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BMJ (Clinical Research Ed.) Feb 2019
Topics: Biopsy; Dermatitis, Contact; Dermatitis, Seborrheic; Diagnosis, Differential; Emollients; Female; Genital Neoplasms, Female; Gynecological Examination; Humans; Lichen Planus; Patient Care Management; Pruritus Vulvae; Psoriasis; Sexual Health; Symptom Assessment
PubMed: 30733221
DOI: 10.1136/bmj.l83 -
Molecular and Clinical Oncology Nov 2018Invasive Paget's disease of the vulva (IP) is rare among patients with vulvar cancer. Radiation therapy and chemotherapy are not considered as radical, whereas surgical...
Invasive Paget's disease of the vulva (IP) is rare among patients with vulvar cancer. Radiation therapy and chemotherapy are not considered as radical, whereas surgical resection of the tumor with abdominal lymphadenectomy is highly invasive. Thus, more effective and less invasive treatments for IP are required. The present study reports a case of a 64-year-old woman with IP, who was treated with a combination of surgery and concurrent chemoradiotherapy (CCRT). The patient was diagnosed with IP with suspected lymph node metastases to the inguinal and pelvic lymph nodes, after having suffered from pruritus vulvae for 7 years. Following mapping biopsy, wide local excision, bilateral inguinal lymph node resection and laparoscopic pelvic lymphadenectomy were successfully performed. The vulva was reconstructed with a local fat flap. Postoperative pathological examination revealed metastases to the bilateral superficial inguinal and the left obturator and lateral suprainguinal lymph nodes. Adjuvant CCRT (whole pelvic irradiation, 50.4 Gy with weekly cisplatin, 40 mg/m) was completed without notable complications. Therefore, laparoscopic pelvic lymphadenectomy may be useful in determining the irradiation field for adjuvant CCRT in patients with advanced IP.
PubMed: 30402231
DOI: 10.3892/mco.2018.1719 -
Dermatologic Clinics Jul 2018Vulvar pruritus is a common complaint among young girls and women presenting to primary care physicians, gynecologists, and dermatologists. Female genital itch is... (Review)
Review
Vulvar pruritus is a common complaint among young girls and women presenting to primary care physicians, gynecologists, and dermatologists. Female genital itch is especially disruptive because of its interference with sexual function and intimacy. Causes of vulvar itch are vast and may be inflammatory, environmental, neoplastic, or infectious, often with several causes coexisting simultaneously. Diagnosis may be difficult because of the unique anatomy and inherent properties of genital and perianal skin. Treatment is aimed at eliminating outside irritants, restoring epidermal barrier function, and suppressing inflammation.
Topics: Dermatitis, Atopic; Dermatitis, Contact; Female; Humans; Lichen Planus; Neurodermatitis; Photochemotherapy; Postmenopause; Pruritus Vulvae; Psoriasis; Vulvar Lichen Sclerosus; Vulvar Neoplasms; Vulvitis
PubMed: 29929595
DOI: 10.1016/j.det.2018.02.006 -
Taiwanese Journal of Obstetrics &... Feb 2018
Topics: Child; Female; Foreign Bodies; Humans; Magnetic Resonance Imaging; Pruritus Vulvae; Tissue Adhesions; Vagina; Vaginal Discharge
PubMed: 29458893
DOI: 10.1016/j.tjog.2017.12.030 -
Menopause (New York, N.Y.) Feb 2018Vulvovaginal atrophy (VVA) is characterized by vaginal changes, dyspareunia, and itching/irritation. Efficacy and safety of a lower-dose estradiol vaginal cream (0.003%)... (Randomized Controlled Trial)
Randomized Controlled Trial
A randomized, multicenter, double-blind study to evaluate the safety and efficacy of estradiol vaginal cream 0.003% in postmenopausal women with dyspareunia as the most bothersome symptom.
OBJECTIVE
Vulvovaginal atrophy (VVA) is characterized by vaginal changes, dyspareunia, and itching/irritation. Efficacy and safety of a lower-dose estradiol vaginal cream (0.003%) were evaluated in postmenopausal women with VVA-related dyspareunia.
METHODS
This was a phase 3, randomized, double-blind, placebo-controlled study. Sexually active postmenopausal women with moderate-severe dyspareunia as the most bothersome symptom, ≤5% vaginal superficial cells, and vaginal pH >5.0 were randomized (1:1) to 0.003% estradiol vaginal cream (15 μg estradiol; 0.5 g cream) or placebo (0.5 g cream) applied daily for 2 weeks followed by three applications/week for 10 weeks. Coprimary outcomes were changes in dyspareunia severity, vaginal cytology, and vaginal pH from baseline to final assessment. Additional efficacy outcomes and safety were assessed.
