*2.1.2.2 Apthtae*

They are vulva disorder associated to pain. Shallow ulcers most commonly occur on the oral mucosa and less commonly on the genital mucosa. The reasons are uncertain, and risk factors include stress, infections, hormonal factors, vitamin deficiency, and family history. The diagnosis result from exclusion of various genital ulcers causing in most cases in assumption of sexually transmitted infection. Aphthosis appears in simple and rare complex form, and the recurrence rate is about 20% of the general population. For the treatment, it is important to educate the patients to conform in skin and wound care and administration of topical corticosteroid propionate ointment in cases of complex aphthosis [63–71]. Apthae should differentiate from Behcet syndrome, a disorder that causes inflammation of the blood vessels throughout the body, and could affect the vuvla causing open sores in the vulva. Furthermore, vulva aphthous ulcers could appear in patients with HIV infection, Chrohn disease, and ulcerative colitis.

#### *2.1.2.3 Intertrigo combined with candida infection*

Intertrigo is a wet inflammatory dermatitis, which can occur on any fold of the body because of the irritation of the exposed skin surfaces from friction between them. This is more likely to occur in women who are overweight but also in those who wear tight clothing.

The skin is painful, often red and flaky, showing wetness and stretch marks. Weight loss, local hygiene, and local exposure to air, such as the use of socks and cotton lingerie instead of synthetic underwear, should be envisioned. Powders (e.g., talc), astringents (e.g., zinc), or blocking agents in the area may also help.

Candida usually complicates intertrigo and should be treated as described according to clinical practice guidelines for the management of candidiasis [56, 57]. In order to relief the inflammation, since there is no candida infection, steroid creams may be used.

#### *2.1.3 Allergic/irritant dermatitis*

The skin of the vulva, and especially the opening of vagina, is often affected by dermatitis. Dermatitis can be irritating (nonimmune) or actually allergic (immuneinduced). Chemicals that cause skin hypersensitivity include, but are not limited to, cosmetics, perfumes, contraceptive lubricants, sprays, and vaginal washings. Detergents, dyes, softeners, bleaches, soaps, and bleach used to clean the underwear can also cause irritation. In severe cases, hypersensitivity may occur in topical application of anesthetic creams, as well as steroid preparations.

Women with contact dermatitis have an overgrowth inflamed vulva with eczema characters, and patch tests can reveal local irritants. Temporary relief can be achieved with lubricants of the vulva (e.g., Emulsiderm in a daily bath), softeners (e.g., local water creams), and topical corticosteroids (e.g., monthly treatment with Dermovate topical application). As before, nonresponsive lesions need biopsy to confirm the diagnosis [72–75].

#### **2.2 Pruritus**

The term pruritus describes an intense feeling of itching. It is more common in women over the age of 40 years, and symptoms are getting worse by stress or depression. There are many causes of itching.

Biopsy may be necessary for diagnosis, as well as patch tests may be also helpful. If no cause is found, it may be worth considering the possibility of previous sexual abuse or psychosocial problems.

It is important to stop the vicious cycle of irritation/itching cycle that is using strong local steroids for a short time in order to reduce the local inflammation induced by scratching. Applying strong steroid ointment daily for 3 weeks followed by 1% hydrocortisone cream once a day is useful, as well as soap substitutes (e.g., Oilatum).

Irritants, cosmetics added to bath, and synthetic pantyhose, as well as soap substitutes, should be avoided, and comfortable cotton underwear should be used. The area should be gently dry (e.g., with a hairdryer). Antihistamines can also help. If depression coexists, it may require treatment [76–84].Reasons of vaginal pruritus

**41**

9.Warts

*Depigmentation's Disorders of the Vulva, Clinical Management*

Systematic diseases (diabetes mellitus, ureamia, or liver deficiency)

The term VIN was proposed to include dysplastic lesions and vulvar squamous in situ cancer and replace terms such as: (a) Bowen's disease; (b) Bowen's papilloma;

Depending on the degree of maturation of the neoplastic epithelium and the

The lesion is characterized as VIN I when the cellular abnormalities, in comparison with absence of layout, are limited to the lower one-third of the vulvar squamous epithelium, VIN II when the abnormalities extend to the middle third of the epithelium, VIN III when they extend to the upper third of the epithelium, and CIS when lesions occupy all the epithelial layers. Approximately 40% of women present without accompanied symptoms and in the rest cases a background of inflamma-

The disease is not characterized as invasive carcinoma as long as the basal lamina

Common point: VIN is part of a total of epithelial changes in the woman's inferior genital system and may coexist (at least 15–20%). In particular, if there are

acuminate warts in the vulva, the rate for CIN lesions is almost 50%.

4.Cross-reaction or coexistence of high-risk HPV subtypes

extent of atypia, three VIN classes, from I to III, are defined just like in CIN.

*DOI: http://dx.doi.org/10.5772/intechopen.83595*

Vulvar cancer

Psychogenic [82–84]

and (c) dystrophy with atypia.

VIΝ I: mild dysplasia VIΝ II: moderate dysplasia

remains intact [72–75].

*2.3.2 Risk factors VIN*

*2.3.3 Risk factors*

1.Early onset of sexual activity

3.Immune system weakness

8.Chronic irritation of the vulva

6.HPV infection

7.HSV-2 infection

2.Switching (multiple) sexual partners

5.Smoking, alcohol, and unbalanced diet

Vulvar intraepithelial neoplasia (VIN)

**2.3 Vulvar intraepithelial neoplasia (VIN)**

*2.3.1 New terminology: previous terminology*

VIN III: Toy Bowen's disease, severe dysplasia

Squamous cell carcinoma in situ, erythroplasia of Queyrat

tory skin disease in the majority being lichen sclerosus exist.

Infection (candida, luteum, filamentous worms) Eczema Dermatitis (patch tests) Irritation due to vaginal excretion Lichen sclerosus Lichen planus

Vulvar intraepithelial neoplasia (VIN) Vulvar cancer Systematic diseases (diabetes mellitus, ureamia, or liver deficiency) Psychogenic [82–84]
