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