Vulvar Dermatology

Vulvar Dermatology: Navigating Women’s Intimate Skin Health

Vulvar dermatology is a specialised field within dermatology that focuses on the diagnosis, treatment, and management of various skin conditions affecting the vulva—a crucial part of a woman’s anatomy. The vulva encompasses the external female genitalia, including the mons pubis, labia majora, labia minora, clitoris, vaginal opening, and perineum. This delicate and sensitive area can be susceptible to a wide range of dermatological issues, necessitating specialised care and attention.

Conditions Addressed in Vulvar Dermatology: Vulvar dermatologists are trained to diagnose and manage an array of skin disorders that affect the vulva. Some common conditions include:

• Lichen Sclerosis: This chronic inflammatory condition primarily affects the vulvar skin and causes itching, discomfort, and changes in the appearance of the skin. If left untreated, it can lead to scarring and even changes in anatomy, including narrowing of the vaginal opening.
• Lichen Simplex Chronicus: This condition involves thickening and hardening of the vulvar skin due to chronic itching and scratching. It often results from underlying irritants or psychological factors.
• Contact Dermatitis: The vulva can be sensitive to irritants and allergens, leading to redness, itching, and swelling. Identifying and avoiding triggering substances is key to managing this condition.
• Lichen Planus (LP): Lichen planus can cause itching, burning, and the formation of white, lacy patches or sores on the vulva. Scarring with loss of the inner lips (labia minora) may be seen. LP can also affect inside the mouth and the genital area – both the vulva and vagina, nails and scalp.
• Vulvodynia: While not a dermatological disorder per se, vulvodynia involves chronic pain and discomfort in the vulvar region. Vulvar dermatologists may collaborate with gynaecologists and pain specialists to provide holistic care.
• Psoriasis and Eczema: These common skin conditions can affect the vulvar area, causing redness, scaling, and itching.
• Infections: Fungal, bacterial, and viral infections can all impact vulvar health and require accurate diagnosis and appropriate treatment.
• HPV-Related Lesions: Human papillomavirus (HPV) infections can lead to the development of genital warts and other skin abnormalities in the vulvar region.

Specialised Approach: Vulvar dermatology demands a comprehensive approach due to the sensitivity of the area and the potential psychological impact of these conditions. Patients often experience embarrassment and distress, making effective communication and empathy crucial components of care.

Collaborative Care: Vulvar dermatologists often collaborate with gynaecologists, urologists, pain specialists, and psychologists to provide multidisciplinary care. This approach ensures that all aspects of a patient’s physical and emotional well-being are addressed.

Empowerment Through Education: Education is a key aspect of vulvar dermatology. Empowering patients with knowledge about proper hygiene, irritant avoidance, and self-examinations can contribute to early detection and improved outcomes.

When/why should someone see a specialist at Clinica?

If you are experiencing vulval problems such as itching, pain and visible skin changes or lumps, you should seek specialist advice, as well as for already diagnosed vulva skin conditions.

Diagnosis

How is this condition diagnosed?
Diagnosing vulvar dermatological conditions involves a comprehensive evaluation by a dermatologist and may include the following steps:

1. Medical History and Clinical Examination:
   The dermatologist will start by taking a detailed medical history, including information about symptoms, their duration, and any relevant medical conditions or allergies.
   A thorough physical examination of the vulva and surrounding areas will be conducted to observe any visible signs of dermatological conditions.
2. Biopsy:
   In some cases, a biopsy may be performed to obtain a small sample of the affected skin. This sample is then examined under a microscope to confirm the diagnosis and determine the specific type of dermatological condition.
3. Cultures or Swabs:
   If a fungal or bacterial infection is suspected, a culture or swab may be taken to identify the causative organism and guide appropriate treatment.
4. Allergy Testing:
   Patch testing may be performed to identify allergens causing allergic contact dermatitis.
5. Dermoscopy:
   A magnifying light that allows an accurate examination of vulvar skin lesions
6. Colposcopy:
   Colposcopy may be used to examine the vulva in more detail using a colposcope, a magnifying instrument. This can help identify specific patterns or changes in the skin.
7. Additional Imaging or Tests:
   In certain cases, imaging studies like US, MRI or CT scans may be recommended to assess the extent of involvement of deeper tissues.

Clinica London plays a significant role in the diagnosis of vulvar dermatological conditions. Our dermatologists often work in clinics where they conduct consultations, examinations, biopsies, and other diagnostic procedures to assess and diagnose vulvar dermatology conditions.

Treatment

Lichen Planus:

Treatment Options for Lichen Planus:

Topical Treatments:

• Corticosteroid creams or ointments to reduce inflammation and itching.
• Topical calcineurin inhibitors like tacrolimus or pimecrolimus.

Oral Medications:

• Systemic corticosteroids for severe cases.

