Nonneoplastic epithelial disorders of vulva Womens Hospital,School of Medicine Womens...

Nonneoplastic epithelial Nonneoplastic epithelial disorders of vulvadisorders of vulva

Women’s Hospital,School of MedicineWomen’s Hospital,School of Medicine Zhejiang UniversityZhejiang University

General ConsiderationsGeneral ConsiderationsVulvar nonneoplastic epithelial disorders Vulvar nonneoplastic epithelial disorders ：： a spectrum of chronic diseases represent a spectrum of chronic diseases represent

abnormalities of pigmentation and degeneration abnormalities of pigmentation and degeneration in vulvar skin and mucosa. in vulvar skin and mucosa.

previous name previous name 1966:1966: chronic vulvar dystrophy chronic vulvar dystrophy 19871987:nonneoplastic epithelial disorders of skin and :nonneoplastic epithelial disorders of skin and

mucosamucosa (ISSVD or ISGYP)(ISSVD or ISGYP)

Classification of skin diseases of vulvaClassification of skin diseases of vulva▆▆ Nonneoplastic epithelial disorders of skin and mucosaNonneoplastic epithelial disorders of skin and mucosa lichen sclerosuslichen sclerosus squamous hyperplasiasquamous hyperplasia other dermatosesother dermatoses

▆▆ Intraepithelial neoplasiaIntraepithelial neoplasia squamous intraepithelial neoplasiasquamous intraepithelial neoplasia mild dysplasiamild dysplasia moderate dysplasiamoderate dysplasia severe dysplasia or carcinoma in situsevere dysplasia or carcinoma in situ nonsquamous intraepithelial neoplasianonsquamous intraepithelial neoplasia paget’s diseasepaget’s disease tumors of melanocytes, noninvasivetumors of melanocytes, noninvasive

▆▆ Invasive tumors Invasive tumors

ISSVD 1987ISSVD 1987

Lichen sclerosus of Lichen sclerosus of vulvavulva

Usually characterized by thinning Usually characterized by thinning and atrophy of vulvar skin or skin and atrophy of vulvar skin or skin

around the anus.around the anus.

unknownunknown ：： geneticgenetic autoimmune diseaseautoimmune disease decrease or absence decrease or absence

of estrogen and of estrogen and androgenandrogen

EtiologyEtiology

Pathology Epidermis: hyperkeratosis, epithelial atrophy,

and flattening of the rete pegs; cytoplasmic vacuolization of the basal layer of cells

Upper dermis: edematous, pale-staining, acellular, homogenous collagen tissue

Deeper dermis: inflammatory infiltrate, mainly lymphocytic

Clinic featuresClinic features ■■symptomssymptoms

Intensive pruritusIntensive pruritus dyspareuniadyspareunia Burning sensationBurning sensation

■■ signsign Vulvar atrophyVulvar atrophy Color changes: whitishColor changes: whitish

History & clinic History & clinic symptomssymptoms

signsign Assistant examinationsAssistant examinations histologicalhistological

DiagnosisDiagnosis

Treatment Treatment （（ 11 ）） general general

treatmenttreatment drugs therapydrugs therapy physical therapyphysical therapy surgerysurgery

Treatment Treatment （（ 22 ））Local drug treatmentLocal drug treatment effectiveness:effectiveness: 80%80% recommend drugrecommend drug ：： 2% testosterone cream2% testosterone cream 0.3% progesterone cream0.3% progesterone cream 0.05% clobetasol0.05% clobetasol

Squamous cell hyperplasia of vulva

Squamous hyperplasia formerly: hyperplastic dystrophy characterized by benign hyperplasia

of squamous epithelial cells with vulvar pruritus.

unknownunknown ：：Moist environment of vulvaMoist environment of vulva

Repeatedly scratchRepeatedly scratch

EtiologEtiologyy

Pathology Epidermis: hyperkeratosis and acanthosis,

producing thickening of the epithelium and elogation of the rete pegs

Dermis: no inflammatory infiltrate present

Clinic featuresClinic features

symptomssymptoms More intensive More intensive

prurituspruritus

signsign Epithelial thickeningEpithelial thickening Color changesColor changes

History & clinic symptomsHistory & clinic symptoms signsign Assistant examinationsAssistant examinations histologicalhistological

DiagnosisDiagnosis

TreatmentTreatment general general

treatmenttreatment drugs therapydrugs therapy physical therapyphysical therapy surgerysurgery