Lichen sclerosus of the vulva
Introduction
Introduction to vulvar sclerosing moss Vulvar sclerosing moss is a skin disease in which the vulva and the perianal skin are atrophied and thinned. Due to the characteristics of skin atrophy, dermatologists still call this disease "hardened atrophic moss". The lesion mainly invades the clitoris and its foreskin, labia minora, posterior labial joint and perianal. It is the most common vulvar white lesion. . The disease is characterized by skin atrophy, which is still referred to by dermatologists as "sclerosing atrophic moss". basic knowledge The proportion of illness: the incidence rate of elderly women is about 0.002%-0.004% Susceptible people: women Mode of infection: non-infectious Complications: genital itching
Cause
Vulvar sclerosing moss cause
The cause is unclear and there are currently several opinions:
Genetic factors (20%):
It has been reported that mothers and daughters in the family have developed at the same time, and the positive rate of HLA-B40 antigen in patients is significantly higher than that in women without the disease, so the disease is closely related to HLA-B40.
Autoimmune disease factors (10%):
It has been reported that about 21% of patients with autoimmune diseases such as diabetes, hyperthyroidism or hypothyroidism, vitiligo, pernicious anemia, alopecia areata, etc., and lymphocytes infiltrating the epidermis, suggesting that the local tissue has an immune response, presumably the disease may be related to itself Anti-collagen fiber antibodies are associated with subepithelial damage.
Sex hormone deficiency (12%):
Because pre-pubertal patients can be relieved after menarche, it may be related to estrogen deficiency, but clinical application of estrogen therapy is ineffective; some scholars have reported that serum dihydrotestosterone and androstenedione decreased, while free testosterone increased. Topical testosterone treatment is effective, and the total testosterone and dihydrotestosterone in the blood are elevated after treatment. The authors speculate that it may be related to the decrease of 5-reductase activity, which leads to the inhibition of testosterone conversion to dihydrotestosterone. However, in patients with 5-reductase deficiency, The risk of sclerosing moss has not increased. Recently, there have been reports of lack of androgen receptors, and corticosteroid treatment is effective.
Infection factor (25%):
In recent years, it has been found that some patients with genital sclerosing moss have spirochete infection, suggesting that spirochete may be the cause of the disease.
Neurovascular malnutrition (15%):
The neurovascular dysregulation in the connective tissue of the vulva leads to the lesion of the skin covering the upper part of the vulva. Some people exchange the vulvar skin with the normal skin of the patient's thigh, and find that the lesion skin transplanted to the thigh gradually turns into normal, and is transplanted to Sclerosing moss occurs in normal skin of the vulva, so local neurovascular malnutrition is the cause of this disease.
Although it has been clinically observed that the above various phenomena seem to be related to the pathogenesis, it has not been confirmed and generally recognized so far.
Pathogenesis
Epidermis atrophy, surface hyperkeratosis, often seen follicular keratin plug, thinning of the spinous layer, basal cell liquefaction, vacuolar degeneration, epithelial feet become dull or disappear; early edema of the dermis, late collagen fiber glass-like deformation, formation In the homogenization zone, lymphocytes and plasma cells are infiltrated under the homogenization zone. In addition, epithelial melanocytes are reduced, and the appearance of the skin is white due to hyperkeratosis of the epidermis and reduction of melanocytes.
Prevention
Vulvar sclerosing moss prevention
1. Pay attention to genital hygiene, prevent infection, and actively treat systemic related diseases.
2, strengthen nutrition, choose foods that are easy to digest, contain enough calories, protein and vitamins. Such as porridge, milk, soft rice, soy milk, eggs, lean meat, fresh vegetables and fruits rich in vitamins A, B, C. These foods can enhance the body's resistance.
Complication
Vulvar sclerosing moss complications Complications, genital itching
Improper treatment can lead to masculinizing signs.
