Womens’ Health and Vulvar Dermatology | Anne Marie McNeill, M.D. Ph.D

What doctors treat rashes in the vulvar area?
Both dermatologists and OBGYN treat rashes in this area and receive some training in residency. However, not all dermatologists and OBGYN have a good deal of experience in this matter. I do specialize in skin diseases and conditions of the female genital area. I received extended study and specialized training in Vulvar Dermatology at St. John’s Institute of Dermatology in London, England during my residency training and a significant proportion of my practice consists of vulvar dermatology patients.
I think that most women are unaware that there are skin diseases and conditions specific to the female genital area.
Dr. McNeill: It is true, often times these diseases and conditions are undetected, misdiagnosed, even by gynecologists, and lead to chronic pain and discomfort for patients.
What are the most common skin diseases and conditions of the female genital area?
Dr McNeill: The most common skin conditions of the female genital area are common conditions like allergic reactions and yeast infections and psoriasis. There are less common conditions, like lichen sclerosus and lichen planus, which need to be diagnosed and treated appropriately when these other, more common conditions, are ruled out.
And do these only appear in women? Only on the genital area?
Dr. McNeill: Both can appear in men, and very rarely, children, can be found on other spots on the body, but are most prevalent and common in women, after the age of 40, on the genital area.
What are the symptoms of each?
Dr. McNeill: Lichen sclerosus – itching of the entire genital area is the most common symptom. This often causes women to think that they have a yeast infection that will not go away. There is also, on physical exam, the presence of dull white patches all over the genital area. And there can be pain as well, but this is less common.
Lichen planus – the most common symptom is a constant burning sensation and pain in the genital area that will not go away. Sometimes this is mistaken for a sexually transmitted disease. There is also, on physical examination, the presence of red shiny patches all around the genitals.
As a dermatologist, do you know just by looking at the skin, or do you test it?
Dr. McNeill: I do a biopsy to confirm what I see on exam.
What is the treatment upon diagnosis?
Dr. McNeill: For both, topical steroids, such as clobetasol ointment. These steroids will be part of an ongoing treatment plan, there is no cure for each, only management.
No Cure? Are they similar to eczema, where it comes and goes?
Dr. McNeill: Yes, the condition will wax and wane, often flaring under times of stress.
What causes each disease?
Dr. McNeill: We do not know for sure, but we think that they are both autoimmune diseases.
What happens if they are left untreated or misdiagnoses continues?
Dr. McNeill: Both conditions will become more painful and uncomfortable. Scar tissue can develop, which can lead to the inability to have sexual intercourse. Also there is an increased risk of squamous cell carcinoma associated with the untreated conditions.
How can patients be proactive in the determination of lichen sclerosus and lichen planus?
Dr. McNeill: If your symptoms persist for longer than 2 months of treatment for another condition, go to a dermatologist.