Medstar Health, Washington, DC, USA.
Am Fam Physician. 2020 Nov 1;102(9):550-557.
Common benign chronic vulvar conditions include genitourinary syndrome of menopause (formerly called vulvovaginal atrophy), lichen sclerosus, lichen planus, lichen simplex chronicus, and vulvodynia. Genitourinary syndrome of menopause results from the hypoestrogenic state that leads to atrophy of normal vulvar and vaginal tissues. It is typically treated with lubricants, moisturizers, and intravaginal estrogen. Lichen sclerosus is an inflammatory condition characterized by intense vulvar itching. It is treated with topical steroids or, in some cases, topical calcineurin inhibitors. Patients with lichen sclerosus are at risk of vulvar squamous cell carcinoma and should be monitored closely for malignancy. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and vagina in addition to other skin and mucosal surfaces. The first-line treatment is topical steroids, and significant scarring can occur if left untreated. Lichen simplex chronicus manifests as persistent itching and scratching of the vulvar skin that leads to thickened epithelium. Breaking the itch-scratch cycle, often with topical steroids, is the key to treatment. Vulvodynia is a common vulvar pain disorder and is a diagnosis of exclusion. A multimodal treatment approach typically includes vulvar hygiene, physical therapy, psychosocial interventions, and antineuropathy medications.
常见的良性慢性外阴疾病包括泌尿生殖绝经综合征（以前称为外阴阴道萎缩）、硬化性苔藓、扁平苔藓、慢性单纯性苔藓和外阴痛。泌尿生殖绝经综合征是由于雌激素缺乏导致正常外阴和阴道组织萎缩引起的。它通常用润滑剂、保湿剂和阴道内雌激素治疗。硬化性苔藓是一种炎症性疾病，其特征是剧烈的外阴瘙痒。它用局部类固醇治疗，在某些情况下，用局部钙调神经磷酸酶抑制剂治疗。患有硬化性苔藓的患者有外阴鳞状细胞癌的风险，应密切监测恶性肿瘤。扁平苔藓是一种炎症性自身免疫性疾病，除了其他皮肤和黏膜表面外，还可能影响外阴和阴道。一线治疗是局部类固醇，如果不治疗，可能会出现明显的瘢痕形成。慢性单纯性苔藓表现为外阴皮肤持续瘙痒和搔抓，导致上皮增厚。打破瘙痒-搔抓循环，通常使用局部类固醇，是治疗的关键。外阴痛是一种常见的外阴疼痛疾病，是一种排除性诊断。多模式治疗方法通常包括外阴卫生、物理治疗、社会心理干预和抗神经病变药物。
