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Vulvar Dermatitis

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161. List of cutaneous conditions

of many conditions often also requires a which yields information that can be correlated with the clinical presentation and any laboratory data. Contents Acneiform eruptions [ ] See also: are caused by changes in the . (Mallorca acne) (cosmetic acne) (acute febrile ulcerative acne) (acne keloidalis, dermatitis papillaris capillitii, folliculitis keloidalis, folliculitis keloidis nuchae, nuchal keloid acne) (acne varioliformis) (acne simplex) (solid facial edema) (erythematotelangiectatic rosacea (...) , perifolliculitis capitis abscedens et suffodiens of Hoffman) (periocular dermatitis) (rosacea fulminans) (acne rosacea) (SAPHO syndrome) Autoinflammatory syndromes [ ] See also: are a group of inherited disorders characterized by bouts of and periodic . (familial cold autoinflammatory syndrome) (familial Hibernian fever, TRAPS, tumor necrosis factor receptor associated periodic syndrome) Chronic blistering [ ] See also: Chronic blistering cutaneous conditions have a prolonged course and present

2012 Wikipedia

162. Onset of vulvodynia in a woman ultimately diagnosed with Creutzfeldt-Jakob disease. (PubMed)

Onset of vulvodynia in a woman ultimately diagnosed with Creutzfeldt-Jakob disease. Vulvodynia, defined as vulvar pain or burning in the presence of normal vulvar appearance, is common and is associated with chronic pain syndromes and psychiatric disorders.A postmenopausal woman complained of vulvar burning. Causes for vulvar burning including yeast infection, estrogen deficiency, and contact dermatitis were excluded. Vulvovaginal examination was normal. Subsequently, she complained

2010 Obstetrics and Gynecology

163. I have a 25 year old lady with recurrent painful pustular rash in the vulval region since the last two years. They typically subside in 3-4days spontaneously. No aggravating/relieving factors. Possibl

is not in a position to make a diagnosis, we can only provide information on which to base a clinical decision. A 2007 UK National Guideline on the Management of Vulval Conditions (1); this guideline offers recommendations on the diagnostic tests and treatment regimes needed for the effective management of the following vulval conditions: Vulval lichen sclerosus, Vulval lichen planus, Vulval dermatitis, Vulval Intraepithelial Neoplasia (including Paget’s disease), Vulval vestibulitis, Vulvodynia (...) . As this information is extensive we recommend you read the guideline in full by following the link provided in the reference section below. An e-Medicine article on benign vulvar lesions describes conditions characterized by vulvar ulcers and provides information on the size and appearance of the ulcers. This article also contains a substantial section on differential diagnosis and workup. In 2004 a comprehensive article on vulvar ulcers and erosions (3) was published. This contains several tables that discuss

2008 TRIP Answers

164. The role of vulvar skin biopsy in the evaluation of chronic vulvar pain. (PubMed)

The role of vulvar skin biopsy in the evaluation of chronic vulvar pain. Sixty-one percent of refractory vulvodynia patients evaluated in a tertiary care vulvovaginal clinic had clinically relevant dermatoses based on dermatopathologist-analyzed vulvar biopsy including: lichen sclerosus, allergic/irritant dermatitis, lichen planus, and other inflammatory or neoplastic dermatoses. Given the frequency of dermatologic disease, vulvar biopsy and analysis by a dermatopathologist are recommended

2008 American Journal of Obstetrics and Gynecology

165. Determining the Cause of Vulvovaginal Symptoms. (PubMed)

describes both common and uncommon conditions associated with vulvovaginitis, including infectious vulvovaginitis, allergic contact dermatitis, systemic dermatoses, rare autoimmune diseases, and neuropathic vulvar pain syndromes. The focus is on the clinical presentation, specifically 1) the absence or presence and characteristics of vaginal discharge; 2) the nature of sensory symptoms (itch and/or pain, localized or generalized, provoked, intermittent, or chronic); and 3) the absence or presence

