Clinical signs are the manifestation of disease and are visible findings, such as the presence of a lesion, or are elicited by specific examination, for example touch‐provoked tenderness. In some situations, the absence of a normal feature can be very important in reaching a diagnosis; this is particularly important in some of the scarring dermatoses that affect the vulva, such as lichen sclerosus.
It is important to understand the correct terminology in describing lesions (see Table 8.1), as this is helpful in describing cases to colleagues (Table 8.2) and also for documenting change of any disease over time.
Table 8.1 Terminology of vulval lesions.
| Lesion | Description | Clinical example |
| Macule | Flat area of discoloration <1 cm | Melanosis |
| Papule | Well circumscribed, raised and palpable lesions <1 cm in size | Molluscum contagiosum |
| Nodule | Raised, palpable lesion >1 cm | SCC |
| Plaque | Raised, palpable area | Psoriasis |
| Vesicle | Raised lesion <5 mm containing fluid | Herpes simplex |
| Bulla | Raised, fluid containing lesion >5 mm | Bullous pemphigoid, |
| Pustule | Lesions containing pus which may be infected or sterile | Infected – folliculitisSterile – pustular psoriasis |
| Erosion | Superficial loss of epidermis | Erosive lichen planus |
| Ulcer | Loss of whole epidermis and upper dermis | Crohn’s disease |
| Fissure | Linear split through epidermis and superficial dermis | Vulval psoriasis |
| Comedone | Plug of keratin stuck in a dilated pilo‐sebaceous duct. They may be ‘bridged’ with an area of epithelium between two lesions | Hidradenitis suppurativa |
| Telangiectasia | Visible dilatation of small cutaneous bloods vessels; blanch with pressure | |
| Purpura | Macular lesions containing blood that do not blanch with pressure | |
| Ecchymosis | Larger extravasation of blood | Lichen sclerosus |
| Oedema | Diffuse swelling of the tissue | Crohn’s disease |
Table 8.2 Describing vulval lesions.
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| Term | Description | Example |
| Atrophy | Thinning of tissue – may affect the epidermis, dermis or both | Lichen sclerosus |
| Annular | Ring shaped | Granuloma annulare |
| Circinate | Circular | Erythema marginatum |
| Crust | Dried exudate | Impetigo, staphylococcal infection, severe allergic contact dermatitis |
| Desquamation | Superficial peeling of epidermis | Post‐inflammatory change, staphylococcal scalded skin syndrome |
| Erythema | Red colouration of the skin often with increased warmth, due to increased blood supply to the area | Inflammation, infection |
| Excoriation | Break in epidermis due to scratching |