What should be the next management step for a patient with red lesions and white plaques on the vulva?

The next management step for a patient presenting with red lesions and white plaques on the vulva is to refer to a gynecologist for biopsy. This approach is important because the combination of red lesions and white plaques can be indicative of various conditions, including vulvar dermatoses such as lichen sclerosus or vulvar cancer, and a definitive diagnosis is essential for appropriate treatment.

A biopsy allows for histological evaluation, which can differentiate between benign conditions and potential malignancies. Accurate diagnosis is crucial, as the treatment plan can dramatically differ depending on the underlying etiology of the lesions. Early intervention through biopsy can also aid in managing any serious conditions effectively.

Other management strategies, while potentially useful, do not directly address the need for an accurate diagnosis in this context. Topical steroids may help with inflammation but do not confirm a diagnosis or treat underlying pathologies. Similarly, antifungal therapy may be appropriate if a fungal infection is suspected, but it would be premature without a definitive diagnosis. Treating with estrogen cream may be beneficial in cases of vulvar atrophy, but it is not indicated without first ruling out other significant causes.