EpistemisVulvar white patches
Specialty: Gynecology and breast.
Why it occurs
- Vulvar lichen sclerosus (chronic inflammatory pathology with dermal atrophy)
- Vulvar lichen planus
- Squamous hyperplasia of the vulva (lichen simplex chronicus due to continuous scratching)
- Differentiated vulvar intraepithelial neoplasia (dVIN, precursor lesion of squamous cell carcinoma)
- Vitiligo of genital location
Initial workup
Detailed inspection with a magnifying glass or colposcope (vulvoscopy). Vulvar biopsy with a 3-4 mm punch performed under local anesthesia of the area with the greatest suspicion (raised, hyperkeratotic or ulcerated areas) to perform a mandatory differential histological diagnosis and rule out malignancy.
red flags
White plaque that becomes raised, hard, ulcerated or warty, spontaneous vulvar bleeding with friction, deep fissures that do not heal, severe persistent pain, complete loss of vulvar architecture (resorption of the labia minora and rapidly evolving stenosis of the introitus).
Standard management
- Clobetasol propionate cream 0.05% — apply a small amount at night daily for a month, then every other day for another month, and thereafter twice a week as long-term maintenance
- Tacrolimus 0.1% ointment applied every 12 hours as an alternative in refractory cases or intolerance to powerful corticosteroids
- Continuously unscented vulvar emollients to restore the skin barrier (note: lichen sclerosus requires close lifelong monitoring due to a 3-5% risk of malignancy to vulvar squamous cell carcinoma).
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
- 5
- Treatment options
- 3