Genital Pruritus Research Articles

Evaluation and diagnostic approach in patient with Perrault Syndrome

HIGHLIGHTS 1. The rare hereditary condition Perrault Syndrome is characterized by sensorineural hearing loss (SNHL) and ovarian dysfunction2. Cyclic estrogens and progesterone may be given to adolescents with amenorrhea to induce withdrawal bleeding and mimic the menstrual cycle. ABSTRACT Objectives: A multidisciplinary team, which included a reproductive endocrinologist and an otolaryngologist, identified Perrault Syndrome in a patient with secondary amenorrhea and bilateral sensorineural hearing loss. Case Report: A 16-year-old female presented to the obstetrics and gynecology clinic at a type B hospital with primary amenorrhea for one year. Menarche occurred at age 13, followed by regular menstrual cycles for two years, after which menstruation gradually ceased. She denied dysmenorrhea, constipation, leukorrhea, genital pruritus, growth retardation, and weight loss. The patient expressed concern about potential future infertility. At age 9, she was diagnosed with a viral infection by an ENT specialist due to bilateral hearing loss, leading to emotional disturbances. There was no history of prior medication, family illness, or chronic infections. Born at term via spontaneous vaginal delivery, the patient weighed 3,000 grams. Laboratory tests revealed normal T3 (1.51 ng/dl), FT4 (1.16 ng/dl), prolactin (18.25 ng/ml), estrogen (11 pg/ml), and progesterone (0.1 pg/ml) levels, but elevated FSH (66.46 mIU/ml) and LH (29.97 mIU/ml) levels. Symptomatic treatment included bone conduction hearing aids and estrogen replacement therapy. Conclusion: Perrault Syndrome, a rare hereditary condition, manifests as sensorineural hearing loss (SNHL) and ovarian dysfunction, including primary ovarian insufficiency (POI) and gonadal dysgenesis, in individuals with a 46, XX karyotype. Molecular diagnosis remains challenging. Consultation with a pediatric endocrinologist can guide cyclic estrogen and progesterone therapy to induce withdrawal bleeding in adolescents with amenorrhea. Women at risk of ovarian failure should consider donor eggs or oocyte cryopreservation. Avoiding aminoglycosides and excessive noise is crucial for managing hearing loss.

Genital pruritus is associated with longer hospital stays, higher costs and increased odds of psychiatric hospitalization among inpatient adults with pruritus in the United States—National inpatient sample (2012–2015)

AbstractBackgroundThough a link between pruritus and worse quality of life (QoL) has been established, little research has delved into which type of pruritus is associated with the highest inpatient burden. A better understanding of how pruritus interacts with other conditions may help reduce the length of hospital stays and improve patient outcomes in fields beyond dermatology.ObjectivesThe objective of this study is to determine which type of pruritus disorder is associated with higher inpatient burden (cost and length of stay) and increased odds of psychiatric hospitalization among inpatient adults with pruritus in the United States.MethodsWe utilized data from the national inpatient sample (NIS) from 2012 to 2015 international classification of diseases, ninth revision, clinical modification (ICD9‐CM). We included male and female adults ≥18 years with primary and secondary diagnoses of pruritus disorders. The outcomes were primary psychiatric diagnosis (yes vs. no), length (days) and the total cost ($) of hospital stay. We explored associations using survey‐weighted binary logistic and linear regression for binary and continuous outcomes and adjusted for covariables (sociodemographic factors).ResultsCompared with other types of pruritus, prurigo nodularis/lichen simplex chronicus (PN/LSC) (odds ratio [OR] = 2.01; 95% confidence interval [CI]: 1.74,2.33), pruritus ani (OR = 2.83; 95% CI: 1.91,4.21) and genital pruritus (OR = 3.51; 95% CI: 2.96,4.16) had increased odds for hospitalization due to psychiatric reasons. Compared with hospitalized patients with any other type of pruritus, hospitalized patients with genital pruritus had 2.37 higher mean days of hospital stay and $10,644 higher mean total cost.ConclusionsGenital pruritus had the highest odds for hospitalization due to a psychiatric disorder, as well as the highest relative increases of average length and cost of hospital stay compared with the five other types of pruritus diagnoses in ICD9‐CM.

