Live Blog: Vulvar Dermatoses Part One: Knowing What to Do When You Have to Look ‘There.’ Faculty: Rochelle Torgerson, MD, PhD, and Alison Bruce, MBChB
In this live blog from the Annual Fall SDPA Conference in Orlando, FL, Rochelle Torgerson, MD, PhD, co-presented a lecture called “Vulvar Dermatoses Part One: Knowing What to Do When You Have to Look ‘There,’” with Alison Bruce, MBChB. Here are some of the highlights of Dr. Torgerson’s portion covering conditions found “downstairs.”
Dr. Torgerson recognized that it may be uncomfortable examining a patient’s genitalia because it so rarely happens in the dermatology office. Dr. Torgerson emphasized the importance of creating a safe and comfortable environment for both the patient and healthcare professional. Dr. Torgerson encouraged healthcare professionals to develop a history with the patient, establish a rapport and gain the patient’s trust and confidence.
Dr. Torgerson explained that it is important to obtain all the pertinent information from a patient. This can be challenging because some patients have never looked at their vulva, or have only infrequently (sometimes only when the patient experiences discomfort). Some patients may even refuse to look.
The goals of a physical exam are to get the patient appropriately positioned, have accessible lighting (an additional light source is helpful such as an overhead light or a flashlight), approach the genital exam methodically, and perform a full skin exam and oral exam (it can be possible that anything present on the vulva may be on other areas of the skin as well). Dr. Torgerson encouraged health care professionals to try to imagine any condition they find on the vulva on another part of the skin. This can be helpful for healthcare professionals who are less practiced at detecting conditions on the genitalia. Where have you seen something like this before on another area of the body?
Here are some of the vulva conditions Dr. Torgerson mentioned:
Vulvar or vestibular papillae present as monomorphic, round-topped and soft, cobblestone papules on labia minora. No treatment is needed except to reassure the patient. Dr. Torgerson emphasized it is important to educate the patient on the papillae so the patient doesn’t confuse them with warts later on. Pearly penile papules are the male variant of vulvar or vestibular papillae.
Fordyce spots are ectopic pilosebaceous units. They are yellow, smooth, dome-shaped, lobular papules found on the medial labia minora. No treatment is needed, but to reassure the patient.
Angiokeratoma are benign vascular papules. They appear in midlife and appear in a few or multiple patches. They can vary in color from bright red to black. They are usually asymptomatic. They may erode and bleed if they are located in a place that experiences friction. Most women, once they have a name for them and are reassured: they are comfortable living with the papules.
Epidermal cysts are the most common cysts of the vulva. It will most commonly appear on the hair-bearing skin area of the vulva. You treat an epidermal cyst just as you would on any other part of the skin.
Vulvar varicosities are dilated veins that can appear anywhere on the vulva. In theory they could come at any point of life, but often come during pregnancy because of the pressure. They usually resolve after pregnancy. If they don’t resolve, health care professionals can do sclerotherapy.
Dr. Torgerson concluded the lecture by recommending Genital Dermatology Atlas by Libby Edwards as a useful reference guide to learning more.