Causes of redness/fissures of vulvar skin

[JBee70]

Hi there,

I have had symptoms since last June (07) that I have had all infectious conditions ruled out. I am now looking at biopsy of the vulvar skin to uncover some answers, so I wanted to post here to see if any other women have gone to a dermatologist and had results. I have posted on the women's health forums here, but since i have ruled out std's, fungus, bacteris, yeast, hormone levels, strep-B, etc etc, this is clearly a skin issue.
What happens is that I get occassional redness and mild itching of the vulva. My Dr. has observed that my cervix is also reddened at these times. I get a recurring fissure that is located in a natural skin fold next to my clitoris, and one that appears sometimes on my perineum. I have also had what feels like a fissure on my anal area, it will burn and bleed a little when I wipe.  My gyn prescribed a zpak when I also (in october) began having a thick discharge with elevated white cells. ALL tests were done, no answers. Meds do not affect it.
My reproductive endocrinologist tested my hormones, cortisol, tsh, etc etc- all normal. I do have anti-thyroid antibodies as well as antiphospholipid antibody syndrome, which are both auto-immune diseases. I am asymptomatic for both.
WHAT on earth could be causing my symptoms above??? I am not looking forward to a biopsy, but I am wondering if it is Lichen Sclerosis? The redness and fissures do respond to Clobetasol treatment. In fact i went for 6 weeks without a "flare" from mid-november 07 to January 08.
Anyone have ideas?

[CeeTee]

I have had the same thing you describe for about 15 years - with some times better than others, but always there to some extent.  My dermatologist diagnosed "stress eczema" and prescribed Elidel.  I had pretty good results with it, but the problem would always come back.  (I had the fissures in the same places you describe).  About 4 months ago nothing was working and I thought about using something my sister, who has Lupus, uses for her skin - Cetaphil.  It comes in several versions, but I started using the Daily Facial Cleanser on my vaginal area with wonderful results.  It is the purest cleanser I've ever seen. Cetaphil also makes an Antibacterial Gentle Cleansing Bar, which I'm using also - but the Daily Facial Cleanser is the best.  So, I have some to the conclusion that I really have had a reaction to the bath soap I had used.  Safeguard for several years after the onset - and then Zest for the past few years.  I also had used other kinds of soap - Ivory, Dove, even Aveeno - but none of them really helped.  I occasionally use a very little Elidel now.  I haven't gone this long without a flare up in 15 years and I'm sticking with Cetaphil unless I have a problem again, and then might see a dermatologist again (I have moved states.)  Perhaps this might help you.  It's a terrible thing to have and I wish you well.  After those of us who have it go through so much to find out what the problem is, I thought it would be quite interesting if it just turned out to be a very sensitive soap reaction!

CeeTee

[AJ95]

I too am having the same symptoms, and have perplexed 3 Doctors.  I researched on the net and determined that it could be Lichen Sclerosis and took this info. to the gynecologist with me.  He said it could be that but isn't sure and even wants me to be checked for Chrone's disease.  This problem is apparently very common from what I've discovered on my vast search of the internet so why are Doctors so perplexed by it? I will take any answers and treatment advice offered.
AJ95

[AJ95]

A week after seeing my Doctor and following the advice of CeeTee, my condition is almost completely cleared.  I stopped taking baths and now shower only, not using the dove soap and just mild cleanser and water.  My gyno had prescribed a steroid cream which I have used a couple of times.  I now believe it to have been a reaction to soap and possibly aggravated by sitting in the soapy bath.  Thanks CeeTee for the tip, I and my husband are much happier now.

[JBee70]

Hi ladies,
Thank you for the posts and info..
I wanted to update that I had a biopsy of the vulvar tissue in late May. Results were negative.... except that I was found to have "chronic dermatitis". I did more research online and found a condition called "DIV" (desquamative inflammatory vaginitis). It causes redness, itching, fissures etc... And when you've been tested for all infectious and non-infectious conditions and they are all negative, this is what alot of women end up being diagnosed with.
Its cause is unknown, but it responds to a 2 week therapy with Clindamycin cream (vaginally) and hydrocortizone suppositories (again, vaginally). I did this as prescribed and all of my symptoms went away.. They've been gone since early June!
I am thinking that I had some sort of allergic reaction (hence the chronic dermatitis on the biopsy) that just went haywire!??
Anyway, I am hoping that this won't return, but if it does, at least I know what worked for me!!
Thanks again!

[gillbill]

I wrote a long reply and it is not posting for some reason. Long story again….
I have same thing in same place, one side only.  
I am fairly high stress, but even during low stress it is present.
I change my underwear frequently to keep dry. Not changing them seems to make it worse; changing still doesn't solve the problem.
I wear white wall-mart cheapy underwear. I thought it could be something in the processing of the material. Had heard they actually have white dye and thought it could be sensitivity to the dye.
I thought it might have something to do with being gassy, or eating foods that I may have a sensitivity to, either because they makes me gassy, or because it could be an allergic reaction. Could an allergic reaction from food show it self in this area?
I use the cheap individually wrapped industrial TP from SAMs.
We use Poly...Condoms for protection and mineral oil for lubrication, because I thought the spermcide/other condoms were irritating. Also stopped oral sex, obviously, but because I thought that was causing it... It came back without that as a possibility.
I use "free and clear" detergents, mostly arm and hammer, but once another kind.
When I sit on the computer and create a little oven of sorts by sitting up straight, it seems to get worse, but not always and not sitting doesn't let it go away.
Jeans seem to make it worse. I go with out pants, allowing plenty of air flow when I can at home. Which obviously doesn't solve the problem... AND isn't suggested for "in the office."
I do everything wrong and it goes away, I do every thing right and it pops up. I played in the hose with my daughter, wet pants, and then went to the pool, wet bathing suit and that night it went away. The pool, by the way, is salt water, so maybe salt sit baths could help?
Please lets keep talking, and solve this, none of us have a Cindamycin deficiency and I fear that antibiotics could be whacking something else out of balance.

