The skin of the vulva is subject to the same dermatoses that occur over the rest of the body surface. Those described here are only a few of the more common lesions.
Folliculitis refers to a papular or pustular inﬂammation about the apertures of hair follicles, caused by Staphylococcus aureus or mixed organisms. Furuncles are larger and more deeply situated and exhibit the typical signs of inﬂammation about a central core of purulent exudate. Contributory factors for a staphylococcal pyoderma infection include the irritation of tight under- clothes or vulvar pads, lack of cleanliness, diabetes, and lowered immune competence (natural or iatrogenic). Topical therapy with sitz baths, topical antibiotics, and interim drying and ventilation are usually sufﬁcient. Systemic antibiotic therapy may be appropriate in selected cases.
Herpes genitalis is a herpes simplex infection of the vulva similar to that which occurs about the lips, nose, cornea, or, in the male, on the penis. It is a superﬁcial, localized, and frequently recurring lesion, caused by the herpes virus. Herpetic vulvitis appears as groups of vesicles on an edematous, erythematous base. The blisters tend to break, with the formation of small ulcers, or they dry and become covered with crusts. Initial infections are often extremely painful, even to the extent of causing urinary retention. Symptoms of recurrent infections are usually limited to local pruritus or burning. Herpes zoster is differentiated by the distribution of vesicles along a nerve trunk and the occurrence of a prodromal period of fever, malaise, and localized pain.
Intertrigo is a superﬁcial inﬂammation of the external genitalia. It appears as a red or brownish discoloration, particularly of the interlabial sulci, the furrows between the vulva and thighs, and the inner aspect of the thighs. It is caused by chaﬁng, especially in obese women, during hot weather. Anything that contributes to local moisture, such as a persistent vaginal discharge or urinary incontinence, will prolong the irritation. A dermatophytosis frequently is superimposed.
Tinea cruris is a fungus infection or ringworm of the groin, usually caused by Epidermophyton ﬂoccosum. The lesions consist of discrete patches, which may cover the vulva, pubis, lower abdomen, groin, and inner thighs. They are pink or red in color, scaly, and sharply demarcated from normal skin. Secondary inﬂammatory changes may be superimposed as the result of scratching, moisture, and irritation. The condition may be spread by direct contact or through use of contaminated clothing. The diagnosis may be corroborated by culture on Sabouraud medium or by examination of superﬁcial scales placed in a hanging drop of 10% sodium or potassium hydroxide in order to establish the presence of the characteristic branching mycelia.
Psoriasis of the vulva is not uncommon, affecting up to 2% of the general population. The most common presentation is persistent vulvar itching. The presence of similar lesions on the scalp and extensor surfaces of the extremities is helpful in establishing the diagnosis. The general characteristics of psoriasis include (1) reddened, slightly elevated, dry and sharply demarcated patches covered with silvery-white scales; (2) a characteristic distribution; (3) the presence of nail changes; (4) history of chronicity or recurrence; and (5) a familial tendency. The diagnosis is usually established by its characteristic appearance and distribution. Unfortunately, there is no cure for psoriasis, but it can be controlled with treatment. Treatment begins with avoidance of irritants, the use of emollients and moisturizers, and limited use of topical steroids. Topical antibiotics or antifungal therapy is prudent when signiﬁcant skin cracking has occurred. Many of the treatments used to treat soriasis elsewhere are too harsh to use on genital skin.