Question: Hello Dr,
I'm XXXXXXX a 40 year old female with a history of psoriasis. About 3 years ago, my boyfriend noticed a small white patch (about the size of the trimmed fingernail on my pinky finger) on the inside of my left labia minora about half way between the vaginal opening and the clitoris. This white patch was not lumpy, itchy, painful or smelly. I kept my eye on it for a week or so, but there was no change and it wasn't causing me any problems. I'd been having outbreaks of psoriasis on and off for 20 years, and since it had covered most of my body at some point, apart from my face and my vagina, I presumed it was just a psoriasis patch that looked a little different due to the moist conditions of the vagina, and the different skin texture of the labia.

So, it's still there, still not causing me any problems and hasn't grown or shrunk particularly.

I'm concerned because after a rather extensive bikini wax last week, I noticed 2 new moles, one on my right labia majora and one on the left side of the pubic mound. So I looked up some information about new moles, the possibilty of skin cancer, or maybe even signs of vulva cancer, after adding the previously detected white patch into the equation, I have concluded that the white patch is probably a symptom of Lichen Sclerosus. This is highly probable as this is also an autoimmune disorder.

Having looked at other possible symptoms, I have been very fortunate that I haven't suffered from constant itching, painful sex or burning urine, however I have been getting broken skin, like little paper cuts, from scratching when it is itchy, my skin down there is dry, shiny and a bit wrinkly and I have a white patch. Having taken a good look, I think my labia may have shrunk compared to 3 years ago too.

I'm worried because I have left it undiagnosed for so long, and it says that If left untreated lichen sclerosus can cause severe scarring of the vulva (including the shrinking of the labia and narrowing of the vaginal entrance) and that It is also associated with a small increased risk of vulval cancer - which is what I was worried about when I found the two new moles.

Now, the likelihood is that I've just driven myself into a state of panic from my ill advised self diagnosis, (really there is just too much information available on the internet these days) and of course I will be consulting a real doctor as soon as possible, so my first question is, do I make an appointment with a dermatologist, as it is an issue with the condition of my skin, or a gynecologist because of the location of the skin problems? Also, I'm currently an Expat in Ho Chi Minh City, Vietnam and having not needed to go to hospital or see a doctor so far during my stay, I don't know anything about the quality of the doctors or facilities at any of the hospitals. In fact, there's not much information available on the internet either from the quick look that I've had. Can you suggest some ways that I can find the information I need in order to get the best medical attention available please? And finally, I appreciate that it's probably difficult to give your opinion without being able to examine me, but what are your thoughts regarding the white patch and the 2 new moles?

Apologies for probably having gone into too much detail, and thank you in advance for your help.

Kind regards,
XXXXXXX

PS Just another quick unrelated question, I was considering getting a cosmetic procedure done on my face to try to reduce the size of my ice pick acne scars on both sides of my face, and to do something about the sudden increase of little blackheads all over my face which is making my skin feel lumpy. Having looked through the available options, I was the most interested in having a few sessions of micro dermabrasion. However, as I continued my research, looking for possible side effects, it has become evident that any kind of treatment that involves removing layers of facial skin, such as micro dermabrasion, dermabrasion, laser resurfacing and the different kinds of acid peels, are NOT recommended for people who have a history of Psoriasis as it may cause an outbreak. Now, this does make sense to me, due to the nature of psoriasis, and I have noticed sometimes in the past that i'll get a little psoriasis outbreak where the scab was after the wound has healed. An I'm more than happy to be cautious as the LAST thing I want is my face to be covered in psoriasis! My question is, I will need to sort out my skin, especially the hundreds of blackheads, also my face skin seems to be losing elasticity and just generally looks old and not glowing. Wha talternative treatment would you suggest for me in orde to improve the appearance and condition of my face skin? Thanks

Hello Dr. XXXXXXX , I took some photos but I can't figure out how to upload them. Is it where it says upload news reports? I hope it is private as someone will be very surpirsed if they suddenly find photos of someone's vagina!
To answer your questions:
Was there itching over the area any time?
Yes ,but I think it was because I often get psoriasis in my pubic hair, on the pubis on on the labia majora which can be very itchy
Is there any redness over the area or surrounding?
I haven't noticed anything out of the ordinary, but it has been very dry recently which can make it look redder because I have to keep readjusting my labia as it gets uncomfortable sometimes. It's a little sore today.
Is there any change in the consistency or thickness of the affected area?(thickening or thinning)?
I can't be sure but I have a feeling that my labia minora maybe thinner than before, they feel very thin right now.
Any bleeding through the area? No bleeding.
I will send several photos, some of them may look a strange colour, but that's because I changed the saturation on some of them so the white patch would be more noticeable. You should also clearly be able to see the brown mole at the top end of my labia majora, the other mole you may not notice,it's just a tiny brown pigmentation, but I think it might be raised. I cant tell if it's the mole or the hairs underneath trying to grow through.
In photo 1, you can see the white patch on my left labia minora about a third of the way down. Also if you look just above the clitoris to the right, you will see the new mole that I recently discovered.
In Photo 2, Every thing is a wierd colour but the white patch should be more noticeabe.
In photo 3, you can see my two new moles, the big brown raised one on my labia majora, and if you look carefully just to the right of my fingers, you should also be able to see a little brown patch
In photo 4, it is a normal colour, but you can just about see my white patch
In photo 5, it is a strange colour again,but with a very clear view of the white atch. I really would be happy if you could tell what it was from looking at the photos.

Thanks, that puts my mind at ease, I will go to see a dermatologist here in HCMC and let you know the outcome!