Oral Immunosuppressants:

• Methotrexate or cyclosporine to suppress the immune response.

Antihistamines:

• To relieve itching.

Intralesional Injections:

• Steroid injections directly into the affected areas.

Laser Therapy:

• Excimer laser for localized lesions.

Pain and Anaesthesia:

Most treatments are not painful. For procedures like injections, a local anaesthetic may be used to minimise discomfort.

Outpatient Procedure:

Many treatments for lichen planus are outpatient procedures, allowing you to go home the same day.

Number of Sessions Needed:

The number of sessions required depends on the treatment and the individual response to the therapy.

Special Equipment Used and Why:

Equipment varies based on the treatment method, including light therapy machines, lasers, or instruments for administering injections.

Recovery Time:

Recovery time varies based on the treatment. It may range from immediate relief (for topical treatments) to several weeks (for systemic treatments).

Side Effects of Treatment:

Potential side effects vary with the treatment but can include skin irritation, pigmentation changes, thinning skin, or systemic effects with oral medications.

Aftercare:

Aftercare may involve following specific instructions from your dermatologist, regular follow-ups, moisturising the skin, and avoiding triggers that exacerbate the condition.

Duration of Results:

Results can vary from temporary relief of symptoms to long-term control. Lichen planus may require ongoing management.

Why Use This Treatment Over Another Treatment Option:

The choice of treatment depends on various factors such as the severity of the condition, the affected areas, patient preferences, and potential side effects. The dermatologist will consider these factors to determine the most suitable treatment.

Contact Dermatitis:

Contact dermatitis is an inflammatory skin condition that occurs when the skin comes into contact with a substance that triggers an allergic reaction or irritates the skin. Treatment options vary based on the type and severity of contact dermatitis. Common treatments include:

• Treatment may involve identifying and avoiding the triggering substances (allergens or irritants).
  Topical corticosteroids may be prescribed to reduce inflammation and itching.
• Emollients, moisturizers, and soap substitutes can help soothe the skin and maintain its moisture barrier.
• Oral antihistamines may be recommended to alleviate itching and discomfort.

Duration of Treatment:

• The treatment duration varies based on the severity of the contact dermatitis and how well you respond to the treatment.
• It may range from a few weeks to several months.

Side Effects:

• Potential side effects may include skin thinning and change of colour (with prolonged corticosteroid use), irritation, or allergic reactions to the prescribed medications.

Vulvar Psoriasis:

Vulvar psoriasis is a chronic skin condition characterised by red, itchy, and sometimes painful patches on the vulva. The treatment of vulvar psoriasis typically involves a combination of topical treatments, phototherapy, and in some cases, systemic medications. Here’s a detailed overview:

How do I prepare for the procedure?
Before any procedure or treatment, it’s important to consult with a dermatologist specialising in psoriasis to discuss your medical history, current medications, allergies, and any concerns you might have.

Explain the treatment procedure & how it’s performed.

• Topical Treatments: Topical corticosteroids, calcineurin inhibitors, and emollients are commonly used to manage vulvar psoriasis. They are applied directly to the affected areas.
• Phototherapy: Phototherapy involves exposing the vulvar area to specific wavelengths of light (usually ultraviolet B or UVB). This can help reduce inflammation and itching.
• Systemic Medications: In more severe cases, oral medications like methotrexate, cyclosporine, or biologic drugs may be prescribed to target the immune response and control psoriasis.

Explain what will happen during the procedure.

• Topical Treatments: You will be instructed on how to apply the prescribed topical medication to the affected areas. The affected vulvar areas will be thoroughly cleaned and then the ointment, cream, or solution will be applied as directed.
• Phototherapy: You will be positioned under specialized lights that emit the required wavelengths. The vulvar area will be exposed to this light for a specific duration, as determined by your healthcare provider.
• Systemic Medications: Oral medications will be prescribed with specific instructions on dosage and timing. Regular follow-ups will be necessary to monitor your response and adjust the medication if needed.

Side effects of treatment.

• Topical Treatments: Possible side effects include skin thinning, irritation, or changes in skin colour.
• Phototherapy: Potential side effects can include sunburn-like reactions, dry skin, and in rare cases, an increased risk of skin cancer.
• Systemic Medications: Side effects may include nausea, fatigue, increased risk of infections, and potential effects on organs like the liver or kidneys.

Aftercare, if needed.
Your dermatologist will provide instructions on aftercare, including proper hygiene, moisturising the area, and any necessary follow-up appointments.

How long do results last?

Results can vary. Some individuals may experience long-term relief, while others may need ongoing treatment to manage symptoms effectively.

Why use this treatment over another treatment option?

The choice of treatment depends on various factors, including the severity of psoriasis, patient preferences, medical history, and potential risks and benefits. Your dermatologist will recommend a treatment plan based on your specific situation.

