Leukoplakia of the labia minora. Leukoplakia of the vulva: a serious disease of the female genital organs

Diseases of the mucous membrane caused by the deposition of keratin - horny substance - in the cells are known collectively as leukoplakia. Most often they affect the genitals.

Under the influence of certain factors, the cells of the squamous epithelium lining the external genitalia begin to multiply too quickly - this leads to this kind of changes.

Although vulvar leukoplakia is traditionally considered a disease of the elderly, recently it is increasingly affecting women who are far from menopause, and sometimes children.

Risk factors

Modern medicine cannot say with absolute certainty what exact reasons were the impetus for the development of leukoplakia in each specific case, but the factors that provoke the onset of the disease are well known. This

• chronic diseases: inflammatory processes in the genital organs, genital herpes, human papillomavirus,
• genital injuries,
• cervical dysplasia,
• insufficient personal hygiene,
• metabolic disorders, excess weight and diabetes,
• lack of vitamins, especially those that are important for maintaining healthy skin and mucous membranes.

These factors are especially dangerous after the age of 40 and at the onset of menopause, however, in principle, they can cause changes in the vulvar mucosa in women of any age.

Vulvar leukoplakia is diagnosed much less frequently in children, however, given that girls up to a certain age do not undergo regular preventive gynecological examinations, you need to be very attentive to the appearance of its signs in order to immediately consult a doctor.

Signs of leukoplakia

The first signs that a woman feels when leukoplakia develops can easily be confused with the symptoms of many gynecological diseases: this is itching in the external genital area, which intensifies after urination, with intense movement (during sexual intercourse or when walking), sometimes in combination with noticeable swelling of the vulva .

The appearance of such symptoms means that there is an urgent need to visit a gynecologist. It is during a gynecological examination that specific signs of the disease are revealed - thin grayish-white films that are easily removed with a tampon, and later - spots of the same color and denser plaques, the thickness of which can reach several millimeters. At the next stage, individual lesions grow so large that they actually merge; cracks and inflammation are often found on them.

To make an accurate diagnosis, a visual examination is supplemented with colcoscopy and cytological analysis: this allows not only to determine the extent of changes and the boundaries of neoplasms, but also to clarify their nature, since leukoplakia is considered a precancerous condition.

Kraurosis and leukoplakia

In terms of subjective sensations and the course of the disease, kraurosis and vulvar leukoplakia are very similar, although with kraurosis there are no horny seals. It begins with a violation of blood microcirculation in the genital organs, gradually the tissues lose elasticity, the skin becomes dry, and the mucous membrane atrophies.

To correctly diagnose the disease, colcoscopy, cytological analysis, and biopsy are also used. Cases when kraurosis is combined with leukoplakia are especially dangerous for malignant degeneration.

Treatment

The decision on how to treat vulvar leukoplakia is made by a gynecologist, often together with an oncologist. It depends on the degree and nature of the changes and pursues such goals as reducing the symptoms of the disease and preventing the malignant degeneration of plaques. As a rule, this is a long-term complex treatment that requires regular monitoring by a doctor. Often, along with traditional treatment, the doctor prescribes well-proven folk remedies.

Traditional Treatments

1. Drug therapy

First of all, this is the use of anti-inflammatory, anti-itch and antihistamines, most often in the form of suppositories, vaginal balls, creams, ointments. Based on the test results, the doctor may prescribe internal anti-inflammatory drugs: tablets or injections.

If hormonal correction is necessary, prednisolone, estrogen and estriol preparations are prescribed.

As a rule, vitamin complexes are prescribed, especially a course of vitamin A, which is responsible for the health of the epithelium.

2. Physiotherapeutic procedures

Physiotherapy is aimed at strengthening the body's defenses, normalizing metabolism and hormonal levels, and has an additional anti-inflammatory effect.

3. Surgery

Surgery is not always a last resort; sometimes such methods are used in the early stages if therapeutic treatment has proven ineffective. It consists in the fact that foci of leukoplakia are excised with a scalpel (sometimes a more gentle instrument is used - a radio knife). After healing and the formation of a healthy epithelium, it is necessary to take preventive measures to prevent the recurrence of the disease.

If the disease is advanced, vulvar extirpation is possible: this is a radical operation, which, however, does not serve as a guarantee against relapses.

