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Published in: Current Geriatrics Reports 4/2020

01-12-2020 | Vulvovaginal Candidiasis | Invited Commentary

Geriatric Vulvar Dermatology

Authors: Nga Nguyen, Sarah Corley

Published in: Current Geriatrics Reports | Issue 4/2020

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Abstract

Purpose of Review

The purpose of this review is to provide the diagnosis and management of inflammatory vulvar dermatoses in the geriatric population. The increasing geriatric population in the USA necessitates informing a broad base of healthcare providers on this topic.

Recent Findings

In the elderly, there are increasing case reports of contact dermatitis due to sanitary napkins, incontinence pads, and over the counter medications. Superimposed vulvovaginal candidiasis and lichen simplex chronicus can occur simultaneously with the primary vulvar disease. The limited research specific to geriatric populations confirms the current state of vulvar dermatosis underdiagnosis.

Summary

In order to close the gaps in diagnosis and treatment of vulvar dermatoses, providers should carefully review the patient’s medical history and complete a physical examination of the genitoanal area for asymptomatic and symptomatic elderly women. Prompt, consistent treatment can vastly improve the patient’s quality of life and is critical to preventing the advancement of lesions to squamous cell carcinoma in conditions that incur this increased risk such as lichen sclerosus and lichen planus.
Literature
1.
go back to reference Hamidi M, Joseph B. Changing epidemiology of the american population. Clin Geriatr Med. 2019;35:1–12.PubMed Hamidi M, Joseph B. Changing epidemiology of the american population. Clin Geriatr Med. 2019;35:1–12.PubMed
2.
go back to reference Savas JA, Pichardo RO. Female genital itch. Dermatol Clin. 2018;36:225–43.PubMed Savas JA, Pichardo RO. Female genital itch. Dermatol Clin. 2018;36:225–43.PubMed
3.
go back to reference Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases: Approach to the patient. J Am Acad Dermatol. 2020;82:1277–84. Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases: Approach to the patient. J Am Acad Dermatol. 2020;82:1277–84.
4.
go back to reference Dhingra I, De Sousa A, Sonavane S. Sexuality in older adults: clinical and psychosocial dilemmas. J Geriatr Ment Health. 2016;3:131. Dhingra I, De Sousa A, Sonavane S. Sexuality in older adults: clinical and psychosocial dilemmas. J Geriatr Ment Health. 2016;3:131.
5.
go back to reference USPSTF, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Screening for cervical cancer: US preventive services task force recommendation statement. JAMA. 2018;320:674–86. USPSTF, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Screening for cervical cancer: US preventive services task force recommendation statement. JAMA. 2018;320:674–86.
6.
go back to reference Schlosser BJ, Mirowski GW. Approach to the patient with vulvovaginal complaints. Dermatol Ther. 2010;23:438–48.PubMed Schlosser BJ, Mirowski GW. Approach to the patient with vulvovaginal complaints. Dermatol Ther. 2010;23:438–48.PubMed
7.
go back to reference Connor CJ, Eppsteiner EE. Vulvar contact dermatitis. Proc Obstet Gynecol. 2014;4:1–14. Connor CJ, Eppsteiner EE. Vulvar contact dermatitis. Proc Obstet Gynecol. 2014;4:1–14.
8.
go back to reference Farage M, Maibach H. Lifetime changes in the vulva and vagina. Arch Gynecol Obstet. 2006;273:195–202.PubMed Farage M, Maibach H. Lifetime changes in the vulva and vagina. Arch Gynecol Obstet. 2006;273:195–202.PubMed
9.
go back to reference Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215:704–11.PubMed Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215:704–11.PubMed
10.
go back to reference Moyal-Barracco M, Edwards L. Diagnosis and therapy of anogenital lichen planus. Dermatol Ther. 2004;17:38–46.PubMed Moyal-Barracco M, Edwards L. Diagnosis and therapy of anogenital lichen planus. Dermatol Ther. 2004;17:38–46.PubMed
11.
