Patologia vulvar - Prurito vulvar
In the vulva many diseases may occur for various reasons: infectious, benign tumors, malignant and premalignant. Non-neoplastic epithelial disorders, autoimmune diseases, ulcers etc..
One of the most common problems is the vulvovaginitis, stressing that caused by Candida albicans, as the most common vulvovaginitis. Produces redness in the area, flow increase and pruritus
Pruritus is defined as itchy skin that produces the need for scratching to relieve this sense.
Itching can be acute and short-term, caused by problems such as infectious vulvovaginitis.
Chronic pruritus is produced by other pathologies., and non-neoplastic epithelial disorders of vulva:
- Lichen sclerosus
- Squamous cell hyperplasia or lichen simplex chronicus
- Lichen Planus
Lichen sclerosus
It is an inflammatory skin lesion that affects the vulva and perineum. It is a chronic disease that can also be progressive. Usually occurs during periods of recovery and other referral.
It usually occurs in postmenopausal, but it can also occur at other ages, even girls.
Its cause is unknown, but it is thought to be an autoimmune process, and also it seems to have a genetic basis.
It is characterized by atrophy of the skin and thinning of this, with fragile appearance is defined as skin aspect "cigarette paper". There may be cracks. Areas of skin thickening appear whitish, injuries and abrasions and scratching.
Lichen is characterized by a symmetrical arrangement , with involvement of labia, clitoris, clitoral hood , perianal.La introitus perineum and vaginal area not affected.
If your own evolution is left untreated, It produces significant alterations in the morphology and structure of the vulva, reaching deleted or labia minora disappear. It can produce clitoral burial enclosure or stenosis and vulvar introitus. Sometimes they may appear atypia on biopsy, with the consequent risk of progressing to cancer vulva.
Symptomatology
The most consistent symptom is pruritus, which may be accompanied by itching and burning.
It can also cause pain.
The progression of the disease entails significant problems for women:
- Sexual dysfunction
- Difficulty or inability to have sex
- Anxiety, depression, frustration, shame.
- Autoimagen negative
Diagnosis
The suspected diagnosis can be established with the symptoms and clinical appearance of the lesions
Safety diagnosis is established by biopsy of the vulva. Although in some cases it can be ignored practice biopsy, in others it is essential to its realization.
Treatment
The first line treatment is topical application of ultra-powerful steroids , having potent anti-inflammatory properties. Decrease inflammation symptoms and prevent disease progression to phases sclerosis and scarring
If no response can be used topical calcineurin inhibitors (Tacrolimus , Pimecrolimus). These substances have an anti-inflammatory action, Local immunomodulatory effect, but with little immunosuppressive action at a general level. Also not produce atrophy. They should only be prescribed under the control of a specialist , to evaluate the risk of malignancy.
Other treatments
- Retinoides
- Sedatives
- Antihistamines
- Photodynamic therapy
- Laser vaporization
- Surgery. It is not recommended because the disease recurrence in a very high proportion of cases. Only you can tell in some selected cases: inability to urinate or inability to have sex. It is recommended that the CO2 laser intervention.
- Hygiene measures
- Using moisturizers
Vulva cancer risk. Lichen sclerosus is associated with an increased risk of cancer of the vulva (between 3-7% of the cases).
Squamous cell hyperplasia or lichen simplex chronic
It is a lichenification or thickening of the skin caused by frequent scratching.
Chronic itching and scratching leads to increasingly evident skin lesions and large raised. .
You can have a relationship with the tendency to atopy, environmental factors, history of infections (vulvovaginitis), lichen, psoriasis, etc.
The lesions are usually located, asymmetrical and can affect the mons, labia, clitoris. There may be hyper or hypopigmentation
SYMPTOMS
itch: It is the most common symptom. It is very intense and the patients describe it as intractable and the need to scratch is irresistible.
Diagnosis
He is a clinical. If necessary it is to be biopsied.
Treatment
The goal is to treat itching and break the vicious circle of itching-scratching.
- Ultra-powerful corticosteroid or medium power for 1 my
- If necessary sedating antihistamines and.
- Hygiene measures.
Vulva cancer risk
Atypia on biopsy may appear, and then the injury should be classified as VIN. It may be associated with vulvar cancer, thereby requiring long term monitoring.
Lichen Planus
Lichen planus is an autoimmune inflammatory disease that affects the epithelium keratinized (skin) as mucosal.
Exist 3 variants of LP:
- Erosiva
- Scaly papules or classic. It may be asymptomatic.
- Hypertrophic: keratinized lesions.
It is a rare disease, appearing mainly in women between 50-60 years.
Its frequency is unknown, and the least common of the non-neoplastic epithelial disorders.
The cause of lichen planus is unknown, but we know that are associated with other autoimmune diseases.
Lichen planus affects the vulva, but also to other body locations: boca, flexor surfaces of the wrists, lower extremities and trunk. In addition, It can affect the fingernails.
Symptomatology
- itch
- Burning
- Ardor
- Pain
- Pain with sexual intercourse
- Impossibility of sex
Erosive lichen planus
It is the most common form and the most severe. It is characterized by erosive and symmetrical lesions in the vulva
Frequently affects vaginal, producing adhesions and narrowing or stenosis of the cavity. It is associated with hemorrhagic vaginitis.
It can also affect the gums producing the so-called "vulvovaginal gingival syndrome".
Diagnosis
This is done by biopsy
Treatment
Treatment is difficult
- Ultra-powerful steroids
- Intralesional / intramuscular injection of corticosteroids
- Orally Coricoides
- Calcineurin inhibitors
- Retinoides
- Mycophenolate
- Hydrocortisone suppositories for vaginal involvement
- Surgery. It is indicated to do it in a few situations: fusion of labia minora or narrowing of the introitus or vaginal cavity. We recommend carrying out the CO2 laser treatment.
Cancer Risk
Little is known about the association of lichen planus with cancer of the vulva, but it is recommended to monitor long-term and strict control.