Vulval dermatoses

Dermatological disorders in the vulva are common. They are often misdiagnosed and mistreated because of the patient's delay in seeking help, or the doctor's failure to examine the area and inadequate training in anogenital diseases. Knowledge of the anatomy and appearance of the normal vulva is essential in order to recognize any abnormality or disease. Common skin diseases (eczema and psoriasis) affect the vulva, but may look different because of the moist flexural site. A careful family history and the general examination of the rest of the patient's skin, including the scalp and nails, may give clues as to the diagnosis. Treatment is similar to that used at other body sites. There are also skin diseases that preferentially affect the vulva (lichen sclerosus, lichen planus and vulval intraepithelial neoplasia). Women with complicated vulval skin disorders should be referred to a dermatologist or, preferably, a multidisciplinary vulval clinic.