Skip to main content
SpringerLink
Log in
Book cover

Postmenopausal Diseases and Disorders pp 101–120Cite as

Vulvar Dermatoses and Menopause

  • Chapter
  • First Online:

Abstract

Vulvar dermat may have added an increased risk of missing oses are prevalent inflammatory conditions, frequently associated with itching and burning. The diagnosis is usually clinical but sometimes challenging due to superimposed or associated conditions. This challenge can be harder in postmenopausal women, as the signs and symptoms of vulvovaginal atrophy frequently overlap with those of a dermatosis. Recently, the creation of the “genitourinary syndrome of menopause” may have added an increased risk of missing vulvar diseases.

While these are benign conditions, some (lichen sclerosus and lichen planus) can increase the risk of vulvar cancer, through the pathway of vulvar intraepithelial neoplasia, differentiated type. Failing to recognize this is a missed opportunity to avoid vulvar cancer.

Vulvovaginal symptoms are a frequent cause of gynaecological referral, and dermatologic conditions should always be considered among the differential diagnosis. A systematic evaluation of the symptoms may simplify the diagnostic process.

The authors consider that the classification proposed by the International Society for the Study of Vulvovaginal Diseases (ISSVD), in 2006, and the 2011 terminology are both useful and complimentary tools in daily clinical practice.

In this chapter, the most common vulvar dermatoses encountered in postmenopausal women—lichen simplex chronicus, lichen sclerosus, lichen planus, psoriasis, and atopic and contact dermatitis—are reviewed. An evaluation of the state of the art regarding pathology, classification, and treatment is made.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Stockdale CK, Boardman L. Diagnosis and treatment of vulvar dermatoses. Obstet Gynecol. 2018;131(2):371–86.

    Article  Google Scholar 

  2. Ozalp SS, et al. Vulval pruritus: the experience of gynaecologists revealed by biopsy. J Obstet Gynaecol. 2015;35(1):53–6.

    Article  CAS  Google Scholar 

  3. American College of Obstetricians and Gynecologists. Diagnosis and management of vulvar skin disorders. ACOG practice bulletin no. 93. Obstet Gynecol. 2008;111:1243–53.

    Article  Google Scholar 

  4. Vieira-Baptista P, et al. Deconstructing the genitourinary syndrome of menopause. Int Urogynecol J. 2017;28(5):675–9.

    Article  Google Scholar 

  5. Lynch PJ, Moyal-Barrocco M, Bogliatto F, Micheletti L, Scurry J. 2006 ISSVD classification of vulvar dermatoses: pathologic subsets and their clinical correlates. J Reprod Med. 2007;52(1):3–9.

    Google Scholar 

  6. Lynch PJ. 2006 International Society for the Study of Vulvovaginal Disease Classification of Vulvar Dermatoses: a synopsis. J Low Genit Tract Dis. 2007;11(1):1–2.

    Article  Google Scholar 

  7. Lynch PJ, Moyal-Barracco M, Scurry J, Stockdale C. 2011 ISSVD Terminology and Classification of Vulvar Dermatological Disorders: an approach to clinical diagnosis. J Low Genit Tract Dis. 2012;16(4):339–44.

    Article  Google Scholar 

  8. Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17:8–19.

    Article  Google Scholar 

  9. Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353:1777–83.

    Article  CAS  Google Scholar 

  10. Goldstein AT, Marinoff SC, Christopher K, Srodon M. Prevalence of vulvar lichen sclerosus in a general gynecology practice. J Reprod Med. 2005;50(7):477–80.

    PubMed  Google Scholar 

  11. Leibovitz A, Kaplun VV, Saposhnicov N, Habot B. Vulvovaginal examinations in elderly nursing home women residents. Arch Gerontol Geriatr. 2000;31:1–4.

    Article  CAS  Google Scholar 

  12. Pérez-López FR, Vieira-Baptista P. Lichen sclerosus in women: a review. Climacteric. 2017;20(4):339–47.

    Article  Google Scholar 

  13. Vieira-Baptista P. Lichen Sclerosus in breast cancer survivor. J Gen Intern Med. 2013;28(3):344.

    Article  Google Scholar 

  14. Vieira-Baptista P, Lima Silva J, Cavaco-Gomes J, Beires J, Martinez-De-Oliveira J. What differentiates symptomatic from asymptomatic women with lichen sclerosus? Gynecol Obstet Invest. 2015;79:263–8.

    Article  Google Scholar 

  15. Xavier J, Vieira-Baptista P, Moreira A, Portugal R, Beires J. Vaginal lichen sclerosus: report of two cases. Facts Views Vis Obgyn. 2017;9(3):171–3.

    CAS  PubMed  Google Scholar 

  16. Halonen P, Jakobsson M, Heikinheimo O, Riska A, Gissler M, Pukkala E. Lichen sclerosus and risk of cancer. Int J Cancer. 2017;140:1998–2002.

    Article  CAS  Google Scholar 

  17. Preti M, Scurry J, Marchitelli CE, Micheletti L. Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol. 2014;28:1051–62.

    Article  Google Scholar 

  18. Cooper SM, Gao XH, Powell JJ, Wojnarowska F. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004;140:702–6.

    Article  CAS  Google Scholar 

  19. Brodrick B, Belkin ZR, Goldstein AT. Influence of treatments on prognosis for vulvar lichen sclerosus: facts and controversies. Clin Dermatol. 2013;780–6(2013):31.

