Chikungunya associated vulvitis: case report and literature review / Vulvite associada a Chikungunya: relato de caso e revisão de literatura

Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.

Introdução: O vírus Chikungunya está se espalhando pelo mundo por conta da migração e da globalização, podendo apresentar sintomas sistêmicos e incomuns. Objetivo: Relatar um caso de infecção pelo vírus detectado em uma mulher por ocasião do exame ginecológico em clínica de patologia vulvar. Relato do caso: Uma mulher caucasiana de 73 anos foi a uma clínica vulvar por causa de dispareunia e queimação vulvar. Úlceras foram observadas nos pequenos lábios e no períneo. O diagnóstico de Chikungunya foi realizado por soroconversão em espécimes pareados. Foi prescrita prednisolona 40 mg uma vez ao dia por dez dias. Após o tratamento com esteróides orais, a mulher não apresentou erupções ou lesões nos órgãos genitais. Conclusão: Este estudo enfatizou que quadros raros de vulvite com úlcera podem estar associados à infecção por Chikungunya.

Vulvitis de Zoon en mujer en edad fértil. Reporte de un caso / Zoon vulvitis in a woman of childbearing age. A case report / Zoon vulvitis in a woman of childbearing age. A case report

RESUMEN La vulvitis de Zoon o vulvitis de células plasmáticas es una enfermedad inflamatoria crónica infrecuente, caracterizada por placas eritematosas bien delimitadas y brillantes que pueden afectar cualquier localización de la vulva. Suele presentarse en mujeres posmenopáusicas y plantea un difícil diagnóstico diferencial. Se insiste en la necesidad de realizar biopsia vulvar para obtener un diagnóstico histológico de certeza. Se presenta el caso de una paciente de 36 años y se comenta las opciones terapéuticas actuales descritas en la literatura.

ABSTRACT Zoon vulvitis or vulvitis circumscripta plasmacellularis is a rare chronic inflammatory disease characterized by well-delimited and shiny erythematous plaques that can affect any location of the vulva. It usually occurs in postmenopausal women and poses a difficult differential diagnosis. The need for a vulvar biopsy is emphasized to obtain a certain histological diagnosis. The case of a 36-year-old patient is presented and the current therapeutic options described in the literature are discussed.

Micosis fungoide en vulva: Presentación de un caso / Vulvar mycosis fungoides: A case report

Mycosis fungoides is a malignant neoplasm originating in T lymphocytes. It usually starts with the appearance of flat spots, called "patch stage". As time goes by, lesions infiltrate surrounding tissue and plaques appear ("plaque stage"). We present the case of a 50-year-old female patient wiht clinical and histological findings of vulvar mycosis fungoides in patch stage.

La micosis fungoide es una neoplasia maligna originada en los linfocitos T. Usualmente inicia con la aparición de manchas planas o estadio de mancha. Con el correr de los años, las lesiones van siendo infiltrantes, apareciendo las placas o estadio de placas. Presentamos a un paciente de sexo femenino de 50 años con hallazgos clínicos e histopatológicos de micosis fungoide en estadio eritematoso o manchas a nivel de vulva.

Zoon vulvitis

Abstract Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign inflammation of the vulvar mucosa, diagnosed histologically, with variable therapeutic responses. It is important to be diagnosed because it mimics the presentation of other genital conditions, such as lichen planus and squamous cell carcinoma, which require specific treatment. We report a case of a female patient with three asymptomatic shallow ulcers on the labia minora. Laboratory tests ruled out infectious diseases and the biopsy was consistent with Zoon Vulvitis.

Vulvitis de Zoon: caso clínico / Zoon vulvitis: clinical case

Se presenta un caso de una paciente de 84 años con vulvitis de Zoon. Se trata de una dermatosis vulvar de etiología incierta, muy poco frecuente, que ocasiona sintomatología inespecífica de prurito y escozor vulvar de larga evolución, acompañados de una o varias lesiones focales circunscritas y eritematosas de difícil diagnóstico clínico. Se insiste en la necesidad de realización de biopsia vulvar para obtención de un diagnóstico histológico de certeza. Se comentan las opciones terapéuticas actuales descritas en la literatura aunque no existe un tratamiento de elección.

