EpistemisCircumscribed vulvar hyperkeratosis
Specialty: Gynecology and breast.
Why it occurs
- Chronic scratching-itching cycle due to uncontrolled vulvar itching of any origin
- Atopic or chronic contact dermatitis
- Persistent fungal or bacterial infections that are poorly treated
- Use of abrasive synthetic fiber underwear or excessively alkaline hygiene products
Initial workup
Vulvar physical examination with colposcope. Vulvar biopsy with a 3 mm punch of the white plaque to rule out malignancy, atypical squamous hyperplasia or differentiated type vulvar intraepithelial neoplasia (VIN). Previous microbiological culture of the area to rule out superinfection.
red flags
Rough or warty raised white plaque with a suspicious appearance that becomes hard on palpation, ulceration or bleeding of the plaque with mild scratching, appearance of unilateral indurated inguinal lymphadenopathy, lack of therapeutic response to powerful topical corticosteroids after 2-3 weeks of prescribed treatment.
Standard management
- Clobetasol propionate 0.05% cream applied in a thin layer on the plaque once a day at night for 2 to 4 weeks, decreasing to alternate days and then twice a week according to response
- Oral sedative antihistamines such as Hydroxyzine 25 mg at night to mitigate involuntary nocturnal scratching
- Neutral emollient creams and protective pastes with zinc oxide (note: it is mandatory to explain to the patient the crucial importance of completely breaking the scratching habit to enable skin regeneration).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 4
- Treatment options
- 3