4. Hygiene measures

When identifying and treating vulvar leukoplakia, careful hygiene of the genital organs is of great importance. It is important to prevent cracks from appearing and becoming infected, as well as to reduce irritation and itching.

Therefore, it is not recommended to use soap; it is more correct to perform hygiene procedures with warm boiled water, or even better with chamomile/calendula decoctions. A noticeable positive effect comes from avoiding synthetic tampons, pads, and underwear made from non-natural materials.

5. Catering

The diet recommended for leukoplakia is aimed at reducing the risk of allergenic and carcinogenic effects. It involves avoiding fatty, smoked, spicy, black tea and coffee (green tea, on the contrary, is recommended because it has strong antioxidant properties), and alcohol.

Folk remedies

When vulvar leukoplakia is detected, treatment with folk remedies is not the main thing, but in combination with traditional medicine methods it gives a good effect.

In addition to chamomile and calendula, with their general sedative and anti-inflammatory effects, treatment with decoctions is practiced in folk medicine

• Veronica officinalis (orally up to 300 ml daily, also douching and sitz baths),
• boron uterus (drink 1 glass daily, the course of treatment is 1 month, after which a break of the same duration is necessary),
• a collection of equal parts of Veronica officinalis, oregano, chamomile, yarrow, stinging nettle, knotweed and fireweed (this decoction is also taken orally: two glasses should be drunk during the day).

Even with timely detection of vulvar leukoplakia and an integrated approach, treatment requires time and patience, and after its completion, relapses of the disease are possible. Therefore, such patients should be regularly observed by a gynecologist and undergo the necessary examinations.

Leukoplakia is a disease in which the mucous membranes undergo changes in the form of keratinization of the integumentary multilayer epithelium (dyskeratosis phenomenon). In gynecology, leukoplakia of the vagina, labia and vulva, cervix, and clitoris is more common, with white or grayish spots appearing on the surface of these organs. Treatment of leukoplakia should begin as early as possible, because the pathology is considered precancerous: in 5-15% of cases it degenerates into a cancerous tumor. But some types of the disease (simple form) do not have atypical cells, and therefore are considered relatively safe. The disease is usually diagnosed at the age of 40 years and older, and its causes are not always clear. Among all cervical pathologies, leukoplakia accounts for up to 3-7%.

Types of leukoplakia

The classification includes the division of pathology into 3 forms:

1. simple leukoplakia;
2. scaly leukoplakia;
3. erosive leukoplakia.

Simple leukoplakia of the cervix is ​​not visible during a gynecological examination, being detected only after colposcopy with staining. It is a thin film of grayish color, dry to the touch, somewhat rough, but not protruding above the surface of the mucous membrane. Simple leukoplakia is a disease that often affects the vaginal walls and the labia area.

With squamous leukoplakia, the affected epithelium thickens, its structure becomes tuberous. The color of the spots is gray, white, they protrude above the surface of the vaginal mucosa and cervix by 1-3 mm. Often the spots are layered one on top of the other, with large areas of the genital mucosa becoming lumpy. The disease is easy to detect during a routine gynecological examination. Treatment is mandatory: after the occurrence of scaly leukoplakia, cancer most often develops.

The erosive type of pathology causes the appearance of white spots that go deep into the upper layer of the mucosal epithelium in the form of erosions. They can have varying degrees of severity and unequal sizes, and cracks often form on erosions. This type of disease almost always gives a clear clinical picture.

The last two forms of the disease are considered proliferative. After proliferative transformation, the differentiation of the mucous membrane into layers is disrupted, elements of an atypical structure appear, that is, the initial focal stage of the precancerous process occurs. Gradually, proliferative forms of leukoplakia develop into dysplasia, or intraepithelial neoplasia.

According to another classification, leukoplakia is divided into:

1. primary (actually, one of the above types of disease);
2. secondary (leukoplakia becomes a symptom of another disease, for example, genital syphilis).

Causes of leukoplakia

Currently, the exact causes of the disease are a controversial issue. Most experts agree that the basis for the initiation of the pathological process is hormonal imbalances, which develop a lack of estrogen - female sex hormones. When studying the hormonal status of patients, an incorrect ratio of estradiol and other estrogens in the blood is also revealed. Oddly enough, progesterone deficiency with hyperestragenia can also become a prerequisite for the development of leukoplakia. Women diagnosed with the disease often have abnormal menstrual cycles (eg, amenorrhea).

