Vulvar Dermatoses Case Review: Diagnosis, Overlap, and Key Clinical Pearls

Conclusions

• The presentation concludes that vulvar dermatoses often overlap, and clinicians should avoid anchoring on a prior diagnosis when the morphology or course suggests something else.
• In immunosuppressed patients with vulvar erosions, HSV should be actively considered and tested for even when another explanation seems likely.
• Jacquet’s erosive dermatitis with pseudoverrucous papules and nodules can arise from severe irritant and occlusive exposure, not just medication allergy.
• Psoriasis and vulvar lichen sclerosus are associated with one another, so patients with either condition should be examined for the other when symptoms or exam findings suggest it.
• Genital seborrheic dermatitis may be underrecognized and can present in isolation on the vulva without classic scalp or chest findings.
• Neutrophilic sebaceous adenitis is a likely explanation for recurrent cyclical painful vulvar papules, and tetracyclines or hormonal therapies may be more helpful than antiviral treatment.
• Epidermolysis bullosa acquisita commonly involves mucosal sites, especially the oral mucosa, and genital disease is clinically important because it can scar and cause adhesions or stenosis.
• An isolated vulvar or perineal plaque can be the first manifestation of pemphigus vulgaris before more widespread oral or mucosal disease appears.
• Papular acantholytic dyskeratosis is a localized benign anogenital disorder that can mimic pemphigus vulgaris histologically and clinically, so evolution over time and DIF/serology may be needed to distinguish them.
• When vulvar pathology is uncertain, close follow-up and repeat evaluation are essential because diagnosis may change as new lesions or mucosal involvement develop.