Vulvar leukoplakia is a chronic pathology characterized by keratinization of the epithelium of the external genital organs, which is accompanied by the appearance of yellow or white plaques. This disease is often called sclerotic lichen, referring it to the category of squamous hyperplasia.
Such a pathology can be encountered at any age, but it most often occurs in women during menopause, aged 45-55 years.
Causes
Dystrophic disorders of the mucous membrane of organs that appear during leukoplakia of the vulva are considered to be a specific protective reaction of the body to the influence of various pathogenetic and etiological conditions. For example, pathology occurs due to chronic inflammation caused by neuroendocrine, immune and metabolic malfunctions.
The main risk categories include women:
- over 40 years old;
- carriers of papillomavirus infection or genital herpes;
- Forgetting the rules of personal hygiene;
- suffering from chronic genital inflammation;
- diagnosed with cervical dysplasia;
- with metabolic disorders, including obesity and diabetes;
- deficient in vitamin A in the body.
Clinical picture
Hormonal disorders, which are a prerequisite for the occurrence of vulvar leukoplakia, are usually explained by age-related changes, hypothyroidism, ovarian dysfunction, lack of estrogen, and adrenal insufficiency.
Among other things, many experts believe that at the root of the origin and development of this disease lies many different psychological and emotional failures. Among those, doctors distinguish too high demands, dissatisfaction with oneself, excessive distrustfulness to people around. In some cases, pathology also occurs in pregnant women.
But nevertheless, the conditions of increased risk include the postmenopausal and too short reproductive period.
Disease classification
Due to the diversity of the forms of the pathology and the brightness of the symptoms, several types of the disease are distinguished:
- Simple or flat vulvar leukoplakia. Its peculiarity lies in the appearance on the mucous membrane of the organs of white spots, which occur again after their removal with a tampon. With this form, there are no signs of an inflammatory process.
- Hypertrophic variety. It is characterized by the appearance of dry volume formations of a white-gray hue, which cannot be removed by oneself from the surface of the genital organs.
- The most severe form of pathology is considered to be warty leukoplakia - it is it that most often precedes oncological diseases. It is accompanied by the rapid development and spread of many foci of the pathological process, reminiscent of simple warts. The disease is characterized by numerous cracks, erosions and severe inflammation of the mucous membrane of the vulva.
According to the international classification of diseases (ICD) of vulvar leukoplakia, code N90.4 is assigned.
Symptoms of the disease
Signs of vulvar leukoplakia include proliferation and active keratinization of the squamous epithelium, due to which sclerotherapy of nearby tissues occurs in the future.
The initial stage of the pathology proceeds without any particular symptoms. Damage mainly affects the labia minora and the clitoris. The surface of the organs is covered with numerous small white spots, which, as the pathological process develops, turn into grayish convex plaques. Gradually, these characteristic formations become thicker, increasing in size and spreading, filling with themselves an increasingly large area. In the photo of the vulvar leukoplakia, you can see the changes relating to the genitals with this phenomenon.
The sclerosing process of nearby tissues is accompanied by a distinct itch and even a slight burning sensation. Such symptoms are intensified after urination, during intimacy with a partner and at night.
A typical sign of pathology is the appearance of paresthesia - a slight tingling or numbness at the site of inflammation. Damaged skin acquires folding, rigidity and a peculiar pearlescent shade. The labia majora become thicker, but the entrance to the vagina, on the contrary, narrows.
Warty leukoplakia is characterized by the spread of keratinized layers of the epithelium, ulcers, painful fissures, microbial infections and erosion. The injured mucous membrane of the vulva heals for quite some time.
Hyperemia and severe swelling join the pathological process. The pain and discomfort experienced by a woman during intercourse affect the intimate side of her life, which, in turn, contributes to the occurrence of neuropsychiatric disorders.
Diagnostics
In general, many patients learn about their disease during a routine examination on a gynecologist’s chair. The diagnosis is made on the basis of the patient's complaints, as well as the results obtained through instrumental and laboratory examination. Leukoplakia is very important to distinguish from eczema, syphilis, lichen planus, lupus, and psoriasis.
