Active Ingredients: Hydroxyzine
Management consists in the removal of all irritants and potential allergens and application of topical steroids until the skin returns to normal.
Figure 1 Allergic contact dermatitis to an intimate product.
Lichen Sclerosus Lichen sclerosus LS is a chronic inflammatory dermatosis of unknown etiology first described by Hallopeau in 1897 as an atrophic form of lichen planus.
Most cases are seen in prepubertal girls or in postmenopausal women. A possible association with psoriasis has been suggested.
Classically it is taught that LS does not affect the vagina, in contrast to lichen planus, which is an important clue in the differential diagnosis. A few cases of LS with vaginal involvement have been reported. In most cases the itch is predominant but some women will complain more of soreness, burning, and pain.In this review we want to focus on not only itch problems specific to women, namely, pruritic vulvodermatoses, but also the specific pruritic dermatoses of pregnancy. The specific characteristics of the vulva and the hormonal changes during the different age periods make these dermatoses very particular.
Both presented cases had significant pelvic organ prolapse and so the vaginal mucosa was more chronically exposed. Treatment consists of high potency topical corticosteroids, also in younger patients; however, it is proposed to use not the most potent preparations in these younger patients.
Figure 2 Lichen sclerosus in a postmenopausal woman. Lichen Planus The prevalence of lichen planus LP in the genital area is much lower than lichen sclerosus. Differential diagnosis with lichen sclerosus is not always easy.
Women complain of soreness, itching, burning, and dyspareunia. Three types of vulvar lichen planus have been described: erosive, classical, and hypertrophic.
Erosive LP is characterized by erosions involving the introitus, clitoris and clitoral hood, labia minora and majora.
A lacy white edge to the erosions is regularly seen. Vaginal involvement is very common and presents with vaginal erythema, contact bleeding, erosions, and scarring with synechiae.
Very recently diagnostic criteria for erosive LP of the vulva have been published. The classical type presents with small purple, polygonal papules, with sometimes a reticulate lace pattern.
Postinflammatory hyperpigmentation is rather frequent in the flexures. Hyperkeratotic lichen planus presents as single or multiple white-hyperkeratotic papules and plaques. Many patients present with a mix of different clinical subtypes.
A very recent study documents that a significant percentage of patients with vulval LP have associated lichen planopilaris.
The commonest pattern of scalp lichen planopilaris was that of the frontal fibrosing alopecia variant FFA. Treatment consists in the first place of topical steroids.
Classical LP is normally treated with a moderately potent topical corticosteroid.