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Vulvodynia: A Common and Under-Recognized Pain Disorder in Women and Female Adolescents -- Integrating Current Knowledge into Clinical Practice

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Lichen sclerosus (LS) is a chronic inflammatory condition of the vulva, most likely of autoimmune etiology. Both photos show cases of LS, but the photo on the left shows a severe case with a whitish color, itching, and fragile skin that may bruise or tear with contact or sexual intercourse. Diagnosis should be confirmed with vulvar skin biopsy evaluated by a dermatopathologist prior to initiating treatment with ultra-potent topical corticosteroids.

 

 

Erosive lichen planus (LP) is another autoimmune skin disorder that can affect the vulva.  As seen in these photos, lichen planus typically presents with white irregular lines and deep red areas of painful erosions.

 

 

The photo on the left shows nondescript redness in a woman who has an irritant contact dermatitis from using a harsh soap. Contact dermatitis is a rash resulting from the skin’s reaction to an external substance, e.g., ointments, soaps, detergents, dyes or sanitary pads. The rash may occur suddenly with blisters, itching and weeping or it may be of slower onset with redness, burning and some swelling. There are two types of contact dermatitis – irritant and allergic.  Irritant dermatitis is the most common type causing burning, rawness and/or irritation.  Allergic dermatitis may be mild, with simply minor redness, swelling and itching, or severe, with blistering, bright red swelling and severe discomfort.     

The primary symptom of lichen simplex chronicus (aka eczema, atopic dermatitis, neurodermatitis) is itching. Pain and skin abnormalities result from rubbing or scratching, as can be seen from the rubbed and thickened skin in this photo. Lichen simplex chronicus frequently starts because of chronic inflammation from chronic/recurrent candidiasis or recurrent exposure to an irritant and/or allergen, or less commonly vulvar intraepithelial neoplasia (VIN). This chronic inflammation causes an itch-scratch cycle that leads to lichen simplex chronicus. Treatment consists of treating the infectious organism or removal of the allergen or irritant exposure. Application of ice, and an antihistamine or tricyclic antidepressant, are then used to stop the pruritus to break the itch-scratch cycle. Lastly, a potent topical corticosteroid is used to reduce the inflammation. 

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