Vulvar dystrophies: a modern view of the problem

Abstract

This article overviews modern literature data on vulvar dystrophies. The increase in the number of patients with dystrophic diseases of the vulva, a pronounced tendency towards rejuvenation, the complexity of diagnosis, frequent recurrence of the disease and low effectiveness of therapy make this issue extremely urgent. Until now, morphologists have not developed a single classification, and among clinicians, a specific etiopathogenetic concept of development of vulvar dystrophies has not been determined. There are many theories of the disease development. The process starts asymptomatically and is not diagnosed in a timely manner, and due to the localization in the intimate area, it is characterized by low circulation and an increase in the number of neglected cases. Only a comprehensive, timely started treatment with the right choice of drugs and methods of activating reparative processes will prevent development of the disease and reduce the duration of the main symptoms and the likelihood of relapses, exacerbations, and complications.

Keywords

vulvar dystrophy / dermatosis / overview

References

[1] Sakhautdinova IV, Popov OS, Simakova EL. Modern view on the problem of etiology, pathogenesis and therapy of degenerative diseases of the vulva. Medicinskij vestnik Bashkortostana. 2015;10(6):84−88. (In Russ.)

[2] Сахаутдинова И.В., Попов О.С., Симакова Е.Л. Современный взгляд на проблему этиологии, патогенеза и терапии дистрофических заболеваний вульвы // Медицинский вестник Башкортостана. 2015. Т. 10. № 6. С. 84−88.

[3] Porsokhonova DF, Rakhmatullaeva SN, Yakubovich AI, et al. Risk factors of distrophic diseases of vulvae: clinical-epidemiological research. Arhiv akusherstva i ginekologii im. V.F. Snegireva. 2017;4(3):154−158. (In Russ.). DOI: 10.18821/2313-8726-2017-4-3-154-158

[4] Порсохонова Д.Ф., Рахматуллаева С.Н., Якубович А.И. и др. Факторы риска дистрофических заболеваний вульвы — клинико-эпидемиологическое исследование // Архив акушерства и гинекологии им. В.Ф. Снегирева. 2017. Т. 4. № 3. С. 154−158. DOI: 10.18821/2313-8726-2017-4-3-154-158

[5] Apolikhina IA, Sokolova AV, Gumova ZD. External genitalia lichen sclerosus and main causes, clinic, diagnostics and treatment. Medicinskij opponent. 2018;(2):77−82. (In Russ.)

[6] Аполихина И.А., Соколова А.В., Гумова З.Д. Склероатрофический лишай наружных половых органов: ведущие причины, клиника, диагностика и лечение // Медицинский оппонент. 2018. № 2. С. 77−82.

[7] Porsokhonova DF, Medzhitova AM. The principal directions in treatment of degenerative diseases of vulva. Klinicheskaja dermatologija i venerologija. 2015;(5):11−15. (In Russ.)

[8] Порсохонова Д.Ф., Меджитова А.М. Основные направления в терапии дистрофических заболеваний вульвы // Клиническая дерматология и венерология. 2015. № 5. С. 11−15.

[9] Galikhanova EE, Kozlov VK, Khromova AM. Luminescence microscopy in diagnostics of urogenital candidiasis of patients with distrophic diseases of vulvae and vagine. Prakticheskaja medicina. 2011;(2(49):43−45. (In Russ.)

[10] Галиханова Э.Э., Козлов В.К., Хромова А.М. Люминесцентная микроскопия в диагностике урогенитального кандидоза у пациенток, страдающих дистрофическими заболеваниями вульвы и влагалища // Практическая медицина. 2011. № 2 (49). С. 43−45.

[11] Rusakevich PS, Grishanovich RV, Plavskiy VYu. Possibilities of photodynamic therapy with local use of photosensitizers in neurodystrophic vulvae diseases, cervical ectopia and metaplasia. Onkologicheskii zhurnal. 2010;4(1(13):47−53. (In Russ.)