The causes of leukoplakia are often associated with injury to the mucous membrane of the vagina, labia or cervix. Thus, in a significant proportion of women, symptoms of cervical leukoplakia arose after cauterization of erosions by electrocoagulation. Sometimes the disease occurs after abortion, curettage and other manipulations affecting the vagina and cervix.

It has been noted that the causes of leukoplakia of the genital organs in women are often associated with dystrophic changes in the mucous membrane in chronic vaginitis, endometritis, adnexitis, with involutional processes in the body, and occur with recurrent ectopia.

Risk factors for the development of leukoplakia may include:

• work in conditions of occupational hazards;
• smoking;
• complicated heredity (family history of dyskeratosis);
• vitamin deficiencies (especially vitamin A deficiency);
• STIs (ureaplasmosis, chlamydia, genital herpes, HPV);
• decreased local and general immunity;
• poor sexual hygiene.

Sometimes leukoplakia worsens during pregnancy, when serious hormonal changes occur in the body. Labor with trauma to the cervix can also contribute to the rapid progression of the disease.

Symptoms of leukoplakia

When examining the cervix or vaginal walls, lesions are detected in the form of individual grayish-white spots, or group or extensive damage to the mucous membrane is observed. Often, widespread, advanced pathology is combined with cervical hypertrophy or with scars and adhesions. At the initial stage, foci of leukoplakia are bright red areas of inflammation, and only later they become covered with a gray coating that cannot be removed with a gynecological spatula.

Clinical symptoms of simple leukoplakia are rare. But when pathological processes cover significant areas, the following may be observed:

• itching in the perineal area (usually at night);
• pain, discomfort during sexual intercourse;
• feeling of dryness in the vagina;
• feeling of tightness, irritation in the area of ​​the vulva, perineum;
• the appearance of microcracks on the labia;
• the formation on the external genital organs of areas similar to warts, erosion, flaking and cracking, with clear contours.

If the disease is not treated, gradually, against the background of simple leukoplakia, scaly or erosive leukoplakia with a tendency to proliferation may develop. The growth of lesions occurs not only in width, but also upward, resulting in the formation of a plaque of 2-3 mm. height. The plaques become lumpy, cracks and microerosions appear on them.

The disease exists for decades, but sometimes it can suddenly begin its malignant degeneration. The period of malignancy in women varies and takes from a year to several years. Typically, malignant lesions are externally unevenly compacted, and tuberosity and erosion occupy only a certain part of them. But even an apparently benign form of leukoplakia can be prone to transformation into cancer, so when it is detected, a histological analysis is always carried out.

Diagnosis of leukoplakia

The disease diagnostic program includes a routine gynecological examination, colposcopy and collection of material for cytological examination. If necessary, the doctor may recommend a smear test, a smear or blood test for antibodies to STI pathogens (if an infection is suspected) and other examinations.

Pathological changes in the epithelium of the mucous membrane of the genital organs are best visible when examined with a colposcope. It magnifies the image many times, allowing you to evaluate the structure and type of tissue. Additionally, a Schiller test is performed (staining cells with Lugol's solution). In this case, areas with atypical degeneration do not turn brown, but remain the same in color.

To perform cytology, a smear is taken from the cervix and vagina, as well as from the cervical canal. If leukoplakia occurs, a large number of dyskeracites and keratin are revealed in smears. According to indications, a biopsy is taken, after which a histological examination of the biopsy tissue is performed. If the analysis clearly shows epithelial dysplasia, the process is precancerous.

Another method for diagnosing the disease is microcolpohysteroscopy. During such a study, a specialist examines the condition of the epithelium of the genital organs and can also take a biopsy from abnormal areas. Leukoplakia should be differentiated from cervical dysplasia, erosions, and cervical cancer.

Medical and surgical treatment of leukoplakia

The treatment tactics for leukoplakia are determined by whether its simple or proliferative form has been detected. For complete recovery, it is necessary to remove all pathological foci. Cervical leukoplakia is not treated with medications, but treatment of concomitant pathologies is mandatory. It may include antiviral agents, antibiotics, anti-inflammatory, immunomodulatory agents, and hormonal drugs. You cannot prescribe drugs to accelerate tissue regeneration, which can stimulate the development of dysplasia.