go back to reference Kirtschig G. Lichen sclerosus-presentation, diagnosis and management Dtsch Arztebl Int 2016;113:337–343. Kirtschig G. Lichen sclerosus-presentation, diagnosis and management Dtsch Arztebl Int 2016;113:337–343.
13.
go back to reference Day T, Moore S, Bohl TG, Scurry J. Comorbid vulvar lichen planus and lichen sclerosus. J Low Genit Tract Dis. 2017;21:204–8.PubMed Day T, Moore S, Bohl TG, Scurry J. Comorbid vulvar lichen planus and lichen sclerosus. J Low Genit Tract Dis. 2017;21:204–8.PubMed
14.
go back to reference Dubey R, Fischer G. Vulvo-vaginal lichen planus: a focussed review for the clinician. Australas J Dermatol. 2019;60:7–11.PubMed Dubey R, Fischer G. Vulvo-vaginal lichen planus: a focussed review for the clinician. Australas J Dermatol. 2019;60:7–11.PubMed
15.
go back to reference Lewis FM. Vulval symptoms after the menopause - not all atrophy! Post Reprod Health. 2015;21:146–50.PubMed Lewis FM. Vulval symptoms after the menopause - not all atrophy! Post Reprod Health. 2015;21:146–50.PubMed
16.
go back to reference Schwager Z, Stern M, Cohen J, Femia A. Clinical epidemiology and treatment of lichen planus: a retrospective review of 2 tertiary care centers. J Am Acad Dermatol. 2019;81:1397–9.PubMed Schwager Z, Stern M, Cohen J, Femia A. Clinical epidemiology and treatment of lichen planus: a retrospective review of 2 tertiary care centers. J Am Acad Dermatol. 2019;81:1397–9.PubMed
17.
go back to reference Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology. Elsevier Health Sciences; 2012. Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology. Elsevier Health Sciences; 2012.
18.
go back to reference Md LE. Genital dermatology atlas. 2nd ed. Philadelphia: Lww; 2010. p. 384. Md LE. Genital dermatology atlas. 2nd ed. Philadelphia: Lww; 2010. p. 384.
19.
go back to reference Black M, Ambros-Rudolph, Christina M, Edwards L. Obstetric and gynecologic dermatology. 3rd ed. Edinburgh: Mosby; 2008. p. 424. Black M, Ambros-Rudolph, Christina M, Edwards L. Obstetric and gynecologic dermatology. 3rd ed. Edinburgh: Mosby; 2008. p. 424.
20.
go back to reference Byrd JA, Davis MDP, Rogers RS. Recalcitrant symptomatic vulvar lichen planus: response to topical tacrolimus. Arch Dermatol. 2004;140:715–20.PubMed Byrd JA, Davis MDP, Rogers RS. Recalcitrant symptomatic vulvar lichen planus: response to topical tacrolimus. Arch Dermatol. 2004;140:715–20.PubMed
21.
go back to reference Lee A, Fischer G. Diagnosis and treatment of vulvar lichen sclerosus: an update for dermatologists. Am J Clin Dermatol. 2018;19:695–706.PubMed Lee A, Fischer G. Diagnosis and treatment of vulvar lichen sclerosus: an update for dermatologists. Am J Clin Dermatol. 2018;19:695–706.PubMed
22.
go back to reference Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatol. 2015;151:1061–7.PubMed Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: a prospective cohort study of 507 women. JAMA Dermatol. 2015;151:1061–7.PubMed
24.
go back to reference O’Gorman SM, Torgerson RR. Allergic contact dermatitis of the vulva. Dermatitis. 2013;24:64–72.PubMed O’Gorman SM, Torgerson RR. Allergic contact dermatitis of the vulva. Dermatitis. 2013;24:64–72.PubMed
25.
go back to reference Yale K, Awosika O, Rengifo-Pardo M, Ehrlich A. Genital allergic contact dermatitis. Dermatitis. 2018;29:112–9.PubMed Yale K, Awosika O, Rengifo-Pardo M, Ehrlich A. Genital allergic contact dermatitis. Dermatitis. 2018;29:112–9.PubMed
26.
go back to reference Woodruff CM, Trivedi MK, Botto N, Kornik R. Allergic contact dermatitis of the vulva. Dermatitis. 2018;29:233–43.PubMed Woodruff CM, Trivedi MK, Botto N, Kornik R. Allergic contact dermatitis of the vulva. Dermatitis. 2018;29:233–43.PubMed
27.
go back to reference Sand FL, Thomsen SF. Skin diseases of the vulva: eczematous diseases and contact urticaria. J Obstet Gynaecol. 2018;38:295–300.PubMed Sand FL, Thomsen SF. Skin diseases of the vulva: eczematous diseases and contact urticaria. J Obstet Gynaecol. 2018;38:295–300.PubMed
28.
go back to reference Margesson LJ. Vulvar disease pearls. Dermatol Clin. 2006;24:145–55 v.PubMed Margesson LJ. Vulvar disease pearls. Dermatol Clin. 2006;24:145–55 v.PubMed
