Vulvar Erosions: Excoriations, Erosive Lichen Planus, and Fissures
Erosions, ulcers, excoriations, and fissures are among the secondary morphology presentations in the IFCPC clinical terminology of the vulva. Lichen planus (LP) is a chronic inflammatory mucocutaneous disease of unknown etiology. Patients present with vag
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Veronika Suzuki, Veronica Maldonado, and Silvio Tatti
49.1 Introduction
49.2 Erosions
A meticulous vulvar examination and the correct description of the findings are fundamental in the study of vulvar diseases. Also, recognizing the normal vulva with its variants is very important to be able to differentiate normal structures from abnormal findings. The morphology, configuration, and distribution of the lesions may guide us to the presumptive diagnosis. Erosions, ulcers, excoriations, and fissures are among the secondary morphology presentations in the IFCPC clinical terminology of the vulva. Erosions are superficial defects in the skin surface with loss of the epidermis while the dermis remains intact; ulcers are deep defects in the skin surface with absence of the epidermis and/or dermis too. Some of them may appear necrotic at the base with white or yellow fibrinous material, e.g., syphilis, Behcet’s disease, Crohn’s disease, and vulvar aphthae [1]. Large, deep, or long-standing ulcers may heal with scarring, while erosions heal without scar. Vasculopathy pattern is characterized histologically by bloody vessel damage occurring in the setting of widespread dermal inflammation. The resultant deprivation of oxygen and nutrient flow generally lead to erosion or ulceration [2].
Excoriations are erosions or ulcers caused by scratching; they are often linear or angular in configuration. Fissures are thin linear erosions of the skin surface [3]. Many conditions can cause scratching, resulting in excoriations in the vulvar skin, such as the cycle of itching-scratching- rubbing-itching that ends up in lichen simplex chronicus (LSC), a morphologic condition resulting from scratching and rubbing, also called eczema. LSC can be related to an allergic contact dermatitis or an irritant contact dermatitis. Excoriations can also be found in patients with candidiasis, psoriasis, other vulvar dermatoses like lichen sclerosus or lichen planus, or any other vulvar condition that causes itching and scratching, for example, a bacterial infection or scabies. The rest of the vulvar skin needs to be examined to see if there is edema, erythema, scales, papules, or pustular lesions in the adjacent skin.
49.3 Lichen Planus Lichen planus (LP) is a chronic inflammatory mucocutaneous disease of unknown etiology.
49.3.1 Pathogenesis V. Suzuki (*) · V. Maldonado · S. Tatti Hospital de Clinicas “Jose de San Martin”, University of Buenos Aires, Buenos Aires, Argentina
Although it probably has an immunological cause, genetic predisposition has also been dis-
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_49
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cussed, with an association between the DRB1*0101 allele and the cutaneous LP. The DRB1*0102 allele has been detected in 90% of vulvovaginal-gingival LP [4]. There are also other studies that have demonstrated an association between LP with autoimmune diseases like thyroiditis and vitiligo [5]. Other
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