HOUSTON — A new classification of vulvar skin disorders from the International Society for the Study of Vulvovaginal Disease aims to establish a common language for gynecologists and dermatologists in their diagnosis and treatment of vulvar dermatoses, according to Dr. Peter J. Lynch, professor of dermatology at the University of California, Davis, and the document's senior author.
The new document (J. Reprod. Med. 2007;52:3–9) was outlined by Dr. Raymond H. Kaufman at a conference on vulvovaginal diseases jointly sponsored by Baylor College of Medicine and the Methodist Hospital.
“Dermatologic language can be far out for gynecologists and vice versa, and yet we're all seeing the same things on the vulva,” said Dr. Kaufman, who is professor emeritus in obstetrics, gynecology, and pathology at Baylor College of Medicine, Houston.
“What has tended to happen in vulvar diseases is that tumors and neoplasms have been gynecologically handled, and skin rashes have been dermatologically handled,” Dr. Lynch said in an interview. “What we are trying to do is to get rid of the notion of gynecologic disease or dermatologic disease to say that it is vulvar disease. We're trying to break down the barriers. We have to blend the language to get people to talk.”
The new classification is also designed to pull pathologists more closely into the diagnostic discussion, Dr. Lynch added. “In the case of a simple lesion, most clinicians can either diagnose it immediately or the pathologist can make a specific diagnosis. But it's the situation where neither the clinician nor pathologist can be definitive that this new classification is designed for. The pathologist can designate the lesion to a general category and then put the ball back in the clinician's court to get more clinical data.”
Whereas the older International Society for the Study of Vulvovaginal Disease (ISSVD) classification comprised just three categories, the new classification sorts vulvar dermatoses into eight: spongiotic pattern, acanthotic pattern, lichenoid pattern, dermal homogenization/sclerosis pattern, vesiculobullous pattern, acantholytic pattern, granulomatous pattern, or vasculopathic pattern (see box below).
Dr. Lynch says that although the terminology is designed to blend gynecology and dermatology, the document's aim is to help all clinicians.
ISSVD Classification of Vulvar Dermatoses
allergic contact dermatitis
irritant contact dermatitis
lichen simplex chronicus
secondary (to lichen sclerosus, lichen planus, or other vulvar disease)
Dermal homogenization/sclerosis pattern
pemphigoid, cicatricial type
linear IgA disease
Plasma cell vulvitis