Such a pathology as vulvar kraurosis is, in essence, a progressive skin atrophy of the mucous membrane caused by involutional changes in the female external genital organs. In addition to atrophic processes, the disease is expressed in increasing dystrophy and sclerotic defects of the reproductive system, which are often associated with leukoplakia. Often kraurosis of the vulva (the photo can be seen in many specialized medical literature sources) is accompanied by psychoemotional and neurovegetative disorders.
The disease mainly develops in patients during menopause as well as postmenopausal periods, in connection with which the pathology is well correlated with a decrease in the production of estrogen hormones. However, in some cases, the disease can be diagnosed even in women of reproductive age and young girls. Signs of the disease are not just unpleasant, because vulvar kraurosis is a precancerous condition that requires mandatory therapy.
Anatomical features
The vulva is the concept of medical terminology that defines the area of the female external genital organs. On the upper side it is limited by the pubis, on the lower side - the entrance to the vagina, and also in virgins - the hymen. The external genitalia of a woman include the labia minora and labia minora, the vaginal vestibule and the bartholin glands, the urethral outlet (urethral opening outside) and the clitoris.
The vulva is covered with mucous membrane and skin, in which there are a lot of blood vessels, glands and nerve receptors. The vulvar tissue is so delicate that it can easily be injured and prone to inflammation. The immune and hormonal systems are responsible for their condition. Estrogens help maintain the tone of the mucous membrane and skin of the vulva, elasticity, normal blood supply, as well as the ability to deal with negative factors. However, at premenopausal age, with hormonal changes and transformations in the functioning of the pituitary - hypothalamus - ovary system, the production of estrogen decreases, which is not able to affect the state of the tissues of the penis. Functional and structural disorders, thinning (atrophy), slight trauma, dryness, predisposition to various inflammations occur in them.
Description
Vulvar kraurosis (in other words, sclerosing lichen) is a disease related to dystrophic lesions of the external genital organs, which is characterized by atrophy of the mucous membranes and skin due to their involution. It takes a long time and progresses all the time, manifests itself in the form of dry mucous membranes and skin, as well as itching. As already noted, a similar pathology is especially common in older women (during menopause).
Causes of vulvar kraurosis
The exact causes that lead to the development of the disease are still unknown. At the moment, there are a certain number of theories, while none of them fully explains the development mechanism and etiology of sclerotic lichen. Autoimmune and neuroendocrine defects, psychogenic factors, as well as infectious and viral agents are of particular importance in the occurrence of kraurosis and leukoplakia of the vulva.
There are several risk factors in the development of such a pathology of the female external genital organs:
- diseases of the hormonal sphere (adrenal glands, ovaries, pituitary gland, thyroid gland);
- a small reproductive period (if the menopause is early, then this indicates the presence of pronounced ovarian hypofunction);
- injuries of the external genital organs or operations performed on them;
- ovariectomy in adulthood and young age;
- chemical genital burns (for example, after douching with a highly concentrated solution of potassium permanganate);
- autoimmune diseases and reduced immunity;
- obesity;
- persistent vulvovaginitis and vulvitis;
- factors of a psychogenic nature (persistent depression and stress, obsessive fears);
- neglect of intimate hygiene standards;
- herpes or papilloma virus;
- emotional lability;
- permanent overheating.
Features of the development of the disease are also not well understood. With kraurosis of the vulva, several moments stand out, successively replacing each other. Initially, pathology is noted by defects in microcirculation and blood supply in tissues, swelling of the mucous membranes and skin, leading to hypoxia. After this, atrophic disorders of the collagen structure develop, and the elastic fibers disintegrate due to increased elastase activity. In addition, nerve endings are destroyed. The structure of the connective tissue is also violated, leading to blockage of the arterioles and an even more intensified violation of the blood supply in the external genital organs.
Symptoms of Kraurosis of the vulva
With a disease, the symptomatology directly depends on the duration and degree of its prevalence, the severity of the process, as well as the availability of treatment before that. A pathognomonic sign of kraurosis is a recurring or persistent itching in the vulva. This symptom can be combined with a feeling of tightening or burning of the skin, as well as a feeling of dry genital organs after washing with too hard soap. Usually, the onset and intensification of pruritus is characteristic of night time, as well as after hygiene procedures and emotional experiences. Due to the thinning of the mucous membrane and skin, they are easily injured, ulcers and cracks appear in these places, supplementing the itching with pain. Narrowing of the vaginal vestibule and atrophy of the labia negatively affect sexual intercourse, make them painful or, in principle, impossible.
According to reviews, vulvar kraurosis is a rather unpleasant pathology. Due to the narrowing of the urethral opening, problems with urination appear, the patient experiences pain. In addition to local manifestations, patients with sclerosing lichen have pronounced defects in the nervous system: emotional lability, depression, sleep problems, irritability, aggressiveness, vascular disorders (arterial hypertension), problems in the metabolism of fats and carbohydrates (obesity). The disease has a vivid clinical picture, and only two percent of patients have no complaints.
