AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Vulvar Disease: What Do You Know? An Overview

Description

Dr. Shola Kinshimoin Vaughan, a vulvar dermatologist, presented an overview of vulvar diseases, sharing three case studies that highlight common conditions and treatment strategies. The first case involved a 65-year-old woman with vulvar itching and hyperpigmentation, diagnosed with lichen simplex chronicus through biopsy, emphasizing the chronic itch-scratch cycle and challenges in treatment due to limited research and guidelines. The second case examined a 50-year-old woman with vitiligo, identifying FDA-approved treatments like ruxolitinib for managing this condition while acknowledging its cost-prohibitive nature. This section also outlined the need for careful differentiation between vulvar vitiligo and lichen sclerosis, stressing the significance of identifying overlapping conditions. Finally, the last case featured a 60-year-old woman with symptoms consistent with lichen planus, highlighting the common diagnostic challenges faced, particularly in women of color. Dr. Vaughan underscored the importance of thorough evaluation and questioning of diagnoses, given the observed discrepancies in accuracy based on race. She advocated for a more skeptical and experimental approach to treatment, including the exploration of new therapies and a commitment to pelvic floor physical therapy as part of care. Overall, the talk covered the significance of understanding vulvar conditions, the intricacies of diagnosis, and the necessity for tailored treatments based on individual patient needs.

View more

Conclusions

  • Lichen simplex chronicus is a common condition characterized by chronic itch-scratch cycles, often leading to vulvar discomfort, and disproportionately affects black women.
  • The diagnosis of lichen simplex chronicus often requires careful differentiation from other vulvar conditions, including neoplasms and inflammatory diseases.
  • There is a notable lack of studies and guidelines specifically addressing lichen simplex chronicus, emphasizing the need for targeted therapies.
  • Recent treatment options for lichen simplex chronicus include topical therapies such as ruxolitinib and roflumilast, as well as compounded medications.
  • Understanding underlying conditions like atopic dermatitis can help tailor treatment strategies for lichen simplex chronicus.
  • Patients of color may experience unique challenges in the diagnosis and treatment of vulvar diseases, including lichen simplex chronicus.
  • The FDA has approved newer therapies for vitiligo, and practitioners should consider these for vulvar vitiligo to improve patient outcomes.
  • Combination therapies, including topical immunomodulators and phototherapy, offer promise for patients with vulvar vitiligo and lichen sclerosis.
  • Healthcare providers must remain vigilant in reassessing and validating diagnoses, particularly in diverse populations where conditions may manifest differently.
  • Sanchez A, Gandhi K, Lee B, Garcia JG, Ventolini G. Vulvar Neurodermatitis in a Postmenopausal African-American Patient: A Case Report. J Menopausal Med. 2022 Apr;28(1):42-45. doi: 10.6118/jmm.21032. PMID: 35534430; PMCID: PMC9086344.
  • Juarez MC, Kwatra SG. A systematic review of evidence based treatments for lichen simplex chronicus. J Dermatolog Treat. 2021 Nov;32(7):684-692. doi: 10.1080/09546634.2019.1708856. Epub 2020 Mar 6. PMID: 31884840.
  • Butler DC, Berger T, Elmariah S, Kim B, Chisolm S, Kwatra SG, Mollanazar N, Yosipovitch G. Chronic Pruritus: A Review. JAMA. 2024 Jun 25;331(24):2114-2124. doi: 10.1001/jama.2024.4899. PMID: 38809527.
  • Ingrasci G, El-Kashlan N, Alexis A, Yosipovitch G. Chronic itch in African Americans: an unmet need. Arch Dermatol Res. 2022;314(5):405-415. doi:10.1007/s00403-021-02255-6
  • Chang WL, Lee WR, Kuo YC, Huang YH. Vitiligo: An Autoimmune Skin Disease and its Immunomodulatory Therapeutic Intervention. Front Cell Dev Biol. 2021 Dec 14;9:797026. doi: 10.3389/fcell.2021.797026. PMID: 34970551; PMCID: PMC8712646.
  • Rosmarin D, Passeron T, Pandya AG, Grimes P, Harris JE, Desai SR, Lebwohl M, Ruer-Mulard M, Seneschal J, Wolkerstorfer A, Kornacki D, Sun K, Butler K, Ezzedine K. Two Phase 3, Randomized, Controlled Trials of Ruxolitinib Cream for Vitiligo. N Engl J Med. 2022 Oct 20;387(16):1500-1510. doi: 10.1056/NEJMoa2210818. PMID: 36295236.
  • Peterson D, King BA. Ultraviolet light in combination with other therapies for vitiligo: Synergy or necessity? J Am Acad Dermatol. 2021 Jan;84(1):e63-e64. doi: 10.1016/j.jaad.2020.08.120. Epub 2020 Sep 4. PMID: 32891783.
  • Desai S, Blasiak R, Miedema J, Corley S. Enhancing awareness of vitiligoid vulvar lichen sclerosus: An underrecognized variant in patients with skin of color. JAAD Case Rep. 2024 Aug 31;53:50-53. doi: 10.1016/j.jdcr.2024.08.017. PMID: 39430637; PMCID: PMC11488412.
  • Venkatesan T, Teli S, Punnesh K, Tabassum N, Tripathi R. Lichen Sclerosus and its differentials. J Cutan Aesthet Surg. 2023;16(2):107-113. doi: 10.4103/JCAS.JCAS_117_23. PMID: 37143494; PMCID: PMC10110113.