29.
go back to reference Margesson LJ. Practice gaps: practice gaps “down there”: failures in education, physical examination, recognition, diagnosis, therapy, follow-up care, and cancer surveillance in lichen sclerosus. JAMA Dermatol. 2013;149:1203.PubMed Margesson LJ. Practice gaps: practice gaps “down there”: failures in education, physical examination, recognition, diagnosis, therapy, follow-up care, and cancer surveillance in lichen sclerosus. JAMA Dermatol. 2013;149:1203.PubMed
30.
go back to reference Schlosser BJ. Practice gaps. Missing genital lichen sclerosus in patients with morphea: don’t ask? Don’t tell?: comment on “High frequency of genital lichen sclerosus in a prospective series of 76 patients with morphea”. Arch. Dermatol. 2012;148:28–9. Schlosser BJ. Practice gaps. Missing genital lichen sclerosus in patients with morphea: don’t ask? Don’t tell?: comment on “High frequency of genital lichen sclerosus in a prospective series of 76 patients with morphea”. Arch. Dermatol. 2012;148:28–9.
31.
go back to reference Hoang MP, Reutter J, Papalas JA, Edwards L, Selim MA. Vulvar inflammatory dermatoses: an update and review. Am J Dermatopathol. 2014;36:689–704.PubMed Hoang MP, Reutter J, Papalas JA, Edwards L, Selim MA. Vulvar inflammatory dermatoses: an update and review. Am J Dermatopathol. 2014;36:689–704.PubMed
32.
go back to reference Pichardo-Geisinger R. Atopic and contact dermatitis of the vulva. Obstet Gynecol Clin N Am. 2017;44:371–8. Pichardo-Geisinger R. Atopic and contact dermatitis of the vulva. Obstet Gynecol Clin N Am. 2017;44:371–8.
33.
go back to reference Gardner KH, Davis MDP, Richardson DM, Pittelkow MR. The hazards of moist toilet paper: allergy to the preservative methylchloroisothiazolinone/methylisothiazolinone. Arch Dermatol. 2010;146:886–90.PubMed Gardner KH, Davis MDP, Richardson DM, Pittelkow MR. The hazards of moist toilet paper: allergy to the preservative methylchloroisothiazolinone/methylisothiazolinone. Arch Dermatol. 2010;146:886–90.PubMed
34.
go back to reference Schlosser BJ. Contact dermatitis of the vulva. Dermatol Clin. 2010;28:697–706.PubMed Schlosser BJ. Contact dermatitis of the vulva. Dermatol Clin. 2010;28:697–706.PubMed
35.
go back to reference Bauer A, Rodiger C, Greif C, Kaatz M, Elsner P. Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva. Dermatology (Basel). 2005;210:143–9. Bauer A, Rodiger C, Greif C, Kaatz M, Elsner P. Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva. Dermatology (Basel). 2005;210:143–9.
36.
go back to reference Farage MA, Miller KW, Berardesca E, Maibach HI. Incontinence in the aged: contact dermatitis and other cutaneous consequences. Contact Derm. 2007;57:211–7. Farage MA, Miller KW, Berardesca E, Maibach HI. Incontinence in the aged: contact dermatitis and other cutaneous consequences. Contact Derm. 2007;57:211–7.
39.
go back to reference Eason EL, Feldman P. Contact dermatitis associated with the use of Always sanitary napkins. Can Med Assoc J. 1996;154:1173–6. Eason EL, Feldman P. Contact dermatitis associated with the use of Always sanitary napkins. Can Med Assoc J. 1996;154:1173–6.
40.
go back to reference Wakashin K. Sanitary napkin contact dermatitis of the vulva: location-dependent differences in skin surface conditions may play a role in negative patch test results. J Dermatol. 2007;34:834–7.PubMed Wakashin K. Sanitary napkin contact dermatitis of the vulva: location-dependent differences in skin surface conditions may play a role in negative patch test results. J Dermatol. 2007;34:834–7.PubMed
41.
go back to reference Schlosser BJ, Mirowski GW. Introduction: the diagnosis and treatment of vulvar and vaginal disorders. Dermatol Ther. 2010;23:435–7.PubMed Schlosser BJ, Mirowski GW. Introduction: the diagnosis and treatment of vulvar and vaginal disorders. Dermatol Ther. 2010;23:435–7.PubMed
42.
