Vulvovaginal-gingival syndrome

　　1. Etiology

　　The etiology of the disease has not been fully understood. In the past, it was believed to be related to mental factors and neurological disorders: such as overfatigue, mental depression, neurasthenia, tension, excitement, and insomnia, etc. But there are also those who have developed the disease without the above reasons, so some people believe that neurasthenia may be a kind of complication of the disease.

　　The disease is closely related to infection, and in the factors of infection, it is more inclined to the virus theory. There are also individual reports that bacteria or fungi are found in the skin lesions, but most have not been confirmed.

　　In recent years, some scholars believe that the disease is a hypersensitivity or autoimmune disease.

　　Recently, some people have reported a skin disease similar to this disease, which is caused by allergy to certain drugs or contact with certain dyes.

　　In addition, malnutrition, endocrine disorders, gastrointestinal dysfunction, trauma including skin knife injury and contact dermatitis, excessive alcohol consumption, strong tea, and coffee, etc., may be predisposing factors for the disease.

　　The disease has an occasional family history.

　　2. Pathogenesis

　　Tissue taken from the white fine lines shows typical lichen planus pathological changes; tissue taken from the inflammatory site is non-specific inflammation with an unequal number of plasma cells; some are similar to viral infections, and a few patients believe that there is a virus after electron microscopy examination; immunofluorescence method proves that immunoglobulins and complement exist at the junction of the epidermis and dermis in patients, without immune complex deposition.

　　Common complications of vulvovaginal-gingival syndrome: Vulvovaginal-gingival syndrome is related to mental factors and neurological disorders, such as overfatigue, mental depression, neurasthenia, tension, excitement, and insomnia, etc., and neurasthenia is a kind of complication of the disease. It is diagnosed according to the clinical features of erosive vulvitis, vaginitis, and gingivitis. However, the damage to the three sites may not occur simultaneously, and it may only occur in one or two sites. Diagnosis is made based on medical history, clinical manifestations, and pathological biopsy results. Clinical symptoms supporting the diagnosis of lichen planus include: around the eroded injury of the vulva, there is usually a narrow white reticular border, and in the non-erosive lichen planus area of the skin and mucosa, it is also common to see mucosal surface lesions in the oral lichen planus. Biopsy tissue taken from the white reticular border often shows typical lichen planus-like tissue structure; while biopsy tissue taken from the surface of the erosion center often shows non-specific inflammatory reaction.

　　The onset of clinical symptoms is often asynchronous, often with the lesions of several sites appearing sequentially.

　　EisenD studied 22 patients and found that among all patients with lichen planus of the gums, 16 had erosions and erythema, and 6 had white reticular lesions; in most patients, vulvar-vaginal lichen planus also presents as erosions.

　　The clinical features observed are as follows:

　　1. All patients have involvement of the vulva, vaginal, or gingival mucosal surface with erosive or desquamative lesions;

　　2. It often occurs at specific times;

　　3. Only 1 to 2 of the 3 parts involved.

　　At any time, psychological counseling and comfort are very important for patients with lichen planus. Vulvar lesions are often chronic and may undergo malignant transformation. Long-term follow-up should be conducted for patients with lichen planus. Prognosis: It is difficult to control diseases resistant to corticosteroids with other regimens, and the possibility of spontaneous recovery is extremely small. However, the risk of local lesions progressing to keratinocyte carcinoma is relatively small. However, patients and their families should be informed of the risk of kidney function damage and the possibility of tumor occurrence.

　　During the process of taking medicine for vulvovaginal-gingival syndrome, it is necessary to monitor the complete blood cell count, liver function, cholesterol, triglycerides (triglycerides), electrolytes, blood urea nitrogen, creatinine, and creatinine clearance rate. Take a biopsy for diagnosis.

　　1. Dietetic recipes for vulvovaginal-gingival syndrome

　　1. Gentian root and egg: boil gentian root (10 grams) to make a decoction, remove the residue, crack 3 eggs into a nest egg, add 30 milliliters of honey. Eat on an empty stomach, 5 days as a course. It has the function of clearing heat and healing boils. It is mainly used for vulvar ulcers; symptoms include severe vulvar burning pain.

　　2. bitter atractylodes egg: bitter atractylodes 60 grams concentrated decoction, add 2 beaten eggs, 60 grams of brown sugar cooked. Eat the egg and drink the soup, 1 time a day, 6 days as a course. It has the function of clearing heat, detoxifying, drying dampness and healing boils. It is mainly used for damp-heat fire toxin type vulvar ulcers; symptoms include severe vulvar heat and pain.

　　3. bitter tea return to shell decoction: tea, pangolin,当归each 15 grams into the pot, add water, wine half each decoct. 2 times a day, until the ulcer is healed. It has the function of clearing heat, detoxifying, activating blood and resolving phlegm. It is mainly used for damp-heat fire toxin type vulvar ulcers; symptoms include severe vulvar swelling and pain, burning discomfort.

　　4. General's Egg: Make a small hole at the top of a raw egg, add 3 grams of raw rhubarb powder, cover the hole with paper, and boil in water until cooked. Eat on an empty stomach, 3 times a day, for 4 to 5 days as a course. It has the function of cooling blood and healing boils. It is mainly used for vulvar ulcers; symptoms include long-term non-healing, burning pain.

