Brief Answer: Needs examination and workup Detailed Answer: Good Day Madam! My name is Dr S Khan and i would like to talk to you about your concern of white patch at the labial area with no itch irritation or discharge and not responsive to monistat. Madam at the age of 55 and the disease of diabetes and autoimmune disordr it would be too early to say what that white patch is. Only examination and visual inspection and palpation with some work up will make things clear and in a path. To me more than medicines you take, it looks because of the behaviour of never shaving the area, as that compromises the hygiene alot and might be the reason for this infectious etiology. SO my advise keep the area clan and shaved, using depilatory or any way which suits you the best. lll you need is a good groin hygiene to avoid troubles. But steroids have immunosuppressants role so does the other rheumatologis medicines and that ight be the invitation for the opportunistic organisms to invade and result in this kind of patch and bump. Now madam i think you should seek a nearby gynecologist and let assess the patch and this bump. Once vulvar benign lesions are ruled out, all would be left of some infections like vulvovaginitis or candidiasis etc, things which will be managed with some doses of metronidazole and antimycotics with topical hypoallergenic hygiene therapies. Hope this answer finds you in good health and provides you with a path to follow till you reach the treatment and get rid of it. Kindly let me know if you need any thing else. I would love to help you . Otherwise please close the discussion and rate the answer as per your experience. Have a very good rest of the day madam. Regards Dr S Khan

---