Abstract
Many benign diseases can affect the vulva. These varied conditions can present similarly, often with pain, burning, pruritus, vaginal discharge, and dyspareunia. Physical exam findings can be nonspecific, with erythema, excoriations, and lichenification. Contact dermatitis is a frequent cause of vulvar pruritus and pain, and nearly all topical vaginal products can cause irritation. Removal of common irritants usually results in disease resolution. Lichen simplex chronicus is a condition characterized by severe pruritus leading to a persistent itch-scratch cycle. Lichen planus is a chronic, immune-mediated dermatosis presenting with pruritic papules on the vulvar skin and white lacy striae on mucosal surfaces. Lichen sclerosus is an immune-mediated disorder that results in waxy white “cigarette paper” changes to vulvar skin and can also affect the perianal region resulting in a classic “figure of eight” appearance. Patients with lichen sclerosus should be followed closely due to an increased risk of vulvar squamous cell carcinoma. Psoriasis is a dermatologic condition which can manifest as painful and pruritic vulvar erythema. Topical corticosteroids are the first-line therapy for lichen simplex chronicus, lichen planus, lichen sclerosus, and vulvar psoriasis. Vulvar intraepithelial neoplasia (VIN) is a premalignant condition which can present variably with raised or flat lesions, ranging in color from white to red or black. It can be associated with carcinogenic human papillomavirus (HPV) infections as well as with vulvar dermatoses. All cases should be treated, and options range from excision, to laser ablation, to topical medical therapy with Imiquimod. Patients remain at risk for recurrence and require continued surveillance.
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References
American College of Obstetricians and Gynecologists. Diagnosis and management of vulvar skin disorders. ACOG Practice Bulletin No. 93. Obstet Gynecol. 2008;111:1243–53.
American College of Obstetricians and Gynecologists. Management of vulvar intraepithelial neoplasia. ACOG Committee Opinion No. 509. Obstet Gynecol. 2011;118:1192–4.
Anderson M, Kutzner S, Kaufman RH. Treatment of vulvovaginal lichen planus with vaginal hydrocortisone suppositories. Obstet Gynecol. 2002;100:359–62.
Belfiore P, Di Fede O, Cabibi D, Campisi G, Amarù GS, De Cantis S, Maresi E. 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.
Bousema MT, Romppanen U, Geiger JM, Baudin M, Vähä-Eskeli K, Vartiainen J, Vuopala S. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study. J Am Acad Dermatol. 1994;30(2 Pt 1):225–31.
Carli P, Cattaneo A, De Magnis A, Biggeri A, Taddei G, Giannotti B. Squamous cell carcinoma arising in vulval lichen sclerosus: a longitudinal cohort study. Eur J Cancer Prev. 1995;4:491–5.
Cooper SM, Gao XH, Powell JJ, Wojnarowska F. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004;140(6):702–6.
Crone AM, Stewart EJC, Wojnarowska F, Powell SM. Aetiological factors in vulvar dermatitis. J Eur Acad Dermatol Venereol. 2000;14(3):181–6.
Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(4):431–6.
Fairchild PS, Haefner HK. Surgical management of vulvovaginal agglutination due to lichen planus. Am J Obstet Gynecol. 2016;214(2):289.e1–2.
Fischer G, Bradford J. Topical immunosuppressants, genital lichen sclerosus and the risk of squamous cell carcinoma: a case report. J Reprod Med. 2007;52:329–31.
Fischer G, Spurrett B, Fischer A. The chronically symptomatic vulva: aetiology and management. Br J Obstet Gynaecol. 1995;102:773–9.
Fung MA. Inflammatory diseases of the dermis and epidermis. In: Busam KJ, editor. Dermatopathology. 2nd ed. Philadelphia: Saunders Elsevier; 2016. p. 11–78.
Goldstein AT, Burrows LJ. Surgical treatment of clitoral phimosis caused by lichen sclerosus. Am J Obstet Gynecol. 2007;196(2):126.e1–4.
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 Invest. 2007;64:180–6.
Gorouhi F, Davari P, Fazel N. Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. Scientific World Journal. 2014;2014(2):1–22.
Hoang MP, Reuter J, Papalas J, Edwards L, Selim M. Vulvar inflammatory dermatoses: an update and review. Am J Dermatopathol. 2014;36(9):689–704.
Kapila S, Bradford J, Fischer G. Vulvar psoriasis in adults and children: a clinical audit of 194 cases and review of the literature. J Low Genit Tract Dis. 2012;16:364–71.
Kortekangas-Savolainen O, Kiilholma P. Treatment of vulvovaginal erosive and stenosing lichen planus by surgical dilatation and methotrexate. Acta Obstet Gynecol Scand. 2007;86(3):339–43.
Lazar AJF, Murphy GF. The Skin. In: Kumar V, Abbas A, Aster J, editors. Robbins & Cotran pathologic basis of disease. 8th ed. Philadelphia: Saunders; 2009. p. 1141–78.
