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Competing Interests: Conflicts of interest None disclosed.

Background: Vulvar diseases are common in the general population and have a negative impact on the quality of life., Objectives: To describe our experience as dermatologists in the management of vulvar dermatosis consultations., Methods: A retrospective observational study was conducted with patients who attended monographic vulvar consultations over a 5-year period. Clinical information was obtained from the patient's charts., Results: 148 women were studied. Their mean age was 43.24 years (standard deviation: 15.15 years), with ages ranging from 4 months to 80 years. 53.4% of patients took between 2 and 5 years to seek medical attention for the first time. The most frequent diagnosis was lichen sclerosus (41.9%), irritative eczema of the vulva (14.9%), and lichen simplex chronicus (10.1%). 83.8% reported anogenital itching, 66.2% pain, and 45.9% dyspareunia. The most frequently prescribed treatment was ultra-potent topical corticosteroids (clobetasol propionate; 41.2%). Patients with lichen sclerosus were significantly older than those who presented with any of the other diseases. No differences were found in terms of either the time of disease evolution or in symptom presentation., Study Limitations: Retrospective study. Vulvar diseases with an infectious cause are usually managed in primary care, therefore, were not included. All patients were recruited from a single private hospital which limits the comparisons with the public health system., Conclusions: Vulvar diseases frequently occur and are associated with high morbidity. It is essential to promote the development of specific vulvar consultations in hospitals. Specialties such as dermatology, gynecology, urology, or physiotherapy must be part of these units., (Copyright © 2022 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Study Objective: To assess long-term outcomes of lichen sclerosus (LS) in the female pediatric population, specifically in relation to patient age, treatment type and duration, and remission. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Retrospective chart review was conducted to identify female pediatric patients (0-18 years of age) who were diagnosed with LS between January 1, 2015 and January 1, 2020 at the University of North Carolina Dermatology and/or Obstetrics and Gynecology Departments. Patients were contacted via telephone for follow-up interviews consisting of a series of questions regarding patient age, symptom onset, time of diagnosis, treatment, and current symptoms., Results: Of the 128 patients identified, 61 patients consented and participated in follow-up interviews. At the time of study follow-up, 55/61 (90%) of participants reported their symptoms were improved. Patients reported using a variety of treatments, with medium- to high-potency topical steroids being the most common. At the time of follow-up, 53/61 (87%) of patients reported being asymptomatic, 37/53 (70%) of whom were not using any form of maintenance therapy. Those who achieved symptom resolution did so at an average of 8.4 years of age. There was no significant difference in age in asymptomatic patients receiving maintenance therapy and those receiving no maintenance therapy. There was a positive correlation for the duration of LS treatment and time in remission (P < .001). Increased patient age at time of follow-up also correlated positively with time in remission (P < .001)., Conclusion: In our cohort, the need for continued maintenance therapy was not correlated with age or, by proxy, pubertal status. Thus, LS remission might be determined more by early and successful pharmacological interventions., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The aim of the study was to describe the features required for diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM)., Materials and Methods: The International Society of the Study of Vulvovaginal Diseases tasked the difficult pathologic diagnoses committee to develop consensus recommendations for clinicopathologic diagnosis of vulvar lichen planus, lichen sclerosus, and dVIN. The dVIN subgroup reviewed the literature and formulated diagnostic criteria that were reviewed by the committee and then approved by the International Society of the Study of Vulvovaginal Diseases membership., Results: Differentiated vulvar intraepithelial neoplasia is the immediate precursor of human papillomavirus (HPV)-independent vulvar squamous cell carcinoma and shows a spectrum of clinical and microscopic appearances, some overlapping with HPV-related neoplasia. The histopathologic definition of dVIN is basal atypia combined with negative or nonblock-positive p16 and basal overexpressed, aberrant negative, or wild-type p53. The most common pattern of dVIN is keratinizing with acanthosis, aberrant rete ridge pattern, and premature maturation. The morphologic spectrum of keratinizing dVIN includes hypertrophic, atrophic, acantholytic, and subtle forms. A few dVIN cases are nonkeratinizing, with basaloid cells replacing more than 60% of epithelium. Vulvar aberrant maturation is an umbrella term for lesions with aberrant maturation that arise out of lichenoid dermatitis and lack the basal atypia required for dVIN., Conclusions: Evaluation of women at risk for dVIN and VAM requires a collaborative approach by clinicians and pathologists experienced in vulvar disorders. Close surveillance of women with lichen sclerosus and use of these recommendations may assist in prevention of HPV-independent squamous cell carcinoma through detection and treatment of dVIN and VAM., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP.)

Mature women often present with symptomatic vulvovaginal atrophy and vulvar dermatoses, causing noncoital pain, dyspareunia, and sexual changes. Diagnosis of these conditions can be challenging, and long-term management is required to decrease morbidity and enhance quality of life. Vaginal estrogen therapies remain safe and effective for treating symptomatic vulvovaginal atrophy. A vulvar biopsy is easy to perform and generally well tolerated when indicated for the diagnosis of lichen simplex chronicus, lichen sclerosus, and lichen planus. Therapy with moderate- to high-potency corticosteroids is effective for these frequently debilitating conditions., (Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: The purpose of this article is to provide an update for the GP on selected common vulvar concerns in prepubertal girls. Presentation, diagnostic criteria, and management of common vulvar conditions will be described. The following conditions are frequently encountered and may pose diagnostic or management challenges if unrecognized., Recent Findings: The article is a review of current literature on pediatric vulvar conditions and was conducted through searching PubMed and published books on this topic. Areas of interest frequently encountered by providers are presented, including vulvovaginitis, genital ulcers, lichen sclerosus, and labial adhesions along with the most recent North American Society for Pediatric and Adolescent Gynecology recommendations for diagnosis and management., Summary: Vulvar complaints in prepubertal girls are common. Many present with nonspecific symptoms and consequently, the diagnosis may be missed or delayed. Prompt recognition improves long-term outcomes and importantly, provides a positive introduction to longitudinal women's health for young girls.

