By Libby Edwards MD
Visitor Editor Dr. Libby Edwards has accumulated a crew of professional participants to pen articles on a tough region of Dermatology: Vulvar affliction. This factor of Dermatologic Clinics comprises articles on Vulvodynia, Pigmented ailments, touch Dermatitis, Vulvar Ulcers, Hidradenitis Suppurativum, Desquamative Inflammatory Vaginitis, Histology of the Vulva, Vulvar Pruritus and LSC, Vulvar Erosions, Lichen Planus, Lichen Sclerosus, Vulvar Paget’s sickness, and Vulvar Edema.
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Extra resources for Vulvovaginal Dermatology, An Issue of Dermatologic Clinics (The Clinics: Dermatology)
In addition to these complicating factors affecting the patient’s presentation of vulvar pruritus, the provider further must overcome many obstacles. The time, equipment, and support required to perform an adequate history and examination can be cumbersome during a routine appointment. After interviewing, the patient must undress, be positioned for adequate exposure, and be examined with suitable lighting and ideally in the presence of a chaperoning assistant. To further confound the evaluation, both the recognition of normal findings and the subtle changes of vulvar disease require experience to appreciate.
A complete genital examination with positioning for adequate exposure and lighting should include examination of the entire anogenital area. Inspect the entire vulva for subtle erythema, swelling, lichenification, and hyperppigmentation or hypopigmentation and the presence of scarring. Have the patient point to her primary area of pruritus. Take a biopsy of any abnormal findings that cannot be defined or are suspicious for malignancy. Because vaginal disease can have great affect on the vulva, the vaginal mucosa should be included in the examination.
Arch Dermatol 1990;126(10):1352e3. 80. Yoganathan S, Bohl TG, Mason G. Plasma cell balanitis and vulvitis (of Zoon). A study of 10 cases. J Reprod Med 1994;39(12):939e44. 81. Li Q, Leopold K, Carlson JA. Chronic vulvar purpura: persistent pigmented purpuric dermatitis (lichen aureus) of the vulva or plasma cell (Zoon’s) vulvitis? J Cutan Pathol 2003;30(9):572e6. 82. Albers SE, Taylor G, Huyer D, et al. Vulvitis circumscripta plasmacellularis mimicking child abuse. J Am Acad Dermatol 2000;42(6):1078e80.