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Genital Dermatology

 

VULVAL DERMATOLOGY

Patient information                       

British Association of Dermatologists leaflets available at www.bad.org.uk for

  • Vulval skin care
  • Lichen Sclerosus
  • Vulvodynia
  • Vestibulodynia

Patient support group:

British Society for the Study of Vulval Disease website www.bssvd.org

 

Lichen Sclerosus

General Points

  • Uncomplicated vulval lichen sclerosus can be managed in primary care and diagnostic biopsies are only required if there is diagnostic doubt, or failure to respond to treatment
  • However, it is preferable that no super potent topical steroid has been used for 4 weeks prior to biopsy

 

Treatment

  • Appropriate vulval/genital skin care advice, including use of soap substitutes, emollients and avoidance of irritants.
  • Use of lubricants for sex and or topical oestrogens if indicated, if sexually active.
  • Super potent topical steroid (eg Dermovate ointment) applied at night, every night for the first month, alternate nights in the second month and in the third month and thereafter at a frequency which keeps their symptoms under control. (A 30g tube should last 3 - 4 months)

 

Referral Criteria

  • Diagnostic uncertainty
  • Complicated Lichen Sclerosus
  • Lichen planus
  • Any vulval or genital dermatosis not responding to treatment
  • Vulval or genital pain syndrome
  • Pigmented vulval or genital lesions
  • Vulval or penile intraepithelial neoplasia

 

NOTE

  • there is a male genital dermatology clinic

 

References

British Association Dermatologists’ Guidelines for the Management of Lichen Sclerosus 2010

SM Neill, FM Lewis, FM Tatnall and NH Cox