Vulvar Psoriasis
Introduction
Introduction to vulvar psoriasis The psoriatic psoriatic lesions usually exist at the same time as the scalp, trunk, and extremities. Only a few patients occur alone. Psoriasis, commonly known as psoriasis, is a chronic erythema scaly skin with characteristic skin lesions. Diseases, long course, easy to relapse, a small number of patients can not relapse after treatment. basic knowledge The proportion of sickness: 0.0001% - 0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: dermatitis vulvar eczema
Cause
Causes of vulvar psoriasis
(1) Causes of the disease
The cause of this disease is not completely clear. Most scholars believe that the disease is related to the following factors:
1. Genetic factors: The disease has a family history and has a genetic predisposition. It is reported in foreign countries as 10% to 80%, and in China, it is generally 10% to 23.8%. It is autosomal dominant with incomplete explicit and can also be common. Chromosomal recessive inheritance, but there is no conclusion about the genetic mode at home and abroad. The frequency of HLA-B13 and B17 in foreign patients with psoriasis is significantly increased, but there are also the frequency of HIA-B3, C77, W6, and psoriasis patients in China. The frequency of HLA-B13 and HLA-B17 increased, and HLA-A1 increased. The frequency of HLA-B40 and W35 decreased significantly, but the frequency of HLA had no significant significance in evaluating the clinical and prognosis of individual patients.
2. Infection factors: including viral infections and bacterial infections, in which streptococcal infection is closely related to the pathogenesis of psoriasis, especially some acute drip type, arthritic type, erythrodermic patients often accompanied by upper respiratory tract infection or tonsillitis Symptoms, and anti-"O" often rise, is generally considered to be an allergic reaction of bacterial toxins.
3. Drug factors: The following drugs are found to cause psoriasis, such as: beta blockers, lithium, antimalarials, etc., recently discovered terbinafine, calcium channel blockers (nicapine, nitrate Bendipine, nisoldipine, verapamil, diltiazem, captopril, glibenclamide and lipid-lowering drug gefenoxime, dexamethasone and certain cytokines such as G-CSF, interleukin, INF-, INF-, etc. can induce psoriasis.
4. Immunity factors: The patient's cellular immune function is degraded, and the circulating T cells are deficient. In the lesion, the deposition of C3 complement and/or immunoglobulin at the junction of the vessel wall and/or the dermis-epidermal can be found. Serum is present. Anti-IgG antibody, anti-keratinocyte autoantibodies were detected by immunofluorescence.
In addition, it is also related to metabolic disorders, endocrine disorders, mental, food and other factors; seasonal changes, trauma or surgery can induce this disease.
(two) pathogenesis
Pathogenesis
At present, the pathogenesis has not been fully clarified, and there are many theories. There are three main characteristics of psoriasis, abnormal differentiation, hyperplasia of keratinocytes, inflammation, basal keratinocytes entering the hyperplasia pool are significantly increased, cell proliferation is accelerated, mitosis cycle From normal 311h to 37.5h, the epidermal transit time was shortened from 26 to 56 days to 3-4 days. The number of mononuclear cells proliferating in peripheral blood of patients with psoriasis was significantly increased. T and B cells had entered the skin lesions before entering the skin lesions. Activated, local macrophages also activate and proliferate T cells locally in the skin.
In addition, keratinocytes (KC) can synthesize and secrete various cytokines under the stimulation of certain environmental factors such as physicochemical and biological factors, and activate T cells in a non-antigen-dependent manner. KC can express MHC-2 antigens such as HLA-DR. And B7 molecules, under certain conditions, make KC have the ability of antigen-presenting cells (APC) and provide a costimulatory signal for T cell activation. It is also an important intrinsic mechanism of T cell local activation. KC as APC may be mainly for maintaining silver. Psoriasis lesions are of interest, and polyclonal or oligoclonal T cell activation plays a role in the initiation and maintenance of psoriasis, an abnormality of psoriasis epidermal cells highly dependent on CD4:T cells, and more importantly CD8 : T cells maintain a clinical pathological change in psoriasis that is required.
Abnormalities in signal transduction of T cell activation in psoriasis are also associated with disease. Both superantigen and autoantigen are more involved in the process of psoriasis, and these two antigens may complement the expression of T cell-modified diseases. Psoriasis lesions dermis vascular changes are also a feature of the disease, including dermal papillary plexus venous branch excessive degeneration, dilation, increased permeability, endothelial cell proliferation and new blood vessel formation, newly formed dermal capillaries The blood vessels persist in the skin lesions of psoriasis and the skin with normal appearance. The angiogenic factors such as VEGF, bFGF, PDECGF/TP are highly expressed in psoriatic lesions, and play a role in the pathophysiology of psoriasis. The role of epidermal cells in the production of TgaseK and IGF, 1R and interleukin-1, interleukin-8, GRO-, TSP-1, TNF-, KGF, TGF-, ICAM-1 and other cytokines associated with psoriasis Arachidonic acid and its derivatives are also associated with psoriasis, but are not the primary factor.
