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Erkrankungen der Vulva

Vulvar diseases

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Zusammenfassung

Erkrankungen der Vulva stellen den Dermatologen oft vor differenzialdiagnostische Schwierigkeiten, da die Klinik von entzündlichen, infektiösen und auch neoplastischen Vulvadermatosen ähnlich ist. Pruritus und Schmerzen stellen neben Dysurie und Dyspareunie die häufigsten Symptome dar. Entzündliche Dermatosen wie Ekzeme, Lichen planus, Lichen sclerosus oder auch die atrophische Vulvitis stellen die größte Erkrankungsgruppe in spezialisierten Sprechstunden dar. Des Weiteren folgen Neoplasien, wie z. B. das Vulvakarzinom bzw. die vulväre intraepitheliale Neoplasie und der Morbus Paget. Schließlich sind Infektionen z. B. mit Candida-Arten, Herpes-simplex-Viren, humanen Papillomviren eine dritte große Erkrankungsgruppe. Weiterhin bereitet die Therapie der Vulvodynie nicht selten Probleme. Aufgrund der vielschichtigen Klinik ist bei Vulvadermatosen nicht selten eine interdisziplinäre Zusammenarbeit mit Gynäkologen und ggf. Psychosomatikern anzuraten. Typische klinische Zeichen der Krankheiten sowie ihre Spezifika und Fallstricke in der Praxis werden erläutert.

Abstract

Vulvar diseases might cause problems in the differential diagnosis, because the clinical presentation of inflammatory, infectious and neoplastic disorders may be quite similar. Itching and pain as well as dysuria and dyspareunia are the most common symptoms of vulvar diseases. Inflammatory dermatoses like atopic and contact dermatitis, lichen planus, lichen sclerosus and atrophic vulvitis account for the majority of cases in specialized clinics. Furthermore, neoplastic conditions such as vulvar carcinoma, vulvar intraepithelial neoplasia (VIN) and vulvar Paget's disease have to be considered. Another frequent group are infections. Candida spp., herpes simplex viruses and human papilloma viruses are common pathogens. Additionally, vulvodynia is a typical problem that is sometimes difficult to treat. Because of the wide spectrum of clinical symptoms, cooperation with gynaecologists and psychosomatic specialists should be considered in difficult cases. The typical clinical presentations, their specific signs and symptoms, and pitfalls in the dermatological consultation are discussed.

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Literatur

  1. Anemuller W, Recke A, Altgassen C et al (2012) Developing an interdisciplinary consultation service for vulvar disorders. J Dtsch Dermatol Ges 10:350–357

    PubMed  Google Scholar 

  2. Carrozzo M, Pellicano R (2008) Lichen planus and hepatitis C virus infection: an updated critical review. Minerva Gastroenterol Dietol 54:65–74

    CAS  PubMed  Google Scholar 

  3. Chi CC, Kirtschig G, Baldo M et al (2011) Topical interventions for genital lichen sclerosus. Cochrane Database Syst Rev 12:CD008240

  4. Chollet JA, Carter G, Meyn LA et al (2009) Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis. Menopause 16:978–983

    Article  PubMed  Google Scholar 

  5. Cooper SM, Wojnarowska F (2006) Influence of treatment of erosive lichen planus of the vulva on its prognosis. Arch Dermatol 142:289–294

    PubMed  Google Scholar 

  6. Einstein MH, Baron M, Levin MJ et al (2009) Comparison of the immunogenicity and safety of Cervarix and Gardasil human papillomavirus (HPV) cervical cancer vaccines in healthy women aged 18–45 years. Hum Vaccin 5:705–719

    Article  CAS  PubMed  Google Scholar 

  7. Fanning J, Lambert HC, Hale TM et al (1999) Pagetʼs disease of the vulva: prevalence of associated vulvar adenocarcinoma, invasive Pagetʼs disease, and recurrence after surgical excision. Am J Obstet Gynecol 180:24–27

    Article  CAS  PubMed  Google Scholar 

  8. Friese K, Mendling W (1996) Therapie der vaginalen Mykosen – oral vs. lokal. Gynäkologe 29:221–228

    Google Scholar 

  9. Funaro D, Lovett A, Leroux N et al (2014) A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05 % versus topical tacrolimus 0.1 % in patients with vulvar lichen sclerosus. J Am Acad Dermatol 71:84–91

    Article  CAS  PubMed  Google Scholar 

  10. Garzon MC, Paller AS (1999) Ultrapotent topical corticosteroid treatment of childhood genital lichen sclerosus. Arch Dermatol 135:525–528

    Article  CAS  PubMed  Google Scholar 

  11. Goldstein AT, Creasey A, Pfau R et al (2011) A double-blind, randomized controlled trial of clobetasol versus pimecrolimus in patients with vulvar lichen sclerosus. J Am Acad Dermatol 64:e99–e104

