Vulvar Dermatoses and Menopause

Abstract

Vulvar dermat may have added an increased risk of missing oses are prevalent inflammatory conditions, frequently associated with itching and burning. The diagnosis is usually clinical but sometimes challenging due to superimposed or associated conditions. This challenge can be harder in postmenopausal women, as the signs and symptoms of vulvovaginal atrophy frequently overlap with those of a dermatosis. Recently, the creation of the “genitourinary syndrome of menopause” may have added an increased risk of missing vulvar diseases. While these are benign conditions, some (lichen sclerosus and lichen planus) can increase the risk of vulvar cancer, through the pathway of vulvar intraepithelial neoplasia, differentiated type. Failing to recognize this is a missed opportunity to avoid vulvar cancer. Vulvovaginal symptoms are a frequent cause of gynaecological referral, and dermatologic conditions should always be considered among the differential diagnosis. A systematic evaluation of the symptoms may simplify the diagnostic process. The authors consider that the classification proposed by the International Society for the Study of Vulvovaginal Diseases (ISSVD), in 2006, and the 2011 terminology are both useful and complimentary tools in daily clinical practice. In this chapter, the most common vulvar dermatoses encountered in postmenopausal women-lichen simplex chronicus, lichen sclerosus, lichen planus, psoriasis, and atopic and contact dermatitis-are reviewed. An evaluation of the state of the art regarding pathology, classification, and treatment is made.