If intraepithelial neoplasia is present, conization of the uterus or excision of the cervix is ​​often performed. Without the presence of precancerous changes, minimally invasive removal of leukoplakia lesions is carried out using modern techniques. After the procedure, which is performed under local (less commonly, general) anesthesia, the recovery period lasts 2-8 weeks. During this time, you cannot be sexually active or use any methods of contraception.

Chemical coagulation

This method is most often used to treat vulvar leukoplakia. Chemical coagulation, or cauterization of leukoplakia lesions using special preparations, is performed by Solkovagin. Treatment involves treating the affected areas with this substance, excluding healthy areas of the mucous membrane. This method of therapy is practically painless and very effective: recovery after it is observed in 75-96% of women.

Electrocoagulation

Treatment with electrocoagulation is the cauterization of leukoplakia using an electric current. Despite the complete removal of plaques and erosions, serious side effects often develop after this technique. These include implantation endometriosis, severe bleeding, exacerbation of ovarian diseases, menstrual irregularities, and tissue infection. Therefore, electrocoagulation of leukoplakia is not often used.

Cryodestruction

Cold treatment, or treating areas of leukoplakia with liquid nitrogen, promotes tissue death and rejection. The procedure takes no more than 5 minutes, is painless, and is performed once. The effectiveness of the technique reaches 96%. The remaining 4% are relapses, and in most cases they occur in women with hormonal imbalances in the body.

Laser cauterization

Laser removal of leukoplakia is a modern and, along with cryodestruction, the most preferred treatment for the disease. The technique eliminates direct contact with tissues, is completely aseptic, and does not cause pain. There is also no bleeding after the procedure, because the laser beam seals the damaged tissue, preventing microbes from penetrating into them. If the disease covers large areas of the genital organs, treatment is carried out in several stages. Complete tissue healing occurs in 4-5 weeks.

Radio wave cauterization

Radio wave treatment of leukoplakia is no less effective than laser treatment, but is somewhat more expensive. It is recommended to nulliparous women who are planning a pregnancy in the near future. The procedure is performed using a radio knife, which evaporates the affected areas using high temperature. This treatment method does not require anesthesia and does not cause bleeding or septic complications.

Folk remedies for leukoplakia

Doctors do not recommend treating leukoplakia with folk remedies if it involves the use of tampons or douching, because the procedure itself can intensify the growth of plaques and keratinization, and cause bleeding from erosions and cracks. Also, using exclusively traditional methods, you can waste time and not detect cancer in time. But after diagnosis and treatment, the following recipes can be used in parallel:

1. Shallow washing of the external genitalia with infusions of chamomile, calendula, eucalyptus, St. John's wort twice a day for 14 days. Infusions are prepared based on the norm: 4 tablespoons of raw materials per liter of boiling water, leave for 1 hour.
2. For leukoplakia of the vulva, you can gently rub this ointment into painful areas. Melt 100 gr. palm oil in a water bath, add 3 grams. calendula tincture, 10 ml. glycerin, 1 ml. vitamin A, 2 ml. propolis tinctures and eucalyptus tinctures. After cooling the ointment in the refrigerator, it is applied twice a day, without rinsing, for 10 days.
3. You can take an infusion of boron uterus internally, which improves the functioning of the reproductive system in women. It is prepared by brewing 2 tablespoons of herbs with a glass of boiling water. Take 50 ml. four times a day in a course of 21 days, excluding menstruation.

Leukoplakia during pregnancy

The combination of leukoplakia and pregnancy, as a rule, greatly frightens a woman when a pathology is detected during a standard examination. The disease itself does not have a harmful effect on the baby or the pregnancy. But there is a risk for the expectant mother herself, since hormonal and immune changes and stretching of the uterus often provoke the progression of leukoplakia. In severe cases, the disease during pregnancy can develop into cancer. If leukoplakia is identified at the planning stage, it is removed using low-traumatic methods. Often large foci of pathology have to be cauterized during gestation, especially if atypical cells are detected after cytological analysis.

Prevention of leukoplakia

To prevent the occurrence of leukoplakia, you must follow these rules:

• treat erosions, STIs, inflammations in the genital area in a timely manner;
• prevent any gynecological diseases from becoming chronic;
• exclude abortions;
• choose only reliable clinics for gynecological procedures;
• maintain intimate hygiene;
• have a permanent, trusted partner;
• treat menstrual irregularities as they arise;
• be regularly observed by a gynecologist;
• quit smoking.

