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Generalized skin disease can affect the vulva as part of the process but there are a number of conditions which are more specifically localized to vulval skin. These are grouped together under the term vulval dermatoses. They share some characteristics and yet have their own distinct features. Treatment of all these conditions relies on a precise diagnosis.
Eczema: vulval eczema may occur on its own or be part of a more widespread disease. It frequently affects the vulva and is a common cause of itch which has often been mistakenly ascribed to a thrush infection. There are a number of subtypes with different underlying causes. Atopic eczema occurs in people with a strong family history and in those with asthma and hay fever. Medicaments and perfumes are major causes of contact irritant dermatitis (eczema), which is very common on the vulva and may cause an acute eczema. Contact allergic dermatitis may be caused by an underlying allergy to e.g. lanolin or latex and may need to be excluded. Although it is a lifelong chronic condition with proper treatment, good control can be achieved.
Lichen simplex: lichen simplex is a very common cause of vulval itch and can be very severe. The skin thickens as a result of scratching and the skin barrier is not working properly. Like eczema, the itch is often mistakenly ascribed to a thrush infection. Of course both may occur together and need the appropriate treatment. Strong steroids may be required. It can be chronic with flares and recurrences.
Lichen sclerosus: In lichen sclerosus, the skin becomes thin, brittle and often appears white and wrinkled. Although the cause is unknown, the skin is damaged by the immune system. About ¼ of women will have another immune condition such as thyroid disease. It can affect women of any age but is often not diagnosed early. It is important to get an accurate early diagnosis because if the disease is not controlled, noticeable scarring and damage can occur. There is also a small (5-10%) increased risk of developing a skin cancer, so long term follow up is recommended.
Psoriasis: vulval psoriasis may occur on its own or be part of more widespread disease. The classic appearance of psoriasis is lost on the vulva making diagnosis more difficult. When only the vulva is affected, accurate and early diagnosis is important so that if disease develops elsewhere it can all be managed correctly. Many of the standard treatments used are too irritating on vulval skin. It is a lifelong chronic condition.