Symptom
Vulvar sclerosing moss symptoms Common symptoms Itching peeling vulvar atrophy edema pigment loss hardening foreskin adhesion papules genital itching
The main symptoms are genital itching, dyspareunia and coughing when there is a burning sensation or pain. It can be caused by cycling, defecation or sexual intercourse when the perineal skin is split. The typical clinical feature is that the vulva is atrophied, and the labia minora becomes smaller, even Disappears, can adhere to the clitoris, the labia majora becomes thinner, the clitoris shrinks and its foreskin is too long, the skin color becomes white, shiny, shrinking, poor elasticity, often accompanied by cleft palate and peeling, the lesion is usually symmetrical, and may affect the perineum and It is butterfly-shaped in the perianal area, with mild lesions in the early stage, red and swollen skin, pink or ivory white papules, and papules are purple-like after fusion. If the lesions develop further, typical clinical manifestations can be formed. Late skin is thin and wrinkles like cigarettes. Paper or parchment, often subcutaneous hemorrhage, symmetrical distribution, vaginal opening contracture, severe dysuria, urine impregnated vulva thin skin, can cause erosion and tingling, sclerosing moss rarely progress to invasive cancer, However, there may be sclerosing moss around the invasive cancer.
The symptoms of pruritus in young girls are not obvious. They may feel genital or perianal discomfort after urination. The sclerosing atrophy of young girls and some adult women is mainly caused by swelling of the clitoris and adhesion to the foreskin, lack of labia minora, and white patches after the labia. The skin of the labia majora can retain a certain elasticity. Because the hyperkeratosis of the young girl's lesions is not obvious to adults, the local skin is yellowish or stained with pigmentation spots. If it is vulvar and perianal lesions, it can present a lock. Hole or white disease is damaged, and most patients' lesions may disappear on their own during puberty.
Examine
Examination of vulvar sclerosing moss
1, secretion examination.
2, biopsy pathological examination.
3, according to clinical manifestations can make a preliminary diagnosis, biopsy is the only final diagnosis. According to the patient's genital itching and typical predilection sites, clinical manifestations, local pigmentation and white patches, pathological examination of hyperkeratosis, atrophy of the spinous cell layer, dermal edema and collagen fibrosis, diagnosis is not difficult.
Diagnosis
Diagnosis and identification of vulvar sclerosing moss
diagnosis
According to the clinical manifestations, a preliminary diagnosis can be made. The biopsy is the only final diagnosis method. According to the patient, there are vulvar itching and typical predilection sites, clinical manifestations, local pigmentation and white patches, and pathological examination is hyperkeratotic. Atrophy of the spinous cell layer, dermal edema and collagen fibrosis, the diagnosis is not difficult.
Differential diagnosis
1. Sclerosing moss should be distinguished from physiological atrophy in the elderly. The latter is only found in senile women. The atrophy of the genital skin is the same as that of other parts of the body. The vulva tissue, including the skin layers and the subcutaneous fat layer, is atrophied. Therefore, the labia majora is flattened and the labia minora is degraded, but the patient has no symptoms.
2. Primary vulvar atrophy, can occur in middle-aged women, the subcutaneous fat tissue disappears at the beginning, the labia majora flattens, and then the hair falls off, the epidermis withered, dry and shiny, pale or grayish white, possible Small erythema, labia minora and clitoris also disappeared, accompanied by genital itching, burning or tingling. Although there is no typical papular lesion in the early stage of sclerosing moss, the clinical and pathological findings cannot be Patients with advanced sclerosing moss are different. Therefore, some scholars believe that the so-called primary vulvar atrophy may have been caused by vulvar sclerosing moss in the young female period. After recovery, it relapses in middle age, so the vulva shrinks, so it should still be diagnosed as vulvar sclerosing. Moss should not be diagnosed as a primary vulvar atrophy to avoid confusion.
3. Sclerosing moss should be differentiated from vitiligo and albinism. Vitiligo has no symptoms. The white area of the skin and the surrounding tissue are clearly defined. The surface is smooth and moist, the elasticity is normal, other parts of the body may be accompanied by vitiligo, no symptoms of albinism, other parts of the body. The same lesion can also be found.
