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Medline ® Abstracts for References 1-4

of 'Vulvar dermatitis'

1
TI
Vulvar dermatoses: lichen sclerosus, lichen planus, and vulval dermatitis/lichen simplex chronicus.
AU
Ball SB, Wojnarowska F
SO
Semin Cutan Med Surg. 1998;17(3):182.
 
In our vulvar specialty clinic at Oxford Radcliffe Hospital (Oxford, UK), dermatoses are frequently seen. A recent survey of new patients showed that lichen sclerosus was the most commonly diagnosed vulvar dermatosis; approximately one third of the women had this disorder. Vulvar dermatitis was observed in 20% to 25% of new patients, but lichen planus was rare. Differences were observed in treatment outcomes for patients with vulvar dermatoses, such as lichen sclerosus and lichen planus, versus those with dermatologic disorders affecting the vulva, such as psoriasis and eczema.
AD
Department of Dermatology, Oxford Radcliffe Hospital, United Kingdom.
PMID
2
TI
The chronically symptomatic vulva: aetiology and management.
AU
Fischer G, Spurrett B, Fischer A
SO
Br J Obstet Gynaecol. 1995;102(10):773.
 
OBJECTIVE: To determine the causes and management of chronic vulval symptoms and to compare the findings in patients first presenting to a gynaecologist with those in patients first presenting to a dermatologist.
DESIGN: A prospective study of 144 patients, approximately half each being referred to a gynaecologist and a dermatologist. Diagnosis was based on clinical history, vulvoscopy, vulval biopsy and bacteriology. Biopsies were examined by a histopathologist experienced in dermatopathology and gynaecological pathology.
RESULTS: The two patient groups were similar in both range and frequency of conditions. The commonest cause of chronic vulval symptoms was dermatitis, which was found in 64% of our patients. Dermatitis occurred alone in 55% and was found in association with histological evidence of human papilloma virus (HPV) in a further 9%. These patients responded to simple dermatological methods, mainly topical corticosteroids. Histopathological evidence of HPV was encountered in only 23% of our patients, and of these 36% also demonstrated dermatitis on biopsy. Most responded to topical corticosteroids. Another 7% had lichen sclerosus, and all responded to potent topical corticosteroid. The remaining 15%demonstrated a range of diagnoses, including psoriasis, dysaesthetic vulvodynia, vulval intraepithelial neoplasia (VIN) and chronic candidiasis. The majority of patients had a corticosteroid responsive dermatosis rather than a gynaecological condition.
CONCLUSIONS: The majority of patients with a chronically symptomatic vulva who present to either a gynaecologist or a dermatologist have a dermatological condition that responds to simple dermatological treatments. We believe that the presence or absence of the human papilloma virus is not relevant to most patients with a chronically symptomatic vulva and treatments should not be aimed at eradicating this virus. Histopathologists and gynaecologists who have focused on gynaecological disorders have often missed simple dermatological conditions that are easily treatable.
AD
Royal Alexandra Hospital for Children, Sydney, Australia.
PMID
3
TI
The commonest causes of symptomatic vulvar disease: a dermatologist's perspective.
AU
Fischer GO
SO
Australas J Dermatol. 1996;37(1):12.
 
A prospective study of 141 consecutive adult patients with chronic vulvar symptoms referred to a dermatologist was carried out to determine the commonest conditions seen. Eighty-nine per cent of patients underwent vulvar biopsy. The commonest cause of chronic vulvar symptoms in this group of patients was dermatitis, seen in 54% of patients. The other commonly seen conditions were lichen sclerosus (13%), chronic vulvovaginal candidiasis (10%), dysaesthetic vulvodynia (9%) and psoriasis (5%). Although 38% of patients had previously been diagnosed as suffering from human papillomavirus (HPV) vulvitis, histopathological evidence of HPV was seen in only 5%. All cases showing HPV also demonstrated spongiotic dermatitis on biopsy. In this study group, a majority (overall 72%) of patients with a chronic vulvar complaint had a corticosteroid responsive dermatosis rather than a gynaecological condition. The patients with HPV on biopsy also responded to topical corticosteroids, and it was concluded that their symptoms may have been due to dermatitis unrelated to the presence of HPV. In such patients, the assumption that 'subclinical HPV' is a cause of symptoms and the practice of focusing medical and particularly surgical treatment on eradication of the virus may be inappropriate. A review of the commonest vulvar conditions seen by the author is presented.
AD
Royal Alexandra Hospital for Children, Camperdown, New South Wales, Australia.
PMID
4
TI
Inflammatory Vulvar Dermatoses.
AU
Guerrero A, Venkatesan A
SO
Clin Obstet Gynecol. 2015 Sep;58(3):464-75.
 
Inflammatory vulvar dermatoses affect many women, but are likely underdiagnosed due to embarrassment and reluctance to visit a health care provider. Although itch and pain are common presenting symptoms, the physical examination can help distinguish between different disease entities. Because many women's health providers have minimal training in the categorization and management of dermatologic disease, definitive diagnosis and management can be difficult. Herein, strategies for diagnosing vulvar lichen sclerosus, lichen planus, contact dermatitis, lichen simplex chronicus, and psoriasis are discussed along with basic management of these diseases, which commonly involves decreasing inflammation through behavioral change, gentle skin care, topical corticosteroids, and systemic therapies.
AD
*Stanford University School of Medicine†Department of Dermatology, Stanford University, Redwood City, California‡Department of Medicine, Division of Dermatology, Santa Clara Valley Medical Center, San Jose, California.
PMID