C. albicans vulvovaginitis is a common infection, which some authors estimate precipitates to 10 million office visits annually (19). In addition, many women
Figure 10 Lichen sclerosus: classic changes of lichen sclerosus of the vulva and perianal area in a postmenopausal woman, with areas of thin erythematous skin, white parchment paper-like skin in the perianal area, and thickened white skin. (See color insert pp. 4 and 5.)
self-diagnose a vulvovaginal yeast infection and treat with over-the-counter products without seeking medical assistance. It is estimated that 40% to 50% of women will have more than one episode and 10% to 20% will have complicated vulvovaginal candidiasis (20).
C. albicans is the most common strain of Candida to cause infection in the vulvovaginal area (8). Women complain of vulvar itching and/or vaginal discharge. On examination, the vulvar skin and associated affected skin have an irregular or asymmetrical pattern, mild to intense erythema, edema of the
labia minora (usually), and edema of the labia majora (possibly). If the C. albicans infection spreads to the adjacent skin in the genitocrural folds, as well as to the perianal area, satellite pustules occur frequently in these skin areas as well. Excoriations can be present and there may or may not be vaginal discharge. Vaginal discharge can be scant to heavy, thin and milky, clumpy and curdy, or "cottage cheese-like." In addition, the woman may describe a foul, sweet, or strong odor associated with the discharge. Microscopic evaluation of the vaginal discharge usually documents the presence of hyphae and budding yeast. If the concentration of yeast is low, a yeast culture is useful to document the infection (Fig. 14).
Usually, C. albicans is treated with one of the imidazoles, either with one of the many topical vaginal preparations or with an oral antifungal preparation. Many of the intravaginal preparations can cause burning with application. For symptomatic relief, an antifungal-steroid combination ointment such as nys-tatin-triamcinolone to decrease the inflammation associated with vulvovaginal Candida infections. Lukewarm water soaks, as mentioned before, are soothing, as well.
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