Lipschütz ulcer

Lipschütz ulcer, ulcus vulvae acutum or reactive non-sexually related acute genital ulcers (English: acute ulceration of the vulva) is a rare disease characterized by painful genital ulcers, fever, and lymphadenopathy, occurring most commonly, but not exclusively, in adolescents and young women.[2] Previously, it was described as being more common in virgins.[3] It is not a sexually transmitted disease, and is often misdiagnosed,[4][5] sometimes as a symptom of Behçet's disease.[6]

Lipschütz ulcer
One of the first published cases of Lipschütz ulcer[1]

Lipschütz ulcer is named after Benjamin Lipschütz, who first described it in 1912.[1][5] The cause is still unknown, although it has been associated with several infectious causes, including paratyphoid fever, cytomegalovirus, Mycoplasma pneumoniae and Epstein-Barr virus infection[7][8][9][10]

Signs and symptoms

The most common presentation is a single large, deep ulcer (although several smaller ulcers may occur) in the internal surface of one or both labia minora.[11] The labia majora may be affected, as may the vagina and urethra. The ulcer develops very quickly, and is usually preceded by sudden onset of fever and malaise.[11]

Diagnosis

The diagnosis is mainly clinical and centred in eliminating other more common causes for vulvar ulcers. Nevertheless, it has been proposed that Epstein-Barr detection using polymerase chain reaction for virus genome can help to reach sooner a diagnosis.[7]

Treatment

Treatment is symptomatic, and usually of little value; in most cases, the ulcer heals spontaneously within four to six weeks, sometimes leaving scars. Topical analgesics and anesthetics, as well as topical application of disinfectants/astringents such as potassium permanganate (in sitz baths), is commonly used.[11] In severe cases, a combination of systemic glucocorticoids and broad-spectrum antibiotics has been recommended.

Epidemiology

The disorder typically appears among young girls and adolescents but cases in children as young as 17 months have been reported.[7]

History

The disease was first described in October 1912 by Galician-born Austrian dermatologist and microbiologist Benjamin Lipschütz, who published a series of four cases in girls aged 14 to 17.[1] He initially ascribed the ulcer to infection with "Bacillus crassus" (Lactobacillus acidophilus).[1][5]

See also

References
  1. Lipschütz B (October 1912). "Über eine eigenartige Geschwürsform des weiblichen Genitales (Ulcus vulvae acutum)". Arch Dermatol Res (in German). 114 (1): 363–96. doi:10.1007/BF01973166. S2CID 11890180.
  2. Vieira-Baptista, Pedro; Lima-Silva, Joana; Beires, Jorge; Martinez-de-Oliveira, José (2016-03-01). "Lipschütz ulcers: should we rethink this? An analysis of 33 cases". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 198: 149–152. doi:10.1016/j.ejogrb.2015.07.016. ISSN 1872-7654. PMID 26297242.
  3. Török L, Domján K, Faragó E (2000). "Ulcus vulvae acutum". Acta Dermatovenereologica Alpina, Pannonia et Adriatica. 9 (1). ISSN 1581-2979.
  4. Kluger N, Garcia C, Guillot B (October 2009). "[Lipschütz acute genital ulcer]". J Gynecol Obstet Biol Reprod (Paris) (in French). 38 (6): 528–30. doi:10.1016/j.jgyn.2009.08.005. PMID 19744804.
  5. Lipschütz' ulcer at Who Named It? Retrieved on 2009-12-04.
  6. Braun-Falco O, Plewig G, Wolff HH, Burgdorf WH, Landthaler M, eds. (2005). "Erkrankungen des weiblichen Genitales". Dermatologie und Venereologie (in German). Berlin: Springer. p. 1030. ISBN 978-3-540-40525-2.
  7. Burguete Archel E, Ruiz Goikoetxea M, Recari Elizalde E, Beristain Rementería X, Gómez Gómez L, Iceta Lizarraga A (May 2013). "Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection". Eur. J. Pediatr. 172 (8): 1121–3. doi:10.1007/s00431-013-2013-8. PMID 23636284. S2CID 189872655.
  8. Pelletier F, Aubin F, Puzenat E, et al. (2003). "Lipschütz genital ulceration: a rare manifestation of paratyphoid fever". Eur J Dermatol. 13 (3): 297–8. PMID 12804994.
  9. Martín JM, Godoy R, Calduch L, Villalon G, Jordá E (2008). "Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection". Pediatr Dermatol. 25 (1): 113–5. doi:10.1111/j.1525-1470.2007.00597.x. PMID 18304169.
  10. Vieira-Baptista, Pedro; Machado, Luísa; Costa, Ana Rosa; Beires, Jorge; Martinez-de-Oliveira, José (2013-07-01). "Mycoplasma pneumoniae: a rare cause of vulvar ulcers or an undiagnosed one?". Journal of Lower Genital Tract Disease. 17 (3): 330–334. doi:10.1097/LGT.0b013e3182710896. ISSN 1526-0976. PMID 23486069. S2CID 145823.
  11. Heller DS, Wallach RC (2007). Vulvar disease: a clinicopathological approach. Informa Healthcare. pp. 51–2. ISBN 978-0-8493-3793-2.
Classification
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