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Vulvar Ulceration
Vulval Ulcer

Presentation

The 7 women all presented with 1 or more painful, punched-out vulvar ulcers. [ncbi.nlm.nih.gov]

The cause is mostly infectious, but it may otherwise be a presentation of a wide variety of pathologies, such as autoimmune (eg, Behçet’s disease), cancer or inflammatory processes. The Lipschütz ulcer is a non-sexually transmitted condition. [casereports.bmj.com]

Entire Body System

  • Asymptomatic

    Basal Cell Carcinoma Basal cell carcinomas usually are asymptomatic until they are large enough to be noticed by the patient or until ulceration and bleeding develop. [glowm.com]

    These include: A lump or ulceration on the vulva Itching or irritation Bleeding or discharge Vaginal cancers are more commonly asymptomatic, and are found on routine gynecologic examinations or may result in an abnormal Pap smear. [cedars-sinai.edu]

    […] lesions (see “Differential diagnosis” below) References: [1] [2] Classification Squamous cell carcinoma ( > 80% of cases) Basal cell carcinoma Melanoma Adenocarcinoma ( Paget's disease of the vulva ) References: [2] Clinical features May initially be asymptomatic [amboss.com]

    The main complaint is burning, but some patients are asymptomatic or have mild pruritus. [emedicine.medscape.com]

  • Constitutional Symptom

    symptoms may occur in herpes simplex, secondary syphilis, LGV, or systemic lupus erythematosus. [dermnetnz.org]

    symptoms and regional lymphadenopathy. 3 Figure 1. [aafp.org]

    […] a number of factors, such as geographical area where sexual intercourse has taken place; socioeconomic factors; gender of sexual partners; number of partners; HIV status and local prevalence; drug use; commercial sex; and circumcision.Footnote 4 GUD constitutes [canada.ca]

Musculoskeletal

  • Fracture

    The cancer can also spread to bones causing bone pain and easy fractures. Symptoms of Vulvar intraepithelial neoplasia (VIN) Vulvar intraepithelial neoplasia (VIN) is the precancerous condition that in 80% cases may lead to vulvar cancer. [news-medical.net]

Skin

  • Skin Disease

    Psoriasis is a common skin disease of immunologic origin. The skin is classically red and thick, with heavy white scale produced by rapid turnover of epithelium. [mdedge.com]

    On DermNet NZ Genital skin problems Aphthous ulceration Vulval cancer Other websites Vulvovaginal Disorders : an algorithm for basic adult diagnosis and treatment — ISSVD Books about skin diseases See the DermNet NZ bookstore . [dermnetnz.org]

    […] of the skin. [emedicine.medscape.com]

Psychiatrical

  • Fear

    It is not unusual for a woman to avoid use of topical estrogen out of fear, or to use insufficient amounts only on the vulva, or to use it for only 1 or 2 weeks. 1 Women should be scheduled for a return visit to ensure they have been using the estrogen [mdedge.com]

Urogenital

  • Vulvar Pain

    Chronic pain of the vulva Conditions include: vulvodynia – this is vulvar pain of at least three months’ duration without an obvious cause found. It is not an inflammation or infection vestibular pain is now called vestibulodynia. [betterhealth.vic.gov.au]

    All 3 presented with extensive, painful, and destructive vulvar ulcers. [ncbi.nlm.nih.gov]

    The child developed a sore throat and low-grade fever 3 days earlier, with vulvar pain and vulvar dysuria the next day. [mdedge.com]

Workup

Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. [ncbi.nlm.nih.gov]

Results of a full workup for STIs were negative, including negative immunoglobulin G and M results for herpes simplex virus (HSV). The wound culture results were normal. Test results for Epstein-Barr virus (EBV) were negative. [consultant360.com]

Differential Diagnosis and Workup Workup and procedures If the diagnosis is not readily apparent, unaided (ie, naked-eye) or colposcopic examination of the vulva may define areas of abnormality that may warrant biopsy using a Keyes punch or biopsy forceps [emedicine.medscape.com]

Microbiology

  • Chlamydia

    Lymphogranuloma venereum (LGV) Swab from ulcer NAAT (chlamydia) Chancroid If chancroid suspected, seek specialist advice. [sti.guidelines.org.au]

    Less frequent infectious causes include chancroid ( Haemophilus ducreyi ), lymphogranuloma venereum ( Chlamydia trachomatis, serovars L1-3 ), and granuloma inguinale (Calymmatobacterium granulomatis). [mdmag.com]

    […] following Serology: Herpes simplex (HSV-1/HSV-2) EBV (IgM and IgG) and/ or monotest CMV and Mycoplasma CRP and ESR FBE ANA and Consider HLA-B51 if Behçet's disease is a possibility Sexually active: All of the above plus: Urine: Pregnancy test PCR for Chlamydia [rch.org.au]

    Regional Lymphadenopathy and other tests negative Syphilis Testing Chancre testing with dark field microscopy or direct fluorescent Antibody VDRL or RPR with reflex to confirmatory testing Lymphogranuloma venereum Test Genital swab or bubo aspirate for Chlamydia [fpnotebook.com]

    Since co-infections are common and many STIs are asymptomatic, patients with recent unprotected sexual contact should also be tested for non-ulcerative STIs via: Urine PCR for chlamydia and gonorrhoea Bloods for HIV, and hepatitis B and C serology. [dermnetnz.org]

