Therapeutic Principles in Vulvovaginal Dermatology
Section snippets
General measures
There are several general measures that are essential for the successful treatment of any vulvovaginal disease. Despite adequate diagnosis and treatment, patients may fail to improve if these fundamentals are not addressed. These include educating patients about the nature of their disease, addressing psychosexual issues, stopping irritants, using appropriate vehicles for medications, anticipating and treating iatrogenic disease, prescribing estrogen when appropriate, and having a rescue plan
Topical corticosteroid therapy
Topical corticosteroids are the mainstay of treatment of many vulvovaginal diseases, including lichen sclerosus, lichen planus, and other pruritic diseases. The modified mucous membranes are relatively steroid resistant, and often potent or superpotent corticosteroids, such as clobetasol proprionate, are required for successful treatment.7 A common error in treating vulvar diseases is using a topical steroid that is not potent enough for too little period of time. It is rare to see atrophy of
Summary
Vulvovaginal disease, like many dermatologic diseases, tends to be chronic. Similar to treatment of diseases like atopic dermatitis, chronic vulvovaginal disease requires a multifaceted approach, often addressing multiple issues concurrently. General principles apply to all vulvovaginal patients and must be considered in each patient for treatment to be ultimately successful. The goal of treatment is often control, not cure.
References (60)
Principles of therapeutics for vulvovaginal disease
- et al.
Contact sensitivity in pruritus vulvae: patch test results and clinical outcome
Am J Contact Dermat
(1997) - et al.
Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms
Obstet Gynecol
(1997) - et al.
Topical testosterone in the treatment of vulvar lichen sclerosus
Int J Gynaecol Obstet
(1994) - et al.
Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women
Am J Obstet Gynecol
(2002) Sleep deprivation in depression: what do we know, where do we go?
Biol Psychiatry
(1999)Vaginitis
- et al.
Topical calcineurin inhibitors for the treatment of vulvar dermatoses
Eur J Obstet Gynecol Reprod Biol
(2009) - et al.
Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine
Am J Obstet Gynecol
(2003) Desquamative inflammatory vaginitis: a new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy
Am J Obstet Gynecol
(1994)