Summary about Disease
Vulvar dystrophy is an outdated and imprecise term that was previously used to describe several noncancerous conditions affecting the vulva (the external female genitalia). The term is no longer medically accurate. The more appropriate and current terms are:
Lichen Sclerosus: A chronic inflammatory skin condition that can cause thin, white patches on the vulva and can lead to itching, pain, and scarring.
Lichen Planus: An inflammatory condition that can affect the skin and mucous membranes, including the vulva. It can cause painful sores, itching, and changes in skin appearance.
Vulvar Intraepithelial Neoplasia (VIN): Precancerous changes in the cells of the vulva. It is not a form of vulvar dystrophy, but is related to atypical cell growth
Symptoms
Symptoms vary depending on the specific condition, but common signs and symptoms include:
Itching (pruritus)
Pain or soreness
Burning sensation
Discomfort during sexual intercourse
White patches on the vulva
Redness or inflammation
Thinning of the skin
Thickening of the skin
Fissures (small cracks) in the skin
Bleeding
Ulcers or sores
Causes
The exact causes are not always fully understood and vary depending on the specific condition:
Lichen Sclerosus: Believed to be an autoimmune condition where the body's immune system attacks its own tissues.
Lichen Planus: Also considered to be an autoimmune condition.
Vulvar Intraepithelial Neoplasia (VIN): Often associated with human papillomavirus (HPV) infection.
Medicine Used
Treatment depends on the specific condition:
Lichen Sclerosus: Topical corticosteroids (e.g., clobetasol propionate) are the first-line treatment to reduce inflammation and itching. Topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) may be used as an alternative.
Lichen Planus: Topical corticosteroids are often used. In severe cases, systemic medications like oral corticosteroids or other immunosuppressants may be necessary.
Vulvar Intraepithelial Neoplasia (VIN): Treatment options include topical medications (e.g., imiquimod), surgical excision, laser ablation, or photodynamic therapy.
Is Communicable
Lichen Sclerosus: Not communicable (not contagious).
Lichen Planus: Not communicable (not contagious).
Vulvar Intraepithelial Neoplasia (VIN): While VIN itself is not communicable, it can be associated with HPV, which is sexually transmitted.
Precautions
General precautions can help manage symptoms and prevent complications:
Avoid irritants: Use gentle, unscented soaps, detergents, and personal care products.
Wear loose-fitting cotton underwear.
Keep the vulvar area clean and dry.
Avoid scratching the affected area.
Use lubricants during sexual intercourse.
Follow your healthcare provider's instructions for medication and follow-up.
How long does an outbreak last?
This depends on the specific condition and treatment:
Lichen Sclerosus: It is a chronic condition that may require ongoing management to control symptoms and prevent flares. With proper treatment, symptoms can be well-controlled, but the condition may not be completely cured.
Lichen Planus: Can be chronic. Treatment can help manage symptoms and reduce the duration and severity of outbreaks.
Vulvar Intraepithelial Neoplasia (VIN): The duration depends on the treatment approach. With successful treatment, the abnormal cells can be eliminated, but follow-up is important to monitor for recurrence.
How is it diagnosed?
Diagnosis typically involves:
Physical Examination: A visual examination of the vulva.
Medical History: Discussion of symptoms and medical history.
Biopsy: A small tissue sample may be taken and examined under a microscope to confirm the diagnosis and rule out other conditions, including cancer.
Timeline of Symptoms
The timeline of symptoms varies:
Lichen Sclerosus: Symptoms may develop gradually over months or years. Itching is often the first symptom.
Lichen Planus: Symptoms may appear more suddenly.
Vulvar Intraepithelial Neoplasia (VIN): May be asymptomatic or cause subtle changes in the skin. Regular pelvic exams and Pap tests can help detect VIN.
Important Considerations
Regular Follow-up: Regular check-ups with a healthcare provider are crucial for monitoring the condition and adjusting treatment as needed.
Risk of Cancer: Some conditions, like Lichen Sclerosus and VIN, can increase the risk of vulvar cancer if left untreated.
Psychological Impact: Chronic vulvar conditions can have a significant impact on quality of life, including sexual function and emotional well-being. Support groups and counseling may be helpful.
Early Diagnosis and Treatment: Early diagnosis and treatment are essential to prevent complications and improve outcomes.