Hypertrophic vulvar dystrophy means the skin of the vulva has grown thicker than it should be.

Associated with this thickening are the symptoms of intense itching and burning. These cases present clinically as patients with vulvar itching, initially believed to be yeast, which have failed to respond to standard anti-fungal therapy.

On close inspection, the skin has a patchy white discoloration. A vulvar biopsy confirms the diagnosis.

Treatment is topical steroids, used to thin the skin and relieve the symptoms.

Vulvar biopsy is very important in these cases since differentiating visually between Hypertrophic vulvar dystrophy, lichen sclerosis, and VIN (vulvar intraepithelial neoplasia) is difficult and the treatments are very different. Further, mixed dystrophies (hypertrophic in some areas, and lichen sclerosis in other areas.) are common.