Eczematous Changes Superimposed on Other Vulvar Disorders
Eczematous changes may be superimposed on other dermatoses, complicating the evaluation of the vulvar dermatosis. Any chronic dermatosis can be affected, but the most likely are psoriasis, lichen sclerosus, and usual cutaneous lichen planus. Establishing
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Tanja Bohl
21.1 Introduction Eczematous changes may be superimposed on other dermatoses at the time of presentation (Fig. 21.1) and complicate the evaluation of the vulvar dermatosis. The superimposed eczematous changes make definitive diagnosis difficult if not impossible. Eczematous changes may also develop in a patient throughout the course of the management of her vulvar dermatosis. In this scenario the change in symptoms and appearance should alert the clinician to the possibility of the development of an allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD) (Table 21.1).
deficiency may also precipitate the development of eczematous changes. Any chronic dermatosis can be affected, but the most likely are psoriasis, lichen sclerosus, and usual cutaneous lichen planus (LP) [rather than erosive] than less common vulvar dermatoses such as Darier’s disease and Hailey-Hailey disease.
21.2 Pathogenesis and Etiology Expression of an underlying atopic diathesis can also lead to eczematous changes and can be precipitated by environmental changes and endogenous changes in general health that result in impairment of epidermal function on the vulva or generally. These changes can only occur in the presence of an intact epidermis and therefore not present with erosive, bullous, or ulcerative dermatoses. General health conditions that produce or exacerbate xerosis such as hypothyroidism and iron T. Bohl (*) Jean Hailes for Women’s Health, Clayton, VIC, Australia
Fig. 21.1 Vulvar eczema developing on existent dermatitis
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_21
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T. Bohl
150 Table 21.1 Causes of eczematous changes Causes and background conditions that may lead to exematous changes • Irritant contact dermatitis • Allergic contact dermatitis • Underlying atopic diathesis • Supervening infections – Candidiasis – Bacterial; streptococcal, Staphylococcus • Environmental Changes in humidity • General health factors – Hypothyroidism – Iron deficiency – Medications (cholesterol lowering medications)
Chronic candidiasis can result in eczematous changes.
21.3 Histopathology The characteristic histology of the underlying dermatosis may be obscured by the eczematous changes. Acute changes include spongiosis with microvesicle formation in the epidermis, and scale crusts due to scratching may also be present. A predominantly perivascular inflammatory infiltrate that may be patchy and predominantly lymphocytic may also be seen. Eosinophils are more likely with superimposed ACD. There may be clues to the cause of eczematous changes such as pseudo-hyphae among the hyperkeratosis.
21.4 Clinical Features Acute eczematous changes comprise dryness, fine scale, erythema, edema, vesiculation, excoriations, and possibly serous exudate and crusts. Chronic changes in more established eczematization changes are increased dryness and possibly altered skin color and texture.
The
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