Plasma Cell Vulvitis: A Systematic Review.

OBJECTIVE: This systematic review aimed to present the available literature on plasma cell vulvitis (PCV), a relatively uncommon form of inflammatory vulvovaginal dermatitis. MATERIALS AND METHODS: A literature search was performed in PubMed, Science Direct, and Google Scholar using the following key words: "plasma cell vulvitis," "Zoon vulvitis," and "vulvitis circumscripta plasmacellularis." Specific variables were assessed in each article, including patient age, menopausal status, comorbidities, presenting symptoms, symptom duration, histological description, treatment, and treatment response. RESULTS: Thirty-nine articles met inclusion criteria, including 38 case reports and 1 observational study, with a total of 96 cases of PCV reported. The mean age of diagnosis was 52.9 years, with an age range of 8-76 years. Most common presenting symptoms included pruritis and vaginal discomfort, with average duration of symptoms 28.2 months (range = 2 months to 10 years). All reports demonstrated subepithelial plasma cell infiltrate on histology. Five percent of PCV cases reported concomitant autoimmune conditions and 6% sexually transmitted infections. Most common treatment modalities included topical corticosteroids (n = 41), tacrolimus (n = 6), and imiquimod (n = 6). In 53 reported outcomes, 88.7% of patients had resolution of symptoms with treatment. CONCLUSIONS: Clinical research is needed to better determine the diagnostic criteria and to assess the efficacy of treatment options for PCV.

Plasma Cell Vulvitis: A Systematic Review of Interventions.

OBJECTIVES: Plasma cell vulvitis (PCV) is a rare chronic inflammatory disorder, where the symptoms can be severe and may affect patient's quality of life. However, there are currently no evidence-based treatment guidelines. The aims of this systematic review were to evaluate efficacy of individual treatments and to inform future research. MATERIALS AND METHODS: A systematic search was conducted of publication between 1952 and August 2020 via MEDLINE, Embase, and Emcare. All publications that evaluated the efficacy of treatments for patients with PCV were included. Forty-seven publications comprising 45 case reports and case series and 2 cohort studies were included. RESULTS: To date, there are no randomized controlled trials evaluating the efficacy of different treatment options. There are also no studies that assess the impact of treatment on quality of life. Topical corticosteroids are the most frequently used first-line therapy, with limited evidence to support their efficacy, followed by topical imiquimod and surgical excision. The least supported intervention is cryotherapy. CONCLUSIONS: Although descriptive studies support the use of topical corticosteroids and, to a lesser degree, topical calcineurin inhibitors and imiquimod, this review highlights the need for standardized outcome measures and randomized clinical trials for more definitive therapeutic recommendations for women with PCV.

Novel Potential Probiotic Lactobacilli for Prevention and Treatment of Vulvovaginal Infections.

Lactobacilli in the vaginal tract are essential to protect against microbial infections. We therefore focused on isolating vaginal lactobacilli from pregnant women and testing their functional properties. Lactobacilli were isolated from 50 vaginal swabs and the purified isolates were identified by MALDI-TOF MS. Functional properties (antimicrobial activity, organic acids and hydrogen peroxide production, antibiotic susceptibility, auto-aggregation, and hydrophobicity) of selected isolates were tested. Lactobacilli (41 strains) were identified in 58% of swabs with a predominance of Lactobacillus crispatus (48%) followed by L. jensenii (21%), L. rhamnosus (14%), L. fermentum (10%), and L. gasseri (7%). The highest antibacterial activity was determined for L. fermentum and L. rhamnosus. Strong anti-Candida activity was observed for strains L. crispatus, L. fermentum, and L. rhamnosus. Strain L. jensenii 58C possessed the highest production of hydrogen peroxide (6.32 ± 0.60 mg/l). The best lactic acid producer was strain L. rhamnosus 72A (11.6 ± 0.2 g/l). All strains were resistant to fluconazole and metronidazole. The highest auto-aggregation was observed for strain L. crispatus 51A (98.8 ± 0.1% after 24 h). Strain L. rhamnosus 68A showed the highest hydrophobicity (69.1 ± 1.4%). Strains L. fermentum and L. rhamnosus showed high antibacterial activity and hydrophobicity, and strains L. crispatus possessed high auto-aggregation and anti-Candida activity. Thus, these strains alone or in a mix could be used for the preparation of probiotic products for treatment and prevention of vulvovaginal infections of pregnant and non-pregnant women.