Vulvar Infections:

Vulvar infections can be caused by various factors such as bacteria, viruses, yeast, or other pathogens. The specific treatment options and procedures can vary depending on the type and severity of the infection. Common types of vulvar infections include yeast infections (e.g., candidiasis), bacterial infections, viral infections (e.g., herpes), and parasitic infections (e.g., trichomoniasis). Below is a general overview of treatment options and related information:

Preparation for the Procedure: Before any procedure or treatment, it’s essential to consult a dermatologist who will provide specific instructions for preparation. Generally, this may involve providing a thorough medical history, discussing symptoms, performing physical examination, and possibly conducting diagnostic tests.

Treatment Procedure: The treatment procedure depends on the type of infection and may involve medications, lifestyle changes, or minor surgical procedures. It’s important to follow the healthcare provider’s instructions carefully.

Procedure Details:
Areas Addressed: The vulvar area will be the focus of treatment, targeting the infection site and affected tissues.

What Happens: Medications may be administered orally, topically, or through other methods to eliminate the infection. For surgical procedures, targeted removal of infected tissue may be performed.

Duration of Treatment/Procedure: The duration varies based on the type and severity of the infection. Medication-based treatments may last from a few days to a couple of weeks, while surgical procedures can typically be completed in a single session.

Outpatient Procedure: Most vulvar infection treatments are outpatient procedures, meaning you can return home the same day.

Number of Sessions: The number of sessions needed depends on the type and severity of the infection. Some infections may require multiple rounds of treatment.

Special Equipment: Specialised medical instruments may be used for diagnosis and treatment, such as swabs for sample collection or specialised surgical tools for minor surgical interventions.

Side Effects: Potential side effects may include mild discomfort, irritation, or allergic reactions to medications. Your healthcare provider will inform you of potential side effects specific to your treatment.

Aftercare: Aftercare may involve proper hygiene, follow-up appointments, medication adherence, and avoiding irritants that could worsen the condition.

Duration of Results: The duration of results varies depending on the type of infection and the effectiveness of the treatment. Some infections may recur and require additional treatment.

Genital Warts:

Genital warts, caused by certain strains of the human papillomavirus (HPV), are typically treated through a variety of methods. It’s important to note that treatment does not cure the underlying HPV infection but aims to remove or manage the visible warts.

Preparation for the Procedure:

• Before the procedure, consult with your dermatologist to discuss your medical history, current medications, allergies, and any concerns.
• Consider abstaining from sexual activity before the procedure to minimize potential irritation or spreading of the virus.
• Ensure you understand the procedure, possible side effects, and the recovery process.

Treatment Procedure:

• Depending on the size, location, and number of warts, treatment options may include topical creams, cryotherapy (freezing), electrocautery (burning), laser therapy, or surgical excision.
• Topical treatments involve applying creams (such as imiquimod) or solutions directly to the warts.
• Cryotherapy freezes the warts using liquid nitrogen.
• Electrocautery uses an electric current to burn the warts.
• Laser therapy involves using a laser to destroy the warts.
• Surgical excision involves cutting the warts off.
• Sometimes a combination of topical treatment and cryotherapy may be used, to improve the outcomes.

Procedure Details:

• The procedure will target the affected genital area where the warts are present.
• Depending on the method, the warts will either be treated topically or physically removed using appropriate techniques.

Duration of Treatment:

• The length of the treatment can vary based on the method chosen and the severity of the warts.
• Some treatments may require multiple sessions over several weeks.

Pain and Anaesthesia:

• Cryotherapy may cause some discomfort and pain. Local or topical anaesthesia may be administered to minimise pain during the procedure.

Outpatient Procedure:

• Yes, most genital wart treatments are outpatient procedures, allowing you to go home the same day.

Number of Sessions:

• The number of sessions needed will depend on the severity of the warts and the chosen treatment method.

Special Equipment:

• Specialised instruments such as cryoprobes, lasers, or cautery tools may be used depending on the treatment method.

Recovery Time:

• Recovery time varies based on the treatment. It can range from a few days to a few weeks. Follow your dermatologist’s instructions for care during this period.

Side Effects:

• Side effects may include pain, swelling, redness, blistering, or scarring at the treatment site. These usually subside over time.

Aftercare:

• Follow your dermatologist’s instructions for aftercare, which may include keeping the area clean and dry, avoiding sexual activity for a specified period, and using prescribed medications.

Duration of Results:

• The duration of results can vary. Some treatments may provide a temporary reduction in visible warts, but recurrent outbreaks can occur due to the persistence of the HPV infection.

Choice of Treatment:

• The choice of treatment is based on factors such as the location and size of the warts, patient preferences, and the expertise of the dermatologist provider. The treatment plan is tailored to each individual’s specific situation. It’s essential to discuss the options and their advantages with your healthcare provider to determine the most suitable treatment for you.