Nonneoplastic epithelial disorders of vulva Women’s Hospital,School of Medicine Women’s Hospital,School of Medicine Zhejiang University Zhejiang University

General Considerations Vulvar nonneoplastic epithelial disorders ： a spectrum of chronic diseases represent abnormalities of pigmentation and degeneration in vulvar skin and mucosa. a spectrum of chronic diseases represent abnormalities of pigmentation and degeneration in vulvar skin and mucosa. previous name previous name 1966: chronic vulvar dystrophy 1966: chronic vulvar dystrophy 1987:nonneoplastic epithelial disorders of skin and mucosa 1987:nonneoplastic epithelial disorders of skin and mucosa (ISSVD or ISGYP) (ISSVD or ISGYP)

Classification of skin diseases of vulva ▆ Nonneoplastic epithelial disorders of skin and mucosa lichen sclerosus lichen sclerosus squamous hyperplasia squamous hyperplasia other dermatoses other dermatoses ▆ Intraepithelial neoplasia squamous intraepithelial neoplasia squamous intraepithelial neoplasia mild dysplasia mild dysplasia moderate dysplasia moderate dysplasia severe dysplasia or carcinoma in situ severe dysplasia or carcinoma in situ nonsquamous intraepithelial neoplasia nonsquamous intraepithelial neoplasia paget’s disease paget’s disease tumors of melanocytes, noninvasive tumors of melanocytes, noninvasive ▆ Invasive tumors ISSVD 1987 ISSVD 1987

Lichen sclerosus of vulva Usually characterized by thinning and atrophy of vulvar skin or skin around the anus.

unknown ： genetic genetic autoimmune disease autoimmune disease decrease or absence of estrogen and androgen decrease or absence of estrogen and androgen Etiology

Pathology Epidermis: hyperkeratosis, epithelial atrophy, and flattening of the rete pegs; cytoplasmic vacuolization of the basal layer of cells Upper dermis: edematous, pale-staining, acellular, homogenous collagen tissue Deeper dermis: inflammatory infiltrate, mainly lymphocytic

Clinic features ■ symptoms ■ symptoms Intensive pruritus Intensive pruritus dyspareunia dyspareunia Burning sensation Burning sensation ■ sign Vulvar atrophy Vulvar atrophy Color changes: whitish Color changes: whitish

History & clinic symptoms History & clinic symptoms sign sign Assistant examinations Assistant examinations histological histological Diagnosis

Treatment （ 1 ） general treatment general treatment drugs therapy drugs therapy physical therapy physical therapy surgery surgery

Treatment （ 2 ） Local drug treatment effectiveness: 80% effectiveness: 80% recommend drug ： recommend drug ： 2% testosterone cream 2% testosterone cream 0.3% progesterone cream 0.3% progesterone cream 0.05% clobetasol 0.05% clobetasol

Squamous cell hyperplasia of vulva Squamous hyperplasia formerly: hyperplastic dystrophy characterized by benign hyperplasia of squamous epithelial cells with vulvar pruritus.

unknown ： Moist environment of vulva Repeatedly scratch Etiology

Pathology Epidermis: hyperkeratosis and acanthosis, producing thickening of the epithelium and elogation of the rete pegs Dermis: no inflammatory infiltrate present

Clinic features symptoms symptoms More intensive pruritus More intensive pruritussign Epithelial thickening Epithelial thickening Color changes Color changes

History & clinic symptoms History & clinic symptoms sign sign Assistant examinations Assistant examinations histological histological Diagnosis

Treatment general treatment general treatment drugs therapy drugs therapy physical therapy physical therapy surgery surgery