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I have a 25 year old lady with recurrent painful pustular rash in the vulval region since the last two years. They typically subside in 3-4days spontaneously. No aggravating/relieving factors. Possible diagnoses so far – Fordyces, Herpes, Folliculitis. These are not the least convincing since she is sexually inactive and Herpes negative.

Associated tags: Genitourinary, pustular rash, recurrent, vulva, Women's health

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Question answered:09/01/08 Warning! this question is over two years old.

ATTRACT is not in a position to make a diagnosis, we can only provide information on which to base a clinical decision.

 

A 2007 UK National Guideline on the Management of Vulval Conditions (1); this guideline offers recommendations on the diagnostic tests and treatment regimes needed for the effective management of the following vulval conditions: Vulval lichen sclerosus, Vulval lichen planus, Vulval dermatitis, Vulval Intraepithelial Neoplasia (including Paget’s disease), Vulval vestibulitis, Vulvodynia. As this information is extensive we recommend you read the guideline in full by following the link provided in the reference section below.

 

An e-Medicine article on benign vulvar lesions describes conditions characterized by vulvar ulcers and provides information on the size and appearance of the ulcers. This article also contains a substantial section on differential diagnosis and workup.

 

In 2004 a comprehensive article on vulvar ulcers and erosions (3) was published. This contains several tables that discuss infectious causes of vulvar ulcers/erosions: (HSV) herpes simplex virus; and (DIF) direct immunofluorescence, dermatoses causing vulvar erosion/ulcers(s): (TEN) toxic epidermal necrolysis; and (EM) erythema multiforme, malignancies causing vulvar ulcer(s), traumatic causes of vulvar ulcer/erosion, and summary of dermatoses presenting as vulvar ulceration/erosion: (DIF) direct immunofluorescence; and (IIF) indirect immunofluorescence. However, we are unable to gain full access to this article as a subscription is necessary.

 

If you require further information we would recommend discussing this with a local specialist.

 

  1. http://www.bashh.org/documents/vulvalguidedraft07.pdf
  2. http://www.emedicine.com/med/topic3295.htm
  3. Bohl T. Vulvar ulcers and erosions – a dermatologist’s viewpoint. Dermatologic Therapy. 2004;17(1) 55-67.


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