Vulva
General
Inflammatory lesions

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 4 October 2017, last major update February 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Inflammatory lesions vulva

Cite this page: Roychowdhury, M. Inflammatory lesions. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvainflammatory.html. Accessed October 22nd, 2017.
Crohn's disease
Definition / general
  • May be associated with perineal disease or vulvar fistulas
  • May be separated from anal lesions by normal tissue
  • Vulvar involvement in Crohn's may be contiguous (direct extension of intestinal involvement) or noncontiguous (no connection between the vulva and bowel)


Case reports

Treatment
  • Medical treatment for initial stages (metronidazole alone or with steroids)
  • Surgical treatment (local excision or vulvectomy) for advanced disease


Clinical images

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Multiple fleshy ulcers



Gross description
  • Hyperemia, edema, ulceration, "knife cut" ulcers (resemble lacerations, almost pathognomonic of Crohn's disease but also reported in herpetic infections in immunocompromised and in cutaneous tuberculosis), "apthous-like" ulcer


Microscopic (histologic) description

Microscopic (histologic) images

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Ulcerated epidermis

Skin biopsy

Terminal ileum

Necrotizing fasciitis
Definition / general
  • Risk factors: diabetes mellitus (greatest risk factor), hypertension, immunocompromise, increasing age, obesity, peripheral vascular disease, radiation exposure
  • Primary site of infection: surgical incision (50% cases), skin damaged by infection or trauma


Types
  • Manifests as 2 types
  • Type 1:
    • Forms majority of vulvar necrotizing fasciitis infections
    • Synergistic polymicrobial infection of both aerobes and anaerobes
    • Most commonly seen in setting of: diabetes, peripheral vascular disease, postoperative patients
    • Most common bacteria: B. fragilis, Clostridia, E. coli, enterococci, S. aureus, streptococci (J Bone Joint Surg Am 2003;85:1454)
  • Type 2:
    • Monomicrobial infection of group A Streptococcus (Streptococcus pyogenes) and less frequently methicillin resistant Staphylococcus aureus (MRSA)
    • Seen in patients without underlying comorbidities


Diagrams / tables

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Diagnostic criteria



Prognostic factors

Treatment
Nonspecific vulvitis
Definition / general
  • Associated with avitaminoses, blood dyscrasias, diabetes, malnutrition, uremia
Vasculitis - isolated
Case reports
Vestibular adenitis
Definition / general
  • Inflammation of vestibular glands in vulvar vestibule submucosa
  • Produces small ulcerations


Treatment
  • Surgical removal of mucosa
Vulvar vestibulitis
Definition / general
  • Common cause of superficial dyspareunia in young women although vulvar pain likely represents many disorders (J Sex Med 2008;5:5)
  • Chronic inflammation of vulvar vestibular mucosa, lamina propria and periductal connective tissue of vestibule
  • May see mild exocytosis of lymphocytes in vestibular glands and ducts (Ann Dermatol Venereol 2008;135:367)