External leukoplakia on the labia. Kraurosis and leukoplakia of the external genital organs of a woman. Traditional medicine against leukoplakia

Vulvar leukoplakia is a common gynecological disease that is most often diagnosed in women over 50 years of age. But modern medicine knows cases of the development of leukoplakia in women of reproductive age. Leukoplakia of the vulva is a process of dystrophic changes in the mucous tissue of the vulva, accompanied by increased keratinization of the superficial epithelium of the vulva. It is possible to visually determine the development of this disease by the whitish "plaques" that appear on the mucous surface of the external genital organs. The main danger of leukoplakia is that it is considered a precancerous disease in which complex treatment is required.

Causes of vulvar leukoplakia

In most cases, vulvar leukoplakia acts as a complication of chronic inflammation of the vulvar mucosa; metabolic, immune or neuroendocrine disorders in the female body. To date, the main reasons that can provoke the appearance of vulvar leukoplakia have not been finally established. But experts identify a number of factors that can significantly accelerate the development of this disease:

The main factors that can provoke the development of the pathological process in the area of the outer labia are age-related changes in the female body. It has been scientifically established that most often the disease is characteristic of middle-aged and older women who have crossed the threshold of menopause.
The cause of vulvar leukoplakia may be the lack of the necessary regular hygiene of the external genital organs.
Very often, vulvar leukoplakia acts as a complication of various diseases of the endocrine system - diabetes mellitus, thyroid dysfunction, obesity.
Smoking, consumption of alcoholic beverages or food with a minimum of vitamins and microelements useful and necessary for the female body has a negative effect on the state of the mucous membrane of the external genital organs.
Leukoplakia of the vulva in most cases develops against the background of chronic inflammatory processes of the reproductive organs - papillomavirus infection, cervical dysplasia, genital herpes, chlamydia, toxoplasmosis, colpitis, cervicitis.

Only specialists can help to deal with the causes that provoke the disease.

The main symptoms of leukoplakia

In the most frequent cases, the initial stage of the disease is asymptomatic - the woman does not experience pain or discomfort in the external genital area. The progression of leukoplakia is accompanied by the appearance of the following symptoms:

The first symptom of the pathological process in the labia is the appearance of small whitish spots on the mucous membrane of the vagina and labia minora.
In the process of developing a gynecological disease, whitish spots increase in size, they can merge, and their color becomes more pronounced and saturated. With further progression of leukoplakia, small specks turn into so-called "plaques", which protrude noticeably above the surface of the mucous membrane.
Pathological processes in the vulva are accompanied by itching, swelling, redness, burning of the external genital organs. Especially the discomfort increases immediately after sexual contact, during menstruation, urination, prolonged active movements or just walking.
Also, painful microcracks can form on the mucous surface of the vulva, in place of which bleeding ulcers and erosion gradually appear.
A characteristic symptom of vulvar leukoplakia is pain in the vagina and labia, which intensifies during sexual intercourse or at night.

Depending on the intensity and severity of symptoms, vulvar leukoplakia is divided into 2 types: isolated and diffuse. An isolated form of the disease is characterized by the development of one deformed area of the vulvar epithelium. In turn, with a diffuse type of leukoplakia, spots and "plaques" have a pronounced tendency to merge and merge. Treatment of the disease also depends on its form and severity.

Treatment of vulvar leukoplakia

Treatment of the pathological process in the external genital area should be started immediately after the first signs of the disease have been identified. Many women who have been diagnosed with this gynecological disease are wondering how to treat vulvar leukoplakia. As a rule, treatment of vulvar leukoplakia is a rather lengthy process that requires an integrated approach. Usually, the treatment of this gynecological disease directly depends on the woman's age, factors provoking the development of pathology, as well as the presence of concomitant chronic diseases.

Usually, a comprehensive treatment of gynecological pathology is recommended, consisting of drug therapy, adherence to a certain diet with a sufficient amount of vitamins and minerals necessary for the health of the female reproductive system, as well as a variety of physiotherapy procedures. In some cases, additional hormone therapy is prescribed. Treatment with local medications is shown: creams, ointments, lotions. In the most severe and advanced cases, vulvar leukoplakia requires surgical intervention.

