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Provoked vestibulodynia represents the most frequent cause of dyspareunia before menopause. Vulvodynia's pain and burning sensations are related to neuropathic pain and associated to various degrees of vulvar mucosal hypersensitivity (mostly in the vestibular area), pelvic floor muscles dysfunction, a disorder of general perception of pain and/or various complex regional pain syndromes such as fibromyalgia, glossodynia, painful bladder syndrome (interstitial cystitis)… Vaginal infections such as candidiasis and vaginosis are important trigger and risk factors. Women suffering from vulvodynia are often described as vulnerable, pessimistic, developing feelings of guilt towards their partner. They tend to be hyper vigilant to their pain and develop catastrophizing reactions (rumination, magnification and helplessness) and avoidance/escape behaviors (fear-avoidance model). Diagnosis is based on medical history, clinical examination (Q-tip test) and exclusion of vaginitis. Treatment consists of a multidisciplinary approach involving topical therapies (emollients, anesthetics, hormonotherapy if necessary), pelvic floor physiotherapy with electromyographic biofeedback, drug treatment of pain with antidepressants (amitriptyline…) or anticonvulsants (pregabaline…) and a psychosexual support., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Atopic dermatitis (AD) requires permanent skin care., Objective: A cream containing 2% SO (sunflower oleodistillate), with peroxisome proliferator-activated receptor-alpha (PPAR-α) agonist properties, has been compared to a topical steroid (hydrocortisone butyro-propionate 1 mg/g)., Methods: An open, randomized study included two groups of 40 children (aged 3 months to 4 years). Group A applied the steroid and group B applied the 2% SO cream, twice a day. SCORAD (SCORing Atopic Dermatitis) was determined at D0, D7 and D21 and quality of life (QoL) at D0 and D21., Results: SCORAD was similar at D0 (37.2 versus 36.9), D7 (18.9 versus 19.2) (-49% and -48%) and D21 (11 versus 9.4) (-70% and -75%) (p < 0.01 versus D0). The Infant Dermatitis Quality of Life and Dermatitis Family Impact Questionnaire improved similarly by 65%/67% in group A and 72%/75% in group B at D21 (p < 0.01 versus D0)., Conclusion: A 2% SO cream has demonstrated therapeutic properties, using clinical scores and QoL, comparable to those of a topical steroid.

Early postnatal life is a period of active functional reorganization and cutaneous physiological adaptation to the extrauterine environment. Skin as the outermost organ of mammalians is endowed of multiple functions such as protection, secretion, absorption and thermoregulation. Birth stimulates the epidermal barrier maturation and the skin surface acidification especially in premature infants. In full-term infants the developed stratum corneum accomplishes competent barrier function, in contrast to prematures. Complete barrier maturation in preterm infants is fulfilled by 2-4 weeks of the postnatal life. However, in preterms with 23-25 weeks gestational age this process takes longer. Versatile regulatory mechanisms, namely skin surface acidity, calcium ion gradient and nuclear hormone receptors/ligands are interrelated in the complex postnatal newborn adaptation. The skin of newborns is adjusting quickly to the challenging environmental conditions of the postpartum. However, certain functions, for example, microcirculation, continue to develop even beyond the neonatal period, that is, up to the age of 14-17 weeks. Different environmental factors (for instance, dry and cold climate, diapers and cosmetic care procedures) influence the postnatal development of skin functional parameters such as stratum corneum hydration and the permeability barrier especially in premature infants. The aim of this article is to summarize the current knowledge on skin physiology in newborn and infants with a practical approach and to discuss the possible clinical consequences. This review offers the readership a critical and practical overview of skin physiology in newborns and infants. It emphasizes possible new research fields in neonatal and infantile skin physiology.

Emollients are commonly used for their effectiveness on atopic skin, supported by a few clinical studies suggesting their potential role as corticosteroid sparing agents. We investigated the effect of a new natural emollient on corticosteroid sparing and quality of life of young atopic children and their family. Eighty-six patients (4-48 mos) with moderate atopic dermatitis were randomized by 20 pediatricians to five groups for 21 days: corticosteroids (from twice daily to one application every other day) combined or not with the studied cream (twice daily), and evaluated by SCORAD and specific quality of life questionnaires. At the end of the study, all five groups were statistically improved in terms of SCORAD and quality of life index. Thus, application of a topical corticosteroid every other day in addition to the studied cream was as effective as a once or twice daily application of the steroid alone. The studied cream had a significant impact on lichenification, excoriation and quality of life. A twice daily application of a new natural emollient provided a major corticosteroid sparing, improved lichenification and excoriation and improved the quality of life in children and their parents.

Definition: Vulvodynia includes a group of vulva disorders in patients with a normal clinical presentation. Chronic and spontaneous complaints are observed, sometimes aggravated by sexual intercourse. Most patients complain of a burning vulva., Management: The diagnostic and therapeutic approach to vulvodynia is long and difficult. Complementary explorations may be useful initially but should not be repeated too often. They are helpful in ruling out vulvovaginal infections (candidiasis, sexually transmitted diseases) and vulva dermatosis. Vulvodynia can then be classed as cyclic vulvo-dynia, vestibulitis or essential (dysesthesic vulvodynia)., Multidisciplinary Care: Each different type of vulvodynia requires specific care. In all cases, the psychosomatic aspect must be considered. Multidisciplinary care may involve the primary care physician, the gynecologist, the dermatologist, the pain specialist, the psychologist, the psychiatrist, and the physical therapy specialist.

Among the VIN (vulvar intraepithelial neoplasia), it is necessary to distinguish the classical Bowen's disease (CBD) and bowenoid papulosis (BP). This retrospective study concerning 75 VIN (36 CBD and 39 BP) demonstrated that the most efficient criteria are the clinical aspect and the age of the onset (CBD = 55.6 years old; BP = 33.2 years old). BP is clinically related to genital warts (41 cases). They share the same age of onset, the fact to be sexually transmitted diseases and the benign evolution. Although virological results between CBD and BP are very similar (human papilloma virus type 16, 18, 31, 33), the development of an invasive carcinoma is mostly related to the CBD (27.8%) and is exceptional in the BP (2.6%).