Vulvar Dystrophies: An Evaluation

EDITORIAL COMMENT: This paper provides readers with a logical plan of treatment for patients presenting with pruritus, vulvitis or visible vulvar disease who are found on directed biopsy to have vulvar dystrophy (hyperplasia, lichen sclerosus or mixed dystrophy). Excellent results were obtained using topical corticosteroid therapy for patients with hyperplasia, and topical testosterone for those with lichen sclerosus. In presenting the results in this series of 86 patients the authors do not explain the criteria for directed vulvar biopsy in women presenting with pruritus or vulvitis. These excellent results suggest that vulvar biopsy should be performed not only in all patients with clinical suspicion of carcinoma, but also in all those who fail to respond to initial therapy. The results presented here seem almost too good to believe because in this reviewer's experience vulvar biopsies in many patients with intractable pruritus and vulvitis show coexistence of hyperplasia and lichen sclerosus — in this series only 7 of 86 patients had mixed dystrophy. Readers should note that medical treatment was not used in patients with atypia on biopsy — these patients require a surgical approach to their treatment.Summary: Of 86 patients diagnosed as having vulvar dystrophy in a 10‐year period 56 (65.1%) had hyperplastic dystrophy, 23 (26.7%) had lichen sclerosus and 7 (26.7%) had mixed vulvar dystrophy. The diagnoses were made by colposcopic or toluidine blue directed biopsies. Fluorinated corticosteroids were given to patients with hyperplastic dystrophy with a response rate of 90.1%. Patients with lichen sclerosus received topical testosterone propionate and the response rate was 87.7%. Topical fluorinated corticosteroids followed by testosterone propionate was given to patients with mixed dystrophy and 85.8% of the patients responded. Surgical therapy was reserved for patients with failed medical treatment.