To prevent the development of vulvar leukoplakia, every woman should pay maximum attention to proper hygiene of the genitals. Treatment is recommended to be combined with the refusal to wear tight, tight underwear made of synthetic materials that do not allow the skin to "breathe". Also, ladies are not recommended to use various cosmetic preparations for intimate areas: shower gels, intimate sprays or deodorants, creams, lotions or bath foams. The best option would be hygiene procedures using plain warm water or herbal decoctions. But you should be extremely careful - decoctions of medicinal herbs are very concentrated and can cause allergic reactions on the delicate skin of the external genital organs.

The main symptoms are:

White spots on the oral mucosa
Genital warts
Discomfort in the external genital area
Microcracks on the labia
Unpleasant sensations when urinating
Irritation in the vulva area
Gray spots on the oral mucosa
Tightness in the vulva area
Scales on the oral mucosa
Erosion on the genitals
Ulcers on the oral mucosa

Leukoplakia is a disease that affects the mucous membranes in the human body and leads to keratinization of the epithelium. Usually, the disease manifests itself on the mucous membrane of the mouth, larynx and genitourinary organs. In medicine, there are cases when a patient also developed esophageal leukoplakia.

An ailment appears in the form of white-pink or grayish-white spots that have clear contours. Sizes, like shapes, can be different. Usually, the appearance of these pathological formations does not give a person any discomfort. Therefore, the first signs of the progression of the disease can be seen only when examined by a doctor for a completely different reason.

The risk group includes people over 30 years old. In children and the elderly, pathology rarely develops. Clinicians refer to leukoplakia as precancerous conditions, since pathological foci can undergo malignancy under the influence of various unfavorable factors. For this reason, during the diagnosis of this pathology, a biopsy is taken from the lesions. Next, the tissue is carefully examined for the detection of atypical cells.

The most common forms of pathology are:

leukoplakia of the cervix;
leukoplakia of the oral cavity;
leukoplakia of the vulva;
leukoplakia of the bladder;
leukoplakia of the tongue;
leukoplakia of the labia.

Cervical leukoplakia is most often diagnosed in patients aged 20 to 30 years. Laryngeal leukoplakia accounts for 30% of all precancerous diseases in this area. But most often, doctors diagnose leukoplakia of the oral cavity. This is due to the fact that the mucous membrane in this place most often comes into contact with most of the factors that can provoke the progression of this pathology. It is worth noting an important point - not all forms of pathology are reborn into malignant ones.

Causes

At this time, it has not yet been reliably established what is the main reason for the progression of leukoplakia of the vulva, larynx or other organs in humans. But the factors that contribute to the development of this pathology are already known:

virus carrier. This reason is often the basis for the progression of the disease;
mechanical trauma, thermal and chemical effects on mucous membranes;
bad habits. In this case, the pathology may develop due to frequent smoking;
a common cause of vulvar or cervical leukoplakia is the use of silicone or latex stimulants without special lubricants;
professional harm;
occupational pathology;
iatrogenic causes. For example, in 30% of women who have previously undergone diathermocoagulation, cervical leukoplakia begins to progress;
STIs;
decrease in general and local immunity;
burdened heredity.

Classification

The classification of the disease is carried out according to the morphological principle - depending on the type of elements that are formed on the mucous membrane:

simple leukoplakia. In the case of the development of this form, a white-gray plaque or spots with clear contours are formed on the surface of the epithelium;
verrucous form. It is also called wart. In its course, it is similar to a simple form. But with the verrucous form, specific nodules are already beginning to form. They tend to "creep" on top of each other. If it is not always possible to detect a simple form during examination, then it is not difficult to diagnose a verrucous form precisely because of such characteristic elements;
erosive form. Erosion and ulcers are added to the elements that were formed in the verrucous form. This type is the most dangerous and often leads to the formation of a cancerous process.

Separately, it is worth highlighting the mild form of the disease. In this case, pathological foci of keratinization appear, from which plaque can be easily removed. No inflammation is found under it. This form most often affects the cheeks and lips.

In medicine, a specific form of the disease is also distinguished - leukoplakia of smokers. This type of pathology manifests itself in the form of nacreous plaques located on the mucous surface of the oral cavity. More often, lesions form on the skin of the cheeks, the lateral surface of the tongue.