Gynecological examination makes it possible to detect the presence of white areas indicating dystrophic changes. Colposcopy is performed, during which the state of the entire organ is determined: shade, presence of hyperemia and the appearance of the surface. This diagnostic technique makes it possible to timely detect malignant tumors or other atrophic phenomena.
Another, no less effective way to detect leukoplakia is the Schiller test, in which a special Lugol solution is used, which gives the normal areas of the vulva a certain color. After the procedure, the foci of pathology become clearly visible.
In addition, a smear from the urethra is taken from the patient for examination under the microscope of microflora and detection of oncocytological phenomena. The PCR method allows to determine the presence of the papilloma virus.
A biopsy is performed to extract an anamnesis for histological examination. If signs of atypia are detected, the patient may be diagnosed with a precancerous condition. A complete specialized examination makes it possible to determine the type and stage of the pathology. In some cases, additional consultation with a psychotherapist, oncologist, dermatologist and immunologist is necessary.
How to treat vulvar leukoplakia ?
The therapy in this case is mainly aimed at stopping the symptoms, preventing the proliferation of pathology and turning plaques into a tumor. During the treatment of vulvar leukoplakia, cytological studies and colposcopy are constantly carried out - these are the examinations that allow you to evaluate intermediate changes in the general condition of the organ and the effectiveness of the chosen technique.
Therapy is carried out taking into account the age, individual characteristics of the patient and associated pathologies. The standard treatment regimen consists of several main stages:
- drug therapy;
- physiotherapy;
- refusal to use alkaline soap;
- surgical intervention;
- physiotherapy;
- hygienic manipulations with the use of herbal infusions;
- adherence to a special diet;
- the help of a psychotherapist;
- prevention of irritating factors, such as the use of tampons, wearing woolen and synthetic underwear.
Drug therapy
According to reviews, vulvar leukoplakia is very well and quickly treatable, especially when it comes to the initial stages of the disease. In this case, the role assigned to physiotherapy and everyday walking is very important. Thanks to such simple exercises, metabolism is accelerated and the psycho-emotional state is stabilized.
Drug therapy involves the use of:
- local antipruritic and anti-inflammatory drugs in the form of creams, ointments, as well as hormonal and antiseptic vaginal balls;
- vitamin complexes;
- antihistamines;
- hormonal drugs.
As for the ointments from vulvar leukoplakia, the most effective are: Sinaflan, Prednisolone, Beloderm, Celestoderm. Of the antihistamines, experts distinguish "Fenkarol" and "Loratadin." If the patient has pronounced symptoms of the disease, it is recommended to take Testosterone Propionate and Estriol.
If the pathology is accompanied by secondary infections, antibiotics can be prescribed: Synthomycin, Chlorophyllipt, and Levomekol. In addition, vitamin therapy is carried out, which is aimed at a general improvement in the condition of the vulva.
Modern treatment methodology
Today, one of the most popular means is considered the cream "Iranian saffron" from vulvar leukoplakia. Numerous studies of this tool have confirmed its high effectiveness: in just a few minutes, patients experience a rapid retreat of unpleasant symptoms: reduction of itching, increased secretion. And just after a month of using the "Iranian saffron" cream, vulvar leukoplakia, subject to all doctor's recommendations, is almost completely retreating. In this case, the external tissues of the genitals change the initial appearance, the seals dissolve, and the skin becomes softer.
Specialized procedures
In addition, modern medicine offers women with a diagnosis of leukoplakia a wide variety of physiotherapy procedures that are very highly effective. Among them, the most effective are: oxygen therapy with correction of brain rhythms and phonophoresis of drugs. These procedures have anti-inflammatory and desensitizing effects, stabilize metabolism, hormonal levels, psycho-emotional state, strengthen the protective properties of the female body.
Leukoplakia surgery
In the case of poor results of conservative treatment, modern gynecology offers the implementation of surgical excision of the foci of pathology with a special scalpel or radio knife, as well as removal by laser or cryodestruction. In severe forms of leukoplakia, the vulva is extirpated.
Predictions and prevention of pathology
The success of treatment is determined by the form of the disease itself: the outcome of simple leukoplakia is usually favorable, but the warty variety often precedes oncology. In 15-35% of all cases, cellular atypia occurs, which turns into a malignant formation.
For the prevention of pathology, a gynecologist should be systematically visited. And if necessary, be sure to timely treat current diseases.