Vulvar Dermatoses

Vulvar dermatoses are skin disorders that affect the vulva, causing itching, burning and discomfort.

These dermatologic conditions may include a type of vulvodynia, or chronic pain in the vulva. Unlike other types of vulvar pain in which there are no visible symptoms, with vulva dermatoses there are physical signs such as lesions and other changes in the color and appearance of the skin in and around the vulva.

Vulvar dermatoses can affect multiple body sites, not just the vulva. While these skin conditions can occur in younger females, they are most commonly found in postmenopausal women.

Three common types of vulvar dermatoses and their symptoms include:

Lichen simplex chronicus. This skin disorder involves intense itching that leads to a chronic itch-scratch cycle, resulting in thickening of the skin in and around the vulva. It can also affect other areas of the body including a woman's neck. Symptoms include large patches of thickened, scaly, darkened or reddened skin caused by repetitive scratching.

Lichen sclerosus. This chronic skin condition affects the vulva but can also appear on the upper body, breasts and arms. Symptoms include severe itching and pain, white patches of skin on the vulva, areas of bruising, and thin, dry, crinkled skin that splits easily, leading to burning, stinging and pain during sex and urination. Symptoms may worsen with stress. Untreated, lichen sclerosus can cause severe scarring of the vulva, include shrinking of the labia, absorption and obliteration of normal anatomy, and narrowing of the vaginal entrance. It is associated with a small increased risk of vulvar cancer. Recurrent symptoms are common.

Lichen planus. This inflammatory skin condition affects the vulva, vagina and other areas of the body, including the mouth and limbs. Symptoms include small, purplish, itchy lesions, soreness and burning, bleeding, and painful intercourse. Vaginal discharge may be heavier, sticky and/or yellow. If left untreated, lichen planus can cause scarring of the vagina and vulva.

The exact cause of vulvar dermatoses is not yet known; however an overactive immune system or genetics may play a role.

Diagnosis may include:

Pelvic exam. A pelvic exam to look for skin changes of the vulva

Biopsy. A biopsy to confirm the diagnosis and test for cancerous cells. The biopsy involves taking a small piece of tissue from the vulva and examining it under a microscope. The vulvar biopsy may be performed through colposcopy, an office procedure that uses a special microscope called a colposcope to view, magnify and biopsy the tissue lining the cervix and vagina.

Discharge sample. A discharge sample may be taken and tested to rule out infection.

Steroid therapy is typically used to reduce the itching and inflammation. Treatment may include both topical steroid creams and in some cases oral or injectable steroids. Prescription topical steroids can also help restore the skin's normal texture and strength; however treatment does not reverse any scarring that has already occurred. Any irritants identified should be avoided, such as tight-fitting clothing, detergents, soaps, etc. that may irritate vulvar skin. Once a woman has been diagnosed with vulvar dermatoses, she should be examined regularly to ensure no cancerous changes have occurred.