Sexually Transmitted Diseases - I. I. Mavrov 2005

Non-Venereal Inflammatory Diseases of the Reproductive Organs
Kraurosis Vulvae

Craurosis vulvae is a progressive diffuse Atrophy of the Skin and mucous membranes of the external genitalia and Vagina in women, leading to partial or complete disappearance of the Labia minora, Clitoris, and prepuce, partial sclerosis and atrophy of the Labia Majora, as well as vaginal atresia and stenosis. It is most commonly diagnosed in women during menopause and very rarely in young individuals following oophorectomy or in cases of ovarian insufficiency.

Etiology AND Pathogenesis. The onset of kraurosis vulvae is associated with a decline in sex hormone production. Typical and pronounced kraurosis is a relatively rare condition, but early-stage forms with various clinical manifestations are frequently observed in elderly women and may represent a manifestation of genital senility. Metabolic Disorders, Inflammatory Diseases of the reproductive Organs, and intoxications also contribute to The Development of the disease.

Clinical Features. The condition is characterized by Changes in the mucous and submucous membranes of the external genitalia, which acquire a pale ivory hue, become firm in consistency, lose their elasticity, and dry out. Pigment spots, as well as frequent erosions and fissures, appear On the surface. The affected areas are smooth and shiny, showing localized hyperkeratosis (Leukoplakia) in some places and distinct atrophy and thinning of the superficial epithelial layer in others. The volume of the labia majora and minora and the clitoris gradually decreases until they disappear completely, accompanied by a narrowing of the vaginal introitus. This is characteristic of the leukoplakic form of the disease, which very frequently serves as the precursor to carcinomatous transformation.

In the so-called craurosis rubra, inflammatory phenomena are observed with pronounced hyperemia or in the form of tile-red patches. The follicular form is characterized by signs of chronic inflammation in the periurethral glands and the vaginal vestibule, along with atrophy of the greater vestibular (Bartholin's) glands. All these clinical forms are accompanied by pruritus, pain, dysuria, and frequently vaginismus and decreased libido.

Possible complications include secondary lichenification, intertriginous eczema, lymphangitis, erysipelas, erosions, and fissures. Carcinomatous transformation is frequently observed, with local signs including leukoplakia, refractory erosions, fissures, and subsequently alterations in regional Lymph Nodes.

Histological examination reveals significant skin alterations characterized by sclerosis and atrophy involving Connective Tissue and elastic fibers. Nonspecific changes include alternating depigmentation and hyperpigmentation, acanthosis, hyperkeratosis, or papillomatosis, alongside inflammatory and vascular changes in the dermis.

Diagnosis is established based on medical history, physical examination, colposcopy, as well as cytologic evaluation of vulvar smears and histological examination of biopsy tissue taken from fissured areas.

Differential diagnosis must be made with standard vulvar leukoplakia, lichen planus, erythroplasia of Queyrat, Bowen's disease, chronic lichen simplex chronicus of Vidal with or without vitiligo, and radiation dermatitis.

Treatment is comprehensive, prolonged, and in most cases yields limited results. Hormone therapy, keratoplastic ointments, and emollients are indicated. Radiation therapy (Bucky rays) is also prescribed primarily to alleviate functional disorders. In all cases showing signs of early carcinomatous transformation, prompt surgical intervention is mandatory. For pruritus and partially to combat dystrophy, local Applications of a 0.25–0.5% solution of quinine hydrochloride in sterile distilled Water are recommended.