Approaching inflammatory vulvovaginal diseases

Contemporary OB/GYN:

What are some of the clinical pearls of vulvovaginal dermatological conditions discusses at Symposia Medicus?

Toby Maurer, MD:

One of the most important things that I like to discuss with the audience is what is normal, and so, reviewing the normal anatomy of the vulvovaginal area. This really I think is helpful for patients who often come in worrying about conditions that may or may not apply. They may not understand what the normal anatomy is and what is pathologic. Some of the conditions I discuss of course include things like warts in various growth on the vulvovaginal area, but also the inflammatory diseases to include things like lichen sclerosus, lichen planus. These are conditions that are easily missed by many clinicians. In addition, I review contact dermatitis. Contact dermatitis has been a very big problem that we've encountered in our patients.

Contemporary OB/GYN:

Are there any clinical pearls for management that clinicians can take home with them?

Maurer:

Yeah, one of the biggest pearls I have is that we in dermatology approach some of these inflammatory diseases using steroids, but class 1 steroids. We've all been taught in medical school training that you should never use these potent topical steroids in the vulvovaginal area and certainly not for long duration. There is some truth to that. But I have found that clobetaso, which is a class 1 steroid, probably is not used enough. Vaginas in the vulvovaginal area are quite resistant to topical steroids. And whatever people have, it either works with club aid as well or it doesn't, and that can give you a lot of information as to what direction your diagnosis goes.