What is the difference between vulvar dermatitis and leukoplakia of the vulva?

 Vulvitis and leukoplakia of the vulva are two distinct vulvar conditions, differing mainly in their causes, typical symptoms, vulvar appearance, pathological features, and prognosis. The specific differences are as follows:

 1. Causes: Vulvitis is often associated with external irritants, such as using irritating cleansers, wearing tight synthetic clothing, exposure to allergens, or prolonged irritation from moist environments, and is classified as an inflammatory condition. The exact cause of vulvar leukoplakia remains unclear but may be related to autoimmune abnormalities, genetic factors, endocrine disorders, or local neurovascular nutritional impairment, and it is categorized as a pigmentation-loss disorder of the vulva.

 2. Typical Symptoms: The primary symptom of vulvitis is itching, which is intense and tends to recur. Scratching may lead to sensations of burning or pain, and symptoms fluctuate depending on exposure to irritants. The core symptom of vulvar leukoplakia is also itching, but it is more severe—especially worsening at night—and is frequently accompanied by vaginal dryness and dyspareunia (pain during intercourse). Symptoms last longer and tend to progressively worsen over time.

 3. Vulvar Appearance: During active episodes, vulvitis presents with redness and swelling of the affected skin, possibly accompanied by papules or vesicles. Scratching may result in erosion, exudation, or crusting. After inflammation resolves, there is usually no significant pigment change. In early-stage vulvar leukoplakia, the skin color first becomes paler, gradually developing white plaques. The skin becomes rough and thickened; in severe cases, fissures, atrophy, and reduced elasticity may occur.

 4. Pathological Features: Histopathology of vulvitis shows inflammatory cell infiltration in the skin, along with epidermal edema and congestion, without abnormal epithelial hyperplasia. In contrast, biopsy of vulvar leukoplakia reveals hyperkeratosis or parakeratosis and varying degrees of epithelial dysplasia, with certain subtypes carrying a risk of malignant transformation.

 5. Prognosis: Once triggering factors are removed, most cases of vulvitis can be completely cured with appropriate anti-inflammatory and antiallergic treatment; recurrence is typically linked to re-exposure to irritants. Vulvar leukoplakia is more difficult to treat and currently cannot be completely cured. Management focuses on symptom control and slowing disease progression.

 In summary, vulvitis and vulvar leukoplakia differ significantly in etiology, clinical presentation, treatment approaches, and outcomes. Therefore, accurate diagnosis and proper management require careful differentiation and guidance by a qualified healthcare professional.