What should be the next course of management for a 72-year-old female with vulvular pruritus and red lesions with white plaques on the vulva?

In the scenario described, the presence of vulvar pruritus and red lesions with white plaques raises concern for potential underlying conditions such as lichen sclerosus or vulvar squamous cell carcinoma. The best course of action is to refer the patient to a gynecologist for a biopsy. A biopsy is essential to establish a definitive diagnosis, which is crucial for guiding appropriate treatment and management.

The examination of the vulva, particularly with these symptoms, can reveal various dermatological conditions or malignancies. A biopsy will allow for histological evaluation to determine the nature of the lesions—whether they are benign, inflammatory, or malignant. Obtaining an accurate diagnosis is especially important in a 72-year-old female, as the risk of vulvar cancer increases with age.

While treatments like topical steroids or estrogen cream may be indicated for certain conditions affecting the vulva, starting with a biopsy when there are such distinct and concerning findings is the most prudent strategy. It ensures that the management is directed appropriately based on the underlying cause, rather than potentially masking a serious condition with symptomatic treatment alone.