Vulvar herpes: clinics and therapy

Vulvar herpes: clinics and therapy

Stefano Astorino – Orcid

Operational unit of dermatology and stds – “Celio” Military Polyclinic, Rome

stefano.astorino.sa@gmail.com


DOI: 10.53146/lriog1202111

Abstract

Most young people with erosive-ulcerative-genital lesions (“Genital Ulcer Disease”) have genital herpes (prevalence 5-40%), sometimes associated with syphilis or other sexually transmitted diseases, with a significant risk of co-infection with HIV.
Also transmissible in asymptomatic (virus shedding) or “undiagnosed” due to mild, atypical symptoms (fissures, erythema, neuralgia), or hidden localizations, the primary infection of vulvar herpes (HSV2-1) has classic acute manifestations: pain, burning (sometimes sciatica, cruralgia, antalgic urinary retention), cluster vesicle- pustules on erythematous-edematous areas that evolve into confluent-polycyclic erosions, often ulcerative-aphthous-like; satellite lymphadenitis, fever sometimes high. In 1-3 weeks they heal (completely the erosions; ulcers with scars); after weeks or months of latency the secondary herpes relapses on average 5-6 times a year, with variable duration (on average 1 week). Relapsing symptoms and signs, similar to primary-Herpes, are more localized and attenuated, except in immunosuppressed, who manifest chronic, severe-ulcerative, disabling, hypertrophic-pseudo-tumor, generalized-varicelliform forms. Possible cause of fetal malformations, neonatal morbidity and lethality, herpes in pregnancy is effectively treated with systemic acyclovir. Sometimes it justifies caesarean-section. According to European-guidelines (2017), the diagnosis is clinical (when possible supported by PCR); topical antiviral-therapy offers few advantages (except foscarnet 1% in case of resistance and imiquimod 5% effective in HIV-associated pseudotumoral-forms) compared to local soothing-antiseptic and anti-inflammatory (including cortisone) therapy. Acyclovir (ACV), since its discovery (Elion_G.B.1978) the best systemic antiherpetic, is effective both with “episodic-therapy” (average adult dose: ACV tbl 200-800mg 3t./die for 7-10 days in primary-Herpes, for 2-5 days at each relapse) both with “continuous-suppressive-therapy” (if>6 relapses a year a.a.d.:ACV400mg 2t./die or similar: Famciclovir FCV 250mg 2t./die, Valaciclovir VLC 500mg 1t./die; replaceable in case of resistance with Foscarnet 40mg / kgI.V./8-12h.).

Keywords: vulvar herpes; HSV2-1; genital herpes; systemic antiviral therapy; topical therapy; guidelines.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Genital filler – the 5Ws – What, Who, Where, When, Why?

Genital filler – the 5Ws – What, Who, Where, When, Why?

Elena Fasola – Orcid

Gyplast Medical Institute, Milan

 

fasolaelena@yahoo.it


DOI: 10.53146/lriog1202110

Abstract

The recent introduction of injectable products in the market, hyaluronic acid based, indicated to counteract the signs and symptoms of tissue atrophy in vulvar area, inevitably generates the need to deepen the subject. The focus will be placed on the biochemical peculiarities and the ractional use of these products, to clarify how they are “processed” before being put on the market and therefore of what is infiltrated into the tissues at the end of the production process; what is the precise anatomical site in which they can be used, for what indications, with what techniques, contraindications and side effects. Among the products based on hyaluronic acid, first it is important to dwell on the big difference between non- cross-linked and cross-linked gels hyaluronic acid based, having themselves two different indications. The firsts are indicated for cutaneous and mucosal atrophy with eutrophication and biostimolating purposes, the seconds are used for iatrogenic scarring results, for example post-episioraffia or for reconstructive purposes in hypo / dystrophies of the fatty body of the Labia Majore and in macroscopic iatrogenic scarring with tissue loss. Also the technique by which they are injected is different (with needle or blunt tip cannula), with different contraindications and side effects. With a practical slant, the author intends to develop the topic with the aim of providing valid help to the doctor in his practical clinic.

Keywords: injectable hyaluronic acid; vulvar filler; atrophy; iatrogenic scarring; needle; cannula.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Covid: related cutaneous and mucosal lesions

Covid: related cutaneous and mucosal lesions, focus on vulvar and perineal area

Gabriella Fabbrocini1 – Orcid, Lucia Gallo2 – Orcid

1 – Dermatological Clinic, Department of Clinical Medicine and Surgery, University of Naples Federico II

Corresponding author: Gabriella Fabbrocini

gabriella.fabbrocini@unina.it


DOI: 10.53146/lriog120219

Abstract

The novel coronavirus disease (COVID-19) is associated with significant morbidity and mortality. While much of the focus has been on the cardiac and pulmonary complications, there are several important dermatologic components that clinicians must be aware of. There are several types of skin findings described in association with COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, purpura, chilblains. While most of these dermatologic findings are self-resolving, they can help increase one’s suspicion for COVID-19. It is important to be aware of the dermatologic manifestations and complications of COVID-19. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications.

Keywords: covid-19; coronavirus; dermatology; skin; mucoses.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Lichen sclerosus

Lichen sclerosus

Paolo Inghirami1 – Orcid, Roberto Senatori– Orcid

1 – Medical Director, Obstetrics and Gynecology, S. Eugenio Hospital, Rome

2 – Freelance Professional, Villa Margherita Nursing Home, Rome

Corresponding author: Paolo Inghirami

inghiramip@tiscali.it


DOI: 10.53146/lriog120218

Abstract

Lichen Sclerosus (LS) is a chronic inflammatory disease of genital and extra-genital muco-cutaneous districts, presenting a double pick of incidence in pre-puberty and peri-post menopausal women. The pathognomonic symptomatology is represented by itch, but also pain, dysuria, restriction of micturition and entry dyspareunia. If not treated, it might cause a significant and permanent subversion of vulvar anatomy with scarring of the clitoral hood, stenosis, and disappearance of skin reliefs. Uncertainty exists around its pathogenesis, however, there are important hypotheses involving an autoimmune target for its formation and progression. The gold standard in treatment is topical steroids. Second line treatment includes calcineurin inhibitors, phototherapy, plated-rich plasma therapy, fractional Co2 laser. Surgery is reserved only for the treatment of obliterative complications such as introital stenosis. Patient education and long follow up have primary importance.

Keywords: lichen sclerosus; itching; topical steroids; differentiated VIN.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Bartholini’s gland cysts

Bartholini’s gland cysts

Franco Anglana – Orcid, Michela Angelucci – Orcid

 

Corresponding Author: Franco Anglana

franco.anglana@gmail.com


DOI: 10.53146/lriog120217

Abstract

Bartholin’s glands are symmetrical vestibular tubular glands that produce a clear, transparent fluid to lubricate the vulval vestibule. When the opening of these glands becomes obstructed, the fluid remains within the gland, causing a cyst. This condition is more frequent in nulliparous women and is rare in menopausal and postmenopausal women. The overall prevalence is 2%, and the average age of the patients is 20-29 years. If the fluid becomes infected with bacteria, the cyst develops an abscess. The most frequently isolated pathogens are Escherichia coli, Neisseria gonorrhoeae and Chlamydia trachomatis. The main symptom is a tender, painful lump near the vaginal opening associated with discomfort while walking or sitting and pain during intercourse. When taking a medical history, doctors should research triggers that might cause the duct to become obstructed (previous infections, poor hygiene, tight clothing, hair removal, oestrogen/progestin use and consequent vulvar atrophy). Bartholin’s cysts are easily diagnosed by clinical examination: no laboratory or radiographic tests are necessary. However, surgery is required to treat them. Marsupialization consists of suturing the cyst wall open to ensure the gland can drain freely, thus restoring its anatomical and functional integrity.

Keywords: cyst; abscess; bartolini gland; vulvar swelling; vulvar neoformation.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Clitoris: target of many vulvar diseases

Clitoris: target of many vulvar diseases

Pietro Lippa1 – Orcid, Federica Frascani2 – Orcid

1 – AIED, Viale Gorizia 14, Rome

2 – BIOS Via Archimede 12, Rome

Corresponding author: Pietro Lippa

dermatologopietrolippa@gmail.com


DOI: 10.53146/lriog120216

Abstract

This article aims to bring attention to how frequently the clitoris, despite being a small anatomical niche within the vulvar region, deserves careful diagnostic observation.
In fact, various inflammatory diseases often originate in the clitoral area and have specific clinical, symptomatic and perceptive characteristics. Lichen planus and scleroatrophic lichen are among the most frequent inflammatory vulvitis to originate in this anatomical region.
We describe in the morphological details all the diagnostic phases of these two pathologies. Often the pathologies affecting the clitoral area are subject to diagnostic delays for subjective reasons of the patients (delays in medical checks, long periods of tolerance of the disorders) or due to lack of attention from clinicians. We want to underline how an early intervention can determine a partial regression of an initial damage, its stabilization and, therefore, an improvement in the patient’s subjective perception with considerable advantages also for the relationship life. The clitoral area, being placed above the vulvar introitus, can very often be subject to in-depth observations. An adequate diagnostic observation, also with the help of the colposcope, a targeted biopsy and a consequent therapeutic behavior suitable for the clinical evolutionary phase in which the pathology itself is located, would also allow to intercept the possible proliferative changes that initially occur indeed in this anatomical site. On the basis of an algorithm based on these observations, it is possible to opt for drug therapy or non-invasive surgical therapy aimed at preventing and removing initially and potentially aggressive lesions.

Keywords: lichen sclerosus; lichen planus; vulva; clitoris; diagnosis; initial forms.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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