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LIVE BLOG: Vulvar Disease: An Overview

Dr. Lynnette Margesson lectures at the SPDA 2013 Summer Conference on Vulvar Disease.  As an overview, Dr. Margesson discusses various skin diseases that affect female patients and possible treatment options.


There is a taboo around the topic of vulvar diseases.  Some want to respect the patient by not asking “personal questions” however, as explained in the lecture, it is often at the cost of the patient.  By educating on morphology and treatments of various vulvar diseases, those working in the dermatological field can be most accurate in diagnosis.


Quick Tips for All

+ Recognize Normal Anatomy: the general patterns

+ Vulvar Papillomatosis: harmless, not wart

+ Biopsying?

Use a topical anesthetic: 2.5% prilocaine

Do a 4mm biopsy

+ Histopathology

Use a dermatohistopathologist or gynecology pathologist with skin training

+ Trust what you see; Pathology may not help

+ Recognize Concurrent Conditions: Infections, Rashes, Cancer, Trauma, Lack of Estrogen


Herpes Simplex Virus

+ Commonest cause of vulvar erosions/ulcers

+ Most women don’t know they have it

+ Very painful ulcers in immunosupressed patients



+ Commonest genital disease


Candida albicans 75%

Candida tropicalis etc. 25%


Vulvar Contact Dermatitis

Avoid it!

Don’t use wipes.

Change your pads.

No tea tree oils.

Watch out for witch hazel.

Benzocaine gives you pain!


Psoriasis (3-7% of patients)

+ In genital area, often atypical

            moist, thin red patches in skin folds

+Scratching may cause secondary infection

+Treat by

Stopping irritants

Treat the infection

Stop inflammation with topical steroids


Lichen Simplex Chronicus (LSC)

+ The itchiest of rashes

+ Itch – Scratch – Itch

+ Worse with heat, humidity, stress and irritants

+ Anatomy likely to look normal, skin will change due to itching

+ Look for more than one problem

            Contact +/- Infection +/- Dermatitis


Get them to stop scratching

Control the infection with cefadroxil

Reduce heat

Stop the excessive hygiene

Immediate therapy:

            Tap water soaks in tepid water

            Use cool packs

            No hot water or ice packs


Lichen Sclerosis

+ Most common cause of chronic vulvar disease

+ Very itchy

What it looks like:

Classic white or waxy papules and plaques

Diffuse erytheme

Secondary changes occur as well as scarring

Loss of anatomical shape

Can be Asymptomatic


 Confirm the diagnosis: Biopsy

 Their treatment will never stop, so be sure

 Control the inflammation, educate, steroids


Lichen Planus

+ An autoimmune, mucocutaneous disorder

+ If it’s in the mouth, check the vulva as well

+ 60% itchy, 70-75% pain

+ Variable morphology

+ Classic, Hypertrophic and Erosive forms

+ LP causes Desquamative Inflammatory Vaginitis


Confirm with a biopsy if needed

Stop itching, scratching

Educate patient

Control infection 


Vulvar Aphthous Ulcers

+ Average age is 14

+ Sudden onset

+ Usually multiple, painful

+ May also be in the mouth


            Control pain

            Ultrapotent corticosteroid



Commonest Missed Concurrent Vulvar Diseases

+ Candidiasis

+ Contact Dermatitis


+ Atrophy Cancer


Treat Vulvar Disease

+ Listen – review history

+ Biopsy and RE-BIOPSY

+ Look for:

– infection – Candida, HSV, bacteria

 – trauma from aggressive hygiene or other practices

– contact dermatitis

– squamous cell carcinoma


+Support – counseling as needed

+ Assess compliance



An Excellent Written Resource can be found here:

University of Michigan Center for Vulvar Diseases


[image by Jennifer Morrow]

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