If no relapse occurs within 2 years after treatment of leukoplakia, the woman is considered recovered, after which she is removed from the register.

– a chronic degenerative process of the vulvar mucosa, expressed by proliferation and increased keratinization of stratified squamous epithelium and further tissue sclerosis. Leukoplakia of the vulva is manifested by the presence of whitish plaques on the mucous membrane, itching, burning, and pain in the area of ​​the external genitalia. Leukoplakia of the vulva is diagnosed using a gynecological examination, vulvoscopy, Schiller test, and targeted biopsy. Treatment of vulvar leukoplakia is aimed at reducing the severity of its manifestations and maintaining immune defense; includes hormone therapy, physiotherapy; according to indications - surgical excision of single lesions or extirpation of the vulva.

ICD-10

N90.4

General information

It is the main manifestation of squamous cell hyperplasia - a dystrophic disease of the vulva with damage to the stratified squamous non-keratinizing epithelium. With leukoplakia of the vulva, the appearance of the horny and granular layers that are normally absent from the epithelium, the development of para- and hyperkeratosis, and acanthosis (without cellular and nuclear atypia or with atypia) are observed.

Most often, vulvar leukoplakia is observed during menopause and menopause. Leukoplakia of the vulva may precede or be combined with kraurosis of the vulva; Recently, their number has been increasing, and among young patients. With vulvar leukoplakia, there is a risk of developing cellular atypia and the potential for its degeneration into vulvar cancer (from 5 to 35% of cases), and when combined with kraurosis, this risk increases.

Classification of forms of vulvar leukoplakia

According to the severity of hyperkeratosis, three forms of vulvar leukoplakia are distinguished: flat (simple), hypertrophic and warty. Flat leukoplakia of the vulva is characterized by the appearance on the surface of the vulva of flat, smooth, whitish spots without visible signs of inflammation, which reappear after removal with a tampon. Flat leukoplakia can be observed in limited areas, and with a generalized process - on the extensive surface of the vulva.

In hypertrophic leukoplakia of the vulva, the lesions are represented by dry, convex plaques of a grayish-white color that cannot be removed from the vulvar mucosa. Leukoplakic plaques can sometimes merge with each other. Warty leukoplakia of the vulva is caused by significant growth and keratinization of limited lesions resembling warts; often complicated by the formation of cracks, erosions and the development of inflammation. Verrucous leukoplakia of the vulva is considered a precancerous condition.

Causes of vulvar leukoplakia

Modern data indicate a variety of etiological and pathogenetic factors that cause dystrophic changes in the genital mucosa in vulvar leukoplakia. Leukoplakia of the vulva is considered a kind of protective reaction to the action of various damaging factors, manifested in inadequate proliferation of the epithelium. Leukoplakia of the vulva develops against the background of chronic inflammation of the mucous membrane with the development of neuroendocrine, immune and metabolic disorders.

Risk factors for vulvar leukoplakia include age over 40 years; the presence of chronic inflammation of the genitals (including chronic papillomavirus infection and genital herpes serotype 2); cervical dysplasia; short reproductive period; metabolic disorders (diabetes, obesity); neglect of personal hygiene; repeated trauma and irritation of the vulvar mucosa; vitamin A deficiency.

Hormonal imbalance leading to vulvar leukoplakia is associated with age-related changes in the hypothalamic-pituitary system, hypofunction of the thyroid gland (hypothyroidism), adrenal cortex (adrenal insufficiency), ovarian dysfunction, and lack of estrogen during menopause and menopause. It is also believed that the occurrence of vulvar leukoplakia is based on a whole complex of psycho-emotional disorders.

Symptoms of vulvar leukoplakia

Leukoplakia of the vulva can be asymptomatic, without causing any discomfort in the patient. Manifestations of vulvar leukoplakia are most often observed in the clitoris and labia minora. With leukoplakia of the vulva, small, sometimes multiple whitish spots begin to appear on the mucous membrane. As a result of further keratinization, the surface of leukoplakia lesions acquires a grayish-white and pearlescent hue, epithelial plaques thicken and begin to protrude slightly above the surface of the mucosa. Slowly increasing in size, the plaques can merge and spread over a significant surface of the vulva. Leukoplakia lesions of the vulva are very persistent and do not disappear when treated.