An 84 year old female patient with Zoons vulvitis case is reported. It is a rare vulvar dermatosis of unknown etiology, with unspecific symptoms such as pruritus and vulvar stinging, both developed over a long period of time, accompanied with focal erythematous injuries. As a clinical diagnosis remains difficult, it is essential that a biopsy is obtained for accurate histological diagnosis. Despite different therapeutic options available, there is no consensus on a standardized treatment.

Clinical and microbiologic characteristics of vulvovaginitis in Korean prepubertal girls, 2009-2014: a single center experience

OBJECTIVE: To update information on the clinical and microbiologic characteristics of pediatric vulvovaginitis in Korean prepubertal girls. METHODS: A total of 120 girls (aged 0 to 9 years) with culture-confirmed pediatric vulvovaginitis, diagnosed between 2009 and 2014, were enrolled in the study. The epidemiologic and microbiologic characteristics, and clinical outcomes were assessed. Patients with sexual precocity, as well as those who were referred for suspected sexual abuse, were excluded. RESULTS: Girls aged 4 to 6 years were at the highest risk of pediatric vulvovaginitis. Seasonal distribution indicated obvious peaks in summer and winter. Of the 120 subjects, specific pathogens were identified in the genital specimens in only 20 cases (16.7%). Streptococcus pyogenes (n=12, 60%) was the leading cause of specific vulvovaginitis. Haemophilus influenzae was isolated in one patient. No cases presented with enteric pathogens, such as Shigella or Yersinia. A history of recent upper respiratory tract infection, swimming, and bubble bath use was reported in 37.5%, 15.8%, and 10.0% of patients, respectively. Recent upper respiratory tract infection was not significantly correlated with the detection of respiratory pathogens in genital specimens (P>0.05). Of 104 patients who underwent perineal hygienic care, 80 (76.9%) showed improvement of symptoms without antibiotic treatment. Furthermore, the efficacy of hygienic care was not significantly different between patients with or without specific pathogens (P>0.05). CONCLUSION: Specific pathogens were only found in 16.7% of pediatric vulvovaginitis cases. Our results indicate an excellent outcome with hygienic care, irrespective of the presence of specific pathogens.

Granulomatous cheilitis with granulomatous vulvitis: A rare association.

Granulomatous cheilitis and granulomatous vulvitis are rare disorders characterized by painless swelling of lips and vulva, respectively. Histopathology of both conditions show non-caseating epithelioid cell granulomas in the dermis. Both disorders have been associated with Crohn’s disease rarely. Occurrence of the two conditions in the same patient is extremely infrequent. We hereby report, the association of granulomatous cheilitis with granulomatous vulvitis in a 30-year-old female.

Idiopathic Granulomatous Vulvitis / 대한피부과학회지

Granulomatous vulvitis is a rare localized inflammatory disease characterized by a painless, swollen, indurated and distorted vulva. Histopathologically, it shows chronic non-necrotizing granulomatous inflammation with edema, fibrosis, and lymphangiectasia. Some cases are associated with granulomatous cheilitis or Crohn's disease. So far, only a few cases of idiopathic granulomatous vulvitis have been reported. A 43-year-old female presented with a 1-year-history of persistent swelling of the vulva. The lesion was enlarged, edematous, and indurated, and there were clustered vesicles and papules on the labia major. Histopathologic examination of the swollen labia major showed granulomatous inflammation composed of multinucleated giant cells and epithelioid cells, with numerous lymphocytes in the dermis. Another biopsy specimen obtained from the clustered vesicles showed lymphangiectasia with chronic inflammation. Based on these characteristic histopathologic features and clinical findings, the patient was diagnosed with idiopathic granulomatous vulvitis. Herein, we reported a rare case of idiopathic granulomatous vulvitis that developed in a healthy woman.