The disease has three stages, which are easily determined during a gynecological examination.
- First stage. At this stage, redness and swelling of the external genital organs appears. If you look at the labia, you can see severe swelling and hyperemia, reminiscent of simple inflammation. Patients at this stage complain of a feeling of goosebumps, tingling, slight or moderate itching.
- Atrophic stage of kraurosis of the vulva in women. During the examination, it is very easy to determine the kraurotic triangle, in which the apex goes to the pubis, while the base is located in the upper third of the labia. The labia minora become thinner, become flat, the size of the clitoris decreases. The color of the soft tissues of the external genitalia also changes, acquiring a whitish hue (waxy or pale blue). The hairy area does not suffer, but narrowing of the vaginal opening may be observed.
- Sclerotic stage. During this stage, the labia minora and the clitoris “disappear”, that is, atrophy, they are practically invisible, while the labia majora become flat and resemble rollers, while limiting the suddenly narrowed vaginal opening. In addition, the opening of the urethra is pretty much reduced. The scalp disappears. Mucous membranes and skin get a pearlescent shade, become glossy. At the same time, many small folds appear on the tissues of the external genitalia, while they resemble a sheet of crumpled parchment. In addition, there are numerous small hemorrhages, combs, and microcracks on the mucous membranes and skin. The process is more and more progressing and at the same time it captures the inguinal folds, the perinatal area and the internal femoral surfaces. At this stage, the itching is unbearable to such an extent that a woman is unable to resist the constant combing of the inflamed surface, due to which microtraumas form again and suppurate.
Diagnosis of the disease
Vulvar kraurosis (ICD code N90.3) at the stage of sclerosis and atrophy is not easy to confuse with any other pathology. However, at the initial stage, the disease should be distinguished from neurodermatitis, vitiligo, lichen planus, vulvovaginitis and diabetes mellitus. Diagnosing sclerosing lichen of the external genitalia is quite easy already during the initial examination of the patient. However, obtaining an anamnesis is unlikely to help make a diagnosis, since characteristic data are not available.
The patient's complaints and information after a gynecological examination are also taken into account. Instrumental research methods are simple, as well as advanced vulvoscopy, that is, examination by means of a colposcope not only of the vaginal walls and uterine neck, but also of the soft tissues of the external genital organs.
Laboratory tests include a blood sugar test to rule out diabetes, and a polymerase chain reaction for HPV carried out with vulvar tissue cells to determine the presence or absence of HPV. In addition, cytology of fingerprints from genital tissues is also performed.
In especially dangerous cases, a histological analysis of the site of the mucosa or skin of the vulva is also performed to exclude the malignant process. It is better to take the material aiming, that is, under vulvoscopy. In addition, you need to examine the details of the immunogram to exclude immunological defects.
How is vulvar kraurosis treated?
Treatment
Treatment is a rather difficult task, since the causes and features of the development of this pathology have not been studied so far. Patients are most often not subject to hospitalization, it is provided only with surgical intervention.
Conservative therapeutic methods are now preferred. Of course, first of all, a change in the usual way of life is required:
- synthetic linen is completely excluded, especially facilitating;
- giving up bad habits (alcohol abuse and smoking);
- compliance with intimate hygiene standards (you need to wash yourself twice a day using a mild soap);
- the use of cotton swabs and pads, as well as toilet paper with fragrances, is not permitted;
- do not use intimate sprays and deodorants, bath foams and shower gels;
- proper nutrition - a healthy lifestyle plays a significant role in the treatment of vulvar kraurosis.
Power Features
With sclerotic lichen of the external genitalia, there is no special diet. You only need to adhere to a healthy diet. First you need to abandon black tea and coffee, because they contain a high degree of caffeine, which has an exciting effect on the psycho-emotional unstable background. In addition, it is necessary to exclude smoked meats, pickles, seasonings and spicy foods, as these products will only aggravate the itching in the vulva. The diet should contain as many vegetable oils as possible as sources of vitamins of groups A and E - natural antioxidants that have a beneficial effect on the condition of the skin and increase its tone and elasticity. It is also necessary to refuse fried and fatty foods, fast food and semi-finished foods, as they contain a lot of preservatives, carcinogens and stabilizers, and this leads to the appearance of malignant neoplasms. Fresh fruits and vegetables should prevail in the diet. In particular, green vegetables and smoothies made from them will benefit. Overweight patients should limit their intake of foods with a lot of calories - simple carbohydrates (carbonated sugary drinks, confectionery, pastries).
How else is vulvar kraurosis treated? Photos of therapies are also found in the medical literature.
Non-drug therapy
Women with kraurosis often benefit from non-drug treatment, which consists in the appointment of physiotherapy. The following methods are applied:
- laser therapy - exposure to an inflamed area with a laser beam for up to five minutes at a number of points, one course - from 12 to 16 procedures (it eliminates itching, establishes a psycho-emotional state and sleep);
- ultrasound;
- acupuncture;
- glucocorticoids and phonophoresis;
- UFO of the lumbar region and sacrum;
- ozone therapy;
- balneological procedures (baths, showers and irrigation using mineral waters, mud treatment);
- photodynamic therapy;
- mistletoe (injected with white mistletoe, stimulating the immune system);
- X-ray therapy.