When the tissues of the vulva become sclerotic and infected, constant severe itching and burning occurs, which intensifies at night, after urination, during movement and sexual intercourse; paresthesia (numbness, tingling) appears. The warty form of vulvar leukoplakia with dense keratinized growths is complicated by the appearance of painful and poorly healing chronic cracks, erosions and ulcers, which are accompanied by a microbial infection. The development of inflammation in vulvar leukoplakia is accompanied by swelling and hyperemia. Pain during sexual intercourse interferes with the patient’s intimate life and leads to the development of neuropsychiatric symptoms.

Diagnosis of vulvar leukoplakia

Diagnosis of vulvar leukoplakia is based on the patient’s complaints, the results of a gynecological examination, instrumental and laboratory tests. Since similar manifestations can also be observed in diabetes mellitus, various dermatoses (lichen planus, eczema, psoriasis, neurodermatitis), lupus erythematosus, syphilis, etc., it is necessary to carry out differential diagnosis with these diseases.

Patients with leukoplakia complain of itching and a burning sensation in the vulva area. During a gynecological examination, characteristic whitish lesions on the mucous membrane can be detected. Colposcopy (vulvoscopy) is mandatory, which in case of vulvar leukoplakia reveals a whitish-gray or yellowish color of the mucous membrane, a slightly transparent keratinized tuberous surface, and the absence or invisibility of the vascular pattern. Colposcopy also helps to identify the presence of dysplastic and atrophic processes in the genitals that accompany vulvar leukoplakia, and to exclude malignant neoplasms.

When performing the Schiller test with Lugol's solution, foci of vulvar leukoplakia do not stain and become clearly visible to the naked eye. A microscopic examination of the smear for microflora and oncocytological changes in the vulvar mucosa is also performed.

A targeted biopsy is performed from areas suspected of having vulvar leukoplakia, followed by a histological examination of the material, showing the nature of the changes in the cells and tissues of the mucosa. Carrying out a full diagnostic examination in gynecology allows us to identify vulvar leukoplakia with 100% accuracy. The detection of vulvar leukoplakia without signs of atypia allows us to consider it a background process, while with the presence of atypia – a precancerous condition.

Treatment of vulvar leukoplakia

Treatment of vulvar leukoplakia is complex and long-term, taking into account the age and concomitant diseases of the patient; includes drug therapy, diet, physical therapy, assistance from a psychotherapist, and, if necessary, surgical intervention. Physical therapy is recommended; walks in the fresh air, dairy-vegetable diet; carrying out hygienic procedures using boiled water and herbal infusions, avoiding soap, potassium permanganate, douching; elimination of irritating factors (woolen and synthetic underwear, tampons and synthetic pads). For leukoplakia of the vulva, hot baths and prolonged sun exposure are contraindicated.

Local anti-inflammatory and antipruritic treatment is prescribed using ointments, creams, vaginal balls with hormones, and antiseptics. In hormonal therapy, prednisolone, estrogens in combination with androgens, estrogen - progestin drugs, unconjugated estrogens and estriol derivatives are used (cyclically or in contraceptive mode for 2-3 monthly courses). It is possible to take vitamins and microelements, antihistamines, and for persistent itching - novocaine blockades.

Modern physiotherapy (ultraphonophoresis of drugs, oxygen therapy with modulation of brain rhythms) for vulvar leukoplakia has an anti-inflammatory, desensitizing effect, normalizes metabolic processes, hormonal and psycho-emotional levels, and strengthens the immune system. Correction of the psycho-emotional state using sedatives and techniques is an important element in the treatment of vulvar leukoplakia.

In the absence of effect from conservative treatment of vulvar leukoplakia, modern gynecology uses surgical excision of single foci of leukokeratosis with a scalpel, radio knife, as well as their removal using laser and cryodestruction. In severe cases of vulvar leukoplakia, a radical operation is performed - vulvar extirpation, which, if there are signs of malignancy, is combined with courses of radiotherapy.

Patients with vulvar leukoplakia are taken under dynamic dispensary observation by a gynecologist or oncologist (if the lesion is malignant) with mandatory colposcopic and cytological monitoring and repeated courses of treatment.

Forecast and prevention of vulvar leukoplakia

The flat form of vulvar leukoplakia is considered reversible, the warty form (in the erosion stage) is considered a precancerous condition. Prevention of vulvar leukoplakia consists of preventing and timely correction of hormonal imbalances in a woman’s body, treatment of associated inflammatory and metabolic disorders.