Management of Urologic Conditions in Small Ruminants.

Small ruminants frequently experience urologic conditions, such as obstructive urolithiasis, posthitis, vulvitis, and urinary tract infections. Urologic conditions are more common in male small ruminants, especially castrated males, primarily due to their anatomy. Traditionally, urologic conditions warranted culling from the herd without significant efforts in treatment. However, more goats and sheep are now being kept as pets. Small ruminant owners have strong emotional attachments to their animals and are more likely to seek treatment of medical disorders, including urologic conditions. Surgical or medical treatments are available. Conditions also may be avoided through hydration, diet, hygiene, and other means.

Evaluation of safety and skin tolerability of organic cotton pads in case of irritative vulvitis.

BACKGROUND: The woman vaginal environment is a fragile and delicate ecosystem that is often impaired by physical and chemical agents. This condition tends to damage skin barrier causing allergic reactions that lead to chronic irritating conditions. METHODS: Clinical and in-vitro studies were performed on organic cotton pads in order to assess if their use can prevent the onset of irritant conditions. During clinical studies, the panelists' skin and mucosae state were checked through a gynecological clinical examination in order to assess tissue dryness and alterations. Moreover, each panelist answered a sensorial questionnaire at the end of the test. Data were gathered and the product acceptability of use was registered in terms of itching, irritations and burning feelings. The panelist score was calculated based on VNS Scale (0-10, where 0 is the minimum value and 10 is the maximum). RESULTS: From a careful analysis of the first part of the study, it is possible to state that the tested product (organic cotton pads) has proved to reduce the onset of irritative phenomena and slight undesired effects caused by the conventional use of synthetic pads. In-vitro tests were conducted to study possible biological processes involved during allergic and sensitizing events produced by vulvitis. In particular, a pro-sensitizing test, a skin irritation on RHE (adapted from OECD 439) and tests to assess the soothing activity were performed on cell substrates. CONCLUSIONS: Results demonstrated that organic cotton pads, in each part, are safe and do not impair any physiological activities of the tissue substrates.

Disorders of vulva and vagina in children and adolescent.

Disorders of vulva and vagina are the most common problem in childhood in gynecological practice. As child is not the little adult, as young girl is not little woman. Childhood is characterized by changing hormone levels, which influenced hormone-dependent tissues. Etiology and diagnostics of this most common diseases are very often different of the same problem in adult woman. The most common diseases in childhood is synechia vulvae, inflammation of vulva and vagina called vulvovaginitis and skin disorders. It is very important to know everything about diagnostics and treatment to help young girls. Key words: vulvovaginitis, lichen sclerosus, synechia vulvae, child rest period, sexual development period, yeast infection.

Vulvar Dermatoses: A Review and Update.

The purpose of this article is to review six important inflammatory dermatoses of the vulva and to update readers on the new advancements in treatment of these mucosal conditions. Psoriasis, lichen sclerosis, lichen simplex chronicus and lichen planus are common vulvar conditions that cause pruritis and/or pain. PIasma cell vulvitis and desquamative inflammatory vaginitis are rare and challenging to be recognized, which often remain undiagnosed.

Inflammatory Vulvar Dermatoses.

Inflammatory vulvar dermatoses affect many women, but are likely underdiagnosed due to embarrassment and reluctance to visit a health care provider. Although itch and pain are common presenting symptoms, the physical examination can help distinguish between different disease entities. Because many women's health providers have minimal training in the categorization and management of dermatologic disease, definitive diagnosis and management can be difficult. Herein, strategies for diagnosing vulvar lichen sclerosus, lichen planus, contact dermatitis, lichen simplex chronicus, and psoriasis are discussed along with basic management of these diseases, which commonly involves decreasing inflammation through behavioral change, gentle skin care, topical corticosteroids, and systemic therapies.