Vulvitis de Zoon / Zoon´s vulvitis

La vulvitis de Zoon fue descripta por primera vez por Zoon y Garnier en 1954. Se trata de una inflamación crónica de la mucosa vaginal, de baja incidencia. La etiopatogenia es desconocida y hasta la fecha no hay descripto ningún tratamiento efectivo. Las características clínicas e histopatológicas remedan su contrapartida masculina, la clásica balanitis circunscripta plasmocelular o de Zoon.

Zoon´s vulvitis was first described by Zoon and Garnier in 1954. It´s a low- prevalence, chronicinflammation of the vaginal mucosa. The etiology is unknown, and an effective standardtreatment has not yet been described. Its clinical and histophatologic features resemble the malecounterpart known as Zoon´s balanitis.

Grau de satisfação de mulheres que usaram absorvente higiênico "respirável" externo por 75 dias consecutivos / Satisfaction of women who used " breathable" panty liners for 75 days consecutively

Introdução: as mulheres modernas desenvolvem 10 a 12 horas de trabalhos consecutivos sem ter facilidades para sua higiene genital, fato que motivou o uso frequente de absorventes higiênicos no período intermenstrual. Objetivo: verificar a satisfação das voluntárias após 75 dias do uso de absorventes "respiráveis" intermenstruais. Métodos: aplicação de questionário para 54 mulheres voluntárias de ensaio clínico sobre o ecossistema vaginal e vulvar,que usaram absorvente higiênico intermenstrual "respirável" externo (AHIRE) por 75 dias, para verificar a satisfação do uso destes absorventes. As voluntárias foram avaliadas clinicamente e responderam a dois questionários sobre atividade laboral, desconforto vulvar (ardor, irritação ou prurido),conhecimento e uso de absorventes intermenstruais, seus motivos para usá-los e satisfação do uso, o primeiro no início e o segundo ao final do estudo.Resultados: as mulheres que participaram deste estudo eram brancas e não brancas em igual proporção, com bom nível educacional, índice de massa corpórea próximo a 25 e com média de 2,06 relações sexuais por semana. A permanência fora de casa é de 7,6 horas por dia, em média. Mais de 85%das voluntárias já conheciam esse tipo de produto, embora apenas 28,3% relatarem o hábito de usar protetor diário durante o período intermenstrual.Não foram identificados sinais irritativos (hiperemia vulvar) em 93,7% das mulheres na visita 2 (após 15 dias de uso) e 93,2% na visita 6 (após 75dias de uso). Queixas espontâneas de desconforto vulvar (ardor e irritação ou prurido) não ocorreram em 91,6% das mulheres na visita 2 e em 95,5%das mulheres na última visita. Essas diferenças não apresentaram significado estatístico (teste exato de Fisher com IC 95%). Estudo complementar indicou que estas porcentagens estão de acordo com a variação encontrada em mulheres que não usaram o AHIRE. Após os 75 dias do estudo, 39mulheres (92,8%) afirmaram que se sentiram mais confiantes, seguras e limpas com o uso do AHIRE. Conclusão: mulheres que usaram absorventesintermenstruais "respiráveis" por 75 dias consecutivos, manifestaram alto grau de satisfação e não apresentaram alterações clínicas significativas(hiperemia) ou reportaram desconforto (ardor e prurido) associado ao uso.

