Advertisement

Gynecologic Dermatology

  • Priscilla Sepe
  • Amy ClouseEmail author
Chapter
Part of the Current Clinical Practice book series (CCP)

Abstract

Skin changes that may occur in the vulvovaginal area can be common in women. These conditions occur most often in postmenopausal women but can also occur in adult women of all ages. It is important to be able to recognize these conditions based on history and appearance. The clinician, in some conditions, may need to perform a skin biopsy to confirm the diagnosis. Treatment can vary from moisturizers to hormonal preparations to high potency steroids to topical calcineurin inhibitors based on which condition is diagnosed.

Keywords

Menopause Lichen sclerosus Lichen planus Lichen simplex chronicus 

References

  1. 1.
    Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Climacteric. 2014;17(5):557–63.PubMedCrossRefGoogle Scholar
  2. 2.
    ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123(1):202–16.CrossRefGoogle Scholar
  3. 3.
    McLendon AN, Clinard VB, Woodis CB. Ospemifene for the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women. Pharmacotherapy. 2014;34(10):1050–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975–4011.PubMedCrossRefGoogle Scholar
  5. 5.
    North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17(2):242–55.CrossRefGoogle Scholar
  6. 6.
    ACOG Practice Bulletin No. 93: diagnosis and management of vulvar skin disorders. Obstet Gynecol. 2008;111(5):1243–53.CrossRefGoogle Scholar
  7. 7.
    Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013;14(1):27–47.PubMedCrossRefGoogle Scholar
  8. 8.
    Cooper SM, Gao XH, Powell JJ, Wojnarowska F. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004;140(6):702–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Kirtschig G, Becker K, Günthert A, et al. Evidence-based (S3) guideline on (anogenital) lichen sclerosus. J Eur Acad Dermatol Venereol. 2015;29(10):e1–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Meyrick Thomas RH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus etatrophicus and autoimmunity—a study of 350 women. Br J Dermatol. 1988;118(1):41–6. Erratum in: Br J Dermatol. 1988;118(5):736.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper SM, Ali I, Baldo M, Wojnarowska F. The association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease: a case-control study. Arch Dermatol. 2008;144(11):1432–5.PubMedGoogle Scholar
  12. 12.
    Hagedorn M, Buxmeyer B, Schmitt Y, Bauknecht T. Survey of genital lichen sclerosus in women and men. Arch Gynecol Obstet. 2002;266(2):86–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Harrington CI, Dunsmore IR. An investigation into the incidence of auto-immune disorders in patients with lichen sclerosus and atrophicus. Br J Dermatol. 1981;104(5):563–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Simpkin S, Oakley A. Clinical review of 202 patients with vulval lichen sclerosus: a possible association with psoriasis. Australas J Dermatol. 2007;48(1):28–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Howard A, Dean D, Cooper S, et al. Circulating basement membrane zone antibodies are found in lichen sclerosus of the vulva. Australas J Dermatol. 2004;45(1):12–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Oyama N, Chan I, Neill SM, et al. Autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Lancet. 2003;362(9378):118–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Neill SM, Lewis FM, Tatnall FM, Cox NH, British Association of Dermatologists. British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol. 2010;163(4):672–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Smith YR, Haefner HK. Vulvar lichen sclerosus: pathophysiology and treatment. Am J Clin Dermatol. 2004;5(2):105–25.PubMedCrossRefGoogle Scholar
  19. 19.