2. Histopathology
The basic characteristics of the psoriatic lesions of the psoriatic lesions are thickening of the cuticle of the epidermis, parakeratosis and reduction or disappearance of the granular layer; hypertrophy of the epidermis, epiphyseal extension of the epidermis, and a small amount of neutrophils gathered in the horn Mutro microabscess formed in the dysplastic region; the acanthosis above the dermal papilla became thin; the dermal papillary telangiectasia was distorted to the top; the mononuclear cells infiltrated in the superficial dermal layer, and the erythrodermic psoriasis histological changes except psoriasis In addition to the basic characteristics, there may be changes in chronic dermatitis and eczema. The histological features of pustular psoriasis are similar to those of psoriasis vulgaris, but the interstitial edema of epithelial cells is more obvious, and spongy pustules appear on the upper part of the epidermis (Kogoj ), the cavity is neutrophils.
Prevention
Vulvar psoriasis prevention
Let patients understand the basic knowledge of the disease, pay attention to eliminate trauma, relieve ideological concerns, try to avoid various triggering factors such as physical, chemical substances, avoid alcohol and tobacco, limit the intake of spicy and stimulating diet, and strengthen physical exercise. Pursuing suspicious causes, paying attention to avoiding upper respiratory tract infections and clearing infectious lesions, should also be used with caution. In the acute phase, avoid irritating external use and ultraviolet radiation.
Complication
Vulvar psoriasis complications Complications, dermatitis, vulvar eczema
Generalized people may have symptoms such as fever and general malaise.
Symptom
Symptoms of vulvar psoriasis Common symptoms Itching redness, eczema, maculopapular rash, skin infiltration, scaly pustule, spotted bleeding, sweating reduction
The patient has genital itching, burning sensation or extreme discomfort. The initial appearance is in the pubic larynx, labia and other places. The size of the needle cap is different from the inflammatory flat papules. It gradually grows into a reddish, drip-like, coin-like, map-like shape. Ring-shaped maculopapular rash, the surface of the papule is covered with multiple layers of silvery white scales, with a slight blush around it, gently removing the scales of the epidermis, revealing a semi-transparent film on the substrate (film phenomenon), and the small bleeding point after peeling off the film is Characteristics, genital sweating, damp and easy to rub, rash often rubbed and eczema-like changes, skin eczema-like changes in the vulva folds more obvious, vaginal lesions similar to seborrheic dermatitis.
According to the clinical features of psoriasis, it can be generally divided into vulgaris, pustular, joint and erythrodermic types. The types associated with the vulva have the following characteristics:
Psoriasis vulgaris
The most common type, usually acute onset, is red inflammatory papules from the beginning, miliary to mung bean large, then gradually expand into each other into a red plaque, the boundary is clear, surrounded by a red halo of 0.2 ~ 0.5cm, the base Infiltrated, the surface is covered with multiple layers of dry silvery white scales, the scales are less acute damage, more chronic damage, the scales in the central part of the lesion are more firmly attached, the scales do not exceed the edge of the erythema, more characteristic, after scaling off the scales Then, a layer of light red shiny transparent film appears, which is the film phenomenon. After the film is scraped off, it reaches the top of the dermal papilla layer, the capillaries are scraped, and a small bleeding point, ie, spotted bleeding, appears. Like (Auspitz sign), sweating at the skin lesions is reduced, and the sweat loss after the skin lesions subsided can continue for a while, and does not return to normal immediately. The lesion distribution is characterized by drip, which is characteristic of punctate psoriasis. In children, especially after infectious diseases such as tonsillitis, it is closely related to infection. If the skin lesions are large, they are round and can be merged into a map. When the lesions are in the regression period. It can be arranged in a ring shape, and the number of skin lesions can be varied from 1 to 100 pieces. It is symmetrically distributed and can occur throughout the body. It is widely distributed and generally occurs in the scalp and the extremities of the extremities. Buttocks, but there are also a few patients with skin lesions confined to a skin fold such as the scalp, vulva, groin.