It is good that among female diseases, vulvar kraurosis is not too common.
Photodynamic treatment
An innovative method is the photodynamic therapy of kraurosis, which consists in introducing the patient with photosensitizers (photogem, photoditazine, photosens, etc.) into the body intravenously, after which the inflamed areas of the external genital organs are irradiated with a low-intensity laser beam. Due to the photochemical reaction that occurs after this, the photosensitizer is activated, after which active radicals and oxygen are released that act on atypical cells, as a result of which necrosis occurs, and healthy cells become intact. The patient is preliminarily assigned such examination methods as:
- colposcopy;
- general blood analysis;
- cytological imprint-smear from the vulva;
- biochemical blood analysis.
Phototherapy has many advantages; its effectiveness in the treatment of kraurosis ranges from 90 to 95%. Its advantages are as follows:
- perfect security;
- the method is painless;
- healing is fast;
- no scars remain;
- hospitalization is not required;
- just one session is enough;
- excellent cosmetic effect;
- complications and adverse reactions are absent;
- effect exclusively on atypical cells;
- short postoperative period and fairly quick recovery of ability to work.
What ointments are effective for vulvar kraurosis?
Drug treatment
Physiotherapy is far from the only method. With kraurosis, medication is also used. Drug treatment for this disease is carried out not only locally, but also systemically. For treatment, topically applied creams and ointments, which include hormones. The vulva area is smeared with creams once or twice a day. How to treat vulvar kraurosis is of interest to women who have undergone this disease. Means for local therapy are as follows:
- cream containing estrogens (Permarin, Estriol) - it is applied twice a day, the duration of the course is 2-3 weeks (endometrial growth is not stimulated, but not shown to patients of reproductive age);
- progesterone cream (Krainon, Prajisan) - also applied twice a day for 3-4 weeks, is optimal for the treatment of young patients;
- ointment containing 2% testosterone - has a bright antipruritic effect, enhances the elasticity of the tissues of the external genital organs, is applied twice a day, the duration of the course is from two to three weeks;
- glucocorticoid ointments, which reduce the sensitivity of skin receptors to histamine, reduce itching, exudation, vascular permeability, tone the vessels, have an anti-inflammatory effect, produce an immunosuppressive local effect (butesonide 0.5%, prednisolone ointment 0.5%, hydrocortisone ointment %).
In addition to hormonal ointments, ointments containing diphenhydramine and vitamin A are also used, and with the appearance of cracks and infection, antibacterial ointments are used.
In systemic treatment, antiallergenic, sedatives and tranquilizers, hormones, biostimulants, vitamins A and E. are prescribed. If necessary, antibiotics are prescribed if inflammatory processes develop in the area of microtraumas.
Alternative therapeutic methods
In the treatment of kraurosis and leukoplakia of the vulva, folk remedies are used as additional to the main therapeutic method. Often women are prescribed warm baths, infused with calendula, string and chamomile flowers (herbs can be brewed both simultaneously and separately). You need to carry out baths at least three times a week. Also effective are compresses from protein of chicken eggs, chopped parsley with the addition of sea salt in small quantities. In addition, it is prescribed the use of a decoction of herbs such as tricolor violet, string, horsetail, strawberry leaf, nettle and blackcurrant, burdock root and yarrow. Such a decoction is taken three times a day for one hundred milliliters for three months.
Surgical methods
Now surgical intervention for vulvar kraurosis disease is carried out infrequently, since there is a high risk of recurrence of the disease and the appearance of cosmetic defects and complications. Most often, surgery is prescribed for violations of the anatomical structures (synechia of the labia minora, stenosis of the urethra or vaginal vestibule, etc.). In the absence of the expected result from conservative therapy, surgical minimally invasive procedures are performed: laser ablation; vulvar denervation; cryodestruction of inflamed areas. If there is a suspicion of a transition to a malignant process, a vulvectomy is performed.
Prevention
In the prevention of vulvar kraurosis (ICD N90.3), a number of significant conditions must be observed. However, even this does not help to recover completely.
- Personal hygiene. A patient with such a diagnosis should carefully monitor the purity of her body every day. It is necessary to wash intimate places systematically - in the mornings and evenings. The use of soap is not allowed, a decoction of calendula or chamomile is better.
- Prevention of stress. With frequent depression and nervous disorders, sedatives are recommended if you can’t cope on your own.
- Timely treatment.
- The right underwear. Synthetic tissues are excluded because they do not allow enough air to pass through and further increase itching in the inguinal region. Cotton underwear is recommended .
Reviews
Reviews treatment of kraurosis of the vulva has in large numbers, both positive and negative. If the pathology is not too neglected, then the use of ointments will be effective. In severe cases, complex treatment, physiotherapy, phototherapy is necessary. If the disease is not treated at all, then the risk of developing oncology is great.