Vulva, Vulvar Skin Conditions: itching, irritation

Below are two medical abstracts providing information about vulvar skin conditions. The second abstract has pictures of vulvar skin conditions and treatment options (place the article title in Google to review the full article with pictures).

In general, vulva skin conditions are treated with steroid creams. However, ongoing use of steroid creams breaks down the skin (epidermal atrophy, degeneration of the dermal structure and collagen deterioration). The following article provides information about how ongoing use of steroid creams breakdown the skin. Does corticosteriod medication harm the skin?

Vulvar dermatologic conditions can be effectively managed. Keirá Feminine Cream is a non steroid therapeutic with anti-inflammatory and anti-microbial properties to support vulva structure. For lichen sclerosus, and lichen simplex chronicus conditions Keirá provides post-steroid vulva support. To learn about Keirá Feminine Cream click here.

J Midwifery Womens Health. 2012 May-Jun;57(3):260-75.
● Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus.
Thorstensen KA, Birenbaum DL. Dartmouth-Hitchcock Medical Center, Department of Obstetrics and Gynecology, Lebanon, NH 

Abstract: 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 (source noted above) 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.

Am Fam Physician. 2008 Feb 1;77(3):321-326.
● Non-Neoplastic Epithelial Disorders of the Vulva
Theodore Xavier O’Connell MD, Leena Shankar Nathan MD, Wendy Ann Satmary MD. Kaiser Permanente Medical Center, California

Abstract: 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.

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