  • Chlamydia Trachomatis

    Less frequent infectious causes include chancroid ( Haemophilus ducreyi ), lymphogranuloma venereum ( Chlamydia trachomatis, serovars L1-3 ), and granuloma inguinale (Calymmatobacterium granulomatis). [mdmag.com]

    trachomatis types L1, L2, L3 (culture, PCR, direct immunofluorescence) Other testing ( Sexually Transmitted Disease s that do not cause Genital Ulcers) Offer testing for other Sexually Transmitted Disease despite not being causes for Genital Ulcers HIV [fpnotebook.com]

    trachomatis, L1 - L3 serotypes, treated with tetracycline Initially small ulcer at contact site, then inguinal adenopathy with stellate abscesses surrounded by epithelioid histiocytes, then scarring, fistulas and strictures of urethra, vagina, rectum [pathologyoutlines.com]

    trachomatis serotypes L1 and L2 Granuloma inguinale (donovanosis) — caused by Klebsiella granulomatis. [dermnetnz.org]

  • Staphylococcus Aureus

    Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005; 352(14): 1445- 1453. ‏ الصفحة 104 - Prevention. 1 998 guidelines for treatment of sexually transmitted diseases. [books.google.com]

    Pending laboratory test results, the patient initially was treated with oral trimethoprim-sulfamethoxazole presumptively for possible methicillin-resistant Staphylococcus aureus infection. [consultant360.com]

Colonoscopy

  • Polyps

    Acrochordon Fibroepithelial polyps are common in the vulvar epithelium. They are referred to as skin tags. There is no malignant potential for this lesion. They are soft, flesh-colored, polypoid structures. [glowm.com]

    Acrochordon If the polyp is causing symptoms, it can be easily removed. [emedicine.medscape.com]

Treatment

الصفحة 34 - A proposed glossary of terminology related to the surgical treatment of vulvar carcinoma. Cancer 83: 13691375, 1998. ‏ [books.google.com]

Ginsburg PM, Dassopoulos T, Ehrenpreis ED: Thalidomide treatment for refractory Crohn’s disease: A review of the history, pharmacological mechanisms and clinical literature. Ann Med 2001;33:516–525. [karger.com]

She was admitted for study and treatment, starting empiric treatment with doxycycline, acyclovir and analgesia (local and intravenous). [casereports.bmj.com]

After Treatment Get information about life as a cancer survivor, next steps, and what you can do to help. [cancer.org]

Prognosis

(Outcomes/Resolutions) The prognosis of Keratoacanthoma of Vulva is excellent after complete excision of the tumor The prognosis may be dependent upon the underlying condition and health status of the individual Despite treatment, these tumors can occasionally [dovemed.com]

Vulvar cancer is usually associated with a poor prognosis. [amboss.com]

The prognosis for women with idiopathic (primary) complex aphthosis involving the vulva is unclear. [plasticsurgerykey.com]

Each of the treatments may be used alone or in combination, depending on the stage of the lesion. 1, 3 The prognosis is determined by the size of the lesion, lymph node involvement, and presence or absence of distant metastasis. [aafp.org]

Etiology

By considering other etiologies, the patient will be spared potentially embarrassing persistent questioning about her sexual history. [ncbi.nlm.nih.gov]

Vaginal cancer is closely related to vulvar cancer in terms of etiology and histology, but it occurs inside the vagina (typically the posterior third of the vaginal wall), rather than the vulva. [amboss.com]

Epidemiology

Genital Ulcer Disease Management Herpes Simplex Management • Treat for syphilis, and, depending upon local epidemiology, either chancroid, granuloma inguinale or lymphogranuloma venereum • Aspirate any fluctuant glands (surgical incision should be avoided [apps.who.int]

This report defines the prevalence of genital colonization in a large population of women, characterizes the women with S. aureus, and describes epidemiologic features of genital carriage. ‎ Pagina 50 - Lautenschlager S, Eichmann A. [books.google.it]

[…] architecture Lichen simplex chronicus : squamous cell hyperplasia Other dermatoses, e.g., genital lichen planus ( hypertrophied skin with purple lesions) Etiology : unclear (hormonal, immunological, and/or infectious factors are believed to play a role) Epidemiology [amboss.com]

[…] arising from the epithelial components of the vulva Since most of the common malignancies affecting the vulva are discussed separately, this section will focus on General aspects of vulvar carcinomas Rare, unusual type of carcinomas that affect the vulva Epidemiology [pathologyoutlines.com]

Epidemiology [ edit ] The disorder typically appears among young girls and adolescents but cases in children as young as 17 months have been reported. [7] History [ edit ] The disease was first described in October 1912 by Galician -born Austrian dermatologist [en.wikipedia.org]

Pathophysiology

The pathophysiologic features involve blockage of the gland duct, with continued secretion or infection of the gland itself. Without a route of egress, the glandular location swells and enlarges (Fig. 17). [glowm.com]

Etiology and Pathophysiology Nonneoplastic epithelial disorders are discussed below. [emedicine.medscape.com]

Prevention

الصفحة 104 - A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. ‏ الصفحة 104 - Lafferty WE, Downey L, Celum C, Wald A. Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. [books.google.com]

C 15, 16 Prevention Avoiding sexual intercourse during outbreaks does not prevent transmission of HSV infection. [aafp.org]

Causes, Risk Factors, and Prevention Learn about the risk factors for vulvar cancer and what you might be able to do to help lower your risk. Early Detection, Diagnosis, and Staging Know the signs and symptoms of vulvar cancer. [cancer.org]

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