Vulval skin conditions – the essentials for nurses in primary care

In the second in our miniseries on vulval health, GP and women’s health specialist Dr Louise Clarke outlines what nurses need to know about common vulval skin conditions

The vulva is the external female genitalia including the clitoris, mons pubis and labia. Like other areas, it can be affected by skin conditions, some of which are more commonly found on the vulva than elsewhere in the body.

These skin conditions can cause unpleasant symptoms such as itching, soreness, burning, dryness and urinary problems.

This can have a significant impact on quality of life – a survey of women with vulval conditions found 22% has contemplated self-harm or suicide as a result of their condition.¹

Vulval symptoms are also common – another survey of a random sample of women found that 18.5% had experienced persistent discomfort lasting over 3 months.²

The first article in this series discussed the normal vulva, normal variation, vulval care, red flags and the most common vulval skin disease, vulval lichen sclerosus.

Related Article: Supporting vulval health – what a primary care nurse needs to know

This article covers the other common vulval skin diseases found in primary care.

Images of all these vulval skin conditions are available on the STI Atlas, a free resource for healthcare professionals.

Atopic and contact dermatitis

Atopic dermatitis is another term for eczema. Genital involvement is common in eczema with 45% of patients having genital involvement in one study.³ Contact dermatitis also commonly involves the vulva, caused by a number of irritants such as urine, sweat and moisture. In addition, products such as wipes, fragrances, lubricants and even sanitary towels can cause contact dermatitis.⁴ These products may cause irritation or a more severe, allergic reaction.

Atopic, irritant and allergic contact dermatitis all present with itch and appear as red, scaley, inflamed skin primary affecting the labia.⁵ There can be scratch marks (excoriations), fissuring, swelling and later thickening of the skin from long-term scratching.

As well as avoiding irritants or allergens, treatment is with topical corticosteroids and emollients.

Lichen simplex chronicus

This is a skin problem caused by another itchy condition, resulting in skin changes secondary to long term itch.⁴ It is most commonly secondary to eczema or psoriasis and has an association with psychiatric conditions.⁶

The diagnosis can be complicated by the presence of the underlying skin disease. Lichen simplex chronicus classically appears as thickened, bumpy (due to papules) and scaley. There can be excoriations and loss of pubic hair, with symptoms worse on the side of the dominant hand. Treatment is often with more potent topical corticosteroids than if treating the underlying disorder alone.^4,6

Seborrheic dermatitis

This is a common disorder in which there is an overgrowth of the yeast Malassezia furfur.⁷ Patients with genital seborrheic dermatitis tend to have the condition in other areas of the body: the eyebrows, scalp, around the nostrils and behind the ears.⁶

Seborrheic dermatitis in other areas of the body tends to be characterised by a yellow, flakey scale but on the vulva the appearances are more subtle. Vulval seborrheic dermatitis tends to have a mild pinky-orange scale, greasy and poorly defined appearances.⁶ Firstline treatment of seborrheic dermatitis is a mix of an anti-fungal and topical corticosteroid cream.⁸

Vulval lichen planus

Vulval lichen planus (VLP) has a prevalence of less than 1% of women⁹ and a mean age of 50 years old at presentation.¹⁰ It is an autoimmune disorder that can affect any area of skin or mucosal surface. Less commonly it can affect internal structures such as the oesophagus, tear ducts and external auditory meatus of the ear.⁶ Many of those with disease in the mouth also have the disease in the genital area, the so-called vulvo-vaginal-gingival (VVG) syndrome.^6,9

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Lichen planus elsewhere in the body is often described by the 6 Ps:

• Purple
• Polygonal (many-sided)
• Planar (flat-topped)
• Pruritic (itchy)
• Papules (bumps)
• Plaques¹¹

Wickham’s striae are often present on the top of lesions and in the mouth. It is a white, lace or net like pattern. On the vulva it looks a little different – there are the papules on thickened skin, sometimes with Wickham’s striae and these often cause darkening of the skin as they resolve. VLP can cause anatomical changes and scarring, leading to complete blockage of the vagina.

This condition can also cause painful erosions and ulcerations which can mimic the appearances of cancer.⁶ One particular subtype of VLP, erosive VLP, is particularly painful and itchy. In this condition the skin appears red and raw¹² with Wickham’s striae around the edge of the erosions. The vulva and vagina tend to be affected in VLP. There is a link between VLP and vulval cancer.⁶ VLP is treated with potent topical corticosteroids.

