Our vulvar dermatoses clinic specializes in the care of skin disorders of the vulva. Vulvar dermatoses are skin disorders that affect the vulva that can lead to itching, burning, or discomfort. A variety of dermatologic conditions affect the vulva. Some conditions present without visible findings during an exam. These conditions can affect a wide range of individuals, but are most commonly found in postmenopausal women.
The clinic combines the expertise of dermatologist Dr. Lynette J. Margesson and gynecologist Dr. Angela Koenig to treat a variety of skin conditions that affect the daily lives of woman. These physicians work together to create a comprehensive and personalized treatment plan for you.
Some of the common types of conditions we treat include:
- Lichen simplex chronicus, which involves intense itching that leads to a chronic itch-scratch cycle. This results in thickening of the skin in and around the vulva. Symptoms include large patches of thickened, scaly areas caused by repetitive scratching.
- Lichen sclerosus, which is the most common chronic skin condition affecting the vulva. It can also appear on other body parts, though this is uncommon. Symptoms include severe itching and pain, white patches of skin on the vulva, areas of bruising, and thin, dry skin that splits easily, leading to burning, stinging, and pain during sex and urination. Symptoms may worsen with stress. If left untreated, lichen sclerosus can cause severe scarring of the vulva and a small increased risk of vulvar cancer. With treatment, further scarring can be prevented and risk of developing skin cancer is decreased.
- Lichen planus, which is an uncommon, inflammatory skin condition can affect the vulva, vagina, and other areas of the body. Symptoms include pain, soreness, burning, bleeding, and painful intercourse. If left untreated, lichen planus can cause scarring of the vagina and vulva.
We offer a wide variety of treatments for vulvar dermatoses, including:
- Topical therapies
- Systemic immunomodulating treatments
- Surgical interventions
Typically, we initially use steroid therapy to reduce itching and inflammation. We can also use a combination of topical steroids with oral and/or injectable steroids. Steroid treatments help restore the skin's normal texture and strength but do not not reverse scarring that has already occurred.
Other immunotherapy can be used to control your skin condition. If you have been diagnosed with vulvar lichen sclerosus and lichen planus, you should be examined regularly to ensure no cancerous changes have occurred.
What to expect from your appointment
History and physical exam
We perform a modified skin exam and review your medical history and outside records, including:
- Performing a pelvic exam and other body system exams if necessary
- Reviewing prior blood tests and skin biopsies
If we suspect a specific vulvar dermatosis, we may remove a small skin sample (biopsy) from the affected area for analysis to provide us with information to make the correct diagnosis.
Blood test and imaging
We may order more blood work or radiologic imaging to determine the extent of your disease.
Based on your history, physical exam, and lab results, we create a personalized treatment plan. Your treatment addresses your manifestations of the disease, severity, and your overall health.
More information on vulvar dermatoses
Appointments and referrals
We provide services in Lebanon, New Hampshire. We typically schedule appointments on the third Friday of the month.
Ask your dermatologist, gynecologist, or primary care physician for a referral to the vulvar dermatoses clinic.