[gillbill]

Meant to say, the other day I tried balmex diaper rash meds for a couple of hours and it seems to of helped. Could be another coincidence. And thanks for the soap suggestion, will try that also! For now it is hardly visible, seems to heal very quickly when conditions are favorable, but it takes no time to pop back up either. Good luck to everyone with this one...

[JBee70]

Hi there,
I read your post and just wanted to respond to the "free and clear" detergents that you said you use..
The reason I ask is because in trying to trace my problem back to when it began, it was when I had decided to switch to "free of dyes" organic "petroleum free" environmentally friendly detergent and toilet paper.
I went on this "go green" spree, and converted to these products. THATS when I started itching and having fissures. A whole YEAR later, I am finally symptom free after multiple dr. visits, tests, biopsy, and even then I STILL had to self-diagnose by reading websites!!!
Chronic Dermatitis can apparently really cause problems down there!! Since Clindamycin and Hydrocortizone suppositories are not as serious as using steroid creams, it seems worth a try for anyone whose Dr. can't figure this stuff out!
best of luck..

[JBee70]

PS- I went back to conventional detergents and toilet paper!!!!

[JackieCalifornia]

Thanks so much to all who posted.  I'm not feeling so confused now.

I'm on prolonged antibiotics for another condition and I thought it might be a low-level yeast infection (which don't always come with white discharge).  An anti-yeast pill like Diflucan has helped in the past, but I haven't tried it this time.

I never thought about the soap irritation mentioned above, but will try the Cetaphil cleanser (I use their lotion).

Thank you to everyone who posted -- !  

[Yiya]

Wow! In addition to these symptoms, has anyone experienced swelling as well. I too have the redness and a fissure;except mine is still present after over two months. I was diagnosed w/ yeast and cervicitis-twice in one month. And twice to no avail. Same soreness and irritation and as mentioned in th above, it has the docs perplexed.
I'm waiting as I write for the 5th diagnosis. Was it a pap that determined the above or should I request a biopsy ?
Thanx in advance/It's nice to know one is not alone-thus the Wow.=)

[Clorets]

I have the SAME thing!!! It occured for the first time 2 months ago when I was showering and I noticed something was stinging me.  I didn't know what was the cause and I thought it was an STD. My problem started with an itch for 2 months, and the itch got worse.  My 2 fissures are 12 o'clock, directly on top of the clitoral hood, and 11 o clock on the inner labia.  At first I was scared that perhaps my partner was too big for me and was causing trauma.  

I have stress induced eczema on my hands.  And come to think of it, this totally makes sense!!.  I have been reading the websites and i thought I had cancer!!! (all the google sites just point to vulva cancer....i was sweating.)  I recently changed soaps 2 months ago.  

Thank you so much everyone.  And for the brilliant dermatologist who recognized CeeTee's problem to start.  I will try Cetaphil cleanser.  It feels so good that I am not alone with this problem.  

[gillbill]

Doc says no oil based lubricants! Body just can not get rid of them. WIih all of this getting back to the basics, I thought "mineral oil," Its in a lot of lotions, if you are putting it all over your skin why not. Well Doc says "no." The rip is still there, but I have another appt. for those who got a biopsy, what is that like? How can they tell if it is herpies (herpes) or skin irritations and how deep? Does it take long to heal? Stitches? Also I got a great idea about sitting in the sun relaxing for 10-15 every other day. I swear that was helping...Also I think it might be getting worse when I eat a sweet, (maybe sugar feeds the yeast?) Do we think that this is yeast or a skin sensitivity? What are the meds the doc are giving out for. Yeast? Bacterial? or mainly steriod? Steriod doesn't work for long and so it isn't just a sore that needs a little help healing. It erupt from the inside. I can feel it before it gets worse sometimes. Can't be both soap issue and yeast, right, is yeast bothered by the wrong soap?
-K

[lisaluck]

Im going on 13 years of issues with vulvar pain it has gotten less painful over the years yet flares up bad from time to time.Just a few things for all of you... try to exercise the pelvic muscles talk to a trainer or research various moves to strengthen. Use sulfate free cleansers Cetaphil is NO GOOD!!! I dont care what doctors say the ingredients are bad!! Go to Whole Foods and pick up these products.. California Baby body wash/shampoo unscented and Aloe Life Personal Gel Lubricant. They both are GREAT!!! Also if your health permits do a cleanse read the book CLEAN and or various detox cleansing books its eye opening! Our bodies are toxic and we wonder why we are in chronic pain. Yeast(candidia),parasites etc..we can control this!!! Good Luck

[hlj9]

I have had the same fissure sympotms as most of you described above.  After many freak outs and thinking it might be herpes (negative) I had a biopsy done.  Turns out it is Lichen Sclerosis.  I have been perscribed a steroid cream and I'm still playing around with different soaps.  I'm not as consistent as I should be ...and the symptom is still consistent- go figure.

I hope this helps!