Hairy leukoplakia is also common. In some medical sources, it is also called hairy leukoplakia. This form of the disease develops only with, as well as other immunodeficiency conditions. Hairy leukoplakia is often diagnosed in patients with AIDS (75% of the total). Hairy leukoplakia is not an independent pathology. It develops against the background of other ailments. It is also called the first symptom that indicates that a person develops an immunodeficiency state. Hairy leukoplakia can be located absolutely on any part of the mucous membrane, but most often it is diagnosed in the oral cavity, vulva, vagina and on the penis in men. As a rule, hairy leukoplakia is not difficult to detect. An infectious disease doctor deals with diagnostics.

Symptoms

The symptoms of pathology directly depend on where the inflammatory process will be localized.

Leukoplakia of the cervix develops gradually. At the initial stage of the development of pathology, there may be no symptoms at all. Therefore, the patient does not seek help from a doctor. As the disease progresses and during its transition to the next stage, a woman may notice a feeling of discomfort in the genitals. Confirmation of the presence of cervical leukoplakia is possible only with a gynecological examination. Whitish spots or nodules will be visible on the vaginal part of the cervix. With a severe form of pathology - ulcers and erosion.

Leukoplakia of the vulva has more pronounced symptoms, so it can be diagnosed at the early stages of the development of the pathological process. The main symptoms are:

a feeling of dryness in the vagina;
microcracks appear on the labia;
leukoplakia of the vulva is manifested by the formation of erosions, warts on the external genital organs, which can peel off or crack;
feeling of irritation and tightness in the vulva area.

Vulvar leukoplakia can develop in both girls and adult women. It is not difficult to diagnose it, since the characteristic symptoms are clearly manifested. The diagnosis and treatment of vulvar and cervical leukoplakia is carried out by a gynecologist.

Oral leukoplakia usually manifests itself in those places where the mucous membrane is constantly injured by the edges of the teeth, dentures or fillings. A pathological focus of white or gray color is formed at the site of the lesion. Later, it can become covered with scales. With a severe form of the disease, erosion and ulcers can form on the surface of the mucous membrane and tongue (this is often observed in hairy leukoplakia in immunocompromised patients).

Bladder leukoplakia manifests itself extremely rarely. Symptoms are usually absent. In some cases, the patient may complain of discomfort in the lower abdomen, as well as discomfort during urination. The diagnosis and treatment of bladder leukoplakia is carried out by a urologist.

Diagnostics

When the first symptoms appear, which may indicate the development of an ailment, you should immediately contact a medical institution for a thorough diagnosis. The disease can be diagnosed by carrying out:

biopsies;
taking smears from pathological foci for their further examination under a microscope;
Schiller's test;
immunogram;
cytological examination of smears from lesions;
clinical.

Treatment

Treatment of leukoplakia should only be comprehensive. The first thing to do is to eliminate the factors that could trigger the progression of the disease. For example, you should stop smoking, do not use metal dentures for your teeth, and so on. Treatment of leukoplakia also includes therapy for infectious and inflammatory pathologies that can develop in the human body.

A simple form of pathology often does not require any specific treatment. But patients will need to regularly visit a doctor so that he can assess whether the pathological focus is increasing and whether new elements appear on it. If necessary, the pathological foci are destroyed using a laser or radio wave technique. Sometimes they resort to cauterization with liquid nitrogen, but after such therapy, scars may remain. In case of suspicion of the degeneration of leukoplakia into a malignant process, it is shown to carry out a radical operation. After the treatment of leukoplakia, the patient will need to visit a doctor for some time for a preventive examination.

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Leukoplakia is a disease in which the mucous membranes undergo changes in the form of keratinization of the integumentary stratified epithelium (dyskeratosis phenomenon). In gynecology, leukoplakia of the vagina, labia and vulva, cervix, clitoris is more common, while white or grayish spots appear on the surface of these organs. Treatment of leukoplakia should be started 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 are therefore considered relatively safe. Usually the disease is diagnosed at the age of 40 and older, and its causes are not always clear. Among all pathologies of the cervix, leukoplakia is up to 3-7%.

Types of leukoplakia

The classification includes the division of pathology into 3 forms:

simple leukoplakia;
scaly leukoplakia;
erosive leukoplakia.

Simple leukoplakia of the cervix is not visible during gynecological examination, showing up only after colposcopy with staining. It is a thin grayish film, 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 walls of the vagina, the area of the labia.

With scaly leukoplakia, the affected epithelium thickens, its structure becomes bumpy. The color of the spots is gray, white, they protrude 1-3 mm above the surface of the vaginal mucosa and cervix. Often the spots are layered one on top of the other, while significant areas of the mucous membrane of the genital organs become lumpy. The disease is easy to detect during a routine examination in gynecology. Treatment is necessary: after the onset of scaly leukoplakia, cancer most often develops.

