Hyperplastic Vulvar Dystrophy (Squamous Cell Hyperplasia)

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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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)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Vulvar cancer (premalignant or malignant changes)
• Chronic mycotic vulvitis
• Contact vulvitis
• Psoriasis
• Lichen sclerosus

Associated Conditions: Vulvodynia, vulvar pruritus, and dyspareunia.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: No imaging indicated.
Special Tests: Biopsy may be required to confirm the diagnosis. Cultures for Candida or other dermatophytes should be considered.
Diagnostic Procedures: History, physical examination, colposcopy, or biopsy of lesions.

Pathologic Findings

Thickening of the epithelium with acanthosis, elongation of the epithelial folds, and chronic inflammatory changes (lymphocytes and plasma cells) occur. Hyperkeratosis may be present.

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