[12] Русакевич П.С., Гришанович Р.В., Плавский В.Ю. Возможности применения фотодинамической терапии с местным применением фотосенсибилизаторов при нейродистрофических заболеваниях вульвы, цервикальной эктопии и метаплазии // Онкологический журнал. 2010. Т. 4. № 1 (13). С. 47−53.

[13] McPherson T, Cooper S. Vulval lichen sclerosus and lichen planus. Dermatol Ther. 2010;23(5):523−532. DOI: 10.1111/j.1529-8019.2010.01355.x

[14] McPherson T., Cooper S. Vulval lichen sclerosus and lichen planus // Dermatol. Ther. 2010. Vol. 23. No. 5. P. 523−532. DOI: 10.1111/j.1529-8019.2010.01355.x

[15] Casabona F, Priano V, Vallerino V, et al. New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration. Plast Reconstr Surg. 2010;126(4):210e−211e. DOI: 10.1097/prs.0b013e3181ea9386

[16] Casabona F., Priano V., Vallerino V. et al. New surgical approach to lichen sclerosus of the vulva: the role of adipose-derived mesenchymal cells and platelet-rich plasma in tissue regeneration // Plast. Reconstr. Surg. 2010. Vol. 126. No. 4. P. 210e−211e. DOI: 10.1097/prs.0b013e3181ea9386

[17] Makarov IO, Chulkova EA, Sheshukova NA, Makarova II. Not tumoral diseases of vulva. Akusherstvo, ginekologiya i reproduktsiya. 2012;6(2):14−17. (In Russ.)

[18] Макаров И.О., Чулкова Е.А., Шешукова Н.А., Макарова И.И. Неопухолевые заболевания вульвы // Акушерство, гинекология и репродукция. 2012. Т. 6. № 2. С. 14−17.

[19] Shier M, El-Khatib S. Vulvar lichen sclerosus. J Obstet Gynaecol Can. 2010;32(10):929−930. DOI: 10.1016/s1701-2163(16)34676-x

[20] Shier M., El-Khatib S. Vulvar lichen sclerosus // J. Obstet. Gynaecol. Can. 2010. Vol. 32. No. 10. P. 929−930. DOI: 10.1016/s1701-2163(16)34676-x

[21] Thorstensen KA, Birenbaum DL. Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus. J Midwifery Womens Health. 2012;(57 Pt 3):260−275. DOI: 10.1111/j.1542-2011.2012.00175.x

[22] Thorstensen K.A., Birenbaum D.L. Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus // J. Midwifery Womens Health. 2012. Vol. 57. Pt. 3. P. 260−275. DOI: 10.1111/j.1542-2011.2012.00175.x

[23] .Chernova NI, Arutyunyan E. Current aspects of treatment in patients with dystrophy and atrophy of the intimate area. What is new? Rossiiskii vestnik akushera-ginekologa. 2018;(3):95−98. DOI: 10.17116/rosakush201818295-98. (In Russ.)

[24] Чернова Н.И., Арутюнян Э. Современные аспекты терапии пациенток с дистрофией и атрофией интимной зоны. Что нового? // Российский вестник акушера-гинеколога. 2018. № 3. С. 95−98. DOI: 10.17116/rosakush201818295-98

[25] Makarov OV, Khashukoeva AZ, Оtdelnova OB, Kupeeva ES. Our experience in treating gynaecological diseases with photodynamic therapy. Lazernaya meditsina. 2012;16(2):40−44. (In Russ.)

[26] Макаров О.В., Хашукоева А.З., Отдельнова О.Б., Купеева Е.С. Опыт применения фотодинамической терапии в лечении гинекологических заболеваний // Лазерная медицина. 2012. Т. 16. № 2. С. 40−44.

[27] Li GT, Guo SZ, Liu YJ, Yang B. Alteration of T-cell subpopulations and lipid peroxidation in the blood of patients with vulvar non-neoplastic epithelial disorder. Clin Exp Obstet Gynecol. 2014;41(2):174−176.

