Geriatric Vulvar Dermatology
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INVITED COMMENTARY
Geriatric Vulvar Dermatology Nga Nguyen 1
&
Sarah Corley 2
Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to provide the diagnosis and management of inflammatory vulvar dermatoses in the geriatric population. The increasing geriatric population in the USA necessitates informing a broad base of healthcare providers on this topic. Recent Findings In the elderly, there are increasing case reports of contact dermatitis due to sanitary napkins, incontinence pads, and over the counter medications. Superimposed vulvovaginal candidiasis and lichen simplex chronicus can occur simultaneously with the primary vulvar disease. The limited research specific to geriatric populations confirms the current state of vulvar dermatosis underdiagnosis. Summary In order to close the gaps in diagnosis and treatment of vulvar dermatoses, providers should carefully review the patient’s medical history and complete a physical examination of the genitoanal area for asymptomatic and symptomatic elderly women. Prompt, consistent treatment can vastly improve the patient’s quality of life and is critical to preventing the advancement of lesions to squamous cell carcinoma in conditions that incur this increased risk such as lichen sclerosus and lichen planus. Keywords Geriatric . Vulvar dermatoses . Contact dermatitis . Lichen planus . Lichen sclerosus . Vulvovaginal candidiasis
Introduction In this review, we will outline the critical components of diagnosis and management of common inflammatory vulvar dermatoses in the geriatric population. This group is generally defined as individuals greater than the age of 65 years old. The geriatric population is expected to comprise 20% of the total US population by 2030 [1]. Primary care providers, gynecologists, and dermatologists are the main interfaces for geriatric patients to seek care for vulvar complaints [2]. Despite the number of providers that can assist with vulvar dermatoses, there is still underdiagnosis or misdiagnosis of the vulvar condition. Patients can be reluctant to share their concern with providers due to anxiety and embarrassment [3]. This article is part of the Topical Collection on Dermatology and Wound Care * Sarah Corley [email protected] 1
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
2
University of North Carolina at Chapel Hill Department of Dermatology, 410 Market Street, Suite 400, Chapel Hill, NC 27516, USA
Negative stigmatization of sexual activity may foster feelings of “guilt” and “shame” that prevent patient’s from seeking the necessary medical treatment for dysfunction [4]. Cervical cancer screening allows us to systematically screen for vulvovaginal conditions without requiring the patient to verbally express their discomfort, but this process is recommended to end at the age of 65 [5]. The US Preventive Service Task Force determined cervical cancer screening for women past the age of 65 did no
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