Vulvar Dermatitis

1. See also
   1. Vulvitis
   2. Vulvar Pruritus
2. Definition
   1. Non-neoplastic epithelial disorders of the vulva
3. Differential Diagnosis
   1. Extramammary Paget's Disease
   2. Squamous Cell Carcinoma
   3. Vulvar intraepithelial neoplasia
4. Causes: Papulosquamous Vulvar Dermatoses
   1. Vulvar Lichen Sclerosus et atrophicus (LSA)
   2. Vulvar Lichen Planus (LP)
   3. Vulvar Lichen Simplex Chronicus (LSC)
   4. Erosive Vulvitis
   5. Irritant and Allergic Contact Dermatitis
   6. Overuse of topicals
   7. Atrophic Vaginitis
   8. Psoriasis
   9. Seborrheic Dermatitis
5. Causes: Bullous Vulvar Dermatoses
   1. Erythema Multiforme
   2. Bullous Pemphigoid
   3. Pemphigus
   4. Benign familial Pemphigus
6. Causes: Systemic Disease
   1. Behcet's Disease
   2. Systemic Lupus Erythematosus
   3. Reiter's Syndrome
7. Management
   1. Mild Steroids
      1. Hydrocortisone ointment (1% or 2.5%)
   2. High Potency Steroids for Lichen Sclerosis only
      1. Child: Hydrocortisone (2.5%) topically
      2. Adult
         1. Testosterone (2%) topically
         2. Clobetasol 0.05% ointment (Ultra-high potency)
            1. Effective for Vulvar Lichen Sclerosis
               1. Cooper (2004) Arch Dermatol 140:702-6
            2. Sample protocol
               1. Apply bid for 1 month then
               2. Apply daily for 1 month then
               3. Apply 1-3 times weekly prn to control symptoms
               4. Taper to Kenalog 0.1% as symptoms controlled
   3. Topical Anesthetics
      1. Lidocaine (Xylocaine) 5% ointment
      2. Avoid benzocaine
         1. Risk of Allergic Contact Dermatitis
   4. Bland Emollients
      1. Milk compresses
      2. Vegetable oil compresses
      3. Plastic ice pack
8. References
   1. Black (1995) OBGyn Dermatology, Mosby-Wolfe
   2. Apgar (1996) Am Fam Physician 53(4):1171-80
   3. Barhan (1997) Postgrad Med 102(3):121-32
   4. Metts (1999) Am Fam Physician 59(6):1547-56