2008 Obstetrical & Gynecological Survey

166. A rare case of vulvar endometriosis in an adolescent girl. (PubMed)

A rare case of vulvar endometriosis in an adolescent girl. To describe a case of vulvar endometriosis in a teenager after a history of vulvar ulcers in the same location.Case report.University medical center.A 13-year-old girl with a history of vulvar ulcers.NoneA 13-yr-old female presented with painful, open vulvar ulcerations on the inner side of her labia minora. Biopsy revealed dermatitis with ulceration. One year later she noted an ulcer and blood in her undergarments. Biopsy results were (...) consistent with endometriosis. Five years later, the lesions persisted and bled during menses. A bilateral labial excision was performed. Pathology again revealed endometriosis.Vulvar endometriosis is extremely unusual. This rare case of vulvar endometriosis in the same location as a previous vulvar ulcer is most likely due to ectopic transplantation of endometrial cells during a menstrual cycle. Excision is considered definitive treatment.

2008 Fertility and Sterility

167. Vulvitis

. In the acute form there is a sudden onset of an erythematous swollen painful vulva and vagina with a thin mucoid discharge. The subacute form usually presents as pruritic erythematous patches and plaques in the vulval and perianal regions. [ ] Group A beta haemolytic streptococcal infection can also cause a vulvovaginitis in adult women. [ ] Dermatological conditions . The most common vulval dermatosis in both adults and children is dermatitis. The majority of these patients are atopic (...) receptor-2, which is an itch mediator. [ ] Idiopathic - uncommon, and only diagnosed when all other causes have been excluded. Vulvitis circumscripta plasmacellularis (Zoon's vulvitis). This is a is a rare, benign vulval disorder that presents with erythematous patches and erosions. [ ] Miscellaneous pain syndromes - causes chronic vulval and pelvic pain, of unknown aetiology. [ ] Vulvodynia is a complex disorder reported by up to 16% of women in the general population. [ ] Vulvar vestibulitis syndrome

2008 Mentor

168. Vulval Lumps and Ulcers

be treated simultaneously. Dermatological conditions Nappy rash Nappy rash is an irritant contact dermatitis. The skin in contact with nappies is exposed to friction and excessive hydration, has a higher pH than other skin, and is repeatedly soiled with faeces containing enzymes with high irritation potential for the skin. [ ] The combination of these factors frequently results in skin damage, leading to visible erythematous lesions that can be irritating and painful to the child. The vulva may be bright (...) by application of the barrier preparation. If there is suspicion of candidal infection, a combination of hydrocortisone and an antifungal is required. Consider oral antibiotics for secondary bacterial infection. Vulval dermatitis Dermatitis may be irritant (for example, from wetness, incontinence, vigorous cleansing) or allergic . Specific allergic reactions (eg, to perfume or rubber) may cause pruritus vulvae. Patch testing may be useful. Almost any skin disorder may also affect the vulva but a few

2008 Mentor

169. Vulval Abnormalities and their Management

be treated simultaneously. Dermatological conditions Nappy rash Nappy rash is an irritant contact dermatitis. The skin in contact with nappies is exposed to friction and excessive hydration, has a higher pH than other skin, and is repeatedly soiled with faeces containing enzymes with high irritation potential for the skin. [ ] The combination of these factors frequently results in skin damage, leading to visible erythematous lesions that can be irritating and painful to the child. The vulva may be bright (...) by application of the barrier preparation. If there is suspicion of candidal infection, a combination of hydrocortisone and an antifungal is required. Consider oral antibiotics for secondary bacterial infection. Vulval dermatitis Dermatitis may be irritant (for example, from wetness, incontinence, vigorous cleansing) or allergic . Specific allergic reactions (eg, to perfume or rubber) may cause pruritus vulvae. Patch testing may be useful. Almost any skin disorder may also affect the vulva but a few

2008 Mentor

170. Lichen Simplex Chronicus

). Alopecia mucinosa - papules and plaques, seen mainly in the young (<40 years), leading to hair loss. (of the primary localised cutaneous type) . . . . , also known as discoid eczema. (Usually more lesions, scattered up a limb). Pretibial myxoedema (usually bilateral). (more widespread than lichen simplex and bilateral). (usually bilateral). Stasis dermatitis. . Investigations Narrowing the list of potential causes may be helped by doing an IgE level and patch testing to exclude atopy and allergy (...) ; Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus. J Midwifery Womens Health. 2012 May-Jun57(3):260-75. doi: 10.1111/j.1542-2011.2012.00175.x. ; International Union against Sexually Transmitted Infections, 2016 ; Medline Plus, 2013 ; Quality Of Life of Patients with Neurodermatitis. Int J Med Sci 2013 10(5):593-598. ; Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008 Jan-Feb21(1):42-6. doi: 10.1111/j.1529

