Mixed lesions of hypoplastic and hyperplastic areas account for 20% of cases of vulval dystrophy. Patients usually report of pruritus, dyspareunia and burning.
The lesion appears as patches of piled-up keratinised white epithelium beside with patches of pale, thin, shiny, wrinkled epithelium.
Diagnosis is by toluidine blue-directed biopsy. Focal areas of atypia are more common than in pure hyperplastic types.
Treatment is with local corticosteroid cream, three times daily for 6 weeks, followed by 2% testosterone cream, three times daily for 6 weeks. The testosterone should be continued indefinitely ensuring that the woman is aware of the possible masculinising effects from systemic absorption.
Areas of atypia should be excised.
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