The periods of menopause and menopause are always associated with hormonal changes in a woman’s body and are often complicated by the appearance of various unpleasant symptoms and diseases. One of these gynecological ailments related to precancerous conditions is vulvar leukoplakia. At first, this disease can be completely asymptomatic, and in the absence of timely treatment, it can lead to the development of an oncological process.

Leukoplakia of the vulva (or lichen sclerosus) is a dystrophic disease of the vulva with manifestations of squamous hyperplasia of the stratified squamous epithelium lining the vulva. With this disease, the appearance of normally absent horny and granular layers in the tissues of the vulva is observed, which leads to the development of para- and hyperkeratosis. This disease can be combined with kraurosis of the vulva, and such clinical cases have been increasingly observed in the practice of gynecologists in recent years. With leukoplakia of the vulva, malignancy of cells and the development of vulvar cancer is observed in 13-30% of patients, and when combined with kraurosis, the risk of occurrence increases. Unfortunately, doctors also note the fact that this gynecological disease is becoming “younger” and is increasingly being detected in young women.

In this article we will introduce you to the causes, symptoms, methods of diagnosis, treatment and prevention of vulvar leukoplakia. This information will allow you to start treatment on time and prevent the development of severe complications.

Reasons

While modern medicine cannot give an exact answer about the cause of the development of vulvar leukoplakia in each specific clinical case, doctors are well aware of the factors that can lead to changes in the cellular composition of the vulvar epithelium. These include:

• chronic inflammatory diseases of the genital organs;
• erosion and dysplasia of the cervix;
• genital injuries;
• hormonal imbalance;
• infection;
• neglect of personal hygiene rules;

All these factors become especially dangerous after the age of 40 or during menopause.

Psychiatrists consider leukoplakia as a psychosomatic disease, which is provoked by a whole complex of psycho-emotional disorders and can be corrected by changing the way of thinking. As a rule, women with this diagnosis experience constant dissatisfaction with themselves and the actions of the people around them, place increased demands on themselves and deep distrust of their loved ones and relatives.

Much less commonly, vulvar leukoplakia develops in childhood. However, all of the above factors can cause changes in the vulvar mucosa in girls. That is why regular preventive examinations at this age become important, and when the first signs of the disease appear, you should immediately consult a doctor.

Symptoms

Sometimes vulvar leukoplakia is asymptomatic for a long time and women learn about its development during a routine or preventive examination with a gynecologist. Pathology can be detected accidentally during examination of the clitoris and labia minora. Small, usually multiple, whitish spots appear on their mucous membrane. Over time, they thicken, become keratinized, slightly rise above the surface of the mucosa and acquire a gray-white color with a pearlescent tint. Foci of changed mucosa can increase in size, merge and spread to a significant surface of the vulva. Patients often experience paresthesia in the form of numbness or tingling in the keratosis area.

When areas of leukoplakia are infected or sclerosed, a woman may notice the sudden appearance of swelling and complain of dryness, tension and tightness of the mucous membrane and skin in the genital area, intense, which intensifies at night or with movement, sexual intercourse and urination. Prolonged itching of the vulva leads to psycho-emotional disorders, exhaustion of the nervous system and loss of ability to work.

Multiple subepithelial hemorrhages may appear in areas of leukoplakia. In the later stages of the disease, hyperkeratosis and sclerosis reach their maximum. The mucous membranes become rigid, folded, and glossy-pearl in color. Telangiectasias and subepithelial hemorrhages appear on their surface. The labia majora become like thickened ridges, the labia minora are almost not defined, and the entrance to the vagina becomes sharply narrowed.

Classification of forms of leukoplakia

According to the severity of hyperkeratosis, leukoplakia can be:

1. Flat. Flat whitish spots appear on the vulva without signs of inflammation. After removal with a tampon, they appear again. The spots may be present in limited areas of the vulva, and with a generalized course they cover a large surface of the mucous membrane.
2. Hypertrophic. Foci of changes in the mucous membrane look like gray-white spots with clearly defined contours; they rise above the surface and sometimes merge with each other and cannot be removed with a swab.
3. Warty. The lesions are significant and have the appearance of warty growths. They may be complicated by ulcerations, inflammation, swelling and the appearance of redness, ulcers, cracks and erosions. This form of leukoplakia is considered a precancerous condition.

