Dermatologic Disorders Causing Vulvar Disease
William J. Ledger, Steven S. Witkin in Vulvovaginal Infections, 2017
Lichen sclerosus, a chronic inflammatory skin condition manifested by intense itching, most commonly affects the genital region. It is more frequently found in women than in men. Although it may be present in women at any age, it appears to primarily occur in either prepubertal girls or postmenopausal women. The mechanism for its onset remains undetermined, but it is believed to result from the interplay between environmental and immune factors in genetically susceptible individuals. In some regions of the world, but not in the United States, an association with a Borrelia infection has been proposed.1 Associations between lichen sclerosus and several human leukocyte antigen haplotypes have been noted.2 It has also been suggested that an increase in oxidative stress, perhaps due to a genetically determined decrease in antioxidant defense mechanisms in patients with lichen sclerosus, leads to the generation of unique antigenic determinants that become targets for an autoimmune response.3
Benign conditions of the vulva and vagina, psychosexual disorders and female genital mutilation
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Lichen sclerosus is a destructive inflammatory skin condition that affects mainly the anogenital area of women. It is believed to affect 1 in 300 women and the cause is believed to be autoimmune. Many patients have other autoimmune conditions, such as thyroid disease and pernicious anaemia. The destructive nature of the condition is due to underlying inflammation in the subdermal layers of the skin, which results in hyalinization of the skin. This leads to a fragility and white ‘parchment paper’ appearance of the skin and loss of vulval anatomy. The condition can involve the foreskin of men to produce a phimosis. Lichen sclerosus is evident elsewhere on the body in 15% of patients. The main symptoms on the vulva are itching and subsequent soreness of the vulva, usually due to scratching. A biopsy can confirm the diagnosis and treatment is a combination of good skin care and strong steroid ointments such as those containing clobetasol. Lichen sclerosus is associated with vulval cancer, but is not a cause. Many women with vulval cancer have lichen sclerosis at the time of diagnosis and it is estimated that there is a low risk of cancer developing in a women with lichen sclerosus (around 3–5%).
Problems with Female Orgasm
Philipa A Brough, Margaret Denman in Introduction to Psychosexual Medicine, 2019
Sexual activity and the ability to orgasm can be detrimentally affected by dermatological conditions of the vulva. These can include vulvovaginitis caused by candidiasis, herpes, trichomonas, atrophic vaginitis, vulvar dermatosis such as lichen sclerosus, lichen planus or eczema that can sometimes be a chemical irritation due to soap, washing powder or perfumes. There can also be provoked vulvodynia, hymenal abnormalities, pelvic radiotherapy causing vaginal stenosis or trauma and scarring such as from previous vaginal surgery or episiotomy (11). Lichen sclerosus gives a classic ‘figure-of-eight’ pattern of white patches surrounding the vulva and anus which can be itchy and sore. Often there is a loss of normal architecture and the clitoris may become buried by affected skin leading to a loss of sensation. Both lichen sclerosus and planus can lead to vulval and vaginal adhesions also affecting function. A detailed history and genital examination must be taken to rule out an organic cause, however there is often a combination of physical and psychological factors for failure to orgasm.
An evaluation of the pharmacotherapeutic options for the treatment of adult phimosis. A systematic review of the evidence
Published in Expert Opinion on Pharmacotherapy, 2022
Anna Lygas, Hrishikesh Bhaskar Joshi
There are various forms of treatment for LS listed in the literature and these include androgen and estrogen ointments, parenteral vitamin E [15], systemic acitretin [18], and surgical interventions such as cryosurgery [19] and laser treatment [20,21], and potent topical corticosteroids [22]. The latter has been recognized as the most successful method stopping the disease progression [22–24]. However, it is important to note that most of the studies focus on female patients with vulvar lichen sclerosus. There is very little evidence showing the effects of long-term topical steroid on the male genitalia and there is some reluctance amongst doctors to prescribe them due to the potential skin thinning and reactivation of local infections such as human papillomavirus, herpes simplex virus as well as candida [25]. Some also fear that prolonged use of topical steroids can cause rare yet serious systemic effects such as Cushing’s syndrome, weight gain and osteoporosis [26–31].
The efficacy and safety of secondary focused ultrasound therapy for recurrence of non-neoplastic epithelial disorders of the vulva
Published in International Journal of Hyperthermia, 2022
The pathogenesis of NNEDV is still unclear, and treatment methods are diverse. Local drugs, such as corticosteroids, have been widely accepted and provide prompt symptomatic relief [5]. Corticosteroids have been a mainstay in the treatment of inflammatory skin conditions for decades, and there is ample evidence to support their long-term efficacy and safety. The British Association of Dermatologists guidelines for the management of lichen sclerosus advocate for an individualized treatment regimen of topical steroids to maintain disease control and prevent scarring [6]. However, advice given to patients with NNEDV by other healthcare professionals regarding corticosteroid-related risks—including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis—may represent a barrier to compliance with long-term corticosteroid usage among female patients [7,8].
Effects of a topical ointment on responses to treatments used for common genital diseases and on quality of life
Published in Cogent Medicine, 2020
Clarence de Belilovsky, Jean-Marc Bohbot
Lichen sclerosus (LS) is the most common genital skin disease, causing pruritus, burning sensation, pain (soreness), and dyspareunia. One-third of patients reports severe impairment of Quality of Life (QoL) (Van Cranenburgh et al., 2017). Vulvar LS is a relapsing disease (relapse rate 50% at 1.3 years, 84% at 4 years post-treatment; Renaud-Vilmer et al., 2004). Patients with vulvar LS require lifetime surveillance and topical steroid (TS) treatment. The ultra-potent clobetasol propionate is the most frequently used treatment, but mometasone furoate (MMF) has similar efficacy (Moyal-Barracco & Wendling, 2014; Virgili et al., 2014). After a 3-month initial attack phase, symptom improvement is incomplete (47.3%) and reversal of clinical signs is rare (21.4%) (Borghi et al., 2018). To prevent relapse and scarring, and to help prevent malignant change, a proactive long-term treatment (e.g., twice-weekly application of TS) strategy is recommended (Kirtschig et al., 2015; Van der Meijden et al., 2017; Virgili, Minghetti, Borghi, Corazza et al., 2013a). Complete remission occurs for only 32% of women after 3 years and 58% after 6 years. (Virgili, Minghetti, Borghi, Corazza et al., 2013b). This means that a lot of patients remain symptomatic, with some activity of their LS, despite the maintenance therapy. However, it is not recommended to increase the frequency of TS applications, because long-term TS therapy can alter skin barrier function and result in steroid-induced dermatitis. Recent guidelines recommend emollient use to protect the skin barrier and relieve symptoms during and after steroid treatment (Lewis et al., 2018).
Related Knowledge Centers
- Glans Penis
- Hair Follicle
- Phimosis
- Vulva
- Sweat Gland
- Autoimmune Disease
- Foreskin
- Dyspareunia
- Anus
- Meatal Stenosis