44141 Genital pruritus is associated with longer hospital stays, higher costs, and increased odds of psychiatric hospitalization among inpatient adults with pruritus in the United States National Inpatient Sample (2012-2015)

44141 Genital pruritus is associated with longer hospital stays, higher costs, and increased odds of psychiatric hospitalization among inpatient adults with pruritus in the United States National Inpatient Sample (2012-2015)

The Effectiveness of Using DermoXen® Lenitiva for the Treatment of Women with Nonspecific Itching of the Intimate Area

Зуд определяется как неприятное кожное ощущение, связанное с немедленным желанием активизировать рефлекс чесания. В частности, зуд может возникать в области наружной генитальной зоны по нескольким причинам (бактериальная инфекция, грибковая инфекция, стресс, неадекватное интимное поведение, синтетическая одежда). Цель исследования заключалась в сравнении эффективности крема DermoXen® Lenitiva с кремом на основе метилпреднизолона ацепоната 0,1% для лечения зуда интимной зоны. Проведено независимое рандомизированное двойное слепое контролируемое исследование у 60 женщин с неспецифическим генитальным зудом и отрицательным вагинальным мазком на бактериальные и грибковые инфекции. Отмечено более выраженное снижение уровня зуда до 0,44 балла в группе использования DermoXen® Lenitiva при достижении 0,89 балла соответственно в группе использования крема метилпреднизолона ацепоната. Через 30 дней после лечения количество пациенток с легким зудом в группе кортикостероидной терапии почти в 2 раза превышало таковую в группе лечения кремом DermoXen® Lenitiva. Следует отметить статистически достоверный непрерывный рост уровня сексуального и генитального комфорта в обеих группах на протяжении всего периода лечения (p<0,05). Itching can be defined as an unpleasant skin sensation associated with an immediate urge to scratch. In particular, the external genital area may itch for several reasons (bacterial infection, fungal infection, stress, bad sexual behavior, synthetic intimate clothing). The purpose of the study was to compare the efficacy of DermoХen® Lenitiva cream versus cream-based methylprednisolone aceponate 0.1% in the treatment of vulvar pruritus. This was an independent, randomized, double-blind, controlled trial on 60 women with a specific genital pruritus with a negative vaginal smear for bacterial or fungal infection. There was a more pronounced reduction in itching to 0.44 points in the DermoXen® Lenitiva group, while reaching 0.89 points, respectively, in the methylprednisolone aceponate cream group. Four weeks after treatment, the number of patients with mild itching in the corticosteroid therapy group was almost 2 times higher than in the DermoXen® Lenitiva cream group. It should be noted a statistically significant continuous increase in the level of sexual and genital comfort in both groups throughout the entire period of treatment (p<0.05).

High prevalence and little awareness in patients with chronic inflammatory skin diseases and genital involvement.

Genital involvement in patients with chronic inflammatory skin diseases is frequent, yet insufficiently acknowledged. To evaluate the prevalence of genital symptoms in psoriasis and chronic urticaria patients, effects on quality of life, physician-patient relations and disease management. 100 patients with psoriasis and 100 with chronic urticaria from our outpatient clinic, as well as 50 healthy controls were included. Data was collected using questionnaires developed by dermatological experts. Out of 250 subjects, 74% had already experienced genital symptoms - 70% of psoriasis patients and 58% of urticaria patients. Seven out of ten even complained about recurrent genital involvement. 50% of psoriasis and 41% of urticaria patients reported an impact on quality of life. 41% identified genital pruritus as the main symptom, with one out of three expecting a better management for this specific problem. Furthermore, 74% complained about a lack of awareness among physicians: 79% of urticaria patients and 58% of psoriasis patients reported never having been questioned about genital symptoms by their physicians. The majority of patients with psoriasis and chronic urticaria suffer from genital involvement and an impaired quality of life. Patient and physician reported outcomes should include genital symptoms as an influencing factor for quality of life.

Clinical Descriptive Study of Masturbatory Behavior Among Infants and Preschool Children: A Recent Observation From Iraq.