Leukoplakia of the vulva and pregnancy

In some cases, vulvar leukoplakia can develop during pregnancy. With the help of timely and well-prescribed drug therapy, it is usually possible to achieve a stable condition without progression of symptoms during gestation and in the early postpartum period. In such cases, women are advised to give birth naturally. In the presence of severe dryness, thinning, the presence of long-healing ulcerations, cracks and extensive foci of leukoplakia, a cesarean section is recommended for delivery.

Diagnostics

To establish a diagnosis, patients are prescribed the following types of examination:

• medical history and gynecological examination;
• general blood test;
• smear on flora from the urethra, vagina and cervix;
• PCR analysis for the presence of human papillomavirus to determine the type of virus;
• biopsy and histological examination;
• cytological examination of scrapings from the cervix and cervical canal for atypical cells;
• vulvoscopy (simple and advanced using dyes);
• colposcopy;
• aspiration of the contents of the uterine cavity and/or cervical canal followed by histological examination of the material;
• immunogram.

In the early stages of vulvar leukoplakia, differential diagnosis of this disease with diseases such as:

• neurodermatitis - itching also appears in other parts of the body, the epithelium is compacted, dry and thickened, the skin is reddened, with inflamed papules of a pink-brown color and has an enhanced pattern;
• – with this disease there are no areas of pigmentation, the itching is mild, there are no atrophic changes in the affected areas of the skin;
• diabetes mellitus – the tissues of the vulva are inflamed, swollen, pasty in consistency, severe itching;
• lichen planus - with this disease, the rashes are papular, multiple and tend to cluster; after opening the papules, areas of atrophy or sclerosis form on the skin with the formation of scar changes.

If a skin disease is suspected, a woman is recommended to consult a dermatologist.

If a woman develops psychoneurological disorders, a consultation with a psychotherapist is prescribed.

Treatment

All patients with vulvar leukoplakia are subject to regular follow-up with a gynecologist or oncologist (if there is a malignant lesion). To monitor the condition of areas of leukoplakia, examination methods such as cytological analysis and colposcopic examination are required.

Treatment tactics for vulvar leukoplakia depend on the degree and nature of changes in the vulvar mucosa and are aimed at eliminating the symptoms of the disease and preventing the degeneration of plaques into. At the initial stages of the disease, the patient is prescribed long-term complex conservative therapy, which requires constant medical supervision and monitoring of its effectiveness (based on test results).

Conservative therapy

For conservative treatment of vulvar leukoplakia, the patient is recommended:

• taking medications;
• proper implementation of hygiene measures;
• diet;
• physiotherapeutic procedures.

Drug therapy

To eliminate unpleasant symptoms of the disease, the following are prescribed:

• local drugs to eliminate inflammation: Baneocin, Elidel cream, Beloderm ointment, Dermovate ointment, Clobetasol propionate, etc.;
• local preparations to eliminate itching: Akriderm, Sinaflan ointment, Beloderm, Triderm, Celestoderm, Progesterone cream, etc.;
• : Tavigil, Loratadine, Clarisens, Fenkarol, etc.;
• local hormonal preparations: Estriol cream, Progesterone cream, Testosterone propionate ointment, etc.;
• antibacterial agents for topical use (for secondary infections): Levomikol, Chlorophyllipt oil solution, 5% Sintomycin liniment, Sintomycin suppositories, Chlorhexidine emulsion, etc.

To generally strengthen the body and improve the condition of the mucous membrane, it is recommended to take vitamin and mineral complexes.

If it is impossible to eliminate itching of the vulva with medications for external use, novocaine vulvar blockades and radio wave puncture of the skin of the vulva are prescribed.

In cases of severe inflammation and secondary infection, anti-inflammatory and antibacterial drugs may be prescribed in the form of tablets or injections. If necessary, drugs for immune correction are prescribed.

Patients with psychoneurological disorders are prescribed psychocorrection classes and the use of antidepressants and tranquilizers.

Hygiene measures

1. Avoid overheating the body.
2. Do not wear synthetic or tight-fitting underwear.
3. Avoid exposure to the sun.
4. Avoid taking hot baths, visiting saunas and steam baths.
5. To wash, do not use antiseptic solutions and soaps that dry out the skin, but use boiled water with the addition of soda (to soften) and herbal decoctions (chamomile, calendula, nettle, sage).
6. Don't douche.
7. Avoid using synthetic pads and tampons.

Diet