Gynecology Book

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Vulvar Dermatitis

Aka: Vulvar Dermatitis, Vulvar Dermatoses
  1. See also
    1. Vulvitis
    2. Vulvar Pruritus
    3. Genital Ulcer
    4. Vulvodynia
  2. Definitions
    1. Vulvar Dermatitis (Vulvar Dermatoses)
      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
    10. Eczematous Dermatitis
  5. Causes: Bullous Vulvar Dermatoses
    1. Erythema Multiforme
    2. Bullous Pemphigoid
    3. Pemphigus
    4. Benign familial Pemphigus
  6. 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
  7. 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)
  8. 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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