Evaluation of patch testing in patients with chronic vulvar symptoms.

The Dermogynaecology Clinic was established at the Mercy Hospital for Women in 1989. Since its inception, 700 patients have been investigated and 15% were clinically diagnosed as having contact dermatitis. Primary irritant dermatitis was regarded as the common cause but to investigate the place of contact allergy 50 patients were patch tested to a standard battery, medicaments, preservatives, corticosteroids and miscellaneous allergens. Twenty-one patients (42%) had a total of 44 positive tests. The most common positive reactions were to nickel (22%), cobalt (6%), fragrances (12%), caine mix (6%) and ethylenediamine (8%). Medicaments and fragrances were regarded as important allergens. Corticosteroid and imidazole allergy was not a problem in this series of patients.

Human papillomavirus vulvitis: a new disease or an unfortunate mistake?

OBJECTIVE: To determine whether human papillomavirus (HPV) was responsible for symptoms in women with vulvar pruritus, pain and superficial dyspareunia who had been referred with a diagnosis of HPV vulvar disease made on clinical and/or colposcopic and/or histological grounds. DESIGN: In addition to standard clinical and laboratory investigations of the whole population, a sample of 15 test cases from the population of 71 women referred with a clinicopathological diagnosis of HPV vulvar disease, and two positive and 21 negative controls were assayed for HPV DNA. Polymerase chain reaction assays using L1 consensus primers were performed blinded to the clinicopathological diagnosis. SETTING: Dermogynaecology Clinic at Mercy Hospital for Women. SUBJECTS: Seventy-one women referred with a diagnosis of HPV vulvar disease. RESULTS: Thirteen cases which could be tested for HPV DNA were negative. Diagnoses other than HPV were found for the women's presentation in all cases. CONCLUSIONS: In the population studied, our investigations indicated that the clinicopathological diagnosis of HPV infection was incorrect and that HPV was not a cause of vulvar symptoms. We believe that the term HPV vulvitis is unfortunate as it has invited destructive treatments and drawn attention away from more likely causes of this difficult group of vulvar conditions.

Pemphigus vulgaris of the esophagus.

We describe a case of pemphigus vulgaris involving the lower esophagus, in a patient with gastroesophageal reflux. As near as we can tell, this is the first reported case of esophageal involvement by pemphigus in the absence of oropharyngeal disease. Gastroesophageal reflux may have precipitated the development of esophageal pemphigus.