    Aidé S, Lattario FR, Almeida G, do Val IC, da Costa Carvalho M. Epstein-Barr virus and human papillomavirus infection in vulvar lichen sclerosus. J Low Genit Tract Dis. 2010;14(4):319–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Eisendle K, Grabner T, Kutzner H, Zelger B. Possible role of Borrelia burgdorferi sensu lato infection in lichen sclerosus. Arch Dermatol. 2008;144(5):591–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Thomas RH, Ridley CM, McGibbon DH, Black MM. Anogenital lichen sclerosus in women. J R Soc Med. 1996;89(12):694–8.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Burrows LJ, Creasey A, Goldstein AT. The treatment of vulvar lichen sclerosus and female sexual dysfunction. J Sex Med. 2011;8(1):219–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Van de Nieuwenhof HP, Meeuwis KA, Nieboer TE, et al. The effect of vulvar lichen sclerosus on quality of life and sexual functioning. J Psychosom Obstet Gynaecol. 2010;31(4):279–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Selk A. A survey of experts regarding the treatment of adult vulvar lichen sclerosus. J Low Genit Tract Dis. 2015;19(3):244–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Murina F, Rehman S, Di Francesco S, et al. Vulvar lichen sclerosus: a comparison of the short-term topical application of clobetasol dipropionate 0.05% versus mometasone furoate 0.1%. J Low Genit Tract Dis. 2015;19(2):149–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Virgili A, Borghi A, Toni G, Minghetti S, Corazza M. First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability. Br J Dermatol. 2014;171(2):388–96.PubMedCrossRefGoogle Scholar
  27. 27.
    Goldstein AT, Creasey A, Pfau R, Phillips D, Burrows LJ. A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J Am Acad Dermatol. 2011;64(6):e99–104.PubMedCrossRefGoogle Scholar
  28. 28.
    Oskay T, Sezer HK, Genç C, Kutluay L. Pimecrolimus 1% cream in the treatment of vulvar lichen sclerosus in postmenopausal women. Int J Dermatol. 2007;46(5):527–32.PubMedCrossRefGoogle Scholar
  29. 29.
    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(1):84–91.PubMedCrossRefGoogle Scholar
  30. 30.
    FDA. Public Health Advisory: Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment. 10 Mar 2005. Retrieved from http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm051760.htm. Accessed on 30 July 2016.
  31. 31.
    Brodrick B, Belkin ZR, Goldstein AT. Influence of treatments on prognosis for vulvar lichen sclerosus: facts and controversies. Clin Dermatol. 2013;31(6):780–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Kroft EB, Berkhof NJ, van de Kerkhof PC, Gerritsen RM, de Jong EM. Ultraviolet A phototherapy for sclerotic skin diseases: a systematic review. J Am Acad Dermatol. 2008;59(6):1017–30.PubMedCrossRefGoogle Scholar
  33. 33.
    Simonart T, Lahaye M, Simonart JM. Vulvar lichen sclerosus: effect of maintenance treatment with a moisturizer on the course of the disease. Menopause. 2008;15(1):74–7.PubMedGoogle Scholar
  34. 34.
    Jones RW, Scurry J, Neill S, MacLean AB. Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics. Am J Obstet Gynecol. 2008;198(5):496.e1–3.CrossRefGoogle Scholar
  35. 35.
    Wang SH, Chi CC, Wong YW, Salim A, Manek S, Wojnarowska F. Genital verrucous carcinoma is associated with lichen sclerosus: a retrospective study and review of the literature. J Eur Acad Dermatol Venereol. 2010;24(7):815–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Eva LJ. Screening and follow up of vulval skin disorders. Best Pract Res Clin Obstet Gynaecol. 2012;26(2):175–88.PubMedCrossRefGoogle Scholar
  37. 37.
    Bradford J, Fischer G. Long-term management of vulval lichen sclerosus in adult women. Aust N Z J Obstet Gynaecol. 2010;50(2):148–52.PubMedCrossRefGoogle Scholar
  38. 38.
    Renaud-Vilmer C, Cavelier-Balloy B, Porcher R, Dubertret L. Vulvar lichen sclerosus: effect of long-term topical application of a potent steroid on the course of the disease. Arch Dermatol. 2004;140(6):709–12.PubMedCrossRefGoogle Scholar
  39. 39.
