Vulvar skin disorders throughout lifetime: about some representative dermatoses

Abstract

The objective of this paper is to present general considerations which should be kept in mind by clinicians in charge of women with vulvar diseases. Four representative vulvar dermatoses are described. Lichen simplex chronicus is a pathological condition related to chemical and mechanical irritant agents. Detrimental effects of these irritants, in the presence of other dermatoses, have to be considered when therapeutic responses are unsatisfactory. Lichen sclerosus is the most common vulvar dermatosis in elderly. However, it should be kept in mind that it may be diagnosed at any age. Lichen planus, in spite of sharing a similar range of etiological factors with lichen sclerosus, is a very distinct entity. Finally, Paget's disease, although rare, is also described especially because of the challenge it represents both clinically and therapeutically.

Figures

Figure 1

(a) Irregular white to brown patch on the vulvar skin of a 74-year-old woman. (b) Representative example of a lichen sclerosus biopsy specimen showing a thinned epidermis with slight hyperkeratosis, loss of the rete ridges, and a band of homogenized collagen below the dermoepidermal junction.

Figure 2

(a) Wide vestibular erythematous erosive lichen planus in a 79-year-old woman. (b) Representative example of a lichen planus biopsy specimen showing an irregular hyperkeratosis and a lymphoid dermal infiltrate appearing as a distinct band close to the epidermis.

Figure 3

(a) Wide red area extending mainly on the left side of the vulva in a 65-year-old woman with Paget's disease. (b) Representative example of Paget's disease biopsy specimen showing many glandular neoplastic cells with clear cytoplasm present singly or in small nests within the epidermis.