Vulvar Squamous Cell Hyperplasia
Vulvar squamous cell hyperplasia is a skin condition of the vulva that develops when chronic rubbing and scratching cause the skin to thicken abnormally. This condition, which creates a cycle of itching and scratching, can significantly affect a woman’s daily comfort and quality of life.
Table of contents
- What is vulvar squamous cell hyperplasia?
- What causes this condition?
- Signs and symptoms
- How is it diagnosed?
- Treatment options
- Risk of cancer
hyperplastic dystrophy, lichen simplex chronicus
What is vulvar squamous cell hyperplasia?
Vulvar squamous cell hyperplasia is an abnormal growth of the skin of the vulva caused by chronic rubbing and scratching[1]. The condition is also known as lichen simplex chronicus or hyperplastic dystrophy. It is classified as a non-neoplastic epithelial disorder, meaning it is not a cancerous condition but rather a change in the skin tissue[4].
The term “vulvar leukoplakia” is sometimes used to describe this condition, along with other similar disorders. Leukoplakia means “white spot” and refers to the appearance of the affected skin rather than a specific diagnosis. Vulvar squamous cell hyperplasia is one of the diseases that can present as white patches on the vulva[5][8].
What causes this condition?
Vulvar squamous cell hyperplasia develops when the skin of the vulva is repeatedly rubbed and scratched over time[1]. This creates what is called an “itch-scratch cycle,” where itching leads to scratching, which causes more skin changes, which in turn causes more itching. The underlying cause of the initial itching can vary from person to person.
Several factors can trigger the itching that leads to this condition. Irritants and allergens are common triggers. These can include soaps, shower gels, feminine hygiene products, scented toilet paper, laundry detergent, fabric softener, and other chemicals that come into contact with the vulvar area[7]. Stress can also contribute to the problem and may need to be addressed as part of treatment[7][16].
Signs and symptoms
The primary symptom of vulvar squamous cell hyperplasia is intense itching of the vulva. Many women also experience gray or white patches of thickened skin on one or both sides of the vulva. The affected skin may show signs of scaling, cracking, and sometimes bleeding[15].
Additional symptoms can include burning sensations, sores on the vaginal area, and painful sexual intercourse due to the skin changes. Some women notice that the itching becomes particularly severe at night, which can disrupt sleep[7][15].
How is it diagnosed?
Diagnosis of vulvar squamous cell hyperplasia begins with a thorough physical examination by a healthcare provider. The doctor will carefully inspect the vulvar area to look for characteristic skin changes such as thickening, white or gray patches, and signs of chronic scratching[13].
A biopsy is the definitive way to diagnose this condition. During a biopsy, a small sample of the affected skin is removed and examined under a microscope. This test helps confirm the diagnosis and rule out other conditions that may have similar symptoms[1][13]. The biopsy also helps determine if there are any precancerous changes in the tissue.
In some cases, a colposcopy may be performed. This procedure uses a special magnifying instrument to examine the vulvar tissue more closely and identify abnormal areas[13].
Treatment options
Treatment of vulvar squamous cell hyperplasia requires a comprehensive approach designed to break the itch-scratch cycle. The most important first step is identifying and eliminating any irritants or allergens that may be triggering the itching. Since more than one irritant may be involved and identifying specific ones can be difficult, it is recommended to eliminate all potential irritants[7][16].
Women with this condition should soak in a sitz bath or tub with plain water twice a day. This helps moisturize the skin and soothe any open sores. After soaking, a strong steroid ointment should be applied to the skin[7][16]. Topical corticosteroids are considered first-line therapy for this condition, though they can have side effects and not all patients respond well to them[5][8][14].
Stopping scratching and rubbing is essential for treatment success. While this may be possible during the day, nighttime scratching is often unconscious. Taking medication at night to ensure sound sleep without scratching is important. If stress is contributing to the problem, it must also be addressed[7][16].
A study of 976 patients treated with graduated topical fluorinated corticosteroid showed that this approach can be effective for managing symptoms[6].
For patients who do not respond to corticosteroid therapy or who experience side effects, alternative treatments are available. These include topical calcineurin inhibitors, topical and systemic retinoids, and various destructive techniques. Newer approaches being explored include platelet-rich plasma therapy and laser treatment[5][8][14].
Surgical removal of affected tissues is generally considered a last resort because of the risk of recurrence[5][8][14].
Daily care recommendations
Good vulvar care is essential for managing symptoms and preventing flare-ups. Women should bathe with unscented soaps and rinse the genital area thoroughly, patting it dry without rubbing. The genital area should be kept dry at all times, and breathable fabrics such as cotton are recommended[15].
Scented products should be avoided, including scented toilet paper, tampons, laundry detergent, fabric softener, feminine hygiene sprays, powders, and bubble baths. Products containing spermicides can also irritate the area[15].
Risk of cancer
Vulvar squamous cell hyperplasia, along with lichen sclerosus, can lead to a risk of malignancy (cancer development). These conditions both cause significant impairment of quality of life and carry a risk of progression to cancer, as well as a risk of recurrence after treatment[5][8][14].
Despite this potential cancer risk, surgical treatment should generally be avoided because of the high risk that the condition will return. Instead, careful monitoring and appropriate medical treatment are recommended[5][8][14].
