Vulvar kraurosis is a chronic progressive atrophic process of the skin and mucous membrane of the vulva associated with involutive changes in the external genitalia. Disease is accompanied by paresthesia, dryness, itching of the mucous membrane; atrophic and sclerotic changes in the labia minora, clitoris, labia majora; dyspareunia, vulvitis, vaginal stenosis. Kraurosis is diagnosed during external examination, vulvoscopy, biopsy of vulva tissues. Treatment includes local and general hormone therapy, physiotherapy, vitamin therapy, according to indications – vulvectomy.
Vulvar kraurosis in gynecology refers to background dystrophic lesions of the vulva. The disease is found among patients of different age groups: less often under the age of 30 and older, most often during menopause. With vulvar kraurosis, atrophy and hyperkeratosis of the multilayer squamous epithelium occur, the proliferation of coarse connective tissue, leading to deformation and reduction of the external genitals, violation of their function. Early detection and adequate therapy can prevent the progression of the disease.
There are three stages in the development of vulvar kraurosis. At the first stage of vulvar kraurosis, there is swelling and redness of the genitals caused by a violation of microcirculation and tissue hypoxia. In the second stage of vulvar kraurosis, there is a violation of pigmentation, dryness, roughness, inelasticity of the skin and mucosa, the appearance of whitish thin scales (lichenification) on them; flattening of the labia minora and labia majora.
The third stage is characterized by complete atrophy and the development of cicatricial sclerosis of the external genitals. Rigid sclerosed vulva tissues shrink, leading to a sharp decrease in the volume of the labia minora and labia majora, clitoris, narrowing of the vagina, the external opening of the urethra and anal opening. Vulvar kraurosis in the stage of sclerosis creates difficulties and causes pain during sexual intercourse, and sometimes urination and defecation.
The occurrence of deep, poorly healing cracks in vulvar kraurosis can easily be complicated by the addition of infection. In combination with vulvar kraurosis with leukoplakia, the risk of malignant transformation increases.
Vulvar kraurosis occurs as an inadequate reaction of the surface layers of the multilayer squamous epithelium to various external and internal factors. Vulvar kraurosis is provoked by existing neuroendocrine disorders: hypofunction of the adrenal cortex, ovaries, thyroid gland, violations of bioelectric activity of the cerebral cortex. In most cases, vulvar kraurosis occurs during a short reproductive period during menopause, and at a young age – after surgical interventions on the genitals.
A certain role in the pathogenesis is played by chronic inflammation of the vulva, including long-term persistent infection with HPV, HSV. The immunopathological mechanism of the development of dystrophic changes is not excluded. It is noted that vulvar kraurosis has psychosomatic roots and is noted in patients suffering from depressed mood, depression, dissatisfaction with themselves and the surrounding reality, having problems in the sexual sphere.
Sometimes the root cause of kraurosis may be a chemical burn of the vulva (for example, with a solution of potassium permanganate). Women with vulvar kraurosis, as a rule, suffer from obesity, diabetes, neglect the rules of personal hygiene.
At the initial stage, disease is manifested by paresthesia (a slight tingling sensation) in the area of the external genitals or symptoms of vulvodynia (burning sensation, feeling of dryness, tightening), which may not attract the proper attention of the patient.
The leading symptom of kraurosis is an unbearable paroxysmal itching of the vulva, which worsens at night, after hot baths and physical exertion. The cause of itching is changes in the receptors of the vulva, causing disturbances in the conduction of nerve impulses. Persistent itching of the vulva, continuing for a long time, leads to a violation of sleep and performance, exhaustion of the nervous system with the development of psycho-emotional and vascular disorders.
Patients with vulvar kraurosis are also concerned about dyspareunia – pain during sexual intercourse, interfering with intimate life; sometimes dysuria and violation of defecation. With vulvar kraurosis, there are scratches and abrasions, multiple cracks, subepithelial hemorrhages, inflammation.
