Other nonneoplastic dermatoses Psoriasis is a multifocal disease that may affect vulvar tissue as well as skin of the joints, knees, and scalp. Seborrheic dermatitis, another multifocal disease of the sebaceous glands commonly affecting the scalp, may affect the labia majora pudendi only. Tinea cruris begins as raised, sharply demarcated, red lesions on the thighs and can spread to the labia. These lesions are best diagnosed by biopsy, which is easily accomplished by punch biopsy with local anesthetic. This diagnostic approach reassures the patient as well as the physician and saves time by avoiding the trial-effect method of treatment.
Most patients have pruritus, but some have no symptoms.
Cases of spontaneous regression of the disease at all stages have been reported. Nonetheless, conventional treatment is wide local excision or laser ablation. Before laser therapy is undertaken, biopsy is imperative to determine that a lesion does not contain invasive cancer. Because of the high association of vulvar intraepithelial neoplasia with human papillomavirus infection, lifelong follow-up is required to watch for recurrence. The lesion appears to have an eczematous or velvetlike surface.