What is the treatment for erosion on the labia minora?

Treatment of Erosion on Labia Minora

Apply white soft paraffin ointment to eroded areas of the labia minora every 4 hours, use Mepitel dressings to reduce pain and prevent adhesions, and consider potent topical corticosteroid ointment once daily to non-eroded inflamed surfaces. 1

Immediate Local Management

Emollient Therapy

• Apply white soft paraffin ointment to the urogenital skin and mucosae immediately upon identification of erosions 1
• Reapply every 4 hours throughout the acute phase to maintain barrier protection 1

Specialized Dressings

• Use Mepitel (Mölnlycke Health Care) dressings directly to eroded areas in the vulva 1
• These dressings serve dual purposes: reducing pain and preventing adhesion formation 1

Topical Corticosteroid Application

• Apply potent topical corticosteroid ointment once daily to involved, non-eroded urogenital surfaces only 1
• Topical corticosteroids reduce urogenital inflammation effectively 1
• For oral mucosal erosions (if concurrent), consider clobetasol propionate 0.05% mixed in equal amounts with Orabase applied directly to affected areas daily during acute phase 1

Infection Prevention and Treatment

Surveillance for Secondary Infection

• Take regular swabs if bacterial or candidal secondary infection is suspected 1
• Secondary infection by bacteria or candida is a frequent complication of urogenital erosions 1
• HSV activation may also occur and should be considered if erosions are slow to heal 1

Antimicrobial Treatment When Indicated

• Treat candidal infection with nystatin oral suspension 100,000 units four times daily for 1 week 1
• Alternative: miconazole oral gel 5-10 mL held in the mouth after food four times daily for 1 week 1
• Slow healing of erosions may reflect secondary infection by or reactivation of HSV 1

Diagnostic Evaluation Required

Rule Out Specific Etiologies

• If lichen sclerosus is suspected: Perform biopsy to confirm diagnosis and rule out squamous cell carcinoma, given the 3.5-5% malignant transformation risk 2
• Lichen sclerosus presents with porcelain-white papules and plaques with areas of ecchymosis affecting the interlabial sulci and labia minora, with erosions or fissures causing pain 3, 4
• Document duration and pattern of symptoms, distinguishing between pruritus (suggesting lichen sclerosus) versus pain with erosions/fissures 2

STI Testing

• Perform STI testing including gonorrhea and chlamydia nucleic acid amplification tests 2
• Viral culture for HSV should be done when ulcerations are present 2
• Serologic testing for syphilis if papules are noted 2

Long-Term Management for Lichen Sclerosus

First-Line Treatment

• Topical corticosteroids are first-line treatment for lichen sclerosus to inhibit chronic inflammatory processes, lessen symptoms, and slow disease progression 2
• Steroids have been shown to reverse some histological changes seen in lichen sclerosus 2

Mandatory Surveillance

• Long-term surveillance is mandatory due to malignant transformation risk of 3.5-5% 2
• Patients need extensive counseling about the chronic and progressive nature of lichen sclerosus 2

Critical Pitfalls to Avoid

• Never apply topical corticosteroids to actively eroded surfaces—only to non-eroded inflamed areas 1
• Do not initiate treatment without establishing the diagnosis, particularly distinguishing between infectious, inflammatory (lichen sclerosus), and traumatic causes 2
• Erosions of the genital mucosae may persist for many weeks after the acute phase has resolved, ultimately healing with scarring—prepare patients for prolonged healing 1
• Serious morbidity can ensue including vaginal synechiae in females with resultant sexual dysfunction if adhesions are not prevented 1
• In prepubertal girls with erosions and ecchymosis, do not dismiss as definitively indicating sexual abuse without considering lichen sclerosus as a differential diagnosis 2, 3