8 cancer: Most patients with vulvar cancer present with a unifocal vulvar plaque, ulcer, or mass (fleshy, nodular, or warty) on the labia. Lichen sclerosus and erosive lichen planus may predispose to vulvar cancers
11Vestibular papillaediscrete, small papules located symmetrically around the edge of vestibulebenign and usually asymptomatic do not require treatment confused with condyloma acuminata except condyloma tend to fuse together and are not confined to the vestibule.
13Acroc hordon : (skin tag, fibroepithelial polyp, soft fibroma) a benign outgrowth of normal skin appear as pedunculated lesions on narrow stalks and tend to be more numerous in patients with diabetes or obesity and in areas of chronic friction.Removal is indicated when the patient is symptomatic
15treatment is often requested by the patient. Cysts : Bartholin gland ,pilonidal, epidermoid ,dermoid, Gartner, and mucous cysts are benign lesions, but can be associated with bothersome symptomstreatment is often requested by the patient.
17Genital warts (condyloma acuminata) Genital warts, caused by (HPV), may be of flat, filliform, verrucous, pedunculated, or giant morphology. They may be flesh colored or pigmented.Lesions of secondary syphilis may have a wart-like appearance, but are not true warts.
20Molluscum contagiosum : umbilicated translucent or pearly papules due to infection from a member of the poxvirus family.in healthy adult woman may indicate an underlying immunosuppressive disorder.Treatment :destructive (eg, cantharidin, cryotherapy) or immunomodulating (eg, imiquimod)
22benign neoplasms of the eccrine sweat glands. Syringoma : benign neoplasms of the eccrine sweat glands.multiple, 1 to 2 mm, flesh-colored to yellow papules arranged symmetrically on the labia majora., heat and sweating, menstruation, or pregnancy may provoke pruritus in vulvar syringomas.Excision or ablation is curative. In some patients, topical atropin or tretinoin
25Hyperkeratosis or lichen simplex chronicus : Raised white or dark colored plaques on the vulva are associated with hyperkeratosissecondary to chronic rubbing or scratching. Erosions and/or excoriations may also be evident..Biopsy of affected skin may be indicated if the underlying disorder is uncertain.
27Lichen sclerosus (white, finely wrink& atrophic patches ) May develop with minor trauma, hemorrhage may be present.Vulvar itching and have typical clinical findings that suggest the diagnosis.A biopsy may be indicated to exclude malignancy if unresponsive to therapy or if lesional skin demonstrates morphologic changes.Be treated medically with a potent topical corticosteroid ointment, such as clobetasol 0.05 percent ointment and followed closely
30Dermatofibroma Ectopic breast usually present as firm, hyperpigmented papules that invaginate (dimple sign) with lateral pressure.It is hypothesized that they arise after trauma.Ectopic breast Present as a hyperpigmented nodule on the vulva on the milk line, which extends from the axilla to the groin. Symptoms may develop with pregnancy or menstruation'
31Kaposi's sarcoma Consists of dusky erythematous to violaceous papules that may ulcerate and become painful.Extra-genital skin, in particular the oral mucosa, should be examined (HIV)infection should be ruled outCompound melanocytic nevi:Darker than intradermal nevi; both are often well circumscribed, dark-colored, soft papules.Definitive diagnosis is made with a biopsy
32Fox-Fordyce:Disease is an extremely pruritic, monotonous eruption of minute, dark papules involving apocrine glands
35Dermatitis : Atopic, irritant, and allergic dermatitis, and neurodermatitis of the vulva erythematous lesions.Long-standing dermatitis hyperpigmentation and thickening of the skin with lichenification.Avoidance of offending agents is the mainstay of treatment of contact and allergic dermatitis.
37Psoriasis : Lichen planus Psoriasis is characterized by erythematous plaques with micaceous scale on the scalp, elbow, knees, palms, and soles. It is often associated with nail changesLichen planus violaceous, flat-topped papules with lacy, white scales the characteristic lesions. Involved areas of the vestibule or vagina often appear as erythematous erosions and patients may develop shortening and narrowing of the vagina.
40Atrophic vulvitis Is a manifestation of hypoestrogenism; although the vagina is much more sensitive to estrogen deprivation than the vulva.
41Infection : The differential diagnosis of erythematous vulvar lesions should also include infections. Candida infection presents as moist erythema with satellite lesionsExcessive vaginal discharge from bacterial vaginosis or trichomoniasis may contribute to erythema and maceration of vulvar skin.
46Urethral lesions : Endometriosis : A midline polypoid lesion may be a urethral caruncle or urethral prolapse.Satisfactory treatment may be achieved with topical estrogen cream alone.Endometriosis :Develops after vulvar implantation of endometrial tissue following a surgical procedure.
48Folliculitis: Furunculosis : Folliculitis:Develop in any hair-bearing surface; Staphylococcus aureus can be cultured from the skin lesions.Furunculosis : Furunculosis and carbuncles may develop with long-standing, severe folliculitis.
49Hidradenitis suppurativa : Manifests with pruritus, erythema, and local hyperhidrosis.As the area heals, it becomes fibrotic and new nodules develop inflammatory masses. Hyperpigmentation, scars, and pitting are seen on the skin.Candida
50Herpes simplex virus (HSV) : Multiple, painful vesicles or ulcerating lesionsIt also often appears as grouped ((herpetiform distributionEvident due to the moisture and friction in this area.Fever, malaise, and lymphadenopathyScabies and insect bites
52Fixed drug reaction :Usually demonstrate discrete, hyperpigmented bullae or erosions that recur in the exact sameLocation with repeat medication administrationHerbal supplements, phenolphthalein,tetracycline,NSAIDS, and sulfonamidesImprovement should occur within two weeksof stopping the causative drug.
57 Surgery Vulvar skin care Soaks Lubricants Topical analgesics and oral antihistamines Estrogen Antimicrobial drugs Antiinflammatory agents (oral or topical)Combination topical antimicrobial and anti-inflammatory agents Surgery
58Geriatric vulvar lesions in postmenopausal women are atrophy due to hypoestrogenemia and cancer. These lesions can be asymptomatic or have nonspecific symptoms such as itching. ".)Immunocompromise at risk for severe manifestations of common infections, as well as atypical infections prone to development of certain types of premalignant and malignant disease.