2008 Mentor

172. Is there any evidence to support the use of topical oestrogen cream in the treatment of vulval pain in young girls?

and Medline databases using the terms ‘vulval pain’ and ‘vulvodynia’ combining these terms with ‘topical oestrogen’ but found very little information relating to young girls. However, an article on vulvar disease in pre-pubertal girls discusses topical oestrogen cream in relation to fusion of the labia and states: “Fusion of the labia is a relatively common condition in young children usually of approximately 2–3 years of age… Unlike true anatomical anomalies, it is an acquired condition. The labia minora (...) or majora are agglutinated to a variable degree from the tip of the clitoris to the posterior fourchette…The vulva has an abnormal flat appearance and it is not possible to see the entire vaginal opening. There may be an underlying vulvitis. Children with fusion of the labia are usually asymptomatic, but sometimes urine can pool behind the fusion causing maceration and secondary dermatitis. Urinary tract infections are, however, rarely a complicating factor. Fusion of the labia responds to topical

2007 TRIP Answers

173. Are there any cases of bacterial vaginosis or vaginal discharge in children under 5 in the literature?

causes such as sexual abuse or foreign body.” An eMedicine article on Vulvovaginitis (7) states: “For premenarchal girls the site of involvement usually is vulvar, with secondary extension into the lower vagina. Effects of maternal hormones wane during infancy, leading to relative atrophy of the genital mucosa. Several other factors are present in prepubertal girls predisposed to vulvovaginitis. Lack of an acidic pH (typical pH being 6-7.5) Lack of the protective effects of estrogen, which leads (...) any history that suggests the presence of a foreign body. ED physicians should strongly suspect this possibility, especially in patients with persistent, recurrent, or severe cases. Diagnose and treat foreign bodies in children by direct vaginal visualization, possibly using sedation or vaginal saline irrigation. Pinworm infection with Enterobius vermicularis is common in prepubertal children. Pinworm infection may present with significant vulvar pruritus in addition to the more familiar anal

2004 TRIP Answers

174. VivaGelâ„¢ in Healthy Young Women

has a history of significant drug allergy. Subject has a history of latex allergy. Biological and hematological parameters are outside of the laboratory's normal reference ranges. Subjects with grade 1 laboratory abnormalities can be included if the Principal Investigator judges that the deviations are not clinically relevant. Subject has a clinically significant history of systemic allergic disease (e.g., clinically significant urticaria, clinically significant atopic dermatitis). Subject has (...) , hematological, genitourinary or other major disorder), or psychiatric illness (e.g., depression, schizophrenia). Subject had a clinically significant illness within 30 days prior to screening. Subject has used a vaginal preparation within 30 days prior to screening. Subject has a clinically detectable genital abnormality (i.e. vulvar, vaginal, cervical, perianal ulcer and/or deep epithelial disruption). Subject has signs, as seen on pelvic exam, consistent with an Sexually Transmitted Infection (STI), other

2006 Clinical Trials

175. Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata. (PubMed)

Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata. Human papilloma virus infections of the anogenital region are very common and cause condylomata acuminata; cervical, penile, vulvar, or perianal intraepithelial neoplasia; and more rarely, invasive cancer. The currently available therapies often result in painful, extensive, slow-healing ulcerations and frequent early relapses. This study was aimed at determining the efficacy of topical (...) occurred within four months of confirmed lesion clearance. Topical applications of cidofovir 1 percent were well tolerated. Thirty-three percent of the patients reported only mild pain caused by erosive dermatitis. In contrast, coagulations caused painful ulcerations that necessitated the use of analgesics in all patients treated this way.Topical applications of cidofovir, an antiviral compound with activity against human papilloma virus, is effective in the majority of patients with perianal

