*2.1.1.3 Psoriasis*

*Depigmentation*

**Figure 1.**

*or gray.*

**Figure 2.**

**38**

beneath it [48–53].

monitoring is required every 6–12 months [26–32].

This chronic and recurrent condition may occur at any age but is more common

*VIN lesions are usually characterized by a change in color on the skin of the vulva. They are usually white and/*

Clinically, the skin appears white, thin, and corrugated but may be overlapped and keratinized, if there is coexistence of squamous cell hyperplasia. There may also be symphysis of the clitoris or the vulva. The diagnosis is made by biopsy. Lichen sclerosus is a nonneoplastic condition but can coexist with vulvar intraepithelial neoplasia, while there is correlation with invasive squamous cell carcinoma of the vulva in 2–5% of cases. This is describing the reason why possible long-term

Treatment is required, especially if the condition is symptomatic, and a strong local topical steroid cream (e.g., Dermovate per 12-hour period) is usually used, which is gradually replaced by a milder formulation (e.g., hydrocortisone per hour, 24 h or less) as the symptoms require. Fluorinated corticosteroids or testosterone

in older patients and usually manifests with pruritus. Less often, it occurs with dyspareunia or pain. It is an autoimmune condition and is associated with other autoimmune diseases such as malignant anemia, thyroid disease, diabetes mellitus, systemic lupus erythematosus, primary biliary cirrhosis, and bullous pemphigoid. Histologically, the skin appears thin with loss of the crevices found between the nipples. Surface skin is vitrified, and a set of chronic inflammatory cells is observed

*VIN lesions: The rarities are lesions in red and brown. Their surface may be flat or abnormal.*

Psoriasis is manifested as dry, red, and papular rash, which is usually clearly circumscribed and extends to the thighs. Diagnosis occurs easily when bleeding is observed during the removal of classic silver-like scars. It may be difficult to differentiate psoriasis from candida infection or dermatitis because the vulva is very often fluid. Candida infection should be ruled out. The lesions can be treated locally with coal tar preparations, ultraviolet maize, steroid creams, or other suitable drugs [54–56].

## *2.1.1.4 Lichen planus*

It is a chronic papular rash with a bluish hue, which is located in the vulva and the bendable surfaces. It may be appeared in other areas like the mucous membrane of the oral cavity, and the diagnosis is enhanced by finding other lesions. Oral lesions precede genital lesions in one-third and simultaneously appear in half of women affected from the disease. After the vulva should be a vaginal examination, the walls of the vaginal may have following pathological abnormalities: erythema erosions and bleeding friable tissue. It is usually idiopathic but can also be related to medications. The treatment includes use of strong steroids locally or ultraviolet light, and the disease tends to subside within the next 2 years. Surgery removal should be avoided [57–62].

### *2.1.2 Others: vitiligo, intertrigo, aphthae*

## *2.1.2.1 Vitiligo*

The lesions of this disease can appear anywhere on the body with a predilection in the genital area. It can be confused with LS, associated to lack the classical signs of inflammation, possible coexistence with LS based on autoimmunogenity. In contrast to LS, which has predilection for hypoostrogenic states, vitiligo can be appeared at any age. No skin biopsies are necessary. Autoimmune thyroid disease is associated to vitiligo. Treatment includes administration of topical steroids and vitamins D, E, C, and B12. Surgery remains a viable option in unresponsive localized disease to conventional therapies [63–71].
