Vaginal stenosis after toxic epidermal necrolysis.

A 17-year-old adolescent girl developed severe toxic epidermal necrolysis after inhalation of methamphetamine. Recovery was complicated by vaginal synechiae and occlusion necessitating surgery.

Women's perception of the outcome of the surgical management of vulvar intraepithelial neoplasia.

OBJECTIVE: To assess women's perception of the effects of vulvar surgery for vulvar intraepithelial neoplasia (VIN). STUDY DESIGN: Women attending a vulvar clinic for routine follow-up after surgical treatment of VIN were invited to respond to a brief questionnaire relating to their perception of vulvar appearance and sexual function. Clinical details, including the patients' age, parity, the focality and size of the lesion, types of treatment and length of follow-up, were extracted from the medical records. The diagnosis of VIN was made according to the histologic criteria of the International Society for the Study of Vulvovaginal Disease. RESULTS: Only 2 of 70 (3%) women expressed dissatisfaction following surgical treatment. One woman described vulvar disfigurement and the second had diminished sexual satisfaction following surgery. CONCLUSION: There is a high level of patient satisfaction following conservative surgery for VIN.

Lipedematous scalp in a child.

A nine year old Maori girl was noted to have a spongy consistency to her posterior scalp. The overlying skin appeared normal, as was hair growth in that area. The abnormal findings became more extensive over the subsequent year. A computerized tomography scan showed diffuse thickening of subcutaneous tissues posteriorly on the scalp. A skin biopsy specimen showed a normal epidermis with a thick layer of mature subcutaneous fat and some disruption of the subcutaneous architecture. The clinical features and investigations were consistent with a diagnosis of lipedematous scalp, which has been described predominantly in adult women and is usually associated with alopecia. This condition has not been reported previously in the pediatric literature.

Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 405 women.

OBJECTIVE: To determine the clinical characteristics, outcome following surgical treatment, and natural history of cases of untreated vulvar intraepithelial neoplasia (VIN). METHODS: Four hundred five cases of VIN 2-3 seen between 1962 and 2003 were reviewed. RESULTS: The mean age of women with VIN decreased from 50.0 years before 1980 to 39.0 in subsequent years. After treatment of VIN by excision and/or laser vaporization, half the women required at least one further treatment by the 14th year. It is estimated that 50% of women with positive surgical margins had at least one further treatment within 5 years, but only 15% of women with negative surgical margins required further treatment. Invasive vulvar, perianal, or urethral carcinoma occurred in 17 (3.8%) women (mean age 42 years) after treatment. Nine (2%) cases represented treatment failure, with a median treatment-to-invasion interval of 2.4 years. Eight (1.8%) cases represented new "field" carcinomas, with a median initial treatment-to-invasion interval of 13.5 years. Ten untreated cases, aged 32-76 years (mean age 55 years), progressed to invasion in 1.1-7.3 years (mean 3.9 years). Age, previous pelvic radiotherapy, unifocality, immunosuppression, and association with multicentric neoplasia were not risk factors for the development of invasive vulvar carcinoma in this study. Spontaneous regression of VIN occurred in 47 women (mean age 24.6 years), with a median interval to complete regression of 9.5 months. CONCLUSION: Surgically treated VIN has a high rate of recurrence. Untreated VIN in women over 30 years has an appreciable invasive potential.

Idiopathic granulomatous vulvitis.

A 20-year-old woman initially presented with clinical evidence of an acute vulval inflammatory disorder incorrectly diagnosed as a Bartholin's abscess. Prolonged healing associated with infection followed attempts to incise and biopsy the area. Over a decade the condition has followed a chronic course with exacerbations and remissions and the vulva has become progressively more swollen and distorted. Lymphangiomas have developed. Histology showed non-necrotizing granulomas. Investigations for Crohn's disease and sarcoidosis were negative. Prednisone resulted in improvement during acute inflammatory episodes.