Dr. Melissa Mauskar discusses the dermatologist’s role in diagnosing and managing vulvovaginal disorders, including when to involve the patient’s gynecologist.
Melissa Mauskar, MD, is Assistant Professor of Dermatology and Obstetrics/Gynecology at UT Southwestern Medical Center, Dallas, Texas.
“There’s so many conditions we see in dermatology that are focused on the vulva. There’s some in particular and then there’s other conditions that affect the vulva, just like they affect anywhere else,” said Melissa Mauskar, MD, Assistant Professor of Dermatology and Obstetrics/Gynecology, UT Southwestern Medical School, Dallas, Texas.
Dr. Mauskar presented, “Accurate Clinical Diagnosis of Mucosal Disorders with an Emphasis on Vaginal Disorders,” at this year’s Practical Symposium 2021.
“One of the conditions I see primarily in my practice is lichen sclerosis. It’s about half of my clinical practice. This is something that dermatologists are very familiar with, and gynecologists get exposed to it, but they just don’t have the comfort level that dermatologists have,” said Dr. Mauskar.
“What I think can be challenging is diagnosing lichen sclerosis when it’s at end stage with scarring and white depigmented kind of crinkly tissue paper-like texture. It’s very easy for almost all dermatologists because we know we see these conditions quite frequently.”
Disease management, however, isn’t always easy, because time is often limited during patient visits.
“The management can be quite complex… when [patients] first get a diagnosis, they don’t always get the all the information from their physicians. A lot of dermatologists have very busy clinical practices, and maybe they only get to spend 5 or 10 minutes with patients. And so they don’t get to go over all of the education and the clinical applications of how to put medication on and where to put it.”
Especially when the diagnosis can be made quickly, Dr. Mauskar recommends focusing the remaining visit time on patient education.
“[I show] patients how much of the medicine to put on—lentil size. I show them on the back of my hand. …I mark up a photo and show them exactly where to put their medication, which I think goes a long way.”
She also provides handouts and offers additional resources to her patients, not only to aid in disease management, but to dispel “Dr. Google” treatment myths.
“A lot of these patients are plugged into social media, portals online through Facebook, and other measures just to have that support system. But there are also a lot of things that go on that we don’t want our patients doing. I’ve got a lot of patients that will put Borax paste—kind of like an alkaline bleach paste that they put on their body. And so obviously we don’t want them to do those kinds of things.”
In addition to discussing the many nuances of managing lichen sclerosis, Dr. Mauskar also pointed out others.
“Another one that we often see is erosive lichen planus that we can see in the mouth and also in the vulva,” she said.
According to Dr. Mauskar, dermatologists often treat lichen planus with both topical and systemic medications, including corticosteroids, mycophenolate mofetil, methotrexate, and more.
“We have a lot of different systemic meds that gynecologists just aren’t as familiar with as dermatologists,” she said. “So whereas sometimes they’re able to diagnose those conditions, I think when it goes beyond just your typical topical steroid, they need our help and so that’s when we would like to collaborate together.”