Below are the different types of vulvar skin conditions and what you need to know about them. As there is substantial overlap in the physical signs of various vulvar dermatoses, women with any vulva problems are advised to consult a medical professional for proper diagnosis and treatment recommendations.

Lichen sclerosis

Lichen sclerosis is associated with a weak or malfunctioning immune system.

Symptoms include:

• Lesions that resemble ivory white papules and plaques
• Areas of thinned out or white thickened skin
• Bruising or bleeding from repeated scratching
• Crinkled skin texture (classic symptom)

If there is scarring and a change in skin colour or structure, seek medical attention promptly.

Vulvar eczema

Vulvar eczema is inflammation of the skin resulting from an external agent that acts either as an irritant or an allergen to produce a rash. It can be acute, subacute or chronic. Contact dermatitis is the most common type of vulvar eczema.

Symptoms include:

• Redness, swelling and blistering for acute cases
• Redness, scaling, abrasions and a variable degree of thickened leathery skin for chronic cases

Management of vulvar eczema involves good vulva hygiene, avoidance of irritants – such as soaps, condoms and sanitary napkins – and topical steroids.

If the condition fails to respond to initial therapy within a month, seek assistance from a medical professional.

Lichen simplex chronicus

Lichen simplex chronicus is associated with the end stage of the itch-scratch-itch cycle and can be due to several underlying causes.

Symptoms include:

• Thickened leathery skin with increased skin markings
• Crusting
• Abrasions
• Skin pigmentation changes

Managing lichen simplex chronicus involves breaking the itch-scratch-itch cycle, good vulva hygiene, topical steroids, anti-histamine medication and investigation of the primary cause. If the condition fails to respond to initial therapy within a month, seek help from a medical professional.

Intertrigo

Intertrigo, or skinfold dermatitis, is caused by friction and worsened by additional infection from the bacteria or yeast that is normally present on the skin.

Symptoms include:

• Redness
• Pruned skin
• Cracking or splitting of skin
• Secretion of fluid from cracked skin accompanied by considerable odour (less common symptom)
• Darkening of surrounding skin as a post-inflammatory reaction

Intertrigo management includes using mild steroids with a combination of antifungals, and investigation of the primary cause. Consult a medical professional if additional features such as scaling or hardened leathery skin are present, if the condition does not respond to treatment, or if psoriasis is suspected (see below for description).

Lichen planus

The exact cause of lichen planus is unknown.

Symptoms include:

• Erosions with scarring
• Vaginal involvement
• Pain and itch

If vulvar erosions and ulcers are present, seek medical attention promptly.

Psoriasis

The exact cause of psoriasis is unknown.

Symptoms include:

• Papules and plaques with a silvery white scale
• Lesions which may be bright red, often glazed and well-demarcated, involving the natal cleft (or “butt crack”)

Patients with psoriasis should seek prompt dermatological assessment.

Ref: S13