Lipschütz ulcer

Lipschütz ulcer
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Lipschütz ulcer, ulcus vulvae acutum or reactive non-sexually related acute genital ulcers (English: acute ulceration of the vulva ) is a rare disease characterized by painful genital ulcers, fever, and lymphadenopathy, occurring most commonly, but not exclusively, in adolescents and young women.<ref>Vieira-Baptista, Pedro,

 Lipschütz ulcers: should we rethink this? An analysis of 33 cases, 
 European Journal of Obstetrics, Gynecology, and Reproductive Biology, 
 
 Vol. 198,
 pp. 149–152,
 DOI: 10.1016/j.ejogrb.2015.07.016,
 PMID: 26297242,</ref> Previously, it was described as being more common in virgins.<ref name="Torok">, 
 Ulcus vulvae acutum, 
 Acta Dermatovenereologica Alpina, Pannonia et Adriatica, 
 2000,
 Vol. 9(Issue: 1),
 
 
 
 
 
 Full text,</ref> It is not a sexually transmitted disease, and is often misdiagnosed,<ref name="Kluger">, 
 [Lipschütz acute genital ulcer], 
 J Gynecol Obstet Biol Reprod (Paris), 
 
 Vol. 38(Issue: 6),
 pp. 528–30,
 DOI: 10.1016/j.jgyn.2009.08.005,
 PMID: 19744804,</ref><ref name="whonamedit">Lipschütz' ulcer at Who Named It? Retrieved on 2009-12-04.</ref> sometimes as a symptom of Behçet's disease.<ref name=Braun-Falco>, 
  
 Dermatologie und Venereologie, 
  
 Berlin:Springer, 
 2005, 
  
  
 ISBN 978-3-540-40525-2, 
  
  
  
 Pages: 1030,</ref>

Lipschütz ulcer is named after Benjamin Lipschütz, who first described it in 1912.<ref name=Lipschutz>Lipschütz B,

 Über eine eigenartige Geschwürsform des weiblichen Genitales (Ulcus vulvae acutum), 
 Arch Dermatol Res, 
 
 Vol. 114(Issue: 1),
 pp. 363–96,
 DOI: 10.1007/BF01973166,</ref><ref name=whonamedit/> The cause is still unknown, although it has been associated with several infectious causes, including paratyphoid fever, cytomegalovirus, Mycoplasma pneumoniae and Epstein-Barr virus infection<ref name="pmid23636284"/><ref name="Pelletier">, 
 Lipschütz genital ulceration: a rare manifestation of paratyphoid fever, 
 Eur J Dermatol, 
 2003,
 Vol. 13(Issue: 3),
 pp. 297–8,
 
 PMID: 12804994,</ref><ref>, 
 Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection, 
 Pediatr Dermatol, 
 2008,
 Vol. 25(Issue: 1),
 pp. 113–5,
 DOI: 10.1111/j.1525-1470.2007.00597.x,
 PMID: 18304169,</ref><ref>Vieira-Baptista, Pedro, 
 Mycoplasma pneumoniae: a rare cause of vulvar ulcers or an undiagnosed one?, 
 Journal of Lower Genital Tract Disease, 
 
 Vol. 17(Issue: 3),
 pp. 330–334,
 DOI: 10.1097/LGT.0b013e3182710896,
 PMID: 23486069,</ref>

Signs and symptoms

The most common presentation is a single large, deep ulcer (although several smaller ulcers may occur) in the internal surface of one or both labia minora.<ref name=Heller>,

 Vulvar disease: a clinicopathological approach. online version, 
  
 Informa Healthcare, 
 2007, 
  
  
 ISBN 978-0-8493-3793-2, 
  
  
  
 Pages: 51–2,</ref> The labia majora may be affected, as may the vagina and urethra. The ulcer develops very quickly, and is usually preceded by sudden onset of fever and malaise.<ref name=Heller/>

Diagnosis

The diagnosis is mainly clinical and centred in eliminating other more common causes for vulvar ulcers. Nevertheless, it has been proposed that Epstein-Barr detection using polymerase chain reaction for virus genome can help to reach sooner a diagnosis.<ref name="pmid23636284"/>

Treatment

Treatment is symptomatic, and usually of little value; in most cases, the ulcer heals spontaneously within four to six weeks, sometimes leaving scars. Topical analgesics and anesthetics, as well as topical application of disinfectants/astringents such as potassium permanganate (in sitz baths), is commonly used.<ref name=Heller/> In severe cases, a combination of systemic glucocorticoids and broad-spectrum antibiotics has been recommended.

Epidemiology

The disorder typically appears among young girls and adolescents but cases in children as young as 17 months have been reported.<ref name="pmid23636284">,

 Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection, 
 Eur. J. Pediatr., 
 
 Vol. 172(Issue: 8),
 pp. 1121–3,
 DOI: 10.1007/s00431-013-2013-8,
 PMID: 23636284,</ref>

History

The disease was first described in October 1912 by Galician-born Austrian dermatologist and microbiologist Benjamin Lipschütz, who published a series of four cases in girls aged 14 to 17.<ref name=Lipschutz/> He initially ascribed the ulcer to infection with "Bacillus crassus" (Lactobacillus acidophilus).<ref name=Lipschutz/><ref name=whonamedit/>

See also

• Vulvovaginal health

External links

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