RESULTS
A total of 550 participants (average age, 58 y) were randomized. Compared with placebo, estradiol reduced dyspareunia severity (mean change from baseline ± SD: -1.5 ± 1.0 estradiol vs -1.2 ± 0.9 placebo), decreased vaginal pH (-1.36 ± 0.89 vs -0.53 ± 0.92), and improved vaginal cytology (percentage superficial and parabasal cells 10.1 ± 16.7 vs 1.4 ± 6.1 and -48.5 ± 45.1 vs -14.6 ± 39.6; P < 0.001, all) at the final assessment. In addition, estradiol decreased dyspareunia severity at weeks 8 and 12, vaginal/vulvar irritation/itching at weeks 4 and 12, and dryness at week 12 versus placebo (P < 0.01, all). VVA severity, pH, and cytology improved at week 12 with estradiol versus placebo (P < 0.001, all). Vulvovaginal mycotic infections were more frequent with estradiol. One serious event leading to discontinuation occurred with estradiol. No deaths occurred.
CONCLUSIONS
Lower-dose estradiol vaginal cream (0.003%) dosed three applications/week is an effective and well-tolerated treatment for VVA-related dyspareunia.
Topics: Administration, Topical; Aged; Atrophy; Candidiasis, Vulvovaginal; Double-Blind Method; Dyspareunia; Estradiol; Estrogens; Female; Humans; Hydrogen-Ion Concentration; Middle Aged; Postmenopause; Pruritus Vulvae; Severity of Illness Index; Vagina; Vaginal Creams, Foams, and Jellies; Vulva
PubMed: 28926514
DOI: 10.1097/GME.0000000000000985 -
Indian Journal of Sexually Transmitted... 2017According to the World Health Organization criteria, geriatric population is people above 60 years of age. In this phase of life, a woman has already gone through...
BACKGROUND
According to the World Health Organization criteria, geriatric population is people above 60 years of age. In this phase of life, a woman has already gone through menopause and its associated emotional, physical, and hormonal changes. These changes are due to gradual loss of estrogen that comes with menopause which results in dramatic changes in the appearance of vulva and vagina. With age, skin of vulva becomes thin, loses elasticity, and moisture so that the patient starts feeling burning and itchy sensation. The normal acidic pH changes to basic which alters the flora and makes the person prone to other bacterial infections. Apart from infections, there are many other dermatological and nondermatological causes of vulvar itching in this age group such as eczema, contact dermatitis, lichen planus (LP), lichen sclerosus atrophicans, lichen simplex chronicus (LSC), prolapse, incontinence, and carcinoma. The aim is to diagnose the causes of pruritus vulvae in the geriatric age group to decrease the misery of these patients.
METHODS
We selected 40 consecutive females of age group ranging from 60 to 75 years coming to skin OPD with the complaint of pruritus of vulvar region over a period of 1 year. Clinical examination, complete blood count, fasting blood sugar, wet mount, pap smear, and skin biopsy were done in every case.
RESULTS
Out of the forty patients who were included in this study, 17 (42.5%) were diagnosed as a case of LSC and 11 (27.5%) patients had atrophic vaginitis. Three (7.5%) patients presented with tinea. Three (7.5%) cases were clinically diagnosed as scabies. Another 2 (5%) cases were diagnosed as LP and was seen in other 2 (5%) cases. 1 (2.5%) case was diagnosed as bacillary vaginosis and 1 (2.5%) patient was of lichen sclerosus.
CONCLUSION
Pruritus vulvae of geriatric age group are of diverse etiology, therefore, treatment based on precise diagnosis is of prime importance.
PubMed: 28442799
DOI: 10.4103/0253-7184.192632 -
Pediatric Dermatology Sep 2016
Topics: Adolescent; Anal Canal; Biopsy, Needle; Combined Modality Therapy; Crohn Disease; Diagnosis, Differential; Edema; Female; Follow-Up Studies; Humans; Immunohistochemistry; Proctoscopy; Pruritus Vulvae; Rare Diseases; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome; Vulvar Diseases
PubMed: 27595873
DOI: 10.1111/pde.12921 -
Current Problems in Dermatology 2016Itch management can be particularly complicated in some small areas like the scalp or the anogenital region for many reasons: the frequently poor diagnosis of the causes... (Review)
Review
Itch management can be particularly complicated in some small areas like the scalp or the anogenital region for many reasons: the frequently poor diagnosis of the causes of itch in these areas, the dense innervation of these areas, and the symbolic value of these areas for the human psyche. The diagnosis of itchy scalp is easier than that of anogenital pruritus. Clinical examination and a careful inventory of all diseases of the patient and of the local environment are necessary. Localized treatments are frequently used at both sites, whereas specific pharmaceutical formulations are necessary for the pilose or the mucous environment. Nonetheless, systemic treatments or psychological interventions can be very useful.