[28] Li G.T., Guo S.Z., Liu Y.J., Yang B. Alteration of T-cell subpopulations and lipid peroxidation in the blood of patients with vulvar non-neoplastic epithelial disorder // Clin. Exp. Obstet. Gynecol. 2014. Vol. 41. No. 2. P. 174−176.

[29] Pamfamirov YK, Zabolotnov VA, Kucherenko YA, et al. Vulvar denervation in dystrophy processes treatment. Zdorov’e zhenshchiny. 2012;4(70):166. (In Russ.)

[30] Памфамиров Ю.К., Заболотнов В.А., Кучеренко Ю.А. и др. Денервация вульвы в лечении дистрофических заболеваний // Здоровье женщины. 2012. № 4 (70). С. 166.

[31] Grigoriadis C, Hassiakos D, Bakas P, et al. Effect of gonadal steroid receptors alterations on the pathophysiology of pelvic organ prolapse and urinary incontinence. Minerva Ginecol. 2016;68(1):37−42.

[32] Grigoriadis C., Hassiakos D., Bakas P. et al. Effect of gonadal steroid receptors alterations on the pathophysiology of pelvic organ prolapse and urinary incontinence // Minerva Ginecol. 2016. Vol. 68. No. 1. P. 37−42.

[33] Jarząbek-Bielecka G, Wilczak M, Potasińska-Sobkowska A, et al. Overweight, obesity and female sexuality in perimenopause: a preliminary report. Prz Menopauzalny. 2015;14(2):97−104. DOI: 10.5114/pm.2015.52151

[34] Jarząbek-Bielecka G., Wilczak M., Potasińska-Sobkowska A. et al. Overweight, obesity and female sexuality in perimenopause: a preliminary report // Prz. Menopauzalny. 2015. Vol. 14. No. 2. P. 97−104. DOI: 10.5114/pm.2015.52151

[35] Nowakowska I, Rasińska R, Głowacka M. Analysis of relationships between perimenopausal symptoms and professional functioning and life satisfaction. Subjective perception of the dependence in women aged 40. Med Pr. 2015;66(3):351−358. DOI: 10.13075/mp.5893.00243

[36] Nowakowska I., Rasińska R., Głowacka M. Analysis of relationships between perimenopausal symptoms and professional functioning and life satisfaction. Subjective perception of the dependence in women aged 40 // Med. Pr. 2015. Vol. 66. No. 3. P. 351−358. DOI: 10.13075/mp.5893.00243

[37] Miyagawa S, Sato M, Sudo T, et al. Unique roles of estrogen-dependent Pten control in epithelial cell homeostasis of mouse vagina. Oncogene. 2015;19(34 Pt 8):1035−1043. DOI: 10.1038/onc.2014.62

[38] Miyagawa S., Sato M., Sudo T. et al. Unique roles of estrogen-dependent Pten control in epithelial cell homeostasis of mouse vagina // Oncogene. 2015. Vol. 34. No. 8. P. 1035−1043. DOI: 10.1038/onc.2014.62

[39] Galikhanova EE. Osobennosti klinicheskogo techeniya i lecheniya kandidoznykh infektsii u zhenshchin s distroficheskimi zabolevaniyami vul’vy i vlagalishcha [dissertation abstract]. Moscow; 2012 [cited 20 Aug 2021]. Available from: https://www.dissercat.com/content/osobennosti-klinicheskogo-techeniya-i-lecheniya-kandidoznoi-infektsii-u-zhenshchin-s-distrof. (In Russ.)

[40] Галиханова Э.Э. Особенности клинического течения и лечения кандидозных инфекций у женщин с дистрофическими заболеваниями вульвы и влагалища: автореф. дис. … канд. мед. наук. Москва, 2012 [дата обращения: 20.08.2021]. Доступ по ссылке: https://www.dissercat.com/content/osobennosti-klinicheskogo-techeniya-i-lecheniya-kandidoznoi-infektsii-u-zhenshchin-s-distrof

[41] Reutskaya MA, Kulinich SI. Vulvar diseases and their interrelation with genital infections. Sibirskii meditsinskii zhurnal. 2010;97(6):239−242. (In Russ.)

