Vaginal Discharge and Vulvitis
, Vuluvar Dystrophies
Causes of vulvar itch
1. Lichen sclerosis (M = balanitis xerotica obliterans)
• 1:300-1:1000 F
• Bimodal age distribution
• AUTOIMMUNE
• Associated with alopecia, vitiligo, thyroid disorders, pernicious anemia
• 10-20% present with extra-genital lesions (trunk)
• Clinical presentation: itchy, white skin, figure 8 appearance, architectural distortion(fusion of clitoral hood, labia minora resorption
• Investigations: biopsy
• Tx: high potency steroid (clobetasol)
• Complications: SCC
2. Lichen simplex chronicus (neurodermatitis)
• Very similar to eczema
• Itch-scratch cycle
• Mainly labia majora
• Normal architecture
• Patches/plaques or erythematous lichenified skin
• Tx: minimize irritants, steroid cream (betamethasone), stop scratching
Note: Clobetasol should be used for scalp, hands, feet, and vulva. Other steroids are not potent enough.
, Vuluvar Dystrophies
Causes of vulvar itch
1. Lichen sclerosis (M = balanitis xerotica obliterans)
• 1:300-1:1000 F
• Bimodal age distribution
• AUTOIMMUNE
• Associated with alopecia, vitiligo, thyroid disorders, pernicious anemia
• 10-20% present with extra-genital lesions (trunk)
• Clinical presentation: itchy, white skin, figure 8 appearance, architectural distortion(fusion of clitoral hood, labia minora resorption
• Investigations: biopsy
• Tx: high potency steroid (clobetasol)
• Complications: SCC
2. Lichen simplex chronicus (neurodermatitis)
• Very similar to eczema
• Itch-scratch cycle
• Mainly labia majora
• Normal architecture
• Patches/plaques or erythematous lichenified skin
• Tx: minimize irritants, steroid cream (betamethasone), stop scratching
Note: Clobetasol should be used for scalp, hands, feet, and vulva. Other steroids are not potent enough.