Background: Pleasurable feelings are normal human behaviors experienced not only by adults but even in infancy and childhood. These feelings might become habitual behavior in form of masturbation.Objective: To evaluate the clinical criteria of infants and preschool children with masturbation habits who were described by parents as having unremitted genital pruritus.Patients and methods: This is a case-series study describing cases of children with masturbation referred to the Department of Dermatology at Baghdad Medical City and Basra Teaching Hospital, central and southern Iraq, for four years (2014-2018). Children and their parents were carefully interrogated including detailed information about the problem. Local and general examinations were performed. Children with obvious genital lesions and those who proved to have urinary or gastrointestinal problems were not included.Results: Forty-four children with masturbation were enrolled in the study (22 females and 22 males). The only reason for referral was unremitted genital pruritus. The mean age was 3.6 years. The frequency of masturbation events was variable; the mean length of events was 5 minutes. In 80% of children, masturbation happened at any time. Behavior during the event was prone or supine posturing with rubbing of the genital area with either hands or furniture followed by facial congestion, sweating, and sleep. The majority of children (68%) belonged to low social class families.Conclusion: Masturbatory behavior is not uncommon in infants and preschool children and may mimic episodes of ongoing genital pruritus.

Clinicomycological study of vulvovaginal candidiasis.

Background:Vaginal candidiasis is one of the most common vaginal infections in women of reproductive age group caused by Candida species of fungi, a normal inhabitant of vagina.Aims:The aim is to study the culture characteristics, species prevalence, and drug sensitivity of vulvovaginal candidiasis (VVC) among females with genital pruritus and discharge per vaginum who are proved to have Candida infection by a vaginal smear study.Materials and Methods:A prospective study was done on female patients aged 18 years attending the Sexually Transmitted Diseases Clinic of the Department of Dermato-Venereo-Leprology (DVL), Tirunelveli Medical College, with complaints of genital pruritus and vaginal discharge over a period of 1½ years from 2013 to 2015. After clinical examination, vaginal discharge was smeared for wet mount, potassium hydroxide mount, and Gram stain. Those with pseudohyphae were chosen for culture, speciation, and drug sensitivity.Results:The most common age group affected was 18–35 years. The most common predisposing factor was HIV infection-induced immunosuppression (48.7%), followed by antibiotic usage and diabetes mellitus. Clinical presentation of VVC was similar in HIV-positive and HIV-negative patients. Recurrent VVC makes up 12% of total cases with most common species being Candida albicans whereas Candida glabrata among the non-C. albicans. Drug sensitivity pattern of C. albicans showed the highest sensitivity to nystatin 85.7%, followed by triazoles (75%–85%) with ketoconazole being more resistant (40%–60%), and was similar in C. albicans and non-C. albicans.Limitations:Exclusion of unmarried and pregnant women and lack of follow-up were limitations in our study.Conclusions:According to our study, elimination of predisposing factors, speciation of fungus, and treatment based on drug sensitivity pattern will reduce the incidence of VVC.

Infectious Vulvovaginitis in Adult Women in a Hospital in Dakar

We included 177 patients, a hospital frequency of 5.7%. The mean age was 33.68 years. 71.8% of the patients were married, and 9% had no sexual activity before. Sexual intercourse was only vaginal in 57% and genito-anal in 8.8%. Genital pruritus was present in 75% of cases and leucorrhoea in 73.4%.

Порівняльне дослідження ефективності топічної терапії комбінованими препаратами змішаних вагінітів, асоційованих з цервіцитами

The objective: to increase the effectiveness of local therapy for recurrent nonspecific vaginitis associated with cervicitis in women of reproductive age on the basis of a comparative evaluation of combined drugs Terzhinan and Neo Penotran Forte. Materials and methods. A prospective, open comparative study included 56 women aged 27.5±2.8 years with recurrent nonspecific vaginitis and cervicitis who were randomized to the main group and comparison group. Patients of the main group (n=28) received the drug Terzhinan® (1 vaginal tablet in the evening, before bed, for 10 days). The comparison group included 28 patients who received Neo-Pentran Forte (1 vaginal suppository in the evening, before bedtime, for 10 days), one vaginal suppository containing 750 mg of metronidazole and 200 mg of miconazole nitrate. The complex clinical-paraclinical examination included the determination of the state of the vaginal microbiota using several methods in parallel: a bacterioscopy of vaginal smears stained by Gram, a bacteriological rapid method using AFGENITAL SYSTEM (Liofilchem®, Italy), real-time PCR (Florocenosis) with detection antigens of chlamydia, herpes simplex virus, human papillomavirus, trichomonads. Results. The main reason for the treatment of patients were abundant pathological discharge from the genital tract (73.2%), pruritus (37.5%) and burning (23.2%) in the vulva, pain during sexual intercourse (8.9%), while 33.9% of women expressed combined complaints. Attention was drawn to the significant frequency of dyshormonal pathology among women with recurrent cervico-vaginal infections. In the examined women, uterine leiomyoma was diagnosed (28.6%), genital endometriosis (19.6%), fibrocystic breast disease (37.5%), combined benign dyshormonal diseases of the genital organs (14.3%). About 21.4% of patients treatment of thyroid gland dysfunction (hypothyroidism). According to the comprehensive examination, in all patients of clinical groups, decompensated vaginal dysbiosis was diagnosed, which was manifested by a sharp decrease in the absence of Lactobacillus spp strains in 39.3% of patients and an increase in the number of isolated opportunistic and pathogenic microorganisms to 1011 CFU/ml with an increase in the number of microorganisms in microbial associations (from 2–3 to 5–6 conditionally pathogenic and pathogenic pathogens) in all the cases analyzed. When using the genital express system in vaginal contents, women of the main group identified Escherichia coli (17.9%), Pseudomonas spp. (10.7%), Gardnerella vaginalis (39.3%), Staphylococcus aureus (17 9%), Enterococcus faecalis (25.0%), Streptococcus Group B (10.7%), Candida spp. (46.4%), Mycoplasma spp./Ureaplasma ur. in the title > 105 (14.0%). In the comparison group, the spectrum of detected pathogenic and conditionally pathogenic microorganisms did not differ significantly from the data of the main group. 92.6% of patients in the main group had a pronounced positive clinical effect, and a positive microbiological effect was achieved in 96.4% of cases that persisted during the next two months of follow-up. Without additional prescription of antifungal agents, a positive effect was achieved in 84.6% of patients in the main group with mixed bacterial-candidiasis vaginitis at 54.5% in the comparison group. The independent recovery of the lactobacilli pool to a titer of 107–109 CFU/ml in 17.9% of patients with a lack of detection of lactobacilli before treatment. A similar effect was not observed in the comparison group. Сonclusion. In a comparative study of the results of the use of Terzhinan and Neo-Penotran Forte in monotherapy in patients with inflammatory diseases of the lower genitalia (nonspecific recurrent vaginitis and cervicitis), the high clinical and microbiological efficacy of Terzhinan has been demonstrated. Key words: mixed vaginitis, cervicitis, Terzhinan, Neo-Penotran Forte.

Knowledge and misconceptions of Saudi women about sexually transmitted infections.

Sexually transmitted infections (STIs) are increasingly becoming one of the most important health challenges , especially among women, as they bear long-term consequences such as infertility and cervical cancer owing to STIs. This study aimed to assess the knowledge and misconceptions of Saudi women about STIs. A descriptive study was conducted among adult women attending the dermatology clinic at King Saud University Medical City, Riyadh, Saudi Arabia, for reasons other than STIs. They were randomly approached and asked to complete an anonymous prevalidated questionnaire. Uneducated females were guided by an interviewer during the filling up of the survey questionnaire. Of 1150 women approached, 843 adult Saudi women responded to the survey (response rate: 73.3%). The mean age was 30.6±10.9 years. Knowledge of STIs was highest for HIV (85.9%) and lowest for genital warts (17.0%). Respondents believed that genital pruritus, foul discharge, and painful micturition are symptoms of STIs (71.1, 69.1, and 56.4%, respectively). A considerable percentage believed that STIs are transmitted by masturbation (54.8%), sleeping on contaminated beds (39.3%), and by eating and drinking from contaminated utensils (26.3%) whereas 8% believed that STIs are transmitted by shaking hands. Nearly two-thirds of women thought that condoms protect against STIs. Knowledge on the modes of transmission and symptoms of STIs was significantly correlated with younger age, higher level of education, and higher monthly income. Despite the huge campaigns and information about STIs seen on the internet and television by these women, there is still scarcity of knowledge on the more important aspects of STIs, especially the recognition of clinical features and modes of transmission/spread of STIs. There is still a need for health authorities to intensify information-dissemination campaigns about STIs to the grassroots level, particularly among women in Saudi Arabia.

SGLT2 inhibitor-related genital pruritus: impact on QoL?

SGLT2 inhibitor-related genital pruritus: impact on QoL?

Effectiveness of Ipragliflozin for Reducing Hemoglobin A1c in Patients With a Shorter Type 2 Diabetes Duration: Interim Report of the ASSIGN-K Study.

BackgroundIpragliflozin is a selective sodium glucose co-transporter 2 inhibitor. The ASSIGN-K study is investigating the efficacy and safety of ipragliflozin for type 2 diabetes mellitus (T2DM) in the real-world clinical setting.MethodsJapanese T2DM patients with inadequate glycemic control despite diet and exercise with/without pharmacotherapy were enrolled in an investigator-driven, multicenter, prospective, observational study examining the efficacy and safety of ipragliflozin treatment (50 mg/day for 52 weeks). We performed interim analysis after 24 weeks.ResultsIn 367 patients completing 24-week ipragliflozin therapy, hemoglobin A1c (HbA1c) decreased significantly from 8.07% at baseline to 7.26% in week 24 (P < 0.001). The change in HbA1c from treatment initiation to week 24 was -0.88% in patients < 65 years old versus -0.55% in those ≥ 65 years and -0.92% in men versus -0.70% in women (all P < 0.001). When baseline HbA1c was < 7%, 7% to < 8%, and ≥ 8%, the change was -0.18%, -0.45%, and -1.48%, respectively (P = 0.5352, P < 0.001, and P < 0.001, respectively). When baseline body mass index (BMI) was < 25, 25 to < 30, and ≥ 30, the change was -1.05%, -0.65%, and -0.87%, respectively (all P < 0.001). Multiple regression analysis showed that HbA1c decreased more in patients with a higher baseline HbA1c or shorter duration of diabetes. An HbA1c < 7% was achieved in 33.3% of the patients, and their baseline HbA1c was significantly lower than that of patients failing to achieve it (P < 0.001). Adverse events (AEs) occurred in 106/451 patients (23.5%), including 29.1% of patients aged 65 or older. Common AEs were vulvovaginal candidiasis (3.1%) and genital pruritus (1.8%). Serious AEs included urinary tract infection, unstable angina, and ketosis, which occurred in patients who did not suspend medication during acute illness.ConclusionsIpragliflozin significantly improved HbA1c in T2DM patients with inadequate glycemic control. Improvement in HbA1c was significant irrespective of age, sex, baseline HbA1c, or BMI, but efficacy was greater with a higher baseline HbA1c and shorter duration of diabetes. For safe continuation of treatment, patients should be advised to suspend medication during acute illness.

Ipragliflozin Improves Glycemic Control and Decreases Body Fat in Patients With Type 2 Diabetes Mellitus.

BackgroundIpragliflozin, a sodium-glucose transporter 2 inhibitor, was administered to patients with type 2 diabetes mellitus for 24 weeks to evaluate its effect on glycemic control and body composition.MethodsThis was an investigator-initiated multicenter prospective intervention study in which ipragliflozin (50 mg) was administered once daily and glycemic control, blood pressure, body weight (BW), body composition (measured by a biological impedance method), the lipid profile, and adverse events were evaluated after 4, 12, and 24 weeks of treatment.ResultsEfficacy and safety up to 24 weeks of ipragliflozin therapy were analyzed in 367 patients and 451 patients, respectively. Hemoglobin A1c decreased significantly from 8.07% at the start of ipragliflozin therapy to 7.26% in week 24 (P < 0.001). Fasting and postprandial blood glucose levels were significantly reduced by ipragliflozin. In week 24, there were significant decreases from baseline in BW (-2.6 kg), waist circumference (-2.9 cm), and body fat mass (-1.9 kg) (P < 0.001). The body water mass and mineral mass were decreased significantly by 0.5 and by 0.1 kg, respectively (P < 0.001), whereas the protein mass did not change significantly. Intracellular water mass did not change significantly, whereas extracellular water mass showed a significant decrease of 0.5 kg (P < 0.001). Muscle mass did not change in the upper and lower limbs, but that of the trunk decreased significantly (P < 0.001). There was a significant decrease in the fasting triglyceride level and a significant increase in fasting high-density lipoprotein cholesterol level, while low-density lipoprotein cholesterol was unchanged. Adverse events occurred in 23.5% of the patients, with a high frequency of genital infections, such as vulvovaginal candidiasis (3.1%) and genital pruritus (1.8%). Adverse drug reactions were noted in 13.7% of the patients.ConclusionsAdministration of ipragliflozin for 24 weeks improved glycemic control and decreased BW. Reduction of body fat accounted for more than 70% of the total weight loss and reduction of extracellular water accounted for about 20%.

Phase I dose-escalation trial of intravaginal curcumin in women for cervical dysplasia.

BackgroundThis is a Phase I trial demonstrating safety and tolerability of intravaginal curcumin for future use in women with cervical neoplasia.ObjectiveThe objective of this study was to assess the safety, tolerability, and pharmacokinetics of intravaginal curcumin in healthy women.Study designWe conducted a 3+3 dose-escalation Phase I trial in a group of women aged 18–45 years. Thirteen subjects were given one of four doses of curcumin powder (500 mg, 1,000 mg, 1,500 mg, and 2,000 mg) packed in gelatin capsules, which was administered intravaginally daily for 14 days. The primary end point for this study was safety based on severe adverse events regarding laboratory toxicity, clinical findings, and colposcopic abnormalities. We administered an acceptability questionnaire to assess product experience and attributes.ResultsNo dose-limiting toxicities (0/13) were experienced (95% confidence interval: 0.0%–22.8%) in this study. The pharmacokinetics data demonstrated that curcumin and curcumin conjugates were not measurable in the serum and negligible in the urine of the study participants. Although 23 adverse events occurred during the course of the trial, all events were grade I based on the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 and were resolved by the end of the study in an average of 9 days. Fifty-six percent of the adverse events were related to the study drug, which included genital pruritus (23% of subjects), vaginal discharge (100%), vaginal dryness (15%), abnormal prothrombin (23%), and hypokalemia (8%).ConclusionIntravaginal curcumin was well tolerated by all subjects and safe. In this Phase I trial, there were no severe adverse events observed at any of the administered dose levels. All adverse events were grade I and did not result in early termination of the study. There was no evidence of systemic absorption or significant local absorption of intravaginally administered curcumin.

Urogenital myiasis caused by Psychoda albipennis in a child

Urogenital myiasis results when flies lay their eggs near the exit of the urethra and the larvae proceed upward along the urogenital tract. In this case report, a 10 year-old female patient diagnosed with urogenital myiasis was reported. The patient presented with complaints including painful and frequent urination, genital pruritus and moving larvae in urine. The patient had received Enterobius vermicularis treatment previously for two times. A 24-hour urine sample was collected and two black larvae were found in the urine. It was found that these larvae were fourth-stage larvae of Psychoda albipennis. Although there was no risk factor, the patient was affected with this rare parasitological disease. This case was presented to draw attention to myiasis in children. Myiasis may be observed in individuals with a favourable hygiene status and a high socioeconomical level. If a detailed history is not taken and appropriate laboratory tests are not performed, the diagnosis may be missed.

Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue.

Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

Genitoanal pruritus

Genitoanal pruritus is usually characterized by intense pruritus in the genital area, possibly also extending to the anal and gluteal regions. Besides pruritus, other sensations such as burning, stinging, heat sensations and pain may occur. Genital pruritus may be associated with specific skin lesions of dermatoses such as eczema, lichen sclerosus or others. The skin is often without pathological findings, but one should be alert to transient erythemas, fetor and excretions in the genital area. Caused by intense scratching, secondary lesions such as papules, excoriations and crusts may appear. Maceration also frequently develops. In chronic dermatoses such as eczema and psoriasis, the anogenital area is commonly involved, but often not mentioned by patients due to feelings of shame or because skin changes in other body areas are more prominent. In addition to a complete medical history and thorough physical examination, special attention must be paid to the anogenital area including the mucosa surfaces. Diagnostics should be performed according to the guidelines on chronic pruritus. Besides a gynecological and if necessary urological examination, allergy testing (patch test) and, in case of possible neuropathic causes, magnetic resonance tomography (MRT) should be performed. Therapy depends on the underlying cause. Symptomatic-antipruritic measures are available. Interdisciplinary medical care is often necessary, usually leading to a clarification of the causes and satisfactory therapy. Somatoform disorders should also be taken into account. In summary, genital pruritus forms a challenge that can, however, be met well by careful diagnostics, therapy and interdisciplinary care in the daily clinical practice.