Topics: Antifungal Agents; Candidiasis; Carcinoma in Situ; Dermatitis, Seborrheic; Female; Genital Diseases, Male; Hemorrhoids; Humans; Keratolytic Agents; Lichenoid Eruptions; Male; Polidocanol; Polyethylene Glycols; Pruritus; Pruritus Ani; Pruritus Vulvae; Psoriasis; Scabies; Scalp Dermatoses
PubMed: 27578079
DOI: 10.1159/000446051 -
Journal of Clinical and Diagnostic... Apr 2016Anogenital pruritus is defined as intense itching, acute or chronic, affecting the anal, perianal, perineal and genital skin, which is a dominant problem in the course... (Review)
Review
Anogenital pruritus is defined as intense itching, acute or chronic, affecting the anal, perianal, perineal and genital skin, which is a dominant problem in the course of various cutaneous and systemic conditions. It is one of the common, extremely annoying symptom for which patients attend the Dermatology Outpatient Department (OPD). Anogenital skin is highly sensitive to soaps, perfumes, clothing and superficial trauma and it is more prone for itchy dermatoses as a result of warmth, friction, lack of aeration, sweating and occlusive inner garments. Anogenital pruritus is associated with a wide spectrum of diseases which includes localized infections, infestations, inflammatory dermatoses, allergic and irritant conditions, anorectal diseases, systemic causes, nutritional disorders, psychological and when the cause cannot be found out it is often termed idiopathic. Patients are highly reluctant in consulting the physician for anogenital itch in the early stage, they usually present at a later stage with either atypical manifestations or depigmentation and lichenification, secondary to constant scratching. They often resort to over the counter topical agents, particularly combination products which contain topical steroids. The irrational use of such products results in complications like skin atrophy, striae, incognito etc. A proper clinical history, clinical examination, investigations like scrapping for fungus and itch mite, skin biopsy, patch test and relevant blood investigations to rule out systemic conditions should be carried out, when needed, to arrive at an accurate diagnosis, before treating the patient.
PubMed: 27190932
DOI: 10.7860/JCDR/2016/18440.7703 -
Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?Contact Dermatitis May 2016Topical remedies based on botanical ingredients are popular. (Observational Study)
Observational Study
BACKGROUND
Topical remedies based on botanical ingredients are popular.
OBJECTIVES
To assess: (i) the usage of botanical substances in subjects affected with itching and chronic vulvar complaints; (ii) the incidence of side-effects associated with their use and the frequency of contact allergy; (iii) the diagnostic usefulness of patch testing.
METHODS
Sixty-six patients were provided with a questionnaire to assess the prevalence and type of topical botanical preparations used and the occurrence of adverse reactions. Patients were patch tested with (i) the Italian baseline series, (ii) a topical medicament series, and (iii) a botanical series.
RESULTS
Forty-two patients (63.6%) reported the use of natural topical products on the vulva. Seven (16.7%) noted adverse reactions; 27 showed positive reactions with the baseline series; 14 (21.2%) had at least one relevant reaction, mainly to allergens in topical products and cosmetics; and 2 (3%) showed positive reactions to the botanical series. Of the 7 patients complaining of adverse effects of botanical products, 3 (42.8%) showed relevant sensitization.
CONCLUSIONS
The use of natural topical products is widespread among women affected with itching vulvar diseases. Contact dermatitis is a possible adverse effect. Botanical series are of questionable usefulness, owing to the wide variety of botanical ingredients.
Topics: Adult; Aged; Allergens; Cosmetics; Dermatitis, Allergic Contact; Female; Humans; Italy; Lichen Planus; Middle Aged; Neurodermatitis; Patch Tests; Phytotherapy; Plant Preparations; Pruritus Vulvae; Psoriasis; Surveys and Questionnaires; Vulvar Diseases; Vulvar Lichen Sclerosus; Vulvitis
PubMed: 26928795
DOI: 10.1111/cod.12559