Vulvar tenderness

Introduction Vulvar tenderness is the clinical manifestation of vulvar Crohn's disease. Vulvar tenderness and treatment prevention mainly use medical treatment and local care, and gastrointestinal inflammation first treats gastrointestinal lesions. The preferred drug is sulfasalazine (SASP) orally 2 to 4 g / d, if the symptoms are not relieved after 1 to 2 months of single drug use, combined with high doses of glucocorticoids. Metronidazole can be used as a second-line drug for SAPS or at the corticosteroid treatment interval. It has been reported that metronidazole 25mg (kg?d) treatment for 6 months, the symptoms of vulvar edema are relieved, but genital erythema is ineffective.

Cause

The cause of vulvar tenderness: vulvar tenderness is caused by genital Crohn's disease.

A characteristic lesion of vulvar Crohn's disease is that the gallbladder-free granuloma infiltrates the subcutaneous tissue and spreads to the subcutaneous fat. It is characterized by tissue hyperplasia, hypertrophy and ulcer formation. Granuloma is mainly composed of epithelial cells, multiple giant cells with infiltrating lymphocytes, and its structure is similar to granulomatous perivascular inflammation. The pathological manifestations of granulomas are consistent with those of intestinal lesions. Typical histological features include inflammatory cell infiltration, ulceration, and abscess formation. Non-caseal granuloma can be found in 10% to 25% of diseased tissues. 22% to 75% of Crohn's disease patients have associated mucosal skin symptoms. Crohn's disease involving the vagina is rare. Burgdorf et al. classify the extraintestinal damage of Crohn's disease into four categories:

1. Skin granuloma includes the formation of sinus and fistula around the anorectum.

2. A mucosal aphthous ulcer.

3. Nutritional changes such as zinc, iron and folic acid deficiency.

4. Idiopathic lesions have multiple erythema, acquired bullous epidermolysis, and necrotizing vasculitis. Among them, perianal skin lesions are the most common. In 25% of Crohn's disease, the first symptom is perihepatic lesion.

an examination

Related inspection

Gynecological ultrasound examination of genital gynecological routine examination

Most patients with vaginal Crohn's disease have a history of ileitis or bowel resection. Crohn's disease vulvar lesions can be manifested as vulvar swelling, vulvar tenderness, perineal ulcer, skin cleft palate, skin blemishes, other rare symptoms, bilateral or unilateral vulvar hypertrophy, multiple erythema, vulvar abscess, perineal fistula or sinus Road formation and so on. Crohn's disease shows a variety of vulvar lesions that are easily misdiagnosed, especially when there are no intestinal symptoms as the first symptom of Crohn's disease. More than half of patients will have menstrual abnormalities.

Common symptoms are fever, abdominal pain, diarrhea and fatigue. Some patients developed abdominal distension and lower abdominal mass. 14% to 17% of patients had perianal fistula and sinus, 21% of which were connected to the abdominal cavity. Parenteral damage, including joints, skin, liver and gallbladder, can be expressed as arthritis, fatty liver, small bile duct inflammation, sclerosing cholangitis, perihepatic abscess, other rare symptoms of nodular erythema, gangrenous pyoderma , absorption disorder syndrome, glossitis, pharyngeal ulcers, etc.

Differential diagnosis

The differential diagnosis of vulvar tenderness should be differentiated from the following diseases:

Vulvar skin erosion, sarcoidosis, sexually transmitted lymphogranuloma, suppurative sweat gland inflammation, deep fungal infection and actinomycosis, vulvar tuberculosis.

Diagnosis: Most patients with vaginal Crohn's disease have a history of ileitis or bowel resection. Crohn's disease vulvar lesions can be manifested as vulvar swelling, vulvar tenderness, perineal ulcer, skin cleft palate, skin blemishes, other rare symptoms, bilateral or unilateral vulvar hypertrophy, multiple erythema, vulvar abscess, perineal fistula or sinus Road formation and so on. Crohn's disease shows a variety of vulvar lesions that are easily misdiagnosed, especially when there are no intestinal symptoms as the first symptom of Crohn's disease. More than half of patients will have menstrual abnormalities.

Common symptoms are fever, abdominal pain, diarrhea and fatigue. Some patients developed abdominal distension and lower abdominal mass. 14% to 17% of patients had perianal fistula and sinus, 21% of which were connected to the abdominal cavity. Parenteral damage, including joints, skin, liver and gallbladder, can be expressed as arthritis, fatty liver, small bile duct inflammation, sclerosing cholangitis, perihepatic abscess, other rare symptoms of nodular erythema, gangrenous pyoderma , absorption disorder syndrome, glossitis, pharyngeal ulcers, etc.

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