What Are White Matter Foci?

White lesions of the vulva include white lesions of the vulva, white spots of the vulva, or malnutrition of the vulva, which were previously considered to be vascular malnutrition, but with further understanding of the disease, the above changes were not found, but the pigmentation of the vulva skin and mucosal tissues and Degenerative lesions. Because patients with sclerosing moss and squamous epithelial cell hyperplasia are mostly white in the vulvar skin, they are called white lesions of the vulva and belong to non-tumorous changes in the vulvar epithelium. Sclerosing moss and squamous epithelial cell hyperplasia changed their names in different ages due to their different clinical and pathological cognition. It was originally called vulvar leukoplakia, leukoplakia, vulvar dryness, proliferative or atrophic vulvitis, Neurodermatitis, sclerosing atrophic moss, etc. Due to the confusion of the disease name, it was collectively referred to as "chronic vulvar malnutrition" in 1975 by the International Society for Research on Vulvar Diseases (ISSVD). In recent years, the understanding of non-neoplastic changes in the vulvar epithelium has continued to deepen, and in fact, no vascular and neurotrophic dysfunction has been found in the vulvar lesions. For this reason, the International Society for Vulvar Research (ISSVD) in 1987 Also discussed with the International Association of Gynecological Pathologists (ISGYP) to develop a new classification of genital skin diseases.

Basic Information

nickname

Leukoplakia, white lesions of the vulva, vulvar malnutrition

English name

whitelesionofvulva

Visiting department

Gynecology

Common symptoms

itch

Classification of white lesions of vulva

1. According to the histological manifestations of chronic vulvar malnutrition:

(1) Sclerosing moss malnutrition;

(2) Proliferative malnutrition: no atypical hyperplasia; atypical hyperplasia;

(3) Mixed malnutrition: no atypical hyperplasia; atypical hyperplasia.

2. Classification of genital skin diseases (ISSVD, 1987):

In recent years, the understanding of non-neoplastic changes in the vulvar epithelium has continued to deepen, and in fact, no vascular and neurotrophic dysfunction has been found in the vulvar lesions. For this reason, the International Society for Vulvar Research (ISSVD) in 1987 Also discussed with the International Association of Gynecological Pathologists (ISGYP) to develop a new classification of genital skin diseases.

Classification of genital skin diseases (ISSVD, 1987):

(1) Nonneoplastic changes in the skin and mucosal epithelium (nonneoplasticepithelialdisordersofskinandmucosa)

1) Lichensclerosus

2) squamous cell hyperplasia

3) other skin diseases (otherdermatoses)

(2) intraepithelialneoplasia

1) Squamousintraepithelialneoplasia

a. Mild atypical hyperplasia (milsdysplasia)

b. Moderate dysplasia (moderatedysplasia)

c. Severe dysplasia or carcinoma in situ (deveredysplasiaorcarcinomainsitu)

2) Nonsquamousintraepithelialneoplasia

a. Paget`sdisease

b. Non-invasive tumors of melanocytes (noninvasive)

(3) invasivetumors

Causes of white lesions of the vulva

The exact cause of the white lesions of the vulva is unknown. May be related to the following factors: genes, autoimmunity, lack of sex hormones, or decline in sex hormone receptors. Squamous epithelial hyperplasia of the vulva may be related to dampness of the vulva and long-term stimulation of the secretions, which may cause itching and repeated scratching of the vulva.

Clinical manifestations of vulvar white lesions

Vulvar itching is the main symptom. Itching time is from 2 to 3 months from the onset to treatment, and it can reach 20 years. The severity of itching is independent of season and day and night. Patients with squamous epithelial hyperplasia of the vulva feel more severe itching. If it is accompanied by trichomoniasis or fungal vaginitis, there will be more secretions, and the local burning sensation and tingling are related to the damage or infection of the skin and mucous membranes caused by itching. Locally there are varying degrees of skin and mucosal hypopigmentation, often with edema, cleft palate and scattered superficial ulcers.

Vulvar white lesion examination

The biopsy should be performed on cleft palate, ulcers, bulges, induration or rough areas. Multiple biopsies were sent for pathological examination to determine the nature of the lesion and exclude early canceration. When scaly epithelial hyperplasia of the vulva is suspected, in order to obtain appropriate materials, the affected area can be coated with 1% toluidine blue, and after drying, the elution color can be rubbed with 1% acetic acid. Where the non-bleaching area indicates the presence of naked nuclei, biopsy there is more likely to find atypical hyperplasia or even canceration.

Diagnosis of white lesions of vulva

A preliminary judgment can be made based on clinical manifestations; a pathological examination is required to confirm the diagnosis. When taking the material, you must take multiple points at the diseased site: ulcers, cleft palate, induration, bulges, or rough spots, and take appropriate materials. For suspected vulvar squamous epithelial hyperplasia, first apply 1% toluidine blue to the lesion area, dry it, and then decolorize with 1% acetic acid solution. Use biopsy forceps perpendicular to the skin in the non-decolorized area, and deepen the dermal biopsy. Where non-bleaching areas indicate the presence of naked nuclei in this area, biopsy in this area can improve the diagnostic accuracy.

Differential diagnosis of white lesions of the vulva

Pay attention to differentiating from vitiligo, albinism, elderly vulvar physiological atrophy, and specific vulvitis.

Treatment of white lesions of vulva

General treatment

Pay attention to keep the vulva clean and dry, prohibit irritating drugs or soap to clean the vulva, do not wear airtight chemical fiber underwear, do not eat spicy and allergic foods. For those with itching symptoms that cause insomnia, sedative, sleeping and anti-allergic drugs can be added.

2. Drug treatment

Common drugs for vulvar sclerosing moss include pyruvate ointment, compound vitamin A ointment and progesterone ointment. Can also choose glucocorticoid ointment or immunotherapy. Medications can improve symptoms but cannot be cured and require long-term medication. Young girls with sclerosing moss may heal to puberty, and generally do not use pyruvate ointment to avoid virilization. Can be applied with 1% hydrocortisone ointment or 0.3% progesterone ointment. Most symptoms can be relieved, but long-term follow-up is required.

Scaloid epithelial hyperplasia of the vulva can be applied topically with corticosteroids to control itching. Most patients are effective, but long-term medication is required.

3. Physical therapy

Applicable to those who are ineffective or severely ill with medication. Microwave treatment, carbon dioxide laser and helium-neon laser, Bohm light, high-frequency electric knife, local electrocautery treatment and liquid nitrogen partial cryotherapy.

4. Surgery

Surgical treatment is only applicable to patients with severe illness, repeated medication or ineffective physical therapy. Squamous epithelial hyperplasia of the vulva requires surgery when suspicious malignancy is suspected.