[42] Реуцкая М.А., Кулинич С.И. Роль инфекций в генезе заболеваний вульвы // Сибирский медицинский журнал. 2010. Т. 97. № 6. С. 239−242.

[43] Batyrshina SV, Galichanova EE, Akberova DR. Candidal and papillomavirus infection in women with inflammatory and dystrophic diseases of the vulva and vagina. Obstetrics and Gynecology. 2012;(9):175−180. (In Russ.)

[44] Батыршина С.В., Галиханова Э.Э., Акберова Д.Р. Кандидозная и папилломавирусная инфекции у женщин с воспалительными и дистрофическими заболеваниями вульвы и влагалища // Акушерство и гинекология. 2012. № 9. С. 175−180.

[45] Kreuter A, Kryvosheyeva Y, Terras S, et al. Association of autoimmune diseases with lichen sclerosus in 532 male and female patients. Acta Derm Venereol. 2013;(93 Pt 2):238–241. DOI: 10.2340/00015555-1512

[46] Kreuter A., Kryvosheyeva Y., Terras S. et al. Association of autoimmune diseases with lichen sclerosus in 532 male and female patients // Acta Derm. Venereol. 2013. Vol. 93. No. 2. P. 238–241. DOI: 10.2340/00015555-1512

[47] Kiyohara T, Satoh S, Kumakiri M. Eosinophilic spongiosis in vulvar lichen sclerosus. J Dermatol. 2013;40(2)148−149. DOI: 10.1111/1346-8138.12044

[48] Kiyohara T., Satoh S., Kumakiri M. Eosinophilic spongiosis in vulvar lichen sclerosus // J. Dermatol. 2013. Vol. 40. No. 2. P. 148−149. DOI: 10.1111/1346-8138.12044

[49] Chang JC, Blake DG, Leung BV, Plaza JA. Langerhans cell histiocytosis associated with lichen sclerosus of the vulva: case report and review of the literature. J Cutan Pathol. 2013;40(2):279−283. DOI: 10.1111/cup.12051

[50] Chang J.C., Blake D.G., Leung B.V., Plaza J.A. Langerhans cell histiocytosis associated with lichen sclerosus of the vulva: case report and review of the literature // J. Cutan. Pathol. 2013. Vol. 40. No. 2. P. 279−283. DOI: 10.1111/cup.12051

[51] Osiecka BJ, Nockowski P, Jurczyszyn K, Ziolkowski P. Photodynamic therapy of vulvar lichen sclerosus et atrophicus in a woman with hypothyreosis – сase report. Photodiagnosis Photodyn Ther. 2012;9(2):186−188. DOI: 10.1016/j.pdpdt.2012.02.002

[52] Osiecka B.J., Nockowski P., Jurczyszyn K., Ziolkowski P. Photodynamic therapy of vulvar lichen sclerosus et atrophicus in a woman with hypothyreosis – сase report // Photodiagnosis Photodyn. Ther. 2012. Vol. 9. No. 2. P. 186−188. DOI: 10.1016/j.pdpdt.2012.02.002

[53] Nasca MR, Lacarrubba F, Micali G. Human papillomavirus infection and lichen sclerosus: coincidence or link? Int J Dermatol. 2018;57(5):617–618. DOI: 10.1111/ijd.13933

[54] Nasca M.R., Lacarrubba F., Micali G. Human papillomavirus infection and lichen sclerosus: coincidence or link? // Int. J. Dermatol. 2018. Vol. 57. No. 5. P. 617–618. DOI: 10.1111/ijd.13933

[55] Sherman V, McPherson T, Baldo M, et al. The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study. J Eur Acad Dermatol Venereol. 2010;24(9):1031–1034. DOI: 10.1111/j.1468-3083.2010.03572.x

[56] Sherman V., McPherson T., Baldo M. et al. The high rate of familial lichen sclerosus suggests a genetic contribution: an observational cohort study // J. Eur. Acad. Dermatol. Venereol. 2010. Vol. 24. No. 9. P. 1031–1034. DOI: 10.1111/j.1468-3083.2010.03572.x

[57] Aranda J, Carder KR. Diagnosis and treatment of diseases of the vulva from the standpoint of the dermatologist. Reproduktivnoe zdorov’e detei i podrostkov. 2012;(3):19−32. (In Russ.)

