Inflammation of the vulva a diagnostic challenge. (Eczema, Contact Dermatitis).

PALM BEACH, FLA. -- Chronic inflammation of the vulva may be partly self-induced, but the relentless scratching or rubbing that typically causes it is a normal response to the itching associated with a milder but persistent case of eczema or contact dermatitis, Dr. Kenneth Tomecki said.

Topical corticosteroids are the treatment of choice for the ill-defined, flaming red rash and thickened hyper and hypopigmented skin that characterize this chronic eczema of the vulva, although a biopsy may be helpful if the condition persists, said Dr. Tomecki, who is a dermatologist with the Cleveland Clinic Foundation.

Other diagnoses-atopic eczema, psoriasis, or pubic lice-should always be considered in determining when to treat, when to biopsy and when to refer patients with inflammatory vulvar disease, he said at the annual meeting of District V of the American College of Obstetricians and Gynecologists.

Think of psoriasis when a patient presents with a nonitchy rash in the groin, often in the labial area and inner thighs, he advised. Plaques are pink to red or salmon colored, often accompanied by a rash on the elbows and knees and by the discolored, pitted nails that are commonly seen in patients with psoriasis.

Onset by the third decade of life is typical, and about one-third to one-half of patients have a family history of the disease, he said.

Lichen planus, a chronic, extremely itchy inflammatory disease, is characterized by pigmentary changes, thickened plaques, and lesions on the perineum and often on the mouth or other mucosal surfaces as well.

Topical corticosteroids are recommended here, too, but the condition is difficult to treat, Dr. Tomecki said. Although lichen ...