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Chronic pruritic vulva lesion

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The patient was not sexually active and denied any vaginal discharge. So what was causing the intense itching on her labia?


 

References

DURING A ROUTINE EXAM, a 45-year-old Caucasian woman complained of intense itching on her labia. She said that the itching had been an issue for more than 9 months and that she found herself scratching several times a day. She denied any vaginal discharge and said she hadn’t been sexually active in years. She had tried over-the-counter antifungals and topical Benadryl, but they provided only limited relief.

The patient had red thickened plaques with accentuated skin lines (furrows) covering both of her labia majora (FIGURE). Throughout the lesion, there were scattered areas of excoriation. Her labia minor were spared.

FIGURE
Red thickened plaques on labia majora


A speculum and bimanual exam were normal. No inguinal lymphadenopathy was present.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

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