[58] Аранда Д., Кардер К.Р. Диагностика и лечение заболеваний вульвы с позиций дерматолога // Репродуктивное здоровье детей и подростков. 2012. № 3. С. 19–32.

[59] Khashukoeva AZ, Kupeeva ES, Narimanova MR. Fotodinamicheskaya terapiya distroficheskikh zabolevanii vul’vy. Fotodinamicheskaya terapiya i fotodiagnostika. 2013;2(3):53−54. (In Russ.)

[60] Хашукоева А.З., Купеева Е.С., Нариманова М.Р. Фотодинамическая терапия дистрофических заболеваний вульвы // Фотодинамическая терапия и фотодиагностика. 2013. Т. 2. № 3. С. 53–54.

[61] Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus: A prospective cohort study of 507 women. JAMA Dermatol. 2015;151(10):1061−1067. DOI: 10.1001/jamadermatol.2015.0643

[62] Lee A., Bradford J., Fischer G. Long-term management of adult vulvar lichen sclerosus: A prospective cohort study of 507 women // JAMA Dermatol. 2015. Vol. 151. No. 10. P. 1061−1067. DOI: 10.1001/jamadermatol.2015.0643

[63] Manolova G, Pehlivanov G, Bakadzhiev I, et al. Lichen sclerosus-clinical and therapeutic aspects. Akush Ginekol (Sofiia). 2014;53(1):35–39.

[64] Manolova G., Pehlivanov G., Bakadzhiev I. et al. Lichen sclerosus-clinical and therapeutic aspects // Akush Ginekol (Sofiia). 2014. Vol. 53. No. 1. P. 35–39.

[65] Lifits-Podorozhansky YM, Podorozhansky Y, Hoffstetter S, Gavard JA. Role of vulvar care guidelines in the initial management of vulvar complaints. J Low Genit Tract Dis. 2012;16(2):88−91. DOI: 10.1097/lgt.0b013e318232fd9a

[66] Lifits-Podorozhansky Y.M., Podorozhansky Y., Hoffstetter S., Gavard J.A. Role of vulvar care guidelines in the initial management of vulvar complaints // J. Low Genit. Tract. Dis. 2012. Vol. 16. No. 2. P. 88−91. DOI: 10.1097/lgt.0b013e318232fd9a

[67] De Grande Curi D, Roa CL, de Aguiar LM, et al. Vulvar lichen sclerosus: description of 5 cases successfully treated with the 2,940 nm Erbium-YAG laser. Surgical and Cosmetic Dermatology. 2017;9(3):265–268. DOI: 10.5935/scd1984-8773.2017931027

[68] De Grande Curi D., Roa C.L., de Aguiar L.M. et al. Vulvar lichen sclerosus: description of 5 cases successfully treated with the 2,940 nm Erbium-YAG laser // Surgical and Cosmetic Dermatology. 2017. Vol. 9. No. 3. P. 265–268. DOI: 10.5935/scd1984-8773.2017931027

[69] Simakova EL, Sakhautdinova IV, Muslimova SYu. Novel technologies with the use of allogeneic biomaterials in the therapy of scleroatrophic lichen. Onkoginekologiya. 2016;(2):59−64. (In Russ.)

[70] Симакова Е.Л., Сахаутдинова И.В., Муслимова С.Ю. Новые технологии с применением аллогенных биоматериалов в терапии склероатрофического лихена // Онкогинекология. 2016. № 2. С. 59−64.