    Di Fede O, Belfiore P, Cabibi D, et al. Unexpectedly high frequency of genital involvement in women with clinical and histological features of oral lichen planus. Acta Derm Venereol. 2006;86(5):433–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Cooper SM, Wojnarowska F. Influence of treatment of erosive lichen planus of the vulva on its prognosis. Arch Dermatol. 2006;142(3):289–94.PubMedCrossRefGoogle Scholar
  41. 41.
    Clayton R, Chaudhry S, Ali I, et al. Mucosal (oral and vulval) lichen planus in women: are angiotensin-converting enzyme inhibitors protective, and beta-blockers and non-steroidal anti-inflammatory drugs associated with the condition? Clin Exp Dermatol. 2010;35(4):384–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Bradford J, Fischer G. Management of vulvovaginal lichen planus: a new approach. J Low Genit Tract Dis. 2013;17(1):28–32.PubMedCrossRefGoogle Scholar
  43. 43.
    Santegoets LA, Helmerhorst TJ, van der Meijden WI. A retrospective study of 95 women with a clinical diagnosis of genital lichen planus. J Low Genit Tract Dis. 2010;14(4):323–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Helgesen AL, Gjersvik P, Jebsen P, Kirschner R, Tanbo T. Vaginal involvement in genital erosive lichen planus. Acta Obstet Gynecol Scand. 2010;89(7):966–70.PubMedCrossRefGoogle Scholar
  45. 45.
    Kirtschig G, Wakelin SH, Wojnarowska F. Mucosal vulval lichen planus: outcome, clinical and laboratory features. J Eur Acad Dermatol Venereol. 2005;19(3):301–7. Erratum in: J Eur Acad Dermatol Venereol. 2005;19(4):530.PubMedCrossRefGoogle Scholar
  46. 46.
    Simpson RC, Littlewood SM, Cooper SM, et al. Real-life experience of managing vulval erosive lichen planus: a case-based review and U.K. multicentre case note audit. Br J Dermatol. 2012;167(1):85–91.PubMedCrossRefGoogle Scholar
  47. 47.
    Belfiore P, Di Fede O, Cabibi D, et al. Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study. Br J Dermatol. 2006;155(5):994–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Cheng S, Kirtschig G, Cooper S, et al. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev. 2012;(2):CD008092.Google Scholar
  49. 49.
    Byrd JA, Davis MD, Rogers RS 3rd. Recalcitrant symptomatic vulvar lichen planus: response to topical tacrolimus. Arch Dermatol. 2004;140(6):715–20.PubMedCrossRefGoogle Scholar
  50. 50.
    Lonsdale-Eccles AA, Velangi S. Topical pimecrolimus in the treatment of genital lichen planus: a prospective case series. Br J Dermatol. 2005;153(2):390–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Anderson M, Kutzner S, Kaufman RH. Treatment of vulvovaginal lichen planus with vaginal hydrocortisone suppositories. Obstet Gynecol. 2002;100(2):359–62.PubMedGoogle Scholar
  52. 52.
    Fairchild PS, Haefner HK. Surgical management of vulvovaginal agglutination due to lichen planus. Am J Obstet Gynecol. 2016;214(2):289.e1–2.CrossRefGoogle Scholar
  53. 53.
    Simpson RC, Murphy R. Is vulval erosive lichen planus a premalignant condition? Arch Dermatol. 2012;148(11):1314–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17(1):8–19.PubMedCrossRefGoogle Scholar
  55. 55.
    Stewart KM. Clinical care of vulvar pruritus, with emphasis on one common cause, lichen simplex chronicus. Dermatol Clin. 2010;28(4):669–80.PubMedCrossRefGoogle Scholar
  56. 56.
    O’Keefe RJ, Scurry JP, Dennerstein G, Sfameni S, Brenan J. Audit of 114 non-neoplastic vulvar biopsies. Br J Obstet Gynaecol. 1995;102(10):780–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Guerrero A, Venkatesan A. Inflammatory vulvar dermatoses. Clin Obstet Gynecol. 2015;58(3):464–75.PubMedCrossRefGoogle Scholar
  58. 58.
    Goldstein AT, Parneix-Spake A, McCormick CL, Burrows LJ. Pimecrolimus cream 1% for treatment of vulvar lichen simplex chronicus: an open-label, preliminary trial. Gynecol Obstet Investig. 2007;64(4):180–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Family MedicineTemple University HospitalPhiladelphiaUSA
  2. 2.Thomas Jefferson University, Sidney Kimmel School of MedicinePhiladelphiaUSA
  3. 3.Family Medicine Residency ProgramAbington Jefferson HealthAbingtonUSA

Personalised recommendations