Carcinoma espinocelular de la vulva: caso clínico

SUMMARY Background: Squamous cell carcinoma (SCC) is a malignant epithelial neoplasm. SCC can be divided into 4 groups: non-melanoma skin cancer (NMSC), head and neck, esophageal and lung cancer. The risk for metastasis of SCC is 0.3-3.7%. Vulvar SCC is approximately 3-5% of all gynecological cancers. Case report: An 86-year old woman with a history of several years of genital pruritus and many consultations for this reason, prior treatments included valacyclovir for genital herpes; topical corticosteroids and tachrolymus for lichen sclerosus et atrophicus (LEA) with poor response. She presented with pruritus and new vulvar lesions. Physical examination showed two ulcerated nodules on the left periclitorid region and the introitus. The biopsy confirmed an infiltrating well-differentiated SCC. CT-scans discarded metastases. She received 7 weeks of radiotherapy. Due to persistence of the tumor the patient entered palliative care. Two years afterwards the patient is in good condition. Discussion: SCC represents 95% of vulvar malignancies. There are 2 types: SCC in young women, associated with high-risk human papilloma virus infection and SCC in elder women associated to the preexistence of LEA. 45-61% of vulvar SCC is associated in with preexisting

Protocolo diagnóstico y terapéutico de las uretritis infecciosas

Infectious urethritis is a sexually transmitted disease. Generally classified as gonococcal urethritis and nongonococcal depending on the pathogen. The most common symptoms are genital pruritus, dysuria, and the presence of mucopurulent or purulent discharge through the urethral meatus. The suspected diagnosis is based on the presence of these symptoms in conjunction with the findings of pyuria in urinary sediment with negative urine culture.Microbiological confirmation will be diagnosed by culture, antigen detection tests or nucleic acids. The goal of the treatment is to eradicate the infection and prevent complications and infecting other patients. The detection of other sexually transmitted infections must be performed on all patients diagnosed.

Guideline vulvovaginal candidosis (2010) of the german society for gynecology and obstetrics, the working group for infections and infectimmunology in gynecology and obstetrics, the german society of dermatology, the board of german dermatologists and the german speaking mycological society

Candida (C.) species colonize the estrogenized vagina in at least 20% of all women. This statistic rises to 30% in late pregnancy and in immunosuppressed patients. The most often occurring species is Candida albicans. Host factors, especially local defense deficiencies, gene polymorphisms, allergic factors, serum glucose levels, antibiotics, psychosocial stress and estrogens influence the risk for a Candida vulvovaginitis. In less than 10% of all cases, non-albicans species, especially C. glabrata, but in rare cases also Saccharomyces cerevisiae, cause a vulvovaginitis, often with fewer clinical signs and symptoms. Typical symptoms include premenstrual itching, burning, redness and non-odorous discharge. Although pruritus and inflammation of the vaginal introitus are typical symptoms, only less than 50% of women with genital pruritus suffer from a Candida vulvovaginitis. Diagnostic tools are anamnesis, evaluation of clinical signs, the microscopic investigation of the vaginal fluid by phase contrast (400 x), vaginal pH-value and, in clinically and microscopically uncertain or in recurrent cases, yeast culture with species determination. The success rate for treatment of acute vaginal candidosis is approximately 80%. Vaginal preparations containing polyenes, imidazoles and ciclopiroxolamine or oral triazoles, which are not allowed during pregnancy, are all equally effective. C. glabrata is resistant to the usual dosages of all local antimycotics. Therefore, vaginal boric acid suppositories or vaginal flucytosine are recommended, but not allowed or available in all countries. Therefore, high doses of 800 mg fluconazole/day for 2-3 weeks are recommended in Germany. Due to increasing resistence, oral posaconazole 2 × 400 mg/day plus local ciclopiroxolamine or nystatin for 15 days was discussed. C. krusei is resistant to triazoles. Side effects, toxicity, embryotoxicity and allergy are not clinically important. A vaginal clotrimazole treatment in the first trimester of pregnancy has shown to reduce the rate of preterm births in two studies. Resistance of C. albicans does not play a clinically important role in vulvovaginal candidosis. Although it is not necessary to treat vaginal candida colonization in healthy women, it is recommended in the third trimester of pregnancy in Germany, because the rate of oral thrush and diaper dermatitis in mature healthy newborns, induced by the colonization during vaginal delivery, is significantly reduced through prophylaxis. Chronic recurrent vulvovaginal candidosis requires a "chronic recurrent" suppression therapy, until immunological treatment becomes available. Weekly to monthly oral fluconazole regimes suppress relapses well, but cessation of therapy after 6 or 12 months leads to relapses in 50% of cases. Decreasing-dose maintenance regime of 200 mg fluconazole from an initial 3 times a week to once monthly (Donders 2008) leads to more acceptable results. Future studies should include candida autovaccination, antibodies against candida virulence factors and other immunological trials. Probiotics should also be considered in further studies. Over the counter (OTC) treatment must be reduced.