[71] Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol. 2015;58(3):476−491. DOI: 10.1097/grf.0000000000000126

[72] Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations // Clin. Obstet. Gynecol. 2015. Vol. 58. No. 3. P. 476–491. DOI: 10.1097/grf.0000000000000126

[73] Murphy R. Lichen sclerosus. Dermatol Clin. 2010;28(4):707−715. DOI: 10.1016/j.det.2010.07.006

[74] Murphy R. Lichen sclerosus // Dermatol. Clin. 2010. Vol. 28. No. 4. P. 707−715. DOI: 10.1016/j.det.2010.07.006

[75] Vtorenko VI, Yezhov VV, Yelkanova EE, Saljuk VA. A case of treating hyperplastic vulva dystrophy with laser shockwave destruction (a practical experience). Lazernaya meditsina. 2015;19(2):42−43. (In Russ.)

[76] Вторенко В.И., Ежов В.В., Елканова Е.Е., Салюк В.А. Случай применения лазерной ударно-волновой деструкции в лечении гиперпластической дистрофии вульвы // Лазерная медицина. 2015. Т. 19. № 2. С. 42−43.

[77] Makarov OV, Khashukoeva AZ, Оtdelnova OB, Kupeeva ES. Fotodinamicheskaya terapiya kak perspektivnyi metod lecheniya distroficheskikh zabolevanii vul’vy. Lechashchii vrach. 2011;(11):28−30. (In Russ.)

[78] Макаров О.В., Хашукоева А.З., Отдельнова О.Б., Купеева Е.С. Фотодинамическая терапия как перспективный метод лечения дистрофических заболеваний вульвы // Лечащий врач. 2011. № 11. С. 28−30.

[79] Kupeeva ES. Fotodinamicheskaya terapiya s ispol’zovaniem fotosensibilizatora fotoditazin v lechenii distroficheskikh zabolevanii vul’vy. [dissertation abstract] Moscow; 2014 [cited 23 Aug 2021]. Available from: https://www.dissercat.com/content/fotodinamicheskaya-terapiya-s-ispolzovaniem-fotosensibilizatora-fotoditazin-v-lechenii-distr. (In Russ.)

[80] Купеева Е.С. Фотодинамическая терапия с использованием фотосенсибилизатора фотодитазин в лечении дистрофических заболеваний вульвы: автореф. дис. … канд. мед. наук. Москва, 2014 [дата обращения: 23.08.2021]. Доступ по ссылке: https://www.dissercat.com/content/fotodinamicheskaya-terapiya-s-ispolzovaniem-fotosensibilizatora-fotoditazin-v-lechenii-distr

[81] Reutskaya MA. Vulvar diseases and their interrelation with genital infection. Sibirskii meditsinskii zhurnal. 2011;105(6):277−279. (In Russ.)

[82] Реуцкая М.А., Кулинич С.И. Новые подходы к диагностике и лечению заболеваний вульвы // Сибирский медицинский журнал. 2011. Т. 105. № 6. С. 277−279.

[83] Pinelli S, D’Erme AM, Lotti T. Management of sexual dysfunction due to vulvar lichen sclerosus in postmenopausal women. Dermatol Ther. 2013;26(1):79−82. DOI: 10.1111/j.1529-8019.2012.01536.x

[84] Pinelli S., D’Erme A.M., Lotti T. Management of sexual dysfunction due to vulvar lichen sclerosus in postmenopausal women // Dermatol. Ther. 2013. Vol. 26. No. 1. P. 79−82. DOI: 10.1111/j.1529-8019.2012.01536.x

[85] D’Antuono A, Bellavista S, Negosanti F, et al. Dermasilk briefs in vulvar lichen sclerosus: an adjuvant tool. J Low Genit Tract Dis. 2011;(15 Pt 4):287−291. DOI: 10.1097/lgt.0b013e31821380a0

[86] D’Antuono A., Bellavista S., Negosanti F. et al. Dermasilk briefs in vulvar lichen sclerosus: an adjuvant tool // J. Low Genit. Tract Dis. 2011. Vol. 15. No. 4. P. 287−291. DOI: 10.1097/lgt.0b013e31821380a0

RIGHTS & PERMISSIONS

Eсо-Vector