Feature Article

Vulval disease. Part 2: patients with a symptomatic rash

Feature Article

Vulval disease. Part 2: patients with a symptomatic rash

Gayle Fischer, Jennifer Bradford

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Abstract

When a vulval rash causes symptoms, it is often assumed to be acute candidiasis. However, there are many other vulval dermatological conditions. Dermatitis, chronic vulvovaginal candidiasis, lichen sclerosus and psoriasis are other common causes.

Key Points

  • Vulval conditions with a symptomatic rash can be divided into those with cyclical symptoms and those with noncyclical symptoms.
  • Rash with noncyclical symptoms can be further subdivided into rash which does or does not involve the vagina and rash with blistering and erosions. Physical examination, with or without biopsy, will usually differentiate the causes.
  • Dermatitis is the most common cause of chronic vulval symptoms, and accounts for about a third of all vulval presentations.
  • Most dermatological conditions, such as dermatitis, psoriasis and lichen sclerosus, are corticosteroid responsive.
  • Most women with chronic vulvovaginal candidiasis are otherwise normal and their susceptibility to the infection is as yet unexplained. Chronic candidiasis accounts for about 15% of patients with longstanding vulval symptoms.
  • It is essential to consider options other than ‘thrush’ when a patient presents with vulval symptoms. There are many other dermatological conditions of the vulva, and specific management is dependent on the underlying condition.