title: Vulvar psoriasis in adults and children:  a clinical audit of 194 cases and review of the literature.
abstract: OBJECTIVE
  There are limited data on psoriasis as it affects the vulva in the medical literature. This observational study aimed to describe the symptoms, signs, and management of vulvar psoriasis in adults and children in a private vulvar disease referral practice.
  
  
  METHODS
  A review of the existing literature on vulvar psoriasis was used to generate inclusion criteria of a chronic noninfective erythematous vulvitis without vaginal involvement. Between January 2009 and October 2011, 201 patients presenting with these criteria were coded as having psoriasis in a computerized database where standardized data were collected. In 194 of these patients, adequate data were available to include in the study.
  
  
  RESULTS
  Only 12.3% of the patients presented with psoriasis as a provisional diagnosis with a mean symptom duration of 4.5 years (range = 6 weeks to 35 years). The most common presentation was a pruritic, bilaterally symmetrical, erythematous, nonscaly, well-demarcated macular eruption or slightly raised plaque (82.5%). Of the remaining patients, 9.2% presented with only diffuse symptomatic erythema, whereas 8.2% were symptomatic without erythema. In 64.9% of the patients, evidence of psoriasis was found on other parts of the skin. Initial induction treatment with potent topical corticosteroid followed by a maintenance treatment with less potent topical steroids and other psoriasis-specific treatment such as tar creams and calcipotriol resulted in a suppression of disease in 93.8% of the patients during a mean follow-up duration of 8.9 months (range = 1 month to 7.25 years).
  
  
  CONCLUSIONS
  Vulvar psoriasis is a difficult diagnosis that should be considered in patients presenting with a chronic erythematous vulvitis without vaginitis. It is a chronic relapsing skin condition that requires long-term management.
authors.affiliation: Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia. drshivamkapila@gmail.com
authors.forename: Shivam
authors.initials: S
authors.lastname: Kapila
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bradford
authors.forename: Gayle
authors.initials: G
authors.lastname: Fischer
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D005260:Female; D006801:Humans; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D063465:Skin Cream / Q000008:administration & dosage; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents