Kraurosis of the vulva in women: treatment, symptoms,causes, diagnosis, diet

Update: October 2018

It is believed that such a disease as Kraurosis of the vulva “prerogative”
women of pre-and postmenopausal age. In part, there is
the proportion of truth, as among 2-10% of women with this disease
it accounts for half of older women.

But krauroz in women can occur in 30 years and younger, and
even girls. The disease is subject to a long and sometimes, nevsegda
effective treatment and delivers a lot of inconvenience to patients with
this pathology.

Little anatomy

A vulva is a medical term that defines a region.
external genital organs of the weaker sex that
limited to the pubis on the upper side and the entrance to the vagina with
the bottom, and the virgins also have a hymen. To outdoor
female genitalia include large and small sex (sex
lips), the threshold of the vagina and Bartholin glands, the clitoris and
urethral exit (external opening of the urethra).

The vulva is covered with skin and mucous in which there is significant
the number of glands, nerve receptors and blood vessels.
Vulvar tissues are so tender that they are easily injured and often
are inflamed. Hormonal and immune conditions are responsible for their condition.
system. Due to estrogen, skin remains elastic and toned
and the vulvar mucosa, their normal blood supply and the possibility
deal with adverse factors.

But in the premenopausal age, when hormonal
restructuring and changes in the system of the hypothalamus – pituitary –
ovaries, there is a decrease in the production of estrogen, which can not but
affect the state of the tissues of the vulva. They are observed
structural and functional disorders, atrophy (thinning),
dryness, mild trauma and susceptibility to
inflammatory reactions.

Krauroz vulva: what is it?

Kraurosis of the vulva or sclerosing lichen is a disease,
which refers to the dystrophic lesions of the external genital
organs and is characterized by atrophy of their skin and mucous membranes, which
due to involution of the vulva. The disease krauroz flows for a long time
and it constantly progresses and is manifested by itching and dry skin and
mucous membrane. As already noted, this pathology is most often
occurs in older women (see menopause in women).

Causes and mechanism of development

The exact causes leading to the development of the disease are unknown.
Currently there are several theories, but none
explains fully the etiology and developmental mechanism of sclerosing
depriving the vulva. A certain role in the causes of this
states play neuroendocrine and autoimmune disorders,
viral and infectious agents, psychogenic factors and others.
There are a number of risk factors in the development of kraurosis of external genital
organs in women:

  • diseases of the hormonal sphere (ovaries, adrenal glands,
    thyroid, pituitary);
  • a short childbearing period (early menopause speaks of the available
    severe ovarian hypofunction);
  • injuries of the external genital organs or surgery on them;
  • genital burns (for example, after douching
    high concentration potassium permanganate solution);
  • ovariectomy at young and mature age;
  • persistent vulvitis and vulvovaginitis;
  • papilloma or herpes virus;
  • reduced immunity and autoimmune diseases;
  • obesity;
  • psychogenic factors (constant stress, depression, obsessive
    fears);
  • emotional lability;
  • neglect of intimate hygiene rules;
  • constant overheating.

The mechanism of development of pathology is also insufficiently studied. With
sclerosing lichen of the vulva is marked somewhat consistently
alternating moments. At the beginning of the disease there is a violation
blood supply and microcirculation in the tissues of the vulva, swelling of the skin and
mucous membranes, leading to hypoxia.

Then atrophic disorders develop, manifesting
hyperkeratosis, edema of the basal (initial) layer of the epidermis and
separation of its cells from the basement membrane. With отеке дермы
the structure of collagen fibers is broken, and break up
elastic fibers due to increased elastase activity. Besides
In addition, the nerve endings are also destroyed. Is broken
structure and connective tissue that leads to clogging
arterioles and increases the blood supply in the vulva. I.e,
formed a vicious circle.

Symptoms

The symptomatology of the disease is directly related to its prescription and
prevalence how pronounced the process and
Has any treatment previously been given?

Itching – a pathognomic symptom of kraurosis is permanent or
occasional itching in the area of ​​the vulva. This sign
can be combined with sensations of burning or tightening of the skin, as well as
dryness of the vulva, like after washing with harsh soap. Usually,
itching increases or occurs either at night or after
emotional or hygienic treatments.

Due to the thinning of the skin and mucous membrane, they are easily injured,
cracks and sores quickly form on the ground of injuries,
which in addition to the itch cause pain. Due to atrophy
labia and narrowing the vestibule of the vagina sexual intercourse becomes
painful or even impossible. With сужении отверстия уретры
there are problems (pain) with urination.

Besides местных проявлений у больных со склерозирующим лишаем
clearly marked disorders of the nervous system:

  • depressed
  • emotional lability
  • aggressiveness and irritability
  • trouble sleeping

And also vascular disorders (arterial hypertension), and
there are also problems in carbohydrate and fat metabolism (obesity).
Pathology has a clearly marked clinical picture and only in 2%
Patients are no complaints. There are three stages of the disease,
which are easily determined by gynecological examination:

initial stage

This stage is characterized by swelling and redness of the outer
genitals. With взгляде на половые губы видна яркая гиперемия
and edema that resemble ordinary inflammation. Patient complaints
this stage of the disease are tingling sensations, “running the goosebumps”,
slight or moderate itching.

Atrophic stage

With осмотре легко определяется так называемый крауротический
a triangle whose apex is directed to the pubis, and the base
located in the upper third of the lips. Thinned small sex
lips, they become flat, and the clitoris is reduced in size. It has
the location and discoloration of the soft tissues of the vulva: they acquire
whitish tint (pale bluish or waxy). Hairy
part of the vulva does not suffer, but a narrowing of the entrance to the
vagina.

Sclerotic stage

At this stage, the clitoris and small labia “disappear” –
atrophy and become almost imperceptible, and large
pussy lips flatten and resemble rollers, sharply limiting
суженный вход во vagina. The hole also narrows significantly.
urethra Hair growth disappears. Skin and mucous become glossy
and get pearl color.

On the tissues of the vulva there are many small folds, and it
becomes like a piece of crumpled parchment. Besides того, на коже
and mucous membranes there are multiple minor hemorrhages,
microcracks and scratching. The process progresses and captures
perianal area, groin folds and internal surfaces
thighs At this stage, the itch becomes so unbearable that
woman can not resist intense scratching affected
surface, which contributes to the formation of all new microtraumas and
their suppuration.

Diagnosis of kraurosis

The disease in the stage of atrophy and sclerosis is difficult to confuse with
some other pathology, but in the initial stage kraurosis follows
differentiate from vitiligo, neurodermatitis, red flat
depriving, as well as from diabetes and vulvovaginitis.

Examination – to diagnose sclerosing lichen of the vulva
quite simple already at the first examination of the patient. But the collection
anamnesis is unlikely to help in the diagnosis (no characteristic
data). Patient complaints and gynecological data are taken into account.
inspection.

From instrumental methods of examination, simple and
advanced vulvoskopiya (inspection colposcope, but not the neck
uterus and vaginal walls, and soft tissue of the vulva).

Laboratory tests include blood sugar testing.
(exclude diabetes) and polymerase chain reaction for HPV,
which is performed with cells of the vulva tissue to determine
the presence / absence of HPV. Cytology is also performed.
smears prints from the tissues of the vulva. In alarming cases
histological examination of a piece of skin / mucous membrane is shown
vulva to exclude a malignant process. Material collection
It is better to carry out sighting, under the vulvoscopy.

It is also necessary to examine the immunogram data to exclude
immunological disorders.

Treatment

With краурозе лечение представляет собой сложную задачу, так как
the causes and mechanism of development of this disease are still not
studied. Hospitalization of patients, as a rule, can not be, only
cases of surgery. Currently preferred
given to conservative therapies. First shown
lifestyle change:

  • wearing synthetic underwear is excluded, especially
    fitting;
  • completely give up bad habits (smoking and
    alcohol consumption);
  • observe the rules of intimate hygiene (wash twice a day with
    using mild soap);
  • do not use pads and cotton swabs,
    flavored toilet paper;
  • do not use intimate deodorants and sprays, shower gels
    and bubble baths;
  • stick to proper nutrition.

Diet with krauroz

There is no special diet for sclerosing lichen of the vulva. Should only
follow the rules of healthy eating. The first is
refuse coffee and black tea, as they have a high content
caffeine, has a stimulating effect on unstable
psycho-emotional background.

Besides того, следует отказаться от солений, копченостей, острого
and seasonings, as these products exacerbate itching in the area of ​​the vulva.
Vegetable oils should prevail in food as sources
vitamins E and A – natural antioxidants that have a beneficial effect on
skin condition, raising it elasticity and tone. From fatty
fried foods, convenience foods and fast food should also be abandoned
due to the high content of carcinogens, preservatives and
stabilizers that provoke the development of malignant
neoplasms.

But the content of fresh fruits and vegetables in the diet should
to prevail. Especially useful green vegetables and cocktails, juices from them.
Overweight women need to limit
eating high-calorie foods – simple carbohydrates
(pastries, confectionery, soft drinks).

