Hyperplastic Vulvar Dystrophy (Squamous Cell Hyperplasia)

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Chapter 74 Hyperplastic Vulvar Dystrophy (Squamous Cell Hyperplasia)

INTRODUCTION

Description: Hypertrophic vulvar dystrophy causes a thickening of the vulvar skin over the labia majora, outer aspects of the labia minora, and clitoral areas. Eczematous inflammation or hyperkeratosis may be present.

Prevalence: Common, 40% to 45% of non-neoplastic epithelial disorders.

Predominant Age: Middle to late reproductive and beyond.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown. Dermal reaction to chronic itch-scratch cycle. Often associated with or worsened by stress.

Risk Factors: Genital atrophy (postmenopausal), recurrent vulvitis.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Vulvar itching (almost always present)

• Dusky-red to thickened-white appearance of the vulva

• Fissuring and excoriations (common)

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Perineal hygiene, sitz baths, stress reduction. Reduce or eliminate sources of irritation such as candidiasis or contact allergy. Wearing white cotton gloves (especially at night) reduces the tissue damage caused by scratching.

Specific Measures: Treatment is focused on interrupting the itch-scratch-rash-itch cycle. Topical steroids, perineal soothing agents, and agents to reduce itching are most effective. If significant improvement is not achieved in 3 months, biopsy is indicated.

Diet: No specific dietary changes indicated.

Activity: No restriction.

Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP088 (Disorders of the Vulva).

Drug(s) of Choice

Fluocinolone acetonide (0.025% or 0.01%), triamcinolone acetonide (0.01%) or betamethasone valerate (Valisone 0.1%), or a similar corticosteroid applied two to three times daily may give relief. Once relief is achieved, treatment should switch to hydrocortisone 2.5% cream or ointment.

For itching: diphenhydramine hydrochloride (Benadryl) or hydroxyzine hydrochloride (Atrax) used at night.

Contraindications: See individual agents.

Precautions: Fluorinated steroids should be used for short periods only and replaced with hydrocortisone or nonsteroidal therapies when possible.

Interactions: See individual agents.

Alternative Drugs

Topical clobetasol propionate (0.05%) may be used if relief of pruritus is not achieved with less potent agents.

Subcutaneous injections of triamcinolone (5-mg suspension mixed with 2 mL of saline) or alcohol (0.1 to 0.2 mL of absolute alcohol) have been reported but should be reserved for the most intractable disease.

Topical progestins and androgens have been advocated as alternative therapies.

FOLLOW-UP

Patient Monitoring: Constant vigilance is required to watch for possible premalignant or malignant changes that can often mimic these lesions and those of lichen sclerosus.

Prevention/Avoidance: Avoidance of local irritants.

Possible Complications: Vulvar cancer may be overlooked; excoriation is common with secondary infection possible.

Expected Outcome: Generally good if itch-scratch cycle is broken.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy.

ICD-9-CM Codes: 624.3.

Bousema MT, Romppanen U, Geiger JM, et al. Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study. J Am Acad Dermatol. 1994;30:225.

Li C, Bian D, Chen W, et al. Focused ultrasound therapy of vulvar dystrophies: a feasibility study. Obstet Gynecol. 2004;104:915.

Cario GM, House MJ, Paradinas FJ. Squamous cell carcinoma of the vulva in association with mixed vulvar dystrophy in an 18-year-old girl. Case report. Br J Obstet Gynaecol. 1984;91:87.

Cattaneo A, Bracco GL, Maestrini G, et al. Lichen sclerosis and squamous hyperplasia of the vulva. A clinical study of medical treatment. J Reprod Med. 1991;36:301.

Friedrich EGJr. Topical testosterone for benign vulvar dystrophy. Obstet Gynecol. 1971;37:677.

Japaze H, Garcia-Bunuel R, Woodruff JD. Primary vulvar neoplasia: a review of in situ and invasive carcinoma, 1935–1972. Obstet Gynecol. 1977;49:404.

Jasionowski EA, Jasionowski P. Topical progesterone in treatment of vulvar dystrophy: preliminary report of five cases. Am J Obstet Gynecol. 1977;127:667.

American College of Obstetricians and Gynecologists. Vulvodynia. ACOG Committee Opinion 345. Obstet Gynecol. 2006;108:1049.

Friedrich EGJr. Vulvar dystrophy. Clin Obstet Gynecol. 1985;28:178.

Frumovitz M, Bodurka DC. Neoplastic disease of the vulva. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:783.

Jasionowski EA, Jasionowski PA. Further observations on the effect of topical progesterone on vulvar disease. Am J Obstet Gynecol. 1979;134:565.

Maloney ME. Exploring the common vulvar dermatoses. Contemp Obstet/Gynecol. 1988;29:91.

McKay M. Vulvar dermatoses. Clin Obstet Gynecol. 1991;34:614.

Murphy FR, Lipa M, Haberman HF. Familial vulvar dystrophy of lichen sclerosus type. Arch Dermatol. 1982;118:329.

Nanda VS. Common dermatoses. Am J Obstet Gynecol. 1995;173:488.

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