Derm Cases · Dermatology / Colorectal
OSCE — chronic perianal itch with white plaques
OSCE: diagnose perianal LS, plan ultra-potent steroid care, counsel surveillance, and state EMPD biopsy red flags.
On this page
Study tools
Target exams
NEET-PGINICETPLABMRCP
Prompt
OSCE: diagnose perianal LS, plan ultra-potent steroid care, counsel surveillance, and state EMPD biopsy red flags.
Brief (to candidate)
A 55-year-old woman has chronic perianal itch and white sclerotic plaques with fissuring. Prior antifungal creams helped only briefly. Assess, give the working diagnosis, outline management and counselling, and state when you would biopsy.
Candidate instructions
- Focused history (night itch, bowel habit, products, genital involvement).
- State working diagnosis and key differentials.
- Examination priorities.
- Medical therapy plan.
- Safety-net for neoplasia and infection.
- Shared-care / referral thresholds.
Examiner checklist
| Domain | Key actions expected |
|---|---|
| Diagnosis | Perianal / anogenital lichen sclerosus for chronic white sclerosis + itch[1] |
| DDx | Inverse psoriasis, candida, EMPD, structural disease |
| Therapy | Ultra-potent topical steroid ointment pathway + barrier/hygiene[3] |
| Biopsy | Non-healing, indurated, ulcerated, or atypical plaque → EMPD/neoplasia concern[8] |
| Communication | Chronic disease; surveillance; not automatically an STI |
Model key actions
- Name LS; stop endless empirical antifungals as sole plan.[1]
- Clobetasol-structured plan and follow-up.[3]
- Explicit EMPD/biopsy safety-net.[8]
Common errors
- Labelling only “pruritus ani.”
- Chronic antifungal without reassessment.
- Missing biopsy threshold for EMPD.
- Ignoring contiguous vulval disease.
References3ShowHide
- [1]De Luca DA, et al. Lichen sclerosus 2023 update. Front Med, 2023.PMID 36873861
- [3]Kirtschig G, et al. EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus. JEADV, 2024.PMID 38822598
- [8]St Claire K, et al. Extramammary Paget disease. Dermatol Online J, 2019.PMID 31046904