White/gray lesions, differentials.

[Guest guest]

Oops forgive me Annie, forgetting your name. It's terrible but I get so used to email handles and if a name isn't there, I'm done for. LOL

Thought I'd throw this in hon as it's a piece on what the various colors of the vulva might be as far as different conditions. (this is for white lesions or coloration.

Vulvar lesions - white/grayish

vitiligo (*see a bit I added about this below*) DT

condyloma accuminata (genital warts)

lichen planus (LP)

psoriasis

diabetic vulvitis

lichen sclerosis (LS)

squamous cell carcinoma insitu

Paget's disease of vulva

Many of the white (gray) lesions are produced by chronic irritation such as scratching or a chronic infectious process or chronic vulvar soiling with urine or feces. In general, whiteness of a lesion connotes that there is a very thin epithelium overlying the disease process.

Goals

Treatment may initially be directed at clearing up any inflammatory process, however, the main reason for doing this is just to indicate what areas will provide the best biopsy to show characteristic changes for whatever the lesion is.

My thought* Generally a biopsy should be done on the border of a lesion or spot, from what I recall reading, so they can get a good clear reading of the edge of it vs. the normal skin. And it's always best to have a dermopatholgist read those types of biopsies. DeeT

Vulvar carcinoma in situ can be present and also underlying malignancies, so biopsy should be performed very early.

*My thought.* Vitiligo, is an autoimmune loss of melanocytes, and is sometimes mistaken for lichen sclerosus, but it is identified by milk-white patches of skin that do not itch, nor does it produce changes in the skin 'texture' such as scales or scars. (it's smooth & flat) Vitiligo may appear on other parts of the body, but often it occurs only on the vulva, you might think of it as being like freckles it's so smooth, but it's more of a cosmetic things that generally painful. DeeT