Diagnosis and Management of Vulvar Ulcers: Part I—Common Vulvar Ulcers

Pathophysiology of Ulcerative Vulvar Lesions Ulcerative vulvar lesions occur after vesicles or bullae on the vulva have been unroofed. The original lesions are filled with clear or yellowish serous fluid that collects between layers of vulvar epidermal cells or between the epidermis and the dermis. These lesions are categorized by size. Vesicles are less than 1 cm (Figure 1A), whereas bullae are more than 1 cm (Figure 1B). The degree of tenseness of the covering membrane of vesicles and bullae is due to the thickness of the layer of epithelium that becomes separated from the layer underlying it and is often a diagnostic clue. It is important to distinguish vesicles from pustules, which are also frequently seen on the vulva. Vesicles are filled with watery, serous fluid whereas pustules contain sebaceous or purulent discharge. This article is the first of 2 parts.