This disorder may require a lifetime of treatment, including either high-potency steroids once or twice weekly, or over the counter steroids every night. Squamous cell hyperplasia is a common and benign vulvar condition that can look similar to other white vulvar lesions, including condyloma, VIN and carcinoma. The skin is typically white or off-white, with focal lesions. The cause is unknown, but may be due to a vulvar irritant callusing thickening of the skin. Pruritus is commonly found and may bring the patient to her health care provider.
Diagnosis is by biopsy.
Colposcopy with acetic acid application may reveal a thickened epithelium, with possible inflammation. Biopsy yield hyperkeratosis. Treatment consists of twice daily steroids for 3 weeks, then once daily thereafter until symptoms disappear. Chronic treatment with OTC steroids is sometimes necessary. Patients should also decrease exposure to vulvar irritants, for example perfumes, dyed toilet paper, etc.