Introduction: modern women develop 10 to 12 consecutive hours of work without having an appropriated genital hygiene, a fact that prompted the frequentuse of panty liners in the intermenstrual period. Objective: check the satisfaction level of subjects after 75 days of wearing "breathable" panty liners (i. e.,ones that allow movement of air and water vapor). Methods: implementation of a questionnaire to 54 women participants of a clinical trial for vulvar andvaginal ecosystem evaluation, who wore breathable panty liner (BPL) for 75 days to verify the satisfaction regarding the wearing there of. The subjects wereassessed for clinical exams and also answered two questionnaires related to work activity, vulvar discomfort (burning, irritation or pruritus), knowledge andwearing of breathable panty liners, their reasons for wearing them as well as satisfaction, being the former at the beginning and latter at the end of the study.Results: the women that attended the research were white and non-white in equal proportions, holding good educational background, body mass indexclose to 25 and with an average of 2.06 sexual intercourses per week, being away from home, on average 7.6 hours per day. Over 85% of subjects werepreviously familiarized with this type of product, albeit just 28.3% reported the habit of wearing panty liners throughout the intermenstrual period. Absenceof irritation signs (vulvar hyperemia) occurred in 93.7% in Visit #2 (after 15 days of usage) and 93.2% of the women in visit #6 (after 75 days). Commoncomplaints of vulvar discomfort (burning and irritation or pruritus) were not observed in 91.6% of the women in Visit #2 and 95.5% of the women in the endof study. These differences were not statistically meaningful (Fisher"s exact test with IC = 95%) between the visits. A complementary study indicates thatthese percentages are in line with the normal variations of women who do not wear panty liners. After 75 days of the study, 39 women (92.8%) said they feltmore confident, protected and clean while wearing BPL. Conclusion: women who used "breathable" panty liners intermenstrual for 75 consecutive days,expressed high satisfaction and showed no clinically significant changes (hyperemia) or reported genital discomfort (burning and itching).

Tiña vulvar: análisis histopatológico de un caso / Tinea of the vulva: a histopathological case analysis

Introducción: la tiña vulvar es una entidad de difícil diagnóstico clínico que puede también pasar desapercibida en la biopsia. Objetivo: presentar el caso de una mujer con esta entidad, diagnosticado por la biopsia, y hacer comentarios relevantes sobre el tema con énfasis en el diagnóstico histopatológico. Metodología: se trata de una paciente sometida a biopsia por prurito vulvar persistente. No se anotan otros datos de historia clínica, incluida la edad. En la biopsia se observó una dermatitis psoriasiforme liquenificada, con paraqueratosis y grupos de neutrófilos en la capa córnea y con tapones córneos infundibulares; en la dermis superficial se apreciaban papilas profundas con algunos linfocitos y fibrosis vertical. Se sospechó el diagnóstico de psoriasis pero la coloración de PAS (coloración de ácido peryódico de Schiff), solicitada por la presencia de neutrófilos intracórneos, demostró abundantes hifas en un infundíbulo confirmándose el diagnóstico de tiña vulvar. Conclusiones: la entidad demostrada es rara y tiene como uno de sus patrones histopatológicos la presencia de una dermatitis psoriasiforme y liquenificada. El hallazgo de neutrófilos intracórneos siempre debe hacer sospechar la presencia de una tiña. La coloración de PAS es una manera fácil de confirmar el diagnóstico. En la literatura revisada se constata que la tiña vulvar es una extensión de la tiña cruris, producida con mayor frecuencia por Trichophyton rubrum. Los diagnósticos diferenciales incluyen candidiasis, psoriasis y dermatitis de contacto.

Introduction: tinea of the vulva is a difficult clinical entity which may well go unnoticed in a biopsy. Objective: presenting the case of a woman suffering this disease, diagnosed by biopsy, and making some comments emphasising the value of histopathological diagnosis. Methodology: a vulvar biopsy was taken as the patient had complained of persistent pruritis. No clinical history was obtained. The biopsy revealed lichenified psoriasiform dermatitis, parakeratosis and groups of neutrophils in the horny layer and infundibulum; deep dermal papillae, lymphocytes and vertical fibrosis were visible in the dermis. Although such findings are also seen in psoriasis, PAS staining was done due to the presence of neutrophils, showing abundant infundibular hyphae, thereby confirming the diagnosis of tinea of the vulva. Conclusions: this rare entity has a lichenified psoriasiform histological pattern. The finding of neutrophils in the horny layer must always lead to suspecting the presence of tinea. PAS staining is an easy way to confirm such diagnosis. Reviewing the literature revealed that tinea of the vulva is an extension of tinea cruris, most frequently caused by Trichophyton rubrum. Differential diagnosis includes candidiasis, psoriasis, and contact dermatitis.