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

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

According to another classification, leukoplakia is divided into:

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

Causes of leukoplakia

Currently, the exact causes of the disease is a controversial issue. Most experts agree that the basis for the pathological process is hormonal disruptions, in which a shortage of estrogens - female sex hormones - develops. When studying the hormonal status of patients, an incorrect ratio of estradiol and other estrogens in the blood is also revealed. Oddly enough, but a deficiency of progesterone with hyperestrogenism can also become a prerequisite for the development of leukoplakia. Women with diagnosed disease often have abnormalities in their menstrual cycle (eg, amenorrhea).

The causes of leukoplakia are often associated with trauma to the mucous membrane of the vagina, labia or cervix. So, in a significant part of women, symptoms of cervical leukoplakia arose after cauterization of erosions by electrocoagulation. Sometimes the disease occurs after abortions, scrapings and other manipulations affecting the machines of the vagina and cervix.

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

Risk factors for the development of leukoplakia can be:

work in conditions of occupational hazards;
smoking;
burdened heredity (family history of dyskeratosis);
beriberi (especially vitamin A deficiency);
STIs (ureaplasmosis, chlamydia, genital herpes, HPV);
decrease in local, general immunity;
non-observance of sexual hygiene.

Sometimes leukoplakia is aggravated 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 the walls of the vagina, lesions are found in the form of separate grayish-white spots, or a group or extensive lesion of the mucous membrane is observed. Often, a common, advanced pathology is combined with cervical hypertrophy or with scars and adhesions. At the initial stage, leukoplakia foci are zones of inflammation of a bright red color, and only later they are covered with a gray bloom that cannot be removed with a gynecological spatula.

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

itching in the perineum (usually nocturnal);
pain, discomfort during intercourse;
a feeling of dryness in the vagina;
feeling of tightness, irritation in 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, scaly or erosive with a tendency to proliferation can gradually develop against the background of simple leukoplakia. The growth of lesions occurs not only in width, but also upward, as a result of which a plaque of 2-3 mm is formed. height. Plaques bulge, cracks and micro-erosion appear on them.

The disease has existed for decades, but sometimes it can suddenly begin its malignant transformation. The period of malignancy in women is not the same and takes from one to several years. Usually, malignant foci are externally unevenly compacted, and tuberosity and erosion on them occupy only a certain part. But even an outwardly benign form of leukoplakia can be prone to transformation into cancer, therefore, when it is detected, a histological analysis is always carried out.

Diagnostics of the leukoplakia

The diagnostic program for the disease includes a routine gynecological examination, colposcopy and taking 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 genital mucosa are best visible when viewed with a colposcope. It magnifies the image many times over, allowing you to assess the structure and type of tissue. Additionally, Schiller's test is carried out (staining of cells with Lugol's solution). In this case, areas with atypical degeneration do not turn brown, but remain the same in shade.

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 dyskeracytes and keratin are detected in the smears. According to the indications, a biopsy is taken, after which a histological examination of the biopsy tissue is carried out. If the analysis clearly shows dysplasia of the epithelium, the process is precancerous.

Another method for diagnosing the disease is microcolpohysteroscopy. During such a study, a specialist examines the state of the epithelium of the genital organs, and can also take a biopsy from abnormal areas. Differentiate leukoplakia with cervical dysplasia, erosions, cervical cancer.

Medical and surgical treatment of leukoplakia

The tactics of treating leukoplakia is determined by whether its simple or proliferative form was found. For complete recovery, it is necessary to remove all pathological foci. Treatment of cervical leukoplakia with medications is not carried out, but the therapy of concomitant pathologies is mandatory. It can include antiviral agents, antibiotics, anti-inflammatory, immunomodulatory agents, hormonal drugs. Do not prescribe drugs to accelerate tissue regeneration, which can stimulate the development of dysplasia.

If there are phenomena of intraepithelial neoplasia, often perform conization of the uterus, or excision of the cervix. Without the presence of precancerous changes, minimally invasive removal of leukoplakia foci is performed using modern techniques. After the procedure, which is carried out under local (less often - under general) anesthesia, the recovery period lasts 2-8 weeks. At this time, you can not live sexually, use any methods of contraception.