Zoon vulvitis as a differential diagnosis in an HIV-infected patient: a short report.

Vulvitis circumscripta plasmacellularis or Zoon vulvitis is a rare benign condition that affects the vulva chronically. We herein report a case of Zoon vulvitis in a 52-year-old HIV-infected patient with an uncommon ulcerovegetating lesion diagnosed by histopathologic findings. The patient was treated with clobetasol propionate ointment and oral corticosteroid. Zoon vulvitisis is a rare vulvar disorder that offers a challenging diagnose and therapy. The patient was appropriately treated and remains disease free.

Severe sepsis and septic shock in pregnancy.

Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. This improvement can be achieved by formulating a stepwise approach that consists of early provision of time-sensitive interventions such as: aggressive hydration (20 mL/kg of normal saline over the first hour), initiation of appropriate empiric intravenous antibiotics (gentamicin, clindamycin, and penicillin) within 1 hour of diagnosis, central hemodynamic monitoring, and the involvement of infectious disease specialists and critical care specialists familiar with the physiologic changes in pregnancy. Thorough physical examination and imaging techniques or empiric exploratory laparotomy are suggested to identify the septic source. Even with appropriate antibiotic therapy, patients may continue to deteriorate unless septic foci (ie, abscess, necrotic tissue) are surgically excised. The decision for delivery in the setting of antepartum severe sepsis or septic shock can be challenging but must be based on gestational age, maternal status, and fetal status. The natural inclination is to proceed with emergent delivery for a concerning fetal status, but it is imperative to stabilize the mother first, because in doing so the fetal status will likewise improve. Aggressive [corrected] treatment of sepsis can be expected to reduce the progression to severe sepsis and septic shock and prevention strategies can include preoperative skin preparations and prophylactic antibiotic therapy as well as appropriate immunizations.

Clinical effectiveness of a special silk textile in the treatment of recurrent pediatric inflammatory vulvitis: an open label pilot study.

AIM: Pediatric inflammatory vulvitis (PIV) is clinically characterized by itching, soreness and inflammation and can be due to both an infective process and a non-specific irritative process, especially in atopic patients. Sometimes these non-specific PIVs, that tend to be recurrent, can be overinfected, with exacerbation of the clinical features. The importance of the cleansers, emollients, and the kind of textiles that enter in direct contact all day long with the inflamed skin, is well known. The study objective is the evaluation of the safety and efficacy of the transpiring, slightly elastic knitted silk briefs, with anti-bacterial and non-irritating properties, registered as Dermasilk®, in recurrent PIV. METHODS: The study we conducted was a prospective cohort study of 12 pre-pubertal girls, aged between 2 and 10 years, affected by recurrent PIV, that used Dermasilk® briefs in association to conventional treatments. RESULTS: Dermasilk® briefs have proven to be an effective and safe adjuvant product available for use in association with conventional drugs for the treatment of recurrent PIV. CONCLUSION: Dermasilk® briefs play an important role in the management of the flares of recurrent PIV, proven by an earlier resolution of symptoms, as well as in the maintenance of the remission and in the prevention of overinfections.

Case series of Zoon vulvitis.

We report 3 cases of plasma cell vulvitis (Zoon vulvitis) over a 10-year period and their management. This series highlights 1 case that was refractory to all modalities of treatment and hence had to be managed surgically, which has only been reported once before.

[Painful perineum in all its forms. Contribution of manual medicine and osteopathy. Clinical study]. / Le périnée douloureux sous toutes ses formes. Apport de la médecine manuelle et ostéopathie. Etude clinique.