Lewis FM. Vulval lichen planus. Br J Dermatol. 1998;138(4):569–75.
Lotery HE, Galask RP. Erosive lichen planus of the vulva and vagina. Obstet Gynecol. 2003;101(5):1121–5.
Lynch P. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17:8–19.
Margesson LJ. Contact dermatitis of the vulva. Dermatol Ther. 2004;17(1):20–7.
Marren P, Wojnarowska F, Powell S. Allergic contact dermatitis and vulvar dermatoses. Br J Dermatol. 1992;126(1):52–6.
McPherson T, Cooper S. Vulval lichen sclerosus and lichen planus. Dermatol Ther. 2010;23(5):523–32.
Meyrick TRH, Ridley CM, McGibbon DH, Black MM. Lichen sclerosus et atrophicus and autoimmunity – a study of 350 women. Br J Dermatol. 1988;118(1):41–6.
Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best practice and research. Clin Obstet Gynaecol. 2014;28(7):946–58.
Muñoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, Brown DR, Koutsky LA, Tay EH, Garcia PJ, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GW, Ferris DG, Paavonen J, Steben M, Bosch FX, Dillner J, Huh WK, Joura EA, Kurman RJ, Majewski S, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan JT, Lupinacci LC, Giacoletti KE, Sings HL, James MK, Hesley TM, Barr E, Haupt RM. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst. 2010;102:325–39.
O Gorman SM, Torgerson RR. Allergic contact dermatitis of the vulva. Dermatitis. 2013;24(2):64–72.
Powell J, Wojnarowska F. Childhood vulvar lichen sclerosus: an increasingly common problem. J Am Acad Dermatol. 2001;44:803–6.
Preti M, Scurry J, Marchitelli CE, Micheletti L. Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1051–62.
Ramer MA, Altchek A, Deligdisch L, Phelps R, Montazem A, Buonocore PM. Lichen planus and the vulvovaginal-gingival syndrome. J Periodontol. 2003;74(9):1385–93.
Rogers 3rd RS, Eisen D. Erosive oral lichen planus with genital lesions: the vulvovaginal-gingival syndrome and the peno-gingival syndrome. Dermatol Clin. 2003;21(1):91–8.
Schlosser BJ, Microwski GW. Lichen sclerosus and lichen planus in women and girls. Clin Obstet Gynecol. 2015;58(1):125–42.
Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis. Arch Dermatol. 2009;145(9):1040–7.
Shiohara T, Kano Y. Lichen planus and lichenoid dermatoses. In: Bolognia JL, Jorizzo J, Rapini RP, editors. Dermatology. 3rd ed. New York: Mosby Elsevier; 2008. p. 183–202.
Sideri M, Jones RW, Wilkinson EJ, Preti M, Heller DS, Scurry J, Haefner H, Neill S. Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD Vulvar Oncology Subcommittee. J Reprod Med. 2005;50(11):807–10.
Simons M, Van De Nieuwenhof HP, Van Der Avoort IA, Bulten J, De Hullu JA. A patient with lichen sclerosus, Langerhans cell histiocytosis, and invasive squamous cell carcinoma of the vulva. Am J Obstet Gynecol. 2010;203(2):e7–10.
Simpson RC, Littlewood SM, Cooper SM, Cruickshank ME, Green CM, Derrick E, Yell J, Chiang N, Bell H, Owen C, Javed A, Wilson CL, McLelland J, Murphy R. 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.
Stewart K. Clinical care of vulvar pruritus, with emphasis on one common cause, lichen simplex chronicus, dermatologic clinic, 2010:28(4):669–680.
Taylor AH, Guzail M, Al-Azzawi F. Differential expression of oestrogen receptor isoforms and androgen receptor in the normal vulva and vagina compared with vulval lichen sclerosus and chronic vaginitis. Br J Dermatol. 2008;158:319–28.
Vallejo MJ, Huerta G, Cerero R, Seoane JM. Anxiety and depression as risk factors for oral lichen planus. Dermatology. 2001;203(4):303–7.
Virgili A, Corazza M, Bacilieri S, Califano A. Contact sensitivity in vulval lichen simplex chronicus. Contact Dermatitis. 1997;37(6):296–7.
Virgili A, Bacilieri S, Corazza M. Managing vulvar lichen simplex chronicus. J Reprod Med. 2001;46:343–6.
Virgili A, Borghi A, Toni G, Minghetti S, Corazza M. Prospective clinical and epidemiologic study of vulvar lichen sclerosus: analysis of prevalence and severity of clinical features, together with historical and demographic associations. Dermatology. 2014;228(2):145–51.
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Cahoon, S.S. (2017). Benign Diseases of the Vulva. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17798-4_75
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DOI: https://doi.org/10.1007/978-3-319-17798-4_75
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