Vulvitis and vulvovaginitis: cutaneous considerations

Article Abstract:

Itching and burning of the vulva are symptoms associated with many skin diseases; in this article, the characteristics and symptoms of vulvar skin disease are reviewed. The dermatoses (formerly called 'dystrophies') include: lichen sclerosus; other dermatoses; and squamous cell hyperplasia (formerly called nonspecific epidermal proliferation). Vesiculobullous diseases are those with blisters or ulcers. Vulvodynia is chronic vulvar discomfort due to burning, stinging, irritation, or rawness. Many patients have irritant reactions, but true allergies are rare. Common irritants are soaps, medications, and alcohol or propylene glycol (ingredients in some products). Itching causes scratching, which causes lichen simplex chronicus (a skin change). Topical steroid drugs are often prescribed to control inflammation and reduce the size of the plaques associated with the disorder, but they should be used for short periods only. The dermatoses discussed include: psoriasis of the vulva; tinea (a fungal disorder); lichen planus; and lichen sclerosus. Vesiculobullous diseases such as erythema multiforme, pemphigus, benign family pemphigus, bullous and cicatricial pemphigoid, and dermatitis herpetiformis, are also discussed. Dermatologists treating children must be able to distinguish the signs of genital abuse from cutaneous disease. In this context, lichen sclerosus (fairly common in prepubescent girls), linear IgA disease (bullous disease of childhood), and bullous impetigo are described. Some systemic diseases, such as Behcet's syndrome, lupus erythematosus, pellagra, and Reiter's disease, can cause lesions of the vulva. Cancer in this part of the body may be extramammary Paget's disease; squamous cell carcinoma in lichen sclerosus; or vulvar intraepithelial neoplasia (VIN). Vulvodynia may take the form of vestibulitis (inflammation of the area between the labia minora), papillomatosis, or diffuse disease (essential vulvodynia). Most chronic skin diseases can be treated but not cured. Effective treatment depends on careful, accurate diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Skin diseases, Vulvar diseases

---

Mycotic vulvovaginitis: a broad overview

Article Abstract:

The incidence of mycotic vulvovaginitis (vaginal inflammation caused by a yeast, a fungal microorganism) has increased dramatically in the US in recent years, primarily as a result of a growing number of infections by Candida organisms. This article reviews the classification, morphology, biochemistry, pathophysiology, mechanisms of action, and therapy associated with fungi that infect humans. Vulvovaginitis often involves organisms from the family Cryptococcaceae, which includes the genus Candida. Some members of this genus are C. albicans and C. tropicalis. Yeasts can ferment and assimilate sugars, a property is used in designing diagnostic tests. Candidal infection causes reddening of the vaginal and vulvar tissues, and patients experience itching, burning, and discharge as a result of excess alcohol produced by the altered vaginal flora. Yeasts have cell walls that resemble those of plants more than of animal cell walls; antifungal agents must interfere with biochemical processes that maintain wall integrity or function. The cell wall also contains receptors for estrogen, and the organism cannot reproduce without the presence of this hormone. C. albicans is the most prevalent species in vulvovaginitis, but the prevalence of non-albicans species has risen significantly since the 1970s. This may be a consequence of antifungal therapy. Many patients who develop non-albicans candidiasis have been treated with many drugs, or for long periods with low doses of antifungals. The drugs typically used are imidazoles and polyene macrolides, although triazoles are increasingly being prescribed; their mechanisms of action are reviewed. Some yeasts are more responsive to certain drugs than others. Fungal infections can be misdiagnosed and inappropriately treated, causing great frustration. Cultures should be grown to accurately identify the infectious agent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Candidiasis, Vulvovaginal, Vulvovaginal candidiasis

---

Vulvovaginitis: the role of patient compliance in treatment success

Article Abstract:

Vulvovaginitis (inflammation of the vulva and vagina) is the cause of a large number of visits to gynecologists. Questions can be raised concerning the high rate of recurrent infections. The role of patient compliance with therapy is evaluated in this report. A patient is more likely to comply with treatment if it meets her needs. Individual characteristics such as age, occupation, and experience with adverse effects should be considered when drugs are prescribed. Preferences for creams versus suppositories, or the advisability of a seven-day versus a shorter treatment course, should be taken into account. An ideal treatment for vulvovaginitis would be given in one dose only, act rapidly without side effects, and be safe during pregnancy. In addition, treatment should be effective over the long, as well as the short term. Psychosocial factors, such as patient denial of the problem, failure to understand basic anatomy, or the influence of a sex partner who finds the treatment inconvenient, can also reduce compliance. Cost may also be a prohibitive factor. A clear discussion of these, and related, issues with patients can aid in making decisions that are best for compliance. Sexual abstinence for patients with Candida vulvovaginitis (caused by Candida microorganisms) should be encouraged. Patients should also be encouraged to continue taking the medication during menstruation; if they do not want to, it is better to postpone treatment. Women who trust their health care team are more likely to take its advice; practitioners are advised to pay attention to their patients and treat them with respect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient compliance

Similar abstracts:

• Abstracts: Human chorionic gonadotropin and relaxin concentrations in early ectopic and normal pregnancies. Multifetal pregnancy in a gonadal dysgenesis mosaic
• Abstracts: Screening and detection of congenital malformation. Ultrasonographic diagnosis of congenital anomalies in twins
• Abstracts: Prophylactic amnioinfusion in pregnancies complicated by oligohydramnios: a prospective study. Atriopeptin in the twin transfusion syndrome
• Abstracts: Survival among patients with clinical Stage I cutaneous malignant melanoma diagnosed in Western Australia in 1975/1976 and 1980/1981
• Abstracts: Immune functions and inflammatory reactions in HLA-B27 positive subjects. Yersinia associated arthritis in SHR rats: effect of the microbial status of the host

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.