Health Questions and Answers

Question: What are the vulvar, non-neoplastic epithelial disorders (previously called vulvar dystrophies)?


  1. Lichen sclerosis: Most common in prepubertal and postmenopausal patients. Characterized by epithelial thinning with edema and fibrosis of the dermis and associated shrinkage and agglutination of the labia and introital stenosis. The edematous skin has a white, thin, and paperlike appearance. The labia minora is usually lost. Patients often experience pruritis. Sexually active women may experience dyspareunia. Lesions usually are symmetric. Diagnosis is confirmed by biopsy.▪ Treatment-includes very high potency topical corticosteroids, such as clobetasol or halobetasol 0.05% cream.
  2. Lichen planus: A papulosquamous, chronic, and inflammatory dermatosis of unknown etiology. The vulvar lesions are chronic and painful and commonly involve the inner aspects of the labia minora, vagina, and vestibule. Initial presentation may vary from a severe erosive process to mild inflammatory changes involving the vagina. Stria are often present at the margins of the lesions, and loss of architecture may be extreme. Diagnosis is confirmed by biopsy.▪ Treatment-vaginal hydrocortisone suppositories, with the addition of estrogen creams for postmenopausal women.
  3. Lichen simplex chronicus: Usually presents with vulvar pruritus. Thickened, white epithelium, slightly scaly and often unilateral and localized, is identified on exam. Biopsy confirms diagnosis.▪ Treatment-medium-potency steroids. Resolution of symptoms usually occurs rapidly.


  • The ulcer of primary syphilis is usually single and painless, while the ulcer of herpes is more often multiple and painful.
  • The warty lesions of HPV are treated with destructive agents, such as TCA, cryotherapy, and laser.
  • Vulvar epithelial disorders differ in that lichen sclerosis is a butterfly distribution of thin epithelium, lichen simplex is local and thick, and lichen planus is inflammatory.
  • The hallmark of vulvar vestibulitis is entry dyspareunia.

Reference: Tovell HMM, Young AW: Diseases of the Vulva in Clinical Practice. New York, Elsevier Science Publishing Co., Inc., 1991.

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