Pınar Solmaz HASDEMİR

Vulvanın Benign Hastalıklarının Tanı ve Tedavisi

Vulva, genital, gastrointestinal ve üriner traktın birleştiği, tüylü ve tüysüz keratinize ciltten mukozal yüzeylere geçişin olduğu özel bir cilt bölgesidir. Vulvaya ait benign hastalıklar, yaşam kalitesini oldukça düşürmekle birlikte, hayati önem arz etmemeleri ve sıklıkla kronik bir süreci takip etmeleri nedenleri ile hasta tarafından sıklıkla göz ardı edilmekte ve hekime başvurmakta geç kalınmaktadır. Biz hekimlerin de vulvar hastalıkları sorgulamakta ve tedavi etmekte geri planda kaldığımız yadsınamaz bir gerçektir. Bu makalede güncel literatür ışığında öncelikle vulvanın genel bakımına ait önerilerde bulunulacak, vulvaya ait belli başlı semptomlar olan vulvar kaşıntı ve ağrıya değinilecek ve ardından da sık görülen vulvar dermatozlar olan liken sklerozus, liken simpleks kronikus ve liken planus ile psöriazis ve vulvar atrofi durumlarında tanı ve yönetimden bahsedilecektir.

Diagnosis and Management of the Benign Diseases of Vulva

The vulva is the area comprising the external genitals. It contains several different structures, including labia majora, labia minora, clitoris and vestibule. Vulvar symptoms such as pain and itching usually progresses slowly and can occur in any of these structures. Effective treatment strategies for benign vulvar diseases are still lacking despite their prevalence and their significant effect on quality of life. In this review article, we first aimed to provide recommendations on daily vulvar care, secondly focusing on obtaining relevant, in-depth information about vulvar symptoms and lastly discuss the differential diagnosis and management of common vulvar dermatoses such as lichen sclerosus, lichen simplex chronicus, lichen planus, psoriasis and vulvar atrophy.

PDF

___

1.Margesson LJ. Contact dermatitis of the vulva. Dermatol Ther. 2004; 17: 20–7.
2. Ozalp SS, Telli E, Yalcin OT, Oge T, Karakas N. Vulval pruritus: the experience of gynaecologists revealed by biopsy. J Obstet Gynaecol. 2015; 35: 53–6.
3. O'Connell TX, Nathan LS, Satmary WA, Goldstein AT. Non-neoplastic epithelial disorders of the vulva. Am Fam Physician. 2008; 77: 321-6.
4. Weichert GE. An approach to the treatment of anogenital pruritus. Dermatol Ther. 2004; 17: 129–33.
5. Diagnosis and management of vulvar skin disorders. ACOG Practice Bulletin No. 93. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2008; 111: 1243–53.
6. Bornstein J, Goldstein AT, Stockdale C, et al. 2015 ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Obstet Gynecol. 2016; 127: 745–51.
7. Persistent vulvar pain. Committee Opinion No. 673. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016; 128: 78–84.
8. Friedrich EG Jr. Vulvar vestibulitis syndrome. J Reprod Med. 1987; 32: 110–114.
9. De Andres J, Sanchis-Lopez N, Asensio-Samper JM, et al. Vulvodynia--An Evidence-Based Literature Review and Proposed Treatment Algorithm. Pain Pract. 2016; 16: 204-36.
10.Vaginitis. Practice Bulletin No. 72. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2006; 107: 1195–206.
11. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015; 64: 1–137.
12. Guerrero A, Venkatesan A. Inflammatory vulvar dermatoses. Clin Obstet Gynecol. 2015; 58: 464–75.
13. Lichen Simplex Chronicus: Background, Pathophysiology, Etiology. https://emedicine.medscape.com/article/1123423- overview.
14. Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004; 17: 8–19.
15. Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best Pract Res Clin Obstet Gynaecol. 2014; 28: 946–58.
16. Schlosser BJ, Mirowski GW. Lichen sclerosus and lichen planus in women and girls. Clin Obstet Gynecol. 2015; 58: 125–42.
17. Kirtschig G, Becker K, Gunthert A, et al. Evidencebased (S3) guideline on (anogenital) lichen sclerosus. J Eur Acad Dermatol Venereol. 2015; 29: 1–43.
18. Chi C, Kirtschig G, Baldo M, et al. Systematic review and meta-analysis of randomized controlled trials on topical interventions for genital lichen sclerosus. Acad Dermatol. 2012; 67: 305–12.
19. Saunders NA, Haefner HK. Vulvar lichen sclerosus in the elderly pathophysiology and treatment update. Drugs Aging. 2009; 26: 803–12.
20. Bigby SM, Eva LJ, Fong KL, Jones RW. The natural history of vulvar intraepithelial neoplasia, differentiated type: evidence for progression and diagnostic challenges. Int J Gynecol Pathol. 2016; 35: 574–84.
21. Fistarol SK, Itin PH. Diagnosis and treatment of lichen sclerosus: an update. Am J Clin Dermatol. 2013; 14: 27– 47.
22. Simonetta C, Burns EK, Guo MA. Vulvar dermatoses: a review and update. Mo Med. 2015; 112: 301–7.
23. Lichen planus. American Academy of Dermatology. https://www.aad.org/public/diseases/rashes/lichenplanus.
24. Stull C, Grossman S, Yosipovitch G. Current and emerging therapies for itch management in psoriasis. Am J Clin Dermatol. 2016; 17: 617–24.
25. Stockdale CK, Boardman LA. Evaluation and treatment of postmenopausal dyspareunia. J Clin Outcomes Manag. 2011; 18: 414–23.
26. Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric. 2016; 19: 151-61.