Differential diagnosis of ulcerative lesions on the vulva

More common*

Less common

Rare

Infectious

HSV in the immunosuppressed patient
Primary syphilis

Cytomegalovirus
HIV
Granuloma inguinale
Lymphogranuloma venereum
Chancroid
Very rare infections
- Tuberculosis
- Amebiasis
- Schistosomiasis
- Leishmaniasis

Noninfectious

Acute vulvar aphthous ulcers
Trauma
- Accidental
- Iatrogenic

Malignancy
- Squamous cell carcinoma
- Melanoma
Crohn disease
Hidradenitis suppurativa

Other malignancies
- Basal cell carcinoma
- Adenocarcinoma
- Hodgkin and non-Hodgkin lymphoma
Pyoderma gangrenosum
Langerhans cell histiocytosis
Complex vulvar aphthous ulcers
Patient-induced trauma

The prevalence categories refer to vulvar manifestations of the listed diseases. The relative frequency of each may vary based on the patient population, geography, and type of clinical practice (eg, gynecology, dermatology, or internal medicine). There are no data on the prevalence of the causes of vulvar ulcers. The prevalence will vary widely in various parts of the world. This is only an estimate for North America.

HSV: herpes simplex virus; HIV: human immunodeficiency virus.
* Vulvar ulcers, in general, are not common. This table represents estimated frequency.

Graphic 96017 Version 5.0

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Differential diagnosis of ulcerative lesions on the vulva