Dermatosis plasmocitarias benignas, integración y revisión del tema / Benign Cutaneous Plasmocytosis, Integration And Revision Of The Topic

Las dermatosis plasmocitarias comprenden un conjunto de enfermedades inflamatorias de causa desconocida y evolución incierta. Se han descrito para ellas múltiples tratamientos con resultados dispares y éxitos terapéuticos anecdóticos, con recaídas posteriores en la mayoría de los casos. Presentamos en este trabajo, además de una actualización y revisión del tema, cuatro dermatosis plasmocitarias que tuvimos oportunidad de ver en nuestro Servicio: la conocida balanitis de Zoon, las poco descritas vulvitis de Zoon y queilitis plasmocitaria y la infrecuente plasmocitosis cutánea de la que hay muy pocos reportes a nivel mundial. Queremos con este trabajo integrar didácticamente las dermatosis benignas, producidas directamente por la infiltración de plasmocitos, sin causa subyacente demostrable.

Cutaneous plasmocitosys is a group of skin's inflammatories disorders with unknown cause and uncertain evolution. In all treatments cases they describe different and uneven results with a few therapeutic success, most of them with reopen symptoms. In the following work, besides an updates and reviews, we present four cases that we received in our Service. The known balanitis of Zoon, the almost unknown vulvitis of Zoon, plasma cell cheilitis and finally the very unfrequently cutaneous plasmocytosis, which is very worldwide unreported. A purpose of this work have a didactic will to include whole skin disorders directly caused for the plasma cells infiltration with no causes in background.

Labial Adhesions in Children: Report of Two Cases

Labial adhesion in prepubertal girls is a common gynecologic problems. The labia minora are fused by thin transparent or thick fibrous membrane in the midline from the clitoris to posterior fourchet. The prevalence of labial adhesion may be even greater because many children with labial fusions are asymptomatic and these cases remain unreported. They are often unrecognized by physician and parents because most of symptomatic children complained urinary symptoms. The authors experienced 2 cases of labial adhesion in girls; one asymptomatic partial fusion and the other symptomatic complete fusion. These lesions were treated successfully by mechanical separation of labial adhesion and petroleum ointment (Vaseline) application without recurrence in follow-ups.

Clinical Effects of Jiefujing Lotion on Vulvitis and Vaginitis with Downward Flow of Damp-heat Syndrome / 中药新药与临床药理

Objective To evaluate the clinical efficacy and safety of Jiefujing lotion in the treatment of patients with vulvi- tis and vaginitis(due to downward flow of damp-heat).Methods A randomized,double blind,and multi-center clin- ical trial was performed with Jie' eryin lotion as positive parallel control.Results No obvious difference was observed in general curative effect and symptom-sign curative effect between the two groups(P＞0.05),neither obvious side ef- fects was observed.Conclusion Jiefujing lotion is safe and effective in the treatment of vulvitis and vaginitis due to downward flow of damp-heat.

A Case of Vulvitis Circumscripta Plasmacellularis / 대한피부과학회지

We present a 40-year-old woman who had a well circumscribed, pea sized red-brown glistening erosive papule on the foreskin of clitoris for four months which had been resistant to various forms of treatment. Histopathologic examination revealed flattened epidermis with lozenge keratinocytes and watery spongiosis, In the upper dermis, dense bandlike infiltration of plasma cells, endothelial proliferation, and capillary dilatation were noted. Peroxidase-antiperoxidase stain showed polyclonal pattern of reaction in the cytoplasm of plasma cells.