Vulvar Dermatitis

Aka: Vulvar Dermatitis, Vulvar Dermatoses

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II. Definitions

  1. Vulvar Dermatitis (Vulvar Dermatoses)
    1. Non-neoplastic epithelial disorders of the vulva

III. Differential Diagnosis

  1. Extramammary Paget's Disease
  2. Squamous Cell Carcinoma
  3. Vulvar intraepithelial neoplasia

IV. 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
  10. Eczematous Dermatitis

V. Causes: Bullous Vulvar Dermatoses

  1. Erythema Multiforme
  2. Bullous Pemphigoid
  3. Pemphigus
  4. Benign familial Pemphigus

VI. Causes: Systemic Disease and other causes

  1. Genital Ulcer (e.g. Behcet's Disease)
  2. Systemic Lupus Erythematosus
  3. Reiter's Syndrome
  4. Crohn Disease

VII. Management

  1. General approach
    1. Exclude neoplasm
    2. Treat specific causes (including systemic causes)
  2. Low Potency Corticosteroids may be trialed
    1. Hydrocortisone ointment (1% or 2.5%)
  3. Moderate Potency Corticosteroid (e.g. Triamcinolone) Indications
    1. Vulvar Lichen Simplex Chronicus
  4. High Potency Corticosteroid (e.g. Clobetasol) indications
    1. Lichen Sclerosis
    2. Lichen Planus
  5. Topical Anesthetics
    1. Lidocaine (Xylocaine) 2-5% ointment
      1. Short-term use only and expect variable efficacy
    2. Avoid benzocaine
      1. Risk of Allergic Contact Dermatitis
  6. Bland Emollients
    1. Milk compresses
    2. Vegetable oil compresses
    3. Plastic ice pack (<20 min/hour)

VIII. References

  1. Black (1995) OBGyn Dermatology, Mosby-Wolfe
  2. Apgar (1996) Am Fam Physician 53(4):1171-80 [PubMed]
  3. Barhan (1997) Postgrad Med 102(3):121-32 [PubMed]
  4. Metts (1999) Am Fam Physician 59(6):1547-56 [PubMed]
  5. Ringel (2020) Am Fam Physician 102(9):550-7 [PubMed]

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