Psoriasis of psoriasis accounts for 3% to 5% of the disease, mainly involving the groin, axillary fossa, breast perineum and other folds. The boundary of the lesion is clear, the erythema is widespread, there is no scale, and the wrinkles are locally moist and easy to rub, and the lesion is damaged. The surface is moist and eczema-like, and the psoriasis in the mucosa is relatively rare. It is usually found on the male glans, inside the foreskin, infiltrating red or dark red spots or plaques with clear edges, smooth and smooth scales, or less scales. No scales, can exist for a long time, can also be located in the bladder, urethra, etc., this disease rarely occurs in the female vaginal mucosa, occasionally white or grayish yellow slightly raised spots or patches, the base is infiltrated lightly, a little around Red, the surface of the rash is free of scales, and psoriasis in the vulva often coincides with psoriasis damage in other parts of the body, rarely in solitary.
The disease is divided into the ongoing period, the stable period and the regression period.
(1) Progression period: new rash appears constantly, old skin lesions continue to expand, scaly thick accumulation, inflammation is obvious, there is inflammatory redness around, and there is a homotypic reaction at this time.
(2) Stabilization period: The condition remains static, basically no new rash appears, and the old rash does not disappear.
(3) Degenerative period: Inflammatory infiltration gradually subsides, scales decrease, red becomes lighter, and even skin lesions disappear, leaving hypopigmentation or pigmentation spots.
2. erythrodermic psoriasis
More common in adults, caused by topical stimulant drugs or pustular psoriasis subsided, a large number of hormones will be suddenly stopped, clinical manifestations of diffuse red or dark red skin, inflammatory infiltration, a large number of surface Verrucous scaly, continuous desquamation, for patients with erythroderma, generalized skin infiltration and swelling throughout the body, perineum, groin, anal and other swelling is also more obvious, more exudate, the formation of serous molting, underarm secretion More accumulation of substances, often cause skin cracks after the activity, mucosal symptoms are also more obvious, the female genital, urethra, anal mucosa often smashed, there are secretions, patients with pain when urinating, and easy to concomitant perineal infection.
3. Pustular psoriasis
On the basis of the original skin lesions, it is characterized by acute erythema, aseptic pustules with dense needle tip to mung bean size, which can be spread all over the body, and can also be confined to the palm and ankle. It is a chronic disease, repeated attacks, vulva. Similar lesions appear in the department, and blister wall rupture, erosion and crusting, purulent sputum, and exudate due to easy friction.
Examine
Examination of vulvar psoriasis
Blood routine, secretion examination. Histopathological examination.
Diagnosis
Diagnosis and diagnosis of vulvar psoriasis
diagnosis
It has typical genital lesions: the surface is thickened, reddened, covered with a layer of fine miliary suede, a little dark red papule under the suede, the haze is like seborrheic dermatitis, and other parts of the body have psoriatic skin. Loss, there is a film phenomenon, the diagnosis can be established.
Differential diagnosis
The performance of psoriasis in the vulva is different from that in other parts, and must be identified with the following diseases.
1. Female genital eczema: Female genital eczema is located in the labia and surrounding skin. In the acute phase, erythema, papules, erosion, and exudate are mainly used. The labia may be slightly red and swollen. Because the skin of the perineum is thin and tender, it is often scratched and moist. , friction, easy to form erosion surface, chronic area and surrounding skin can be infiltrated and thickened, rough surface, few scales, the general state is clear, may be accompanied by pigmentation or hypopigmentation.
2. Female Yin Lichen Moss: It occurs in any part, more limbs than the trunk, and the limbs are more flexed than the extension side. It is also common in the face, oral mucosa, glans or female genitals, and is a purple-red flat polygonal papule. The needle tip is 1cm in size, distributed separately or in groups, and the papules are covered with fine scales. The surface of the papules has a smooth and shiny waxy film with fine white stripes, ie Wickham stripes. The lesions in the mucosa can be eroded or Ulcer, itchy.
3. Hardened atrophic moss: occurs in the labia minora, labia majora, clitoris and perineum, can extend to the medial side of the femur, single in the female genital, can also be found in other parts, clinically expressed as oval cigarette paper wrinkles, There is telangiectasia, the edge of the damage, ivory atrophic papules or patches, due to friction and moisture, can be broken, flushed, smashed, blistering, bullae, severe itching or pain.
4. Genital candida disease: damage is a dark red spot with sharp edges, which merge into irregular small pieces, which occur around the anus and can spread to the buttocks, groin, labia majora, pubic sputum, etc. Mycelium pseudohyphae and spores.
5. Vulvar red sputum: often occurs in the inner side of the thigh, is not very regular, large reddish plaques, no herpes on the edges, no scales, microscopic examination of Corynebacterium.
6. Perineal seborrheic dermatitis: the edge of the lesion is not very obvious, the scaly is yellow, oily, no spotting after scraping, often occurs in the pubic area with hair removal, most in the scalp, face, chest, etc. Similar lesions exist.
