Psoriasis is an autosomal dominant inherited disorder that caninvolve the vulvar skin as part of a generalized dermatologic process. With approximately 2% of the general populationsuffering from psoriasis, the physician should be alert to its prevalence and the likelihood of vulvar manifestation, because it may appear during menarche, pregnancy, and menopause.
The lesions are typically slightly raised round or ovoid patches with a silver scale appearance atop an erythema-tous base. These lesions most often measure approximately 1 × 1 to 1 × 2 cm. Though pruritus is usually minimal, these silvery lesions will reveal punctate bleeding areas if removed (Auspitz sign). The diagnosis is generally known because ofpsoriasis found elsewhere on the body, obviating the need for vul-var biopsy to confirm the diagnosis. Histologically, a prominentacanthotic pattern is seen, with distinct dermal papillaethat are clubbed and chronic inflammatory cells between them.
Treatment often occurs in conjunction with consulta-tion by a dermatologist. Like lesions elsewhere, vulvar lesions usually respond to topical coal tar preparations, followed by exposure to ultraviolet light as well as cortico-steroid medications, either topically or by intralesional injection. Coal tar preparations are extremely irritating to the vagina and labial mucous membranes and should not be used in these areas. Because vulvar application of some of thephotoactivated preparations can be somewhat awkward, topical steroids are most effective, using compounds such as betametha-sone valerate 0.1%.