Vulvar Neurodermatitis in a Postmenopausal African-American Patient: A Case Report

Abstract

Lichen simplex chronicus commonly presents as a distressing vaginal lesion caused by severe, cyclical itch-scratch behavior. Lichen simplex chronicus is diagnosed by obtaining a detailed medical history, performing a physical exam, and recording of self-reported symptoms. Lichen simplex chronicus can be treated by corticosteroids, immunomodulators, antiepileptics, antihistamines, antidepressants, and phototherapy. Our case describes a 55-year-old female patient who presented to a clinic with recurrent vaginal itching, combined with compulsive scratching behavior that disrupted daily functioning. Physical examination revealed hypertrophic nodules located on the labia minora with scaling and hyperpigmentation. And the patient was diagnosed with lichen simplex chronicus. Empirical treatment with behavioral modifications and clobetasol propionate cream with an occlusive dressing produced significant improvements in symptoms at a six-month follow-up. Lichen simplex chronicus can have unusual presentations and; therefore, must be carefully differentiated from infectious and malignant skin lesions.

The Importance of p16 and p53 Immunohistochemical Staining in Diagnosing Vulvar Lichen Simplex Chronicus Mimicking Vulvar Intraepithelial Neoplasia with False-Positive Human Papillomavirus Type 66

“…This was also accomplished by applying emollient and high-potency topical corticosteroids. 15 , 16 , 36 The patient was diagnosed and treated as vulvar LSC and was given 10 mg cetirizine tablet, emollient, and 0.1% mometasone furoate cream. In the 4 weeks of follow-up, clinical improvement was observed, as the patient’s lesion became hyperpigmented macules without itching.…”

“…Lichen simplex chronicus is a manifestation of an itch-scratch cycle. [13][14][15][16] The common triggering factors for itching were sweating (41.9%), rubbing of thighs while walking for long distances (9.5%), and mental stress (5.7%). 13 The triggering factors identified in this patient are the rubbing of thighs due to tight clothing and mental stress.…”

“… 14 , 15 Vulvar LSC is closely associated with a poorer quality of life, declined mental well-being, sexual function, and damage to the skin due to repeated scratching. 16 Moreover, rather than sharing similar clinical pattern, 13 , 14 vulvar LSC might also progress into DVIN, an HPV-independent form of VIN. 3 Therefore, in diagnosing vulvar lesions suspicious of VIN, in addition to histopathological examination, 11 p53 IHC is also recommended as a biomarker of DVIN.…”

“…5,6 LR-HPV genotypes, including 11,40,42,43,44,54,61,70,72, and 81, cause genital warts and low-grade squamous intraepithelial lesions (LSIL) that seldom progress to cancerous lesions. HR-HPV, including HPV- 16,18,31,33,35,39,45,51,52,56,58,59, and 66, play a crucial role in the pathophysiology of either precancerous HSIL type of VIN 5 or malignancies on the cervix, anus, oropharynx, vulva, and penis. 6 However, some literatures report that the inclusion of HR-HPV-66 in the HPV Array Test is an ongoing source of false-positive results.…”

Superficial Radiation Therapy (SRT-100) for Hypertrophic Neurodermatitis

“…It is important to first control the disease and address any underlying psychological causes for the persistent itching. [ 2 ]…”