White vulvar lesions, also called white vulvar lesions, vulvar leukoplakia or vulvar dystrophy, were previously thought to be vascular dystrophy, but with further understanding of the disease, the above changes were not found, but rather lesions with pigmentation changes and degeneration of the vulvar skin and mucosal tissue. Since the vulvar skin and mucosa of patients with sclerosing moss and squamous epithelial cell hyperplasia are mostly white, they are called white vulvar lesions, which are intraepithelial non-neoplastic lesions of the vulva. Sclerosing moss and squamous epithelial cell hyperplasia have changed their names several times in different ages due to different clinical and pathological understanding. Because of the confusing name, the International Society for the Study of Vulvar Diseases (ISSVD) referred to it as “chronic vulvar dystrophy” in 1975. The exact etiology of white vulvar lesions is unknown. It may be related to the following factors: genes, autoimmunity, sex hormone deficiency or decreased sex hormone receptors, etc. Vulvar squamous epithelial hyperplasia may be related to itchy vulva due to moist vulva and long-term irritation by secretions and repeated scratching. Clinical manifestations Odd itching of vulva is the main symptom, and the itching time from onset to treatment is within 2 to 3 months, or up to 20 years. The intensity of itching does not distinguish between seasons and day and night. Patients with squamous epithelial hyperplasia of the vulva feel itching more severely. In the presence of trichomonas or mycotic vaginitis, the discharge is more frequent. The local burning and tingling sensation is associated with itching-induced skin mucosal breakage or infection. There is varying degrees of localized hypopigmentation of the skin mucosa, often with edema, chancre and scattered superficial ulcers. Examination Biopsies should be performed on areas with chaps, ulcers, bulges, hard nodes or roughness. Multi-point biopsies should be sent for pathological examination to determine the nature of the lesion and to exclude early cancer. In order to take appropriate material when vulvar squamous epithelial hyperplasia is suspected, the lesion area can be painted with 1% toluidine blue first, and then decolorized by scrubbing with 1% acetic acid solution after drying. Any area that does not decolorize indicates the presence of nucleus, and biopsy in this area has a higher possibility of finding atypical hyperplasia or even cancer. Diagnosis Preliminary judgment can be made based on clinical manifestations; pathological examination is needed to confirm the diagnosis. The material should be taken at multiple points of the lesion: ulcer, chancre, hard nodes, elevation or roughness, etc., and taken appropriately. When vulvar squamous epithelial hyperplasia is suspected, 1% toluidine blue can be applied to the lesion area, and after drying, 1% acetic acid solution can be used to decolorize the area without decolorization, using biopsy forceps perpendicular to the skin and deep to the dermis for biopsy. The biopsy of the non-depigmented area indicates the presence of nucleus in the area, and the biopsy in the area can improve the diagnostic accuracy. Differential diagnosis Pay attention to differentiate from vitiligo, albinism, physiological atrophy of the vulva in the elderly and atopic vulvodynia. Treatment 1. General treatment Pay attention to keep the vulva clean and dry, prohibit irritating drugs or soap to wash the vulva, avoid wearing impermeable chemical fiber underwear, and do not eat spicy and allergy-prone food. For those who suffer from insomnia due to obvious itching symptoms, sedative, sleeping and anti-allergic drugs can be added. 2, drug treatment vulvar sclerosing moss commonly used drugs are pyruvic acid ointment, compound vitamin A cream and progesterone ointment. Glucocorticoid ointment or immunotherapy can also be used. Drugs can improve the symptoms but not cure, and long-term medication is needed. Sclerosing moss in young girls may heal spontaneously by adolescence, and is generally not treated with pyruvic acid ointment to avoid masculinization. It can be treated with 1% hydrocortisone ointment or 0.3% progesterone ointment, and the symptoms can be relieved, but long-term follow-up is needed. While vulvar squamous epithelial hyperplasia can be controlled by local application of corticosteroids to control itching. Most patients are treated effectively, but need to adhere to long-term medication. 3.Physical therapy is suitable for those who are ineffective in medication or have severe disease. Microwave therapy, carbon dioxide laser and helium-neon laser, Bohm light, high-frequency electric knife, local electrocautery treatment and liquid nitrogen local freezing treatment, etc. 4.Surgical treatment Surgical treatment is only suitable for those who have serious disease and repeated drug or physical treatment is ineffective. Surgical treatment is required when the vulvar squamous epithelial hyperplasia is suspected to be malignant.