Chemical coagulation

This method is most often used to treat vulvar leukoplakia. Chemical coagulation, or cauterization of leukoplakia foci with the help of special preparations, is performed with 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

Electrocoagulation treatment is a cauterization of leukoplakia with an electric current. Despite the complete removal of plaque and erosion after this technique, serious side effects often develop. Among them are implantation endometriosis, severe bleeding, exacerbation of ovarian disease, menstrual irregularities, tissue infection. Therefore, electrocoagulation of leukoplakia is not often used.

Cryodestruction

Cold treatment, or treatment of leukoplakia areas with liquid nitrogen, promotes tissue death and rejection. The duration of the procedure is no more than 5 minutes, it is painless, it 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 moxibustion

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

Radio wave moxibustion

Radio wave treatment of leukoplakia is no less effective than laser treatment, but it costs a little more. It is advised for nulliparous women who are planning a pregnancy in the near future. The procedure is performed using a radio knife, which vaporizes the affected areas with high heat. This method of treatment does not require anesthesia, does not cause bleeding and septic complications.

Folk remedies for leukoplakia

Doctors do not recommend practicing the treatment of leukoplakia with folk remedies if it is associated with the use of tampons, douching, because the procedure itself can enhance the growth of plaques and cornification, cause bleeding from erosions and cracks. Also, using exclusively folk methods, you can waste time and not detect cancer in time. But after diagnosis and treatment carried out, you can use the following recipes in parallel:

Shallow washing of the external genital organs with infusions of chamomile, calendula, eucalyptus, St. John's wort twice a day for 14 days. Infusions are prepared on the basis of the norm: 4 tablespoons of raw materials per liter of boiling water, stand for 1 hour.
With leukoplakia of the vulva, you can gently rub such an ointment into the painful areas. Melt 100 gr. palm oil in a water bath, add 3 gr. tincture of calendula, 10 ml. glycerin, 1 ml. vitamin A, 2 ml. tincture of propolis and tincture of eucalyptus. After cooling the ointment in the refrigerator, it is applied twice a day, without rinsing, for 10 days.
Inside, you can take an infusion of boron uterus, which improves the work of the reproductive system in women. Prepare it 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 the period of menstruation.

Leukoplakia during pregnancy

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

Prevention of leukoplakia

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

timely treat erosion, STIs, inflammation in the genital area;
prevent the transition of any gynecological diseases into chronic ones;
exclude abortion;
choose only reliable clinics for gynecological manipulations;
observe the hygiene of the intimate sphere;
have a permanent, trusted partner;
treat menstrual irregularities as they occur;
be monitored regularly 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.

The periods of menopause and menopause are always associated with hormonal changes in the 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 absolutely asymptomatic, and in the absence of timely treatment, it can lead to the development of an oncological process.

Vulvar leukoplakia (or lichen sclerosus) is a dystrophic disease of the vulva with manifestations of squamous cell hyperplasia of the stratified squamous epithelium lining the vulva. In this disease, the appearance in the tissues of the vulva of normally absent stratum corneum and granular layers, which lead to the development of para- and hyperkeratosis, is observed. This disease can be combined with vulvar kraurosis, and such clinical cases in recent years have been increasingly observed in the practice of gynecologists. 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 appearance 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 acquaint you with 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.

Causes

So far, modern medicine cannot give an exact answer about the cause of the development of vulvar leukoplakia in each specific clinical case, but 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 trauma;
hormonal imbalance;
infection;
neglect of the rules of personal hygiene;

All these factors are 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 psychoemotional disorders and can be corrected by changing the way of thinking. As a rule, women with such a diagnosis experience constant dissatisfaction with themselves and the actions of the people around them, make increased demands on themselves and deep distrust of their loved ones and relatives.

Much less often, 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 acquire an important role, 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 by a gynecologist. Pathology can be detected by chance when examining the clitoris and labia minora. Small, usually multiple, whitish spots appear on their mucous membrane. Over time, they thicken, keratinize, slightly rise above the surface of the mucous membrane and acquire a gray-white color with a pearlescent tint. The foci of the changed mucous membrane can increase in size, merge and spread over a significant surface of the vulva. Often, patients have paresthesia in the form of numbness or tingling in the area of keratosis.

In case of infection or sclerosis of leukoplakia zones, a woman may pay attention to the sudden appearance of puffiness and complain of dryness, tension and tightening of the mucous membrane and skin in the genital area, intense, which intensifies at night or with movement, intercourse and urination. Prolonged itching of the vulva leads to the appearance of psychoemotional disorders, depletion of the nervous system and disability.

