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Vulvar Psoriasis in Adults and Children: A Clinical Audit of 194 Cases and Review of the Literature

Kapila, Shivam MBBS, BSc(Med), MS1; Bradford, Jennifer MBBS, FRANZCOG2; Fischer, Gayle MBBS, MD, FACD1,3

Journal of Lower Genital Tract Disease: October 2012 - Volume 16 - Issue 4 - p 364–371
doi: 10.1097/LGT.0b013e31824b9e5e
Original Articles

Objective: There are limited data on psoriasis as it affects the vulva in the medical literature. This observational study aimed to describe the symptoms, signs, and management of vulvar psoriasis in adults and children in a private vulvar disease referral practice.

Materials and Methods: A review of the existing literature on vulvar psoriasis was used to generate inclusion criteria of a chronic noninfective erythematous vulvitis without vaginal involvement. Between January 2009 and October 2011, 201 patients presenting with these criteria were coded as having psoriasis in a computerized database where standardized data were collected. In 194 of these patients, adequate data were available to include in the study.

Results: Only 12.3% of the patients presented with psoriasis as a provisional diagnosis with a mean symptom duration of 4.5 years (range = 6 weeks to 35 years). The most common presentation was a pruritic, bilaterally symmetrical, erythematous, nonscaly, well-demarcated macular eruption or slightly raised plaque (82.5%). Of the remaining patients, 9.2% presented with only diffuse symptomatic erythema, whereas 8.2% were symptomatic without erythema. In 64.9% of the patients, evidence of psoriasis was found on other parts of the skin. Initial induction treatment with potent topical corticosteroid followed by a maintenance treatment with less potent topical steroids and other psoriasis-specific treatment such as tar creams and calcipotriol resulted in a suppression of disease in 93.8% of the patients during a mean follow-up duration of 8.9 months (range = 1 month to 7.25 years).

Conclusions: Vulvar psoriasis is a difficult diagnosis that should be considered in patients presenting with a chronic erythematous vulvitis without vaginitis. It is a chronic relapsing skin condition that requires long-term management.

Vulvar psoriasis is a chronic relapsing skin condition in patients presenting with a chronic erythematous vulvitis without vaginitis that requires long-term management.

1Department of Dermatology, Royal North Shore Hospital, St Leonards; 2School of Medicine, University of Western Sydney, Campbelltown; and 3Discipline of Dermatology, Faculty of Medicine, The University of Sydney, New South Wales, Sydney, Australia

Correspondence to: Shivam Kapila, MBBS, BSc(Med), MS, Royal North Shore Hospital, PO Box 4028, Royal North Shore LPO, St Leonards NSW 2065, Sydney, Australia. E-mail: drshivamkapila@gmail.com

The authors declare that there is no source of financial or other support or any financial or professional relationships that may pose a competing interest.

The study was exempted from full ethics review because the collected data were drawn from a noninstitutionalized setting and all data were de-identified.

©2012The American Society for Colposcopy and Cervical Pathology