By Gary M. White, MD
Always take a good history. Many women may be cleaning the area overly aggressively with the potential for causing a contact dermatitis. Or they may be applying a variety of products with allergens (such as fragrance) that could induce a contact dermatitis, irritant, or allergic. Make sure to address the patient's concerns. STD? Cancer? Sometimes a little education about the area and normal anatomy is helpful, e.g., normal sebaceous glands. Multifactorial processes are common on the vulva, e.g., psoriasis and contact dermatitis, contact dermatitis and herpes simplex. Iatrogenic processes also commonly occur, e.g., candidiasis after topical steroids for lichen sclerosus. For treatment, the vulva is relatively steroid-resistant and needs more potent steroids. However, the perianal area, perineum, and labiocrural folds are more sensitive, so less potent steroids or a shorter duration of therapy are appropriate. Topical calcineurin inhibitors are usually not as good as topical steroids for initial control of inflammatory disorders. Tacrolimus can be good sometimes for maintenance.
Staphylococcal Vulvovaginitis. One report described a 27-year-old woman with a 1-month history of profuse vaginal discharge, vulvar erythema, and pruritus. Vaginal yeast culture was negative. Bacterial cultures were positive for group B streptococci and S. aureus. One strain of S. aureus produced both TSST-1 and staphylococcal enterotoxin C (SEC), while the group B streptococci were non–toxin producing. For a picture, see J Low Genit Tract Dis. 2013 Jan;17(1):88-91
Cancer. Cancer blocking lymphatics and infiltrating the skin can cause enlargement. For a picture, see Dermatology Online Journal 19(5).
Lymphedema of the groin. Various diseases may cause lymphedema of the groin including hidradenitis suppurativa.
Crohn's Disease. For a picture, see Indian J Sex Transm Dis. 2014 Jan-Jun; 35(1): 53–55.
History and physical exam should exclude such things as candidiasis, tinea, erythrasma, trichomonal vaginitis, allergic contact dermatitis, irritant dermatitis, extramammary Paget's disease, and lichen sclerosus.
Lichen Simplex Chronicus. Thickened, lichenified skin that the patient scratches nightly.
Squamous Cell Carcinoma. For a picture, see Dermatology Online Journal 14(1).
Vulvar Vestibulitis Syndrome
Syringomas. Syringomas of the vulva are rare.
Benign Mole. Courtesy of Paul Koonings, MD
Melanoma. For a picture, see Progresos Obstetricia Ginecologia
Vulvar Melanosis. For a picture, see Arch Dermatol. 1999;135(7):857-858.
Psoriasis of the Groin
Plasma Cell Mucositis
Behcet's Syndrome. Oral and vaginal ulcers.
Lipschutz Ulcers. The acute onset of painful ulcers in a teenage girl.
Angiokeratoma of Fordyce. These small vascular papules are common on the vulva of older women.
Herpes Genitalis. Photo courtesy of Michael O Murphy, MD
Herpes Zoster. For a picture, see Dermatology Online Journal 14(1).
Lichen Sclerosus. White plaques on the vulva, perineum, and perianal area.
Genital nevi in children have a prevalence of approximately 3.5%, tend to arise before age 2 years, have a globular dermoscopic pattern, and follow a benign course. Biopsy is unnecessary unless there are particularly worrisome features (JAAD March 2014).
Vulvovaginitis, Prepubertal Girls
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