In areas of leukoplakia, multiple subepithelial hemorrhages may appear. In the later stages of the disease, hyperkeratosis and sclerosis reach their maximum. The mucous membranes become rigid, folded, glossy pearlescent in color. On their surface, telangiectasias and subepithelial hemorrhages appear. 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:

Flat. Flat, whitish spots appear on the vulva without signs of inflammation. After removing with a swab, they reappear. Spots can be present in limited areas of the vulva, and in generalized course they capture a large surface of the mucous membrane.
Hypertrophic. The foci of mucosal changes look like gray-white spots with clearly delineated contours, they rise above the surface and sometimes merge with each other, cannot be removed with a swab.
Warty. The lesions are significant and look like warty growths. May be complicated by ulceration, inflammation, swelling and the appearance of redness, ulcers, cracks and erosions. This form of leukoplakia is considered a precancerous condition.

Vulvar leukoplakia 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 state without progression of symptoms during gestation and in the early postpartum period. In such cases, women are shown natural delivery. 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 assigned the following types of examination:

collection of anamnesis and gynecological examination;
general blood analysis;
a smear on flora from the urethra, vagina and cervix;
analysis by PCR for the presence of human papillomavirus with the establishment of 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 with subsequent histological examination of the material;
immunogram.

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

neurodermatitis - itching also manifests itself in other parts of the body, the epithelium is compacted, dry and thickened, the skin is reddened, with inflamed pink-brown papules and has an enhanced pattern;
- with this disease there are no areas of pigmentation, itching is light, there are no atrophic changes in the altered areas of the skin;
diabetes mellitus - the tissues of the vulva are inflamed, edematous, pasty, severe itching;
lichen planus - with this disease, the rash is papular, multiple and prone to grouping, after opening the papules, areas of atrophy or sclerosis form on the skin with the formation of cicatricial changes.

If you suspect a skin disease, a woman is advised to consult a dermatologist.

When a woman develops neuropsychiatric disorders, a psychotherapist's consultation is prescribed.

Treatment

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

The tactics of treating vulvar leukoplakia depends on the degree and nature of changes in the vulvar mucosa and is aimed at eliminating the symptoms of the disease and preventing the degeneration of plaques. 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 the conservative treatment of vulvar leukoplakia, the patient is recommended:

taking medications;
correct hygiene measures;
adherence to a diet;
physiotherapy procedures.

Drug therapy

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

local preparations 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, Loratadin, Clarisens, Fenkarol and others;
local hormonal drugs: Estriol cream, Progesterone cream, Testosterone propionate ointment, etc.;
antibacterial agents for topical use (for secondary infections): Levomikol, Chlorophyllipt oil solution, 5% Synthomycin liniment, Syntomycin suppositories, Chlorhexidine emulsion, etc.

For the general strengthening of the body and improving 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 vulvar skin are prescribed.

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

Patients with neuropsychiatric disorders are assigned classes on psychocorrection and reception, antidepressants and tranquilizers.

Hygiene measures

Do not overheat the body.
Do not wear synthetic or tight-fitting underwear.
Avoid sun exposure.
Refuse to take hot baths, saunas and baths.
For washing, do not use antiseptic solutions and soaps that dry out the skin, but use boiled water with the addition of soda (for softening) and decoctions of herbs (chamomile, calendula, nettle, sage).
Do not douche.
Refuse to use synthetic pads and tampons.

Diet

- a chronic dystrophic process of the vulvar mucosa, expressed by proliferation and increased keratinization of the stratified squamous epithelium and further hardening of tissues. Leukoplakia of the vulva is manifested by the presence of whitish plaques on the mucous membrane, itching, burning, pain in the external genital area. Leukoplakia of the vulva is diagnosed by gynecological examination, vulvoscopy, Schiller test, targeted biopsy. Treatment of vulvar leukoplakia is aimed at reducing the severity of its manifestations and maintaining immune protection; includes hormone therapy, physiotherapy; according to indications - surgical excision of single foci 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 lesions of stratified squamous non-keratinizing epithelium. With leukoplakia of the vulva, the appearance of normally absent in the epithelium of the stratum corneum and granular layers, the development of para- and hyperkeratosis, acanthosis (without cellular and nuclear atypia or with atypia) is 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 leukoplakia of the vulva, 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, there are three forms of vulvar leukoplakia: 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 inflammation, which, after removing them with a tampon, reappear. Flat leukoplakia can be observed in limited areas, and with a generalized process, on the vast surface of the vulva.