No satisfactory therapy has yet been found to relieve many chronic pelviperineal pains such as Dyspareunia, Vulvodynia, Coccygodynia and other various pelvic pains, although these can be highly disruptive in everyday life. They may be brought on by an osteo-myo-fascial disorder, often undetected despite the possibility to effectively treat, this condition using manual medicine in the gynaecologist's office. A framed clinical examination protocol as well as a therapeutic one are offered in this novel approach still rarely implemented in gynaecology. Such treatment is documented in six typical clinical cases and a global study on 86 patients with disruptive chronic pelviperineal pain, showing 71% satisfactory results following two manual medicine sessions. These very encouraging results need to be confirmed on a larger scale in order to establish an appropriate teaching protocol.

[Human seminal plasma allergy type I]. / Typ-I-Allergie auf Seminalplasma.

Human seminal plasma allergy (HSPA) is a rare allergic reaction to specific protein fractions of seminal plasma, whereof PSA seems to be a relevant allergen. Predominantly Type I-immunoreactions can occur. The main symptoms are localized and generalized urticaria and sometimes anaphylactic symptoms. The diagnosis is based on history, skin tests and on the determination of specific IgE-levels for (un)fractionated seminal plasma. Here we report a patient with recurrent episodes of generalized urticaria after unprotected sexual intercourse and positive prick-test-reaction on seminal plasma.

The result of treatment on vestibular and general pain thresholds in women with provoked vestibulodynia.

OBJECTIVE: To correlate changes in vestibular pain thresholds to general pain thresholds in a subgroup of women with provoked vestibulodynia taking part in a treatment study. METHODS: Thirty-five women with provoked vestibulodynia were randomized to 4 months' treatment with either electromyographic biofeedback (n=17) or topical lidocaine (n=18). Vestibular and general pressure pain thresholds (PPTs) were measured and the health survey Short Form-36 (SF-36) was filled out before treatment and at a 6-month follow-up. Subjective treatment outcome and bodily pain were analyzed. Thirty healthy women of the same age served as controls for general PPTs and SF-36. RESULTS: No differences in outcome measures were observed between the 2 treatments. Vestibular pain thresholds increased from median 30 g before to 70 g after treatment in the anterior vestibule (P<0.001) and from median 20 to 30 g in the posterior vestibule (P<0.001). PPTs on the leg and arm were lower in the patients as compared with controls both before and at the 6-month follow-up. Patients reporting total cure were 3/35; 25/35 were improved. The number of patients who frequently reported of other bodily pain was reduced after the treatment. The patients had lower scores for SF-36 (General Health, Vitality) before treatment, which was restored at the 6-month follow-up. DISCUSSION: Treating provoked vestibulodynia by either topical lidocaine or electromyographic biofeedback increased vestibular pain thresholds, reduced dyspareunia, and improved bodily pain. The patients showed a general hypersensitivity to pressure pain compared with controls and in this study the hypersensitivity did not seem to be affected by treating the superficial dyspareunia.

EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis.

BACKGROUND: To evaluate the efficacy of electromyographic biofeedback and topical lidocaine treatment for women with vulvar vestibulitis. METHODS: A prospective randomized study where 46 women with vulvar vestibulitis were randomized to receive either electromyographic biofeedback or topical lidocaine treatment for four months. Assessments with vulvar pressure pain thresholds and questionnaires regarding quality of life, psychosocial adjustments, and sexual functioning were made before treatment, after treatment, and at six- and 12-month follow-ups. Nonparametric statistical methods were used to analyze differences in outcomes. RESULTS: Nine women (9/46) dropped out during the treatment period. Both treatments showed significantly improved values for vestibular pressure pain thresholds, quality of life measurements, and sexual functioning at the 12-month follow-up. No differences were found between the two treatment groups. No severe side effects were reported. CONCLUSIONS: Four months' treatment with electromyographic biofeedback and topical lidocaine gave statistically significant improvements on vestibular pain measurements, sexual functioning, and psychosocial adjustments at the 12-month follow-up. No differences in outcome between the two treatments were observed but a larger sample may be needed to obtain significance. The treatments were well tolerated but the compliance to the electromyographic biofeedback training program was low. A combination of both treatments could potentially benefit many women with vulvar vestibulitis.