HOUSTON — Skin disorders are often overlooked as a cause of chronic vulvovaginal symptoms, Elizabeth “Libby” Edwards, M.D., said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.
Gynecologists are not trained to look for skin disorders, and dermatologists don't want to diagnose vulvovaginal conditions, according to Dr. Edwards, chief of dermatology at the Southeast Vulvar Clinic in Charlotte, N.C. and also a faculty member at the University of North Carolina, Chapel Hill.
“Most physicians across all specialties are unaware of how unbelievably common chronic skin diseases of the vulva and the vagina are,” said Dr. Edwards.
“Most physicians are taught that chronic vulvovaginal symptoms are due to yeast—maybe bacterial vaginitis and, if not that, maybe a sexually transmitted disease. And they keep looking for those same things over again,” she said. “[But] there are hundreds of skin diagnoses that can be playing a role.”
Some of these diseases will present as vulvovaginal, gingival, and even ocular conditions. Dr. Edwards told of one patient who was being followed by an ophthalmologist for dry eye syndrome, a dentist for gingivitis due to poor hygiene, and a gynecologist for lichen sclerosus. The common condition was cicatricial pemphigoid, which is a nonspecific skin disease that can affect mucous membranes in the eyes, mouth, vagina, and vulva.
Dr. Edwards urged physicians to get a culture and do biopsies when they can't identify the cause of a chronic vulvovaginal condition. She suggested sending samples with a differential diagnosis to a dermatologic pathologist who has experience with erosive skin diseases but warned that a biopsy may not provide the answer.
“A biopsy is not a lab test,” she said. “It is just a different doctor in a different place giving an opinion on looking at the skin under a microscope.”
Even after a diagnosis is made, she urged persistence if the patients still has symptoms.
“Often there is more than one factor in [a] chronic vulvovaginal symptom,” Dr. Edwards said. “If you find one thing—i.e., a yeast infection—don't stop looking, keep going.”