go back to reference Hoffmann JN, You HM, Hedberg EC, Jordan JA, McClintock MK. Prevalence of bacterial vaginosis and Candida among postmenopausal women in the United States. J. Gerontol. B, Psychol. Sci. Soc. Sci. 2014;69 Suppl 2:S205–14. Hoffmann JN, You HM, Hedberg EC, Jordan JA, McClintock MK. Prevalence of bacterial vaginosis and Candida among postmenopausal women in the United States. J. Gerontol. B, Psychol. Sci. Soc. Sci. 2014;69 Suppl 2:S205–14.
43.
go back to reference Rajalakshmi R, Thappa DM, Jaisankar TJ, Nath AK. Lichen simplex chronicus of anogenital region: a clinico-etiological study. Indian J Dermatol Venereol Leprol. 2011;77:28–36.PubMed Rajalakshmi R, Thappa DM, Jaisankar TJ, Nath AK. Lichen simplex chronicus of anogenital region: a clinico-etiological study. Indian J Dermatol Venereol Leprol. 2011;77:28–36.PubMed
44.
go back to reference Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, Kao CH. Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. Br J Dermatol. 2014;170:890–4.PubMed Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, Kao CH. Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. Br J Dermatol. 2014;170:890–4.PubMed
45.
go back to reference Bertram F, Bröcker E-B, Zillikens D, Schmidt E. Prospective analysis of the incidence of autoimmune bullous disorders in Lower Franconia, Germany. J Dtsch Dermatol Ges. 2009;7:434–40.PubMed Bertram F, Bröcker E-B, Zillikens D, Schmidt E. Prospective analysis of the incidence of autoimmune bullous disorders in Lower Franconia, Germany. J Dtsch Dermatol Ges. 2009;7:434–40.PubMed
46.
go back to reference Malik M, Ahmed AR. Involvement of the female genital tract in pemphigus vulgaris. Obstet Gynecol. 2005;106:1005–12.PubMed Malik M, Ahmed AR. Involvement of the female genital tract in pemphigus vulgaris. Obstet Gynecol. 2005;106:1005–12.PubMed
47.
go back to reference Davis SA, Davis LS. Pemphigus vulgaris presenting as chronic vulvovaginal erosions: the importance of autoantibody testing: a case report. J Reprod Med. 2016;61:589–91.PubMed Davis SA, Davis LS. Pemphigus vulgaris presenting as chronic vulvovaginal erosions: the importance of autoantibody testing: a case report. J Reprod Med. 2016;61:589–91.PubMed
48.
go back to reference Murrell DF, Peña S, Joly P, Marinovic B, Hashimoto T, Diaz LA, et al. Diagnosis and management of pemphigus: recommendations of an international panel of experts. J. Am. Acad. Dermatol. 2020;82:575–585.e1.PubMed Murrell DF, Peña S, Joly P, Marinovic B, Hashimoto T, Diaz LA, et al. Diagnosis and management of pemphigus: recommendations of an international panel of experts. J. Am. Acad. Dermatol. 2020;82:575–585.e1.PubMed
49.
go back to reference Joly P, Maho-Vaillant M, Prost-Squarcioni C, Hebert V, Houivet E, Calbo S, et al. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet. 2017;389:2031–40.PubMed Joly P, Maho-Vaillant M, Prost-Squarcioni C, Hebert V, Houivet E, Calbo S, et al. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet. 2017;389:2031–40.PubMed
50.
go back to reference Schmidt E, Zillikens D. The diagnosis and treatment of autoimmune blistering skin diseases. Dtsch Arztebl Int. 2011;108:399–405 I.PubMedPubMedCentral Schmidt E, Zillikens D. The diagnosis and treatment of autoimmune blistering skin diseases. Dtsch Arztebl Int. 2011;108:399–405 I.PubMedPubMedCentral
51.
go back to reference Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512–6.PubMed Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512–6.PubMed
53.
go back to reference Meeuwis KAP, Potts Bleakman A, van de Kerkhof PCM, Dutronc Y, Henneges C, Kornberg LJ, et al. Prevalence of genital psoriasis in patients with psoriasis. J Dermatolog Treat. 2018;29:754–60.PubMed Meeuwis KAP, Potts Bleakman A, van de Kerkhof PCM, Dutronc Y, Henneges C, Kornberg LJ, et al. Prevalence of genital psoriasis in patients with psoriasis. J Dermatolog Treat. 2018;29:754–60.PubMed
Metadata
Title
Geriatric Vulvar Dermatology
Authors
Nga Nguyen
Sarah Corley
Publication date
01-12-2020
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 4/2020
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-020-00332-8

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