In the initial period, the labia majora and labia minora look hyperemic and edematous. Then the skin and mucous membranes become dry and rough, with a whitish-gray tint, acquire a wrinkled appearance, hair disappears on them. Gradually, the clitoris and labia minora cease to be defined, the labia majora acquire the appearance of flattened rollers; the lumen of the vagina and urethra decreases sharply (sometimes to complete obliteration).
Diagnosis includes physical, laboratory and instrumental examination. Vulvar kraurosis is found in the patient usually already during a gynecological examination on a chair. One of the main methods of diagnosing vulvar kraurosis is vulvoscopy (colposcopy), which allows you to see pathological changes in the mucous membrane and skin.
Disease at the stage of complete atrophy and sclerosis does not require differential diagnosis, but in the early stages it must be distinguished from neurodermatitis, lichen planus, leukoplakia, dysplasia, vulvitis, vaginitis, diabetes mellitus, which have similar genital symptoms.
In case of pathology, laboratory examination for the presence of HPV by PCR with virus typing, determination of immunogram, blood sugar is recommended. To detect epithelial cells affected by the virus and the presence of atrophy or atypia, cytological examination of smears and prints from the vulvar mucosa is necessary.
In order to exclude possible malignancy, vulvar tissue biopsy with histological examination of the material is performed with vulvar kraurosis. The pathomorphological picture in vulvar kraurosis is characterized by depigmentation, hyperkeratosis of the epithelium, sclerosis and atrophy of the dermis and connective tissue, complete or partial loss of elastic fibers, homogenization of collagen, inflammatory infiltrates in tissues.
This disease is a difficult-to-treat disease, the causes and course of which may differ in different patients; it requires long-term, comprehensive, adequate treatment. The main emphasis in the treatment of vulvar kraurosis is on conservative therapy (local and general pathogenetic), focused on reducing itching, eliminating inflammation, improving tissue trophism and relieving psycho-emotional stress.
It is advisable to prescribe antihistamines (chloropyramine, mebhydroline, clemastine), as well as sedatives (diazepam, chlorpromazine). Some therapeutic effect with persistent itching can be obtained from the alcohol-novocaine blockade of the genital nerve. Local treatment of vulvar kraurosis includes hormonal ointments containing estrogens (estriol, estradiol dipropionate), progesterone, androgens, corticosteroids.
Estrogens are not shown to young patients, they are recommended progesterone cream in the second phase of the menstrual cycle; elderly patients are prescribed estriol orally or synestrol in / m, and then progestogens – oxyprogesterone capronate in / m or norethisterone orally. Ointments with androgens have a more pronounced antipruritic effect in vulvar kraurosis.
Corticosteroid ointments with hydrocortisone, prednisone, betamethasone, which have a strong anti-inflammatory, desensitizing and stabilizing effect, are widely used in the treatment of vulvar kraurosis. When a microbial infection is attached, antibacterial ointments are indicated.
Local laser therapy, reflexotherapy, balneotherapy, radiotherapy (Bucca rays), photodynamic therapy are used in the treatment of vulva kraurosis. Vitamin therapy (vitamins A, E, C, group B, PP), taking immunocorrectors, biostimulants are mandatory. If conservative therapy of vulvar kraurosis is ineffective, invasive methods of treatment are used: vulvar denervation, laser ablation of the vulva and cryodestruction of affected tissues, if malignancy is suspected, superficial surgical excision of the vulva skin (vulvectomy).
Prognosis and prevention
Treatment is ineffective and complete recovery is impossible to achieve. Malignant transformation can be observed with long-term non-healing erosions, cracks, in combination with dysplasia and leukoplakia.
Disease requires constant observation by a gynecologist and treatment. An individually selected diet, the absence of stress, intimate hygiene, and the right choice of underwear are also important. To reduce the oncological risk, patients with vulvar kraurosis need to undergo vulvoscopy once every six months, and in case of suspicious results, cytological and histological examinations.