Psoriasis

Psoriasis is found in approximately 2% of the general population and 60% of those affected have genital involvement at some point. It is rare that is it the genitals alone that are affected, so patients with anogenital psoriasis almost always have the condition elsewhere.⁶ Genital psoriasis is known to have a significant impact on quality of life and sexual function, more so than when psoriasis affects only other areas in the body.¹³

Vulval psoriasis usually affects the labia majora, mons pubis and often spreads to other regions such as around the anus and in the folds of the groin. There are well demarcated, thickened, red plaques, similar to those found in psoriasis elsewhere on the body but without the scale.^6,13 Treatment is with various strengths of topical corticosteroids but vitamin D analogues, weak coal tar preparations and calcineurin inhibitors also can be used.¹³

All of the conditions described here are uncomfortable, itchy and affect quality of life. You will also notice that they are all treated with topical corticosteroids, in various strengths, sometimes with an anti-fungal and emollient. Ointments are better absorbed and can be used to wash with. Dermol-500 should be avoided as the chlorhexidine can sting.

In addition, women should be always given advice on vulval hygiene:

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• Wash with water. No soap, products or fragrances are needed. Pat dry.
• Avoid abrasive materials in washing e.g. with a loofah.
• Avoid tight underwear, tights, leggings or tight jeans.
• Wear loose cotton underwear or no underwear.
• Tampons and cotton sanitary wear can be less irritating than disposable sanitary pads.
• Avoid washing hair in the bath.^4,6

Dr Louise Clarke is a GP in Derbyshire an clinical academic at the University of Nottingham. Dr Clarke is the Treasurer of the British Society for the Study of Vulval Disease (BSSVD)

Useful resources

• STI Atlas. Free resource for healthcare professionals with high quality images including vulval skin conditions. Melbourne Sexual Health Centre, Australia. Available at: https://stiatlas.org/
• A useful leaflet on vulval skincare is available from the British Association of Dermatologists (BAD).

References

1. Major J, Brackenbury F, Gibbon K, Tomson N. The impact of vulval disease on patients’ quality of life. J Community Nurs2016; 30: 40–4
2. Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001 Sep;185(3):545-50. doi: 10.1067/mob.2001.116748
3. Woo YR, Han Y, Lee JH, et al. Real‐world prevalence and burden of genital eczema in atopic dermatitis: A multicenter questionnaire‐based study. J Dermatol. 2021;48:625‐632
4. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin, Number 224. Obstet Gynecol. 2020 Jul;136(1):e1-e14
5. Brägelmann C, Wölber L, Susok L, Anemüller W, Prüßmann W, Ivanova I, Niebel D. Update vulval dermatology – diagnostics and therapy. J Dtsch Dermatol Ges. 2025 Jan;23(1):65-86
6. Edwards SK, Lewis F, Fernando I, Haddon L, Grover D. 2024 British Association for Sexual Health and HIV (BASHH) UK national guideline on the management of vulval conditions. International Journal of STD & AIDS. 2025;36(5):346-371. doi:1177/09564624241311629
7. Sand, F. L., & Thomsen, S. F. (2017). Skin diseases of the vulva: eczematous diseases and contact urticaria. Journal of Obstetrics and Gynaecology, 38(3), 295–300. https://doi.org/10.1080/01443615.2017.1329283
8. Sebborheic Dermatitis. DermNet. https://dermnetnz.org/topics/seborrhoeic-dermatitis
9. Ringel NE, Iglesia C. Common Benign Chronic Vulvar Disorders. Am Fam Physician. 2020 Nov 1;102(9):550-557
10. Kennedy CM, Galask RP. Erosive vulvar lichen planus: retrospective review of characteristics and outcomes in 113 patients seen in a vulvar specialty clinic. J Reprod Med. 2007;52(1):43-47
11. Arnold DL, Krishnamurthy K. Lichen Planus. [Updated 2024 Oct 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-
12. Erosive Lichen Planus. DermNet. https://dermnetnz.org/topics/erosive-lichen-planus
13. Yang EJ, Beck KM, Sanchez IM, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. Psoriasis (Auckl). 2018 Aug 28;8:41-47
14. Haigh, Claire^a,b; Sun, Helen Yiling^c,d; Fischer, Gayle^b,d. Diagnosis and management of vulval lesions. Current Opinion in Obstetrics and Gynecology 37(5):p 317-325, October 2025