Vulvar lichen sclerosus (VLS) is a chronic, distressing, inflammatory disease with an enormous impact on quality of life. Treatment goals are relieving symptoms, reversing signs and preventing anatomical changes. Despite the availability of numerous therapeutic options, treatment outcome may not be entirely satisfactory and a definitive cure does not exist. This may be due to the fact that the exact VLS etiopathogenesis remains unknown. The objectives of this paper were to review the most up-to-date knowledge on VLS etiopathogenesis and to consider the available therapies through the lens of a plausible pathogenetic model. An electronic search on both VLS etiopathogenesis and its treatment was performed using the National Library of Medicine PubMed database. Based on current knowledge, it is conceivable that various, heterogeneous environmental factors acting on a genetic background trigger an autoimmune, Th-1 response, which leads to a chronic inflammatory state. This, in turn, can determine both tissue and micro-vascular injury and activation of signaling pathways involved in fibroblast and collagen metabolism. This pathogenetic sequence may explain the effectiveness of anti-inflammatory treatments, mostly topical corticosteroids, in improving VLS clinical-pathological changes. Further deepening of the disease pathways will presumably allow key mediators to become new therapeutic targets and optimize the available treatments.

Background and Objectives: Complete clearance of vulvar lichen sclerosus (VLS) occurs in a minority of treated patients. Disease persistence may impact patient well-being. The main objective of this study was to assess if achieving a complete clearance with a corticosteroid treatment leads to a benefit in terms of patient suffering and quality-of-life (QoL) impairment. Methods: We performed an observational study on a cohort of VLS women, who applied mometasone furoate 0.1% ointment for 12 weeks. At treatment completion (T1), we compared the patients who achieved clearance in symptoms (Global Subjective Score [GSS] = 0) or in objective features (Global Objective Score [GOS] = 0) or in both with those who achieved a lower degree of improvement, on the basis of Pictorial Representation of Illness and Self-Measure (PRISM) and Dermatology Life Quality Index (DLQI) scores. Results: In the whole sample (n = 101), GSS, GOS, PRISM, and DLQI scores significantly improved after treatment from baseline; 34 patients (35.8%) achieved GSS = 0, 26 (25.7%) achieved GOS = 0, and 11 (11.5%) clearance of GSS and GOS. PRISM scores at T1 were significantly higher in patients who achieved clearance of symptoms when compared with those who did not, including patients achieving 50–99% GSS improvement from baseline. DLQI scores were lower in patients who achieved clearance of symptoms, signs, or both when compared with the others. Conclusions: VLS clearance corresponded to a significant improvement in the QoL of VLS patients, also in comparison with those who achieved a substantial but incomplete decrease of symptom and sign scores, and should become an ideal therapeutic goal.

The vulvar area is a common site of both irritative and allergic contact dermatitis due to the thin skin, easily traversable by irritant and allergic substances. The purpose of this review is to provide an overview of the most frequent allergens causing contact dermatitis in this particular site. A literature search was conducted via PubMed through May 2021. Relevant English language studies are included in this review. Fragrances, preservatives, botanical products, and topical medicaments were found to be the most commonly involved allergens. Contact dermatitis is a very common occurrence that should also be considered in patients with chronic vulvar or anogenital dermatitis who do not respond to appropriate treatments.

A 10-year-old girl presented with a sudden onset of fever and vulvar pain. Genital examination revealed vulvar edema especially affecting the labia minora; on the inner face deeply penetrating ulcers were observed bilaterally, a larger one of about 3 cm in diameter on the left and two on the right of about 2 cm in diameter (kissing ulcers). They were well-circumscribed, centrally covered with a fibrinous membrane and with purple edges (Figure 1).

Article: Dermoscopy of vulvar multiple syringomas: a diagnostic aid for a rare entity - Italian Journal of Dermatology and Venereology 2023 Aug 04 - Minerva Medica - Journals

Introduction: Solitary keratoacanthoma (SKA) is generally considered as a well-differentiated form of squamous cell carcinoma, but it usually runs a benign course and a not aggressive behavior. Diagnostic criteria, prognosis, and treatment of SKA are not fully defined yet. Surgical treatment with fusiform excision represents the gold standard; nonoperative intralesional therapy of KA is uncommon but may provide a valid option in some categories of patients. Case Series Presentation: We report our experience regarding the treatment of SKA with a hybrid treatment consisting of a minimally invasive technique such as curettage followed by intralesional corticosteroid administration in the same session. Six patients affected with KA were treated ending in a complete resolution, with good esthetic outcome, no relapse after 1 year, and satisfaction of the patients. Discussion and Conclusion: The combined treatment allows us on the one hand to avoid radical surgery in selected patients and particular anatomic areas and on the other the side effects that the use of intralesional chemotherapy/immunosuppressive drugs can entail.