    Article  CAS  PubMed  Google Scholar 

  12. Goldstein AT, Thaci D, Luger T (2009) Topical calcineurin inhibitors for the treatment of vulvar dermatoses. Eur J Obstet Gynecol Reprod Biol 146:22–29

    Article  CAS  PubMed  Google Scholar 

  13. Goldstein I, Alexander JL (2005) Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. J Sex Med 2(Suppl 3):154–165

    Article  PubMed  Google Scholar 

  14. Hengge UR, Krause W, Hofmann H et al (2006) Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus. Br J Dermatol 155:1021–1028

    Article  CAS  PubMed  Google Scholar 

  15. Hollier LM, Straub H (2011) Genital herpes. Clin Evid (Online)

  16. Kreuter A, Wischnewski J, Terras S et al (2012) Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center. J Am Acad Dermatol 67:1157–1162

    Article  PubMed  Google Scholar 

  17. Landry T, Bergeron S, Dupuis MJ et al (2008) The treatment of provoked vestibulodynia: a critical review. Clin J Pain 24:155–171

    Article  PubMed  Google Scholar 

  18. Lewis FM, Bogliatto F (2013) Erosive vulval lichen planus – a diagnosis not to be missed: a clinical review. Eur J Obstet Gynecol Reprod Biol 171:214–219

    Article  CAS  PubMed  Google Scholar 

  19. Lonsdale-Eccles AA, Velangi S (2005) Topical pimecrolimus in the treatment of genital lichen planus: a prospective case series. Br J Dermatol 153:390–394

    Article  CAS  PubMed  Google Scholar 

  20. Luyten A, Sorgel P, Clad A et al (2014) Treatment of extramammary Paget disease of the vulva with imiquimod: a retrospective, multicenter study by the German Colposcopy Network. J Am Acad Dermatol 70:644–650

    Article  CAS  PubMed  Google Scholar 

  21. Manousaridis I, Manousaridis K, Peitsch WK et al (2013) Individualizing treatment and choice of medication in lichen planus: a step by step approach. J Dtsch Dermatol Ges 11:981–991

    Google Scholar 

  22. Nardelli A, Degreef H, Goossens A (2004) Contact allergic reactions of the vulva: a 14-year review. Dermatitis 15:131–136

    Article  PubMed  Google Scholar 

  23. Nguyen RH, Ecklund AM, Maclehose RF et al (2012) Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia. Psychol Health Med 17:589–598

    Article  PubMed  Google Scholar 

  24. Patel H, Wagner M, Singhal P et al (2013) Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis 13:39

    Article  PubMed Central  PubMed  Google Scholar 

  25. Pugliese JM, Morey AF, Peterson AC (2007) Lichen sclerosus: review of the literature and current recommendations for management. J Urol 178:2268–2276

    Article  PubMed  Google Scholar 

  26. Reed BD, Harlow SD, Sen A et al (2012) Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol 206:170 (e171–e179)

  27. Sadownik LA (2014) Etiology, diagnosis, and clinical management of vulvodynia. Int J Womens Health 6:437–449

    Article  PubMed Central  PubMed  Google Scholar 

  28. Santoro N, Komi J (2009) Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med 6:2133–2142

    Article  PubMed  Google Scholar 

  29. Tietz HJ, Mendling W (2001) Haut- und Vaginalmykosen. Blackwell, Berlin

    Google Scholar 

  30. Tuokko H, Bloigu R, Hukkanen V (2014) Herpes simplex virus type 1 genital herpes in young women: current trend in Northern Finland. Sex Transm Infect 90:160

    Article  PubMed  Google Scholar 

  31. Vente C, Reich K, Rupprecht R et al (1999) Erosive mucosal lichen planus: response to topical treatment with tacrolimus. Br J Dermatol 140:338–342

    Article  CAS  PubMed  Google Scholar 

  32. Virgili A, Borghi A, Toni G et al (2014) First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability. Br J Dermatol 171:388–396

    Article  CAS  PubMed  Google Scholar 

  33. Zamirska A, Reich A, Berny-Moreno J et al (2008) Vulvar pruritus and burning sensation in women with psoriasis. Acta Derm Venereol 88:132–135

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Authors and Affiliations

  1. Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland

    M. Peckruhn & P. Elsner

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  1. M. Peckruhn
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  2. P. Elsner
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Correspondence to M. Peckruhn.

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M. Peckruhn und P. Elsner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Peckruhn, M., Elsner, P. Erkrankungen der Vulva. Hautarzt 66, 38–44 (2015). https://doi.org/10.1007/s00105-014-3552-2

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  • DOI: https://doi.org/10.1007/s00105-014-3552-2

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