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface vii Acknowledgements ix 1 Anatomy of the vulva and classification of disease 1 2 Examination of the vulva 7 3 Commonly observed non-pathological lesions 13 4 Inflammatory diseases 19 5 Ulcerating and blistering disorders 63 6 Pilosebaceous inflammation 85 7 Infections and infestations 89 8 Tumours 125 9 Intraepithelial neoplasia 137 10 Malignant disease 145 11 Pigmented lesions 165 12 Vulval diseases in childhood 173 13 Psychological aspects of vulval disease 177 Appendix I 179 Appendix II 181 Appendix III 184 Appendix IV 186 Further reading 189 Index 191 To R.B. C.P.M.S M.J.S. VAB. S.C.M. Preface This atlas has been compiled by specialists in exposure to the clinic in their training, very dermatology, genito-urinary medicine, gynaecol important for future practice. The number of ogy and pathology. patients seen in the clinic is growing rapidly The diagnosis and management of vulval every year as our hospital colleagues and family dermatoses requires such a multidisciplinary practitioners now recognize the great need for approach and the importance of this has been such a clinic. The recent founding of a European amply demonstrated by the evolution of college for the study of vulvo-vaginal disease combined clinics. Too often in the past, complex recognizes this need and should provide a good dermatological conditions have been seen and local forum for the dissemination of knowledge. managed by specialists inexperienced in such The Health Service reforms in the UK do not disorders, resulting in inappropriate treatment. adequately address the funding of multi-disci Perhaps the worst example of this is the unfor plinary clinics. This is a major error, and the tunate patient who is subjected to the physical authors hope that this problem will be rectified and psychological trauma of a vulvectomy and in the not-too-distant future. who is still not cured of her condition. The Vulval disease in many societies can be the combined clinic is, therefore, ideal in that a subject of unnecessary and exaggerated woman will have all aspects of her disease shame and embarrassment, hence their considered and be offered the best therapeutic frequency and importance have been under advice. In addition, there are the major advan estimated. Many women with symptoms delay tages of improving education and dissemination for several years attending a physician of information across the specialties for both because of fears about the source of the staff in training and senior staff alike. condition and the examinations which might be A combined clinic was established at the necessary to investigate it. It is the duty of Westminster Hospital in 1983 with Roger de physicians to do everything possible in their Vere (Gynaecologist), Titus Oates (Genito-urinary practice to minimize this understandable specialist) and Richard Staughton (Der embarrassment and to promote such practice matologist). This clinic forged strong links amongst other doctors. between the three departments, which still exist We hope, therefore, that the wider dissemina today, despite the retirements of both Roger de tion that may be available to this economical Vere and Titus Oates, who have been replaced atlas will increase the understanding of vulval by Roger Marwood and Simon Barton. The disease and benefit the increasing numbers of junior staff in the different specialties have women presenting with vulval dermatoses. Acknowledgements Our French colleagues at Hôpital Tarnier, under All who seek to treat patients with vulval the guidance of Professor Jean Hewitt, formed disease have been inspired by the pioneers, Dr one of the first combined clinics in 1970, gather Hugh Wallace in London and Professor Jean ing together a team of Dermato-venereologists, Hewitt in Paris. Since their deaths, Dr Marjorie Gynaecologists and Pathologists. They have had Ridley and Dr Monique Pelisse have replaced a great influence on our practice and we have them as the great sources of clinical knowledge profited greatly from close collaboration with and experience to whom we have gratefully them. Their definitive text Maladies de la vulve turned over the years. published in 1987 (Jean Hewitt, Monique Pelisse We thank our very many colleagues who have and Bernard Paniel, Medisi-McGraw-Hill) and contributed so generously with advice and photo Marjorie Ridley's The Vulva (first edn, 1988, graphic material for this atlas, especially Prof B Churchill Livingstone) have been our constant Paniel, Mr R D de Vere, Mr V R Tindall, Drs S J sources of reference. It was, therefore, eminently Adams, A C Branfoot, C K Bridgett, C B Bunker, appropriate that in preparing this atlas we should I Lindsey, D A Hawkins, A G Lawrence, C N have enlisted the unrivalled experience of Mallinson, S Mayou, M Moyal Barraco, M Pelisse Professor Michèle Leibowitch, herself a and P L Samarasinghe. Dermatologist and Pathologist and a member of We thank our electronic scribe Jennifer Fell for the Tarnier team, whose knowledge and experi coping so well with five authors and bilingual ence of the subject was invaluable. The majority dictaphonics. Alison Campbell, Rosemary Allen of the histological illustrations in the atlas are also and Martin Dunitz have been kindly and patient French, and we are extremely grateful to all our publishers, and Kevin Marks produced the colleagues at the Hôpital Tarnier for their co marvellous artwork. operation, encouragement and friendship over the Those at home who have tolerated our years. invasions and migrations: we salute you. Authors' Note A small number of photographs appear in this text showing examinations being undertaken by clinicians who are not wearing gloves. These are older photo graphs, and the authors would like to stress that nowadays gloves should always be worn during a physical examination.
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