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Lipschütz’s acute vulvar ulcer: a systematic review

European Journal of Pediatrics volume 179, pages 1559–1567 (2020)Cite this article

Abstract

In previously healthy subjects, vulvar ulcers are mostly caused by sexually transmitted microorganisms. Lipschütz’s acute vulvar ulceration, first reported in 1912, is a non-sexually acquired condition characterized by sudden onset of a few genital ulcers. We systematically review presentation, underlying causes, and disease duration of Lipschütz’s ulceration. A comprehensive source of Excerpta Medica, National Library of Medicine, and Web of Science databases was performed. Reports including cases of apparently previously healthy females affected by Lipschütz’s ulceration were selected. A predefined database was used to extract data on demographics, history, clinical and microbiological findings, and treatment.

The search disclosed 158 cases. Almost 90% of cases were ≤ 20 years of age and sexually inactive. Lesions were usually one to about three, painful, ≥ 10 mm large, well-delimited, with a fibrinous and necrotic center and a symmetric distribution. Voiding disorders and enlarged inguinal lymph nodes were observed in a large subset of cases. Canker sores were noted in 10% of patients. Lipschütz’s vulvar ulceration occurred concomitantly with an infectious disease in 139 cases. Infectious mononucleosis syndrome (N = 40) was the most frequently detected well-defined infection, followed by mycoplasma species infections (N = 11). The disease resolved after ≤ 3 weeks.

Conclusions: Lipschütz’s ulceration mainly affects both sexually inactive and, less frequently, sexually active subjects ≤ 20 years of age, presents with ≤ 3 vulvar ulcers, resolves without recurrences within 3 weeks and is temporarily associated with an infection, most frequently a flu-like illness or an infectious mononucleosis syndrome.

What is Known:

• Lipschütz’s acute vulvar ulceration is a non-sexually acquired condition, which is characterized by a sudden onset of a few necrotic and painful genital ulcers.

• The condition tends to resolve spontaneously and is usually triggered by an infection.

What is New:

• The condition mainly affects subjects ≤ 20 years of age, tends to resolve within 3 weeks, and is usually temporarily associated with a flu-like illness or an infectious mononucleosis syndrome.

• Systemic corticosteroids do not reduce disease duration.

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Fig. 1

Notes

  1. The term “kissing pattern” is frequently used to denote this appearance.

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Author notes

  1. Stefano A. Vismara and Sebastiano A. G. Lava contributed equally to this work.

Authors and Affiliations

  1. Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland

    Stefano A. Vismara, Lisa Kottanattu, Giacomo D. Simonetti, Lorenzo Zgraggen, Mario G. Bianchetti & Gregorio P. Milani

  2. Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland

    Sebastiano A. G. Lava

  3. Università della Svizzera Italiana, Lugano, Switzerland

    Giacomo D. Simonetti & Mario G. Bianchetti

  4. Department of Obstetrics and Gynecology, Ospedale Regionale, Lugano, Switzerland

    Caterina M. Clericetti

  5. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Gregorio P. Milani

  6. Pediatric unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via della Commenda 9, 20122, Milan, Italy

    Gregorio P. Milani

Authors
  1. Stefano A. Vismara
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  2. Sebastiano A. G. Lava
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  3. Lisa Kottanattu
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  8. Gregorio P. Milani
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Contributions

SAGL and GPM conceptualized and designed the study, contributed to data interpretation, drafted the initial manuscript, and reviewed and revised the manuscript.

SAV and MGB conceptualized and designed the study, collected data, carried out the initial analyses, drafted the initial manuscript, and revised the manuscript.

LK, GDS, LZ, and CMC contributed to study design and supervised data collection, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Gregorio P. Milani.

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The authors declare that they have no conflict of interest.

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Not applicable (review study).

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Communicated by Peter de Winter

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Vismara, S.A., Lava, S.A.G., Kottanattu, L. et al. Lipschütz’s acute vulvar ulcer: a systematic review. Eur J Pediatr 179, 1559–1567 (2020). https://doi.org/10.1007/s00431-020-03647-y

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