　　5. Cucumber, Chinese yam, and Green Snake Soup: Peel and clean the inside of a green snake (about 250 grams), boil it in a pot of boiling water, remove the bones, and cook with 100 grams of Chinese yam, 60 grams of red beans, 30 grams of ginger, 8 red dates (with the seeds removed), and 500 grams of cucumber cubes. Add an appropriate amount of water, boil with high heat, and then simmer over low heat for 3 hours. Season and eat. It has the function of clearing heat, detoxifying, and promoting diuresis. It is mainly used for damp-heat type vulvar ulcers with downward accumulation.

　　6. Dandelion Soup: Take 30 grams of dandelion, 90 grams each of half-leaf lily and snake tongue grass, 50 grams of lonicera japonica, 15 grams of scallion whites, and cook together in a pot with an appropriate amount of water. Boil with high heat and then simmer over low heat for 1 hour. Dissolve a suitable amount of brown sugar in the juice and take it all at once, or drink it as tea frequently. It has the function of clearing heat, detoxifying, resolving phlegm and healing boils. It is mainly used for hot toxin type vulvar ulcers with congestion.

　　7. Dandelion and Mung Bean Soup: Boil dandelion leaves (10 grams) to make a decoction, then add 50 to 100 grams of mung beans to cook porridge. Stir in a suitable amount of rock sugar and eat. It has the function of clearing heat, detoxifying and healing boils. It is mainly used for hot toxin type vulvar ulcers.

　　2. What is good for the body with vulvovaginal-gingival syndrome?

　　1. Consume more foods rich in protein and carbohydrates. For example: milk, soy milk, eggs, meats, etc.

　　2. Drink more water and eat more fresh fruits and vegetables. For example: apples, pears, bananas, strawberries, kiwis, cabbage, green vegetables, rapeseed, mushrooms, seaweed, kelp, etc.

　　3. Eat cooling blood and detoxifying foods. Green beans, glutinous rice, cucumbers, bitter melon, Portulaca oleracea, green tea, etc.

　　Third, it is best not to eat the following foods for vulvovaginal-gingival syndrome

　　1. Avoid foods that can cause itching. For example: fish, shrimp, crabs, chicken heads, pork heads, goose meat, chicken wings, chicken feet, etc., eating them can worsen the itching and inflammation of the vulva.

　　2. Eat less spicy and irritating foods. For example: onions, peppers, chili peppers, Sichuan peppercorns, mustard greens, fennel, etc.

　　3. Avoid eating fried and greasy foods. For example: fried dough sticks, butter, butter, chocolate, etc., these foods have the effect of increasing dampness and heat, which can increase the secretion of leukorrhea and is not conducive to the treatment of the disease.

　　4. Quit smoking and drinking. Smoking and alcohol are very irritating and can worsen inflammation.

　　First, medication treatment

　　Most patients respond well to medication, and often a satisfactory therapeutic effect can be achieved by combining several drugs.

　　1. Corticosteroids: Chlorobetasol (chlorobetasol propionate), the dosage forms include ointment and cream, many clinical doctors prefer cream because it is less irritating than ointment, twice a day, and after a month, change to once a day, taken before bedtime, and continued for 2 months, 77% of the patients' symptoms can be relieved; 18% of the patients have partial relief of symptoms; long-term use of corticosteroids, the vulvar skin often can occur atrophy and cracks, while long-term use of chlorobetasol (chlorobetasol propionate) has not shown any change. After the above routine treatment, the patient should be re-examined, and if necessary, can continue to use it, once or twice a week is enough. It is not uncommon for patients with this condition to present with sudden vulvar itching as the main complaint, which is often related to other pruritic causes, such as candidal infection. When this situation occurs, it is usually necessary to do a candidal culture, and any similar infection should be eradicated before the main treatment.

　　2. After the above treatment, if there is still persistent mild itching, the following two methods can be adopted:

　　(1) Woodruff and Thompson suggest that 5mg of triamcinolone acetonide suspension be diluted with 2ml of normal saline and then injected subcutaneously into the labia majora and labia minora. The method is: use a 21-gauge spinal needle to puncture from the upper part of the labia majora along the subcutaneous tissue to the perineum; while withdrawing the needle, slowly inject the suspension. After that, massage the tissue to promote its spread, which can alleviate the patient's itching and control the disease through local medication.

　　(2) Subcutaneous injection of ethanol, the method is: draw a grid pattern with an interval of 1cm on the vulva, inject 0.1-0.2ml of anhydrous ethanol every 1cm, then gently massage to spread the ethanol. This usually can alleviate itching and can last for 6-12 months after the vulva gradually recovers sensation, usually without recurrence. This method is ineffective for patients with the main symptom of vulvar burning pain.

　　3. Antibiotic use: For erosive lichen planus, doxycycline 100mg, twice a day, or clindamycin 150mg, twice a day, and other antibiotics can be used for a long time.

　　4. Hydroxychloroquine 200mg, 2 times a day.

　　5. Isotretinoin 40mg, 2 times a day; or etretinate (11egison) 25mg, 1-2 times a day, can be used to treat oral lichen planus. Once discontinued, recurrence may occur. Long-term use of vitamin A derivatives can cause abnormal liver function, so liver function, cholesterol, triglycerides (triglycerides), and complete blood count should be tested. As these drugs have the potential to cause teratogