Other treatment recommendations include those below. As the condition improves, the application frequency and potency of the corticosteroid should be decreased to minimise the adverse effects. If the disease is refractory after 2–3 weeks of an intermediate-strength corticosteroid, more potent topical steroids can be used on a short-term basis. Treatment principles for lichen simplex of the vulva include using a medium–potency topical steroid (such as triamcinolone ointment) until there is a resolution of active lesions. Short-term topical corticosteroids are used as first-line therapy to break the itch–scratch cycle.
#TRIAMCINOLONE CREAM SKIN#
What is the treatment for lichen simplex of the vulva? Condyloma related to human papillomavirus (HPV).Other disorders that should be considered in a patient with lichen simplex of the vulva include : What is the differential diagnosis for lichen simplex of the vulva? If the vulval lichen simplex is associated with generalised pruritus, a workup for systemic causes can be undertaken (as outlined on our pruritus page).
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Patch testing, if allergic contact dermatitis is suspected.Fungal scraping for dermatophyte fungus.A skin biopsy to rule out squamous cell carcinoma, vulval intraepithelial neoplasia or extramammary Paget disease.When findings are atypical, further tests can be considered to make a definitive diagnosis or to exclude other similar dermatoses such tests to be considered include : The clinical features of vulval lichen simplex are generally sufficient to establish the diagnosis. How is lichen simplex of the vulva diagnosed? Topical steroids can also cause pigmentation abnormalities. Fibrosis and scarring from repeated scratchingĪdverse effects from treatment can also arise, particularly atrophy due to the extended use of a potent topical corticosteroid on vulval skin.Postinflammatory hyperpigmentation or hypopigmentation and, rarely, permanent white marks ( leukoderma).Secondary infection (eg, impetigo or cellulitis).Insomnia or poor quality of sleep - sleep studies have revealed sleep disturbances due to scratching when asleep.What are the complications of lichen simplex of the vulva?Ĭomplications of lichen simplex of the vulva may include : Common sites of involvement are the posterior- lateral neck, the scalp, the extensor surfaces of extremities, and the ankles or lower legs. Lichen simplex can affect other parts of the body. Signs of an underlying skin disorder may also be noted adjacent to the lichen simplex of the vulva and/or on another body site. Hypopigmentation or hyperpigmentation of vulval or perianal skin.Excoriations or linear fissures at skin folds.Other commonly observed features include: There may be a solitary plaque or multiple coalescing plaques or papules. It is often unilateral but it may also be bilateral. Lichen simplex of the vulva manifests as well-demarcated, markedly thickened plaques with a leathery appearance. What are the clinical features of lichen simplex of the vulva? A systemic cause of generalised itch (eg, renal failure, obstructive biliary disease, hyperthyroidism or hypothyroidism, or Hodgkin lymphoma).A benign or malignant skin tumour (eg, squamous cell carcinoma).Psychiatric disorder (eg, anxiety or obsessive– compulsive disorder).Cutaneous fungal infection ( candidiasis or tinea).Contact with an allergen ( allergic contact dermatitis).Contact with an irritant ( irritant contact dermatitis) - often triggered by heat, sweating, chafing from clothing, or the excessive use of cleansers or topical medicaments).Another pruritic skin disorder (eg, psoriasis or lichen planus).Ĭontributing factors to vulval lichen simplex may include : Pruritus may be associated with underlying systemic disease and/or a predisposing psychiatric condition. Pre-existing itch or pruritic conditions induce habitual scratching, which gives rise to histological acanthosis (thickening of the epidermis) and hyperkeratosis (thickening of the stratum corneum). The mechanism of lichen simplex of the vulva is explained by the persistent itch–scratch cycle. Vulvar lichen simplex is most frequently seen in adult women with atopic sensitive skin. (See our page of vulval lichen simplex images). Lichen simplex is also known as lichen simplex chronicus and neurodermatitis. Lichen simplex is typically secondary to an underlying skin condition or neuropathy causing a severely itchy vulva.
Characteristically, there are well- demarcated, erythematous or hyperpigmented, thickened plaques affecting one or both sides of the vulva. Lichen simplex of the vulva is a pruritic form of dermatitis in which excessive scratching or rubbing leads to lichenification.
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