Education, Support Help Ease Genital Dermatoses


HOUSTON — Patient education and support are critical to effective treatment of women with recalcitrant nonneoplastic genital dermatoses, Elizabeth “Libby” Edwards, M.D., said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

Often women will go to a series of physicians before the get a diagnosis. And since many skin conditions are incurable, identifying the problem can also bring the unwelcome news that it will require lifelong care, according to Dr. Edwards, chief of dermatology at the Southeast Vulvar Clinic in Charlotte, N.C.

Explaining the nature of the disease is important, as effective treatment often will control a dermatologic condition without curing it, she said. “If they think they are going to be cured, they are not going to be happy when you tell them, 'Take this three times a week for the rest of your life.'”

Dr. Edwards outlined a patient management strategy that begins with a lengthy 5- to 6-page intake questionnaire she requests new patients to complete before their first visit. The questionnaire “is more for their therapy than my evaluation,” Dr. Edwards said. Without taking up office time, the questionnaire allows the patient to tell the physician everything she has gone through in trying to figure out what is wrong.

Once she makes her diagnosis, Dr. Edwards gives the women preprinted handouts (samples available at

Dr. Edwards said she also uses Polaroid photographs taken on the examining table. She sends one home with the patient as a guide to where to place medication and staples the other in the patient's chart for future reference. “They walk out much less confused,” she said.

Dr. Edwards' patients also are encouraged to go for individual and couples counseling because genital skin conditions often lead to avoidance of sexual activity. “These women almost all have psychosexual issues,” she said, emphasizing that these issues are typically a result rather than a cause of the medical condition.

Other recommendations include stopping irritants such as overwashing, cream medications, and panty liners. Dr. Edwards suggested that petrolatum (petroleum jelly) could be used to soothe irritation without causing contact dermatitis.

Ointments and oral medications are preferred because creams often can sting, Dr. Edwards explained. If the patient complains about feeling itchy at night, she recommended nighttime sedation to prevent scratching. “There are no intrinsic anti-itching medications,” Dr. Edwards said. The alternatives are treating the cause of the itch, applying a topical anesthetic, or making the patient too sleepy to itch.

As treatment with corticosteroids will often bring quick relief, Dr. Edwards said patients should be forewarned against stopping treatment and tapering off too soon. Tiny amounts were recommended, and she said patients taking an ultrapotent steroid every day should be reevaluated on a monthly basis.

Once the disease has stabilized, Dr. Edwards said most patients can tolerate medication 3 days per week as a long-term treatment. If the patient is doing well, switching from ointment to a less greasy cream is also an option.

However, if the patient does not respond positively, Dr. Edwards said the physician should revaluate for possible infection.

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