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How to navigate vulvar dermatology

According to a recent presentation, knowing what is normal and what is abnormal is important when it comes to the vulva, especially when diagnosing and treating diseases that affect the vulva.

This presentation focused on vulvar dermatology and was given by Jean Marino, APRN-CNP, NCMP, IF, at the 25th Annual Premier Women’s Healthcare Conference held September 29-October 2, 2022 in Houston, Texas .

Marino began her presentation by stating that the genitals develop into females by default, but the introduction of androgens is the difference. In women, the vulvovaginal area consists of 3 embryological layers including: vulva (ectoderm), vestibule (endoderm), and vagina (mesoderm).

Both estrogen and androgen play roles in the vulvovaginal area by maintaining blood flow, protecting against harmful pathogens, and supporting the tissues and microbiome. Additionally, Marino said that both androgens and estrogen are essential for vascular health and signaling of sexual responses. Different embryological layers that respond to different groups of hormones. For example, the vulva and vestibule are responsive to androgen while the vagina is responsive to estrogen.

Marino then presented some cases that showed normal vulvovaginal areas versus scenarios that needed further investigation. One such case presented with persistent itching, multiple doses of fluconazole, and burning pain after intercourse.

Marino noted that some common causes of vulvovaginal pruritus include contact dermatitis, trichomonads, vulvovaginal candidiasis, lichen sclerosus, lichen simplex chronicus, and menopausal urogenital syndrome. She added that when diagnosing your patients with complaints of vulvovaginal pruritus, you should ask if they have concerns about exposure to an STI, whether they have self-treated and what their vulvar and vaginal hygiene is like.

If you suspect vulvovaginal candidiasis, Marino said you should look for cracks, erythema and edema, no change in pH, vaginal discharge or lack thereof, and itching and irritation. Pains. itching and dysuria.

As treatments, Marino suggested either azoles (fluconzazole and terconazole), which inhibit fungal growth, or Ibrexafungerp, which kills Candida species.

Other cases were presented, covering a wide range of symptoms, including diseases associated with pruritus such as: B. Genitourinary syndrome of menopause, contact dermatitis, lichen sclerosus, lichen simplex chronicus. Cases of pain-related disorders such as vulvodynia and vestibulodynia and erythema-related disorders such as genital psoriasis and vulvar lichen planus have also been presented.

Marino ended her presentation with some valuable takeaways for the audience:

  • The disease is not ruled out if the biopsy does not confirm what you expect.
  • A thorough history and physical examination that includes hygiene and treatment is crucial.
  • A little clobetasol will do the trick, taking into account the likelihood of yeast
  • Make sure the tissues are healthy before turning to pelvic floor physical therapy or using a dilator.
  • It is important to keep an eye on potentially negative body image and the patient’s sexual health.
  • Vaginal estrogen is great, especially during menopause.
  • Aftercare is essential.

Disclosures: Jean Marino, APRN-CNP, NCMP, IF, is on the Advisory Board of Scynexis and co-owner of The Menopause Retreat.

Relation:

  1. Marino J. Vulvar Dermatology. Presented at: 25th Annual Premier Women’s Healthcare Conference. Houston, Texas. September 29 to October 2, 2022.

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