Therapeutic principles in vulvovaginal dermatology.

The diagnosis and management of chronic vulvovaginal disease requires attention to several issues. Psychological factors are usually important, because women worry about malignancy, impaired sexuality and self-image, fertility, and sexually transmitted diseases. Multifactorial processes are common due to the risk of secondary candidiasis, contact dermatitis, effects of low estrogen in postmenopausal women and women on oral contraceptives, and so forth. Undertreatment of inflammatory dermatoses is common, because clinicians use topical corticosteroids that are of inadequate potency and for insufficient duration. All of these issues must be considered for optimal benefit in the therapy of chronic vulvovaginal diseases.