In hypertrophic leukoplakia of the vulva, the lesions are represented by dry convex plaques of a grayish-white color, which 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, erosion and the development of inflammation. Warty 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 mucous membrane of the genitals 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; the presence of chronic inflammation of the genitals (including chronic papillomavirus infection and genital herpes serotype 2); dysplasia of the cervix; short reproductive period; metabolic disorders (diabetes, obesity); neglect of personal hygiene; repeated trauma and irritation of the vulvar mucosa; vitamin A deficiency.

Hormonal disruption, leading to vulvar leukoplakia, is associated with age-related changes in the hypothalamus-pituitary gland, hypothyroidism (hypothyroidism), adrenal cortex (adrenal insufficiency), ovarian dysfunction, lack of estrogen in menopause and menopause. It is also believed that a whole complex of psychoemotional disorders lies at the heart of the occurrence of vulvar leukoplakia.

Symptoms of vulvar leukoplakia

Leukoplakia of the vulva can be asymptomatic, without causing discomfort in the patient. The 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 foci becomes grayish-white and pearlescent, epithelial plaques thicken and begin to protrude slightly above the mucosal surface. Slowly increasing in size, the plaques can coalesce and spread over a large area of the vulva. Foci of vulvar leukoplakia are very persistent, do not disappear when they are treated.

With sclerosis and infection of the tissues of the vulva, constant severe itching and burning occurs, which intensify at night, after urination, during movement and intercourse; paresthesias appear (numbness, tingling). 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, to which a microbial infection joins. The development of inflammation in vulvar leukoplakia is accompanied by edema and hyperemia. Soreness during intercourse interferes with the patient's intimate life, leading to the development of neuropsychiatric symptoms.

Diagnostics of the 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, burning sensation in the vulva. With a gynecological examination, you can find characteristic whitish foci on the mucous membrane. Necessarily performed colposcopy (vulvoscopy), which, with leukoplakia of the vulva, reveals a whitish-gray or yellowish color of the mucous membrane, a low-transparent keratinized tuberous surface, the absence or lack of expression of the vascular pattern. Colposcopy also helps to identify the presence of concomitant leukoplakia of the vulva, dysplastic and atrophic processes of the genitals, to exclude malignant neoplasms.

When conducting the Schiller test with Lugol's solution, leukoplakia foci of the vulva do not stain and become clearly visible to the naked eye. Also, a microscopic examination of a smear for microflora and for oncocytological changes in the mucous membrane of the vulva is performed.

A targeted biopsy is performed from areas suspicious of vulvar leukoplakia, followed by a histological examination of the material, showing the nature of changes in the cells and tissues of the mucosa. A complete diagnostic examination in gynecology allows you to identify vulvar leukoplakia with an accuracy of 100%. The detection of vulvar leukoplakia without signs of atypia allows us to consider it a background process, with the presence of atypia as 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, physiotherapy, the help of a psychotherapist, and, if necessary, surgery. Physiotherapy exercises are recommended; walks in the fresh air, dairy - plant diet; carrying out hygiene procedures using boiled water and herbal infusions, avoiding soap, potassium permanganate, douching; elimination of irritating factors (woolen and synthetic underwear, tampons and synthetic pads). With leukoplakia of the vulva, hot baths and prolonged insolation are contraindicated.

A local anti-inflammatory and antipruritic treatment is prescribed using ointments, creams, vaginal balls with hormones, antiseptics. In hormone therapy, prednisolone, estrogens in combination with androgens, estrogen - gestagenic drugs, unconjugated estrogens and estriol derivatives (cyclically or in contraceptive mode for 2-3 month courses) are used. It is possible to take vitamins and trace elements, antihistamines, with persistent itching - carrying out novocaine blockades.

Modern physiotherapy (ultraphonophoresis of drugs, oxygen therapy with modulation of brain rhythms) with vulvar leukoplakia have an anti-inflammatory, desensitizing effect, normalize metabolic processes, hormonal and psycho-emotional background, strengthen the immune system. Correction of the psycho-emotional state with the use of sedatives and techniques is an important element in the treatment of vulvar leukoplakia.

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

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

Prediction and prevention of vulvar leukoplakia

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