DERMATOSES
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.