Non-drug treatment of kraurosis

With краурозе у женщин неплохо себя зарекомендовало
non-drug treatment, which is the appointment
physiotherapy. Such physiotherapy methods are used as:

  • laser treatment – exposure to the affected laser beam
    a region lasting 4–5 minutes at several points on
    Course 12 – 16 procedures (effectively eliminates itching, normalizes sleep and
    psycho-emotional state);
  • acupuncture;
  • ultrasound;
  • phonophoresis with glucocorticoids;
  • UFO of the lumbar region and sacrum;
  • spa procedures (mud treatment, showering, bathing)
    or irrigation using mineral water);
  • ozone therapy;
  • radiotherapy;
  • mist therapy (administration of mistletoe preparations, which stimulates
    immunity);
  • photodynamic treatment.

Photodynamic therapy of kraurosis

Photodynamic treatment of kraurosis and not only that
innovative method which is to introduce
photosensitizers (photosens, photoditazine, photohem, and others)
intravenously into the patient’s body, after which the affected areas
the vulva is irradiated with a low-intensity laser beam. Due to
photochemical reaction taking place
is activated and begins to release oxygen and active radicals,
that act on atypical cells, causing their necrosis, while
while healthy cells are intact.

Before the photodynamic therapy, the patient is assigned
examination:

  • colposcopy;
  • cytological smear imprint from the vulva;
  • general blood analysis;
  • blood chemistry.

Phototherapy has several advantages and its effectiveness in
treatment of krauroz reaches 90 – 95%:

  • absolute security;
  • painlessness of the method;
  • fast healing;
  • scars are not formed;
  • does not require hospitalization;
  • one session is enough;
  • good cosmetic effect;
  • no side effects and complications;
  • impact on atypical cells only;
  • short postoperative period and rapid recovery
    working capacity.

Drug treatment

Besides физиотерапии при краурозе вульвы применяют и лечение
drugs. Drug therapy for this
The disease is carried out both locally and systemically. For outdoor
treatments are prescribed ointments and creams, which include hormones.
Applications of creams on the vulvar area are held 1 – 2 times a day.
Preparations for local treatment:

  • cream with estrogen (estriol, permarin) – applied twice in
    day, the course is 2 – 3 weeks (does not stimulate growth
    endometrium, but not indicated for women of reproductive age);
  • Progesterone cream (Pradzhisan, Krahnon) – also applied
    twice a day for 3-4 weeks, optimal for treatment
    krauroz in young women;
  • ointment with 2% testosterone – has a pronounced antipruritic
    action, increases the elasticity of the tissues of the vulva, applied twice in
    day, course duration 2 – 3 weeks;
  • Glucocorticoid ointments reduce skin susceptibility
    histamine receptors, reduce the permeability of vascular walls,
    exudation and itching, tone up blood vessels, have anti-inflammatory
    effect, have a local immunosuppressive effect (1%
    hydrocortisone ointment, 0.5% prednisone ointment, 0.5%
    butesonide).

In addition to hormonal ointments, ointments are used for local treatment.
with vitamin A and diphenhydramine, and in the case of cracks and their
infections are prescribed antibacterial ointment.

Systemic therapy includes the appointment of anti-allergic
drugs (tavegil, claritin), sedatives (motherwort, tincture
peony or valerian) and tranquilizers (seduxen, phenazepam),
hormonal drugs (estrogen and progesterone), vitamins E and
A and biostimulants (aloe extract, vitreous body) and
immunomodulators (polyoxidonium, taktivin). With необходимости
(the development of the inflammatory process in the field of microtraumas) are assigned
antibiotics.

Traditional methods of treatment

With лечении крауроза используются и народные средства, но только
as an addition to the main method of therapy. Many patients
warm baths with calendula, chamomile and
succession (you can brew all the herbs both together and along
separately). Baths are held at least 3 times a week.

Effective and overlay compresses of chopped greens
parsley, chicken egg protein with the addition of a small amount
sea ​​salt. It is also assigned to receive a decoction of the following
grasses: series, tricolor violet, strawberry leaf, field horsetail,
black currant leaf and nettle, yarrow and burdock root.
This decoction is taken in 100 ml three times a day. for three
months.

Surgery

Currently, surgery for sclerosing
deprived are rarely held due to the high risk
recurrence of the disease and the development of cosmetic and complications
defects. Usually, оперативное вмешательство выполняется в
case of violation of anatomical structures (stenosis of the vestibule
влагалища или уретры, синехии малых labia and прочие). But at
ineffectiveness of conservative treatment are minimally invasive
surgical procedures:

  • vulvar denervation;
  • laser ablation;
  • cryodestruction of affected areas.

If there is a suspicion of malignancy,
a vulvectomy is performed.

Prognosis and complications

The prognosis for sclerosing lichen for life is favorable, and for
diseases are unfavorable because the process is chronic and
progressive. Complications include the process of malignancy
(malignancy), which is possible in 4 – 8% of cases.

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