2003 Diseases of the Colon & Rectum

176. Causes of chronic vaginitis: analysis of a prospective database of affected women. (PubMed)

vulvovaginal candidiasis, vulvar vestibulitis syndrome, desquamative inflammatory vaginitis, physiologic leukorrhea, and other diagnoses were compared with one another. Chi-square tests and one-way analysis of variance with Tukey honestly significant difference (HSD) post hoc analyses were used for categorical and continuous data analysis.Two hundred patients were enrolled in this study. The most common diagnoses were contact dermatitis (21%), recurrent vulvovaginal candidiasis (20.5%), atrophic vaginitis (...) (14.5%), and vulvar vestibulitis syndrome (12.5%); 18% of women had 2 or more diagnoses. In the overall study sample, the mean age was 38.4 years, 78% were white, and 55% were college educated. Sixty-two percent had symptoms for over a year. Desquamative inflammatory vaginitis patients were older and less likely to be menstruating. Those with vulvar vestibulitis syndrome had more frequent complaints of dyspareunia. Recurrent vulvovaginal candidiasis patients felt that their symptoms had the greatest

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2006 Obstetrics and Gynecology

177. Cutaneous hypersensitivity to Candida albicans in idiopathic vulvodynia. (PubMed)

Cutaneous hypersensitivity to Candida albicans in idiopathic vulvodynia. We have observed that the majority of our vulvodynia patients give a previous history of vaginal candidiasis that was treated but was followed by symptoms of chronic vulvodynia. 27 vulvodynia patients were patch-tested to a standard series of contact allergens, a customized vulvar series and commensal organisms including ultraviolet-killed Candida albicans. Comparison tests for the commensal organism were made to a group (...) of 13 female atopic dermatitis patients and to 19 female dermatitis patients without a history of childhood flexural dermatitis who were undergoing patch test evaluation in our clinic. Patients reporting vulvodynia were significantly (P < 0.05) more likely to react to C. albicans than the dermatitis comparison group. Interestingly, lower concentrations of C. albicans caused more positive patch tests than higher concentrations. Our findings suggest that previous C. albicans infection may predispose

2005 Contact Dermatitis

178. Ineffectiveness of topical idoxuridine in dimethyl sulfoxide for therapy for genital herpes. (PubMed)

, generalized contact dermatitis, and vulvar carcinoma in situ. Thirty percent idoxuridine in dimethyl sulfoxide has no effect on clinical manifestations of genital HSV infection and may be hazardous.

1982 JAMA Controlled trial quality: uncertain

179. Incontinence in the aged: contact dermatitis and other cutaneous consequences. (PubMed)

Incontinence in the aged: contact dermatitis and other cutaneous consequences. Urinary and faecal incontinence affects a significant portion of the elderly population. The increase in the incidence of incontinence is not only dependent on age but also on the onset of concomitant ageing issues such as infection, polypharmacy, and decreased cognitive function. If incontinence is left untreated, a host of dermatological complications can occur, including incontinence dermatitis, dermatological (...) infections, intertrigo, vulvar folliculitis, and pruritus ani. The presence of chronic incontinence can produce a vicious cycle of skin damage and inflammation because of the loss of cutaneous integrity. Minimizing skin damage caused by incontinence is dependent on successful control of excess hydration, maintenance of proper pH, minimization of interaction between urine and faeces, and prevention of secondary infection. Even though incontinence is common in the aged, it is not an inevitable consequence

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2007 Contact Dermatitis

180. Contact dermatitis associated with the use of Always sanitary napkins. (PubMed)

Contact dermatitis associated with the use of Always sanitary napkins. To report a clinical association between vulvar irritation or contact dermatitis and the use of Always sanitary napkins.Case series.A gynecology practice in Montreal.Women presenting between September 1991 and September 1994 with itching or burning of areas that would be in contact with a sanitary napkin (mons pubis, external surfaces of the vulva and perineum) beginning at least 1 day after the use of the napkins (...) was started and less than 5 days after the use was stopped.Twenty-eight women experienced vulvar itching and burning, often associated with eruptions resembling contact dermatitis, of the vulvar and perineal surfaces after using Always sanitary napkins. Twenty-six reported that symptoms disappeared after they stopped using that brand of sanitary napkin. Seven women who later used the same brand again reported a recurrence of the vulvar irritation.The findings of this case series reveal Always sanitary

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1996 CMAJ: Canadian Medical Association Journal

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