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.

Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene., (© 2012 by the American College of Nurse-Midwives.)

Unlabelled: Vulvar pruritus and pain are common indications for consultation with a gynecologist. Contact dermatitis, lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia are vulvar dermatoses that are often associated with both pruritus and pain. Because these skin conditions are frequently misdiagnosed by providers and incorrectly self-treated by patients, vulvar biopsy is considered the gold standard for diagnosis. The etiology of these vulvar skin conditions is multifactorial; therefore, patient education, behavior modification, and regular follow-up with an experienced clinician are essential to ensure effective control of patient symptoms and management of the skin condition., Target Audience: Obstetricians & Gynecologists and Family Physicians., Learning Objectives: After completing this CME activity physicians should be better able to evaluate common vulvar skin conditions and identify these conditions as a source of significant morbidity for women, diagnose vulvar dermatoses using vulvar biopsy as the gold standard, create a differential diagnosis of vulvar skin disorders.

Vesicobullous and inflammatory diseases produce vulvar erosions that may exhibit nonspecific morphology and represent a diagnostic challenge. An approach to arriving at the correct diagnosis is presented. Most common etiologies are reviewed., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The evaluation of a child presenting with an anogenital complaint or lesion can be challenging for both the clinician and the patient. The doctor met the real possibility that a diagnosis of a condition caused by sexual abuse will affect significantly the child and the family. A misdiagnosis of abuse or failure to recognize a treatable condition can also have detrimental consequences. Most primary care physicians are not trained to recognize the variety of systemic and dermatologic problems that affect the anogenital area. Dermatologists and other specialists often do not appreciate the possibility of sexual abuse. In this article we present a systematic approach to the child with anogenital complaints which may mimic sexual abuse.

Objective: To identify objective clinical signs of vulvodynia and determine specific diagnostic tests for vulvodynia in women referred to a vulvar outpatient clinic for vulval complaints., Study Design: A retrospective study was performed of the medical records of 201 consecutive Danish patients suspected of suffering from vulvodynia who were referred to a vulvar outpatient clinic (Department of Gynecology, Rigshospitalet University Hospital) between October 2003 and January 2006., Results: Of 201 women, 117 were diagnosed with vulvodynia and 84 had other diagnoses. Of the women diagnosed with vulvodynia in the vulvar clinic, 88.9% were correctly diagnosed before referral. The women with vulvodynia were more likely to report dyspareunia (chi2 = 7.89, p = 0.005) and stinging pain (chi2 = 3.74, p = 0.05). The nonvulvodynia group was more likely to report a tendency toward fissures (chi2 = 5.94, p < 0.05)., Conclusion: Self-reported dyspareunia and stinging pain are strongly associated with vulvodynia. Self-reported pruritus and a tendency toward fissures are not likely to be associated with vulvodynia. Whether vulvar biopsies should be performed regularly when redness and pain is present must be explored further in prospective studies.

Vulval disease in the postmenopausal age group is relatively common. Some vulval conditions such as lichen sclerosus are more prevalent in the postmenopausal years. Often more than one condition is present at the same time. Accurate diagnosis is essential for effective treatment. The risk of progression to malignancy associated with some of these diseases dictates long-term surveillance.

Introduction: Dermatologic diseases of the vulva may cause dyspareunia. These disorders may be overlooked by gynecologists and urologists because of lack of residency training experience. Dermatologists who are most familiar with these diseases are infrequently trained in vulvovaginal examination. As such, these disorders are often improperly diagnosed and treated., Aim: To describe the presentation and management of the major vulvar dermatoses including irritant and allergic contact dermatitis, lichen sclerosus, lichen simplex chronicus, and lichen planus., Main Outcome Measure: Data from a peer review literature search on the topic of vulvar dermatoses., Methods: The literature for this review article was obtained through a Medline search. Appropriate dermatology textbooks were utilized for additional information., Results: A comprehensive survey of the vulvar dermatoses., Conclusion: Vulvar dermatoses must be considered a part of the differential diagnosis of any woman with a sexual pain disorder. As such, healthcare providers who evaluate and treat women with dyspareunia must become familiar with the most common dermatologic disorders of the vulva.

Lichen sclerosus, lichen planus, and lichen simplex chronicus are three of the most common non-neoplastic epithelial disorders of the vulva. Lichen sclerosus is characterized by intense vulvar itching and can affect men and women of all ages, but it manifests most commonly in postmenopausal women. Patients with lichen sclerosus have an increased risk of developing squamous cell carcinoma, and they should be monitored for malignancy. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and the vagina; it peaks in incidence between ages 30 and 60. There are three clinical variants of lichen planus affecting the vulva: erosive, papulosquamous, and hypertrophic. Lichen simplex chronicus is caused by persistent itching and scratching of the vulvar skin, which results in a thickened, leathery appearance. It is thought to be an atopic disorder in many cases and may arise in normal skin as a result of psychological stress or environmental factors. Definitive diagnosis of non-neoplastic disorders depends on the histology of biopsied tissue. All three disorders are treated with topical corticosteroid ointments of varying potency. Lichen sclerosus and lichen planus are not routinely treated with surgery, which is necessary only in patients who have a malignancy or advanced scarring that causes dyspareunia or clitoral phimosis. Educational counseling teaches patients that even though these chronic disorders cannot be cured, they can be effectively managed.