    Google Scholar 

  20. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for the use of topical glucocorticosteroids. J Am Acad Dermatol. 1996;35:615–9.

    Article  CAS  Google Scholar 

  21. Funaro D, Lovett A, Leroux N, Powell J. A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2014;71:84–91.

    Article  CAS  Google Scholar 

  22. Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatol. 2015;151:1061–7.

    Article  Google Scholar 

  23. Eshtiaghi P, Sadownik L. Fact or fiction? Adipose-derived stem cells and platelet-rich plasma for the treatment of vulvar lichen sclerosus. J Low Genit Tract Dis. 2018;1:2018.

    Google Scholar 

  24. Bostanci S, Akay BN, Ertop P, Vural S, Okcu Heper A. Lichen sclerosus associated with Nd:YAG laser therapy. J Cosmet Laser Ther. 2019;21:69–70.

    Article  Google Scholar 

  25. ISSVD I. ISSVD/ICS comments on the FDA communication on the use of energy-based devices to perform vaginal “rejuvenation” or vaginal cosmetic procedures. 2018. https://3b64we1rtwev2ibv6q12s4dd-wpengine.netdna-ssl.com/wp-content/uploads/2018/08/2018_08_05-ISSVD_ICS.pdf.

  26. Andreassi L, Bilenchi R. Non-infectious inflammatory genital lesions. Clin Dermatol. 2014;32:307–14.

    Article  Google Scholar 

  27. Micheletti L, Preti M, Bogliatto F, Zanotto-Valentino MC, Ghiringhello B, Massobrio M. Vulval lichen planus in the practice of a vulval clinic. Br J Dermatol. 2000;143(6):1349–50.

    Article  CAS  Google Scholar 

  28. Alaizari N, Al-Maweri S, Al-Shamiri H, Tarakji B, Shugaa-Addin B. Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J. 2016;61(3):282–7.

    Article  CAS  Google Scholar 

  29. Fruchter R, Melnick L, Pomeranz MK. Lichenoid vulvar disease: a review. Int J Womens Dermatol. 2017;3(1):58–64.

    Article  CAS  Google Scholar 

  30. Cooper SM, Wojnarowska F. Influence of treatment of erosive lichen planus of the vulva on its prognosis. Arch Dermatol. 2006;142:289–94.

    PubMed  Google Scholar 

  31. Lewis FM. Vulval lichen planus. Br J Dermatol. 1998;138(4):569–75.

    Article  CAS  Google Scholar 

  32. Schlosser BJ, Mirowski G. Lichen sclerosus and lichen planus in women and girls. Clin Obstet Gynecol. 2015;58:125–42.

    Article  Google Scholar 

  33. Halonen P, Jakobssen M, Heikinheimo O, Riska A, Gissler M, Pukkala E. Cancer risk of Lichen planus: a cohort study of 13,100 women in Finland. Int J Cancer. 2018;142(1):18–22.

    Article  CAS  Google Scholar 

  34. Regauer S, Reich O, Eberz B. Vulvar cancers in women with vulvar lichen planus: a clinicopathological study. J Am Acad Dermatol. 2014;71(4):698–707.

    Article  Google Scholar 

  35. Day T, Otton G, Jaaback K, Weigner J, Scurry J. Is vulvovaginal lichen planus associated with squamous cell carcinoma? J Low Genit Tract Dis. 2018;22(2):159–65.

    Article  Google Scholar 

  36. Preti M, Micheletti L, Privitera S, et al. Vulvar lichen planus. J Low Genit Tract Dis. 2018;22(3):264–5.

    Article  Google Scholar 

  37. Simonetta C, Burns EK, Guo MA. Vulvar dermatoses: a review and update. Mo Med. 2015;112:301–7.

    PubMed  PubMed Central  Google Scholar 

  38. Meeuwis KA, de Hullu J, Massuger LF, van de Kerkhof PC, van Rossum MM. Genital psoriasis: a systematic literature review on this hidden skin disease. Acta Derm Venereol. 2011;91:5–11.

    Article  Google Scholar 

  39. American College of Obstetricians and Gynecologists. Management of menopausal symptoms. ACOG Practice Bulletin Number 141. Obstet Gynecol. 2014;123:202–16.

    Article  Google Scholar 

  40. Sand FL, Thomsen SF. Skin diseases of the vulva: eczematous diseases and contact urticaria. J Obstet Gynaecol. 2018;38(3):295–300.

    Article  Google Scholar 

  41. Stockdale CK, Boardman LA. Evaluation and treatment of postmenopausal dyspareunia. J Clin Outcomes Manag. 2011;414–23(2011):18.

    Google Scholar 

  42. North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of the North American Menopause Society. Menopause. 2013;20:888–902, 2013.

    Article  Google Scholar 

Download references

Conflict of Interest

No conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Gynaecology and Obstetrics Department, Centro Hospitalar de São João, Porto, Portugal

    Joana Lyra

  2. Hospital Lusíadas Porto, Porto, Portugal

    Pedro Vieira-Baptista

  3. Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal

    Pedro Vieira-Baptista

Authors
  1. Joana Lyra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pedro Vieira-Baptista
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Zaragoza Facultad de Medicina, Zaragoza, Spain

    Faustino R. Pérez-López

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lyra, J., Vieira-Baptista, P. (2019). Vulvar Dermatoses and Menopause. In: Pérez-López, F. (eds) Postmenopausal Diseases and Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-13936-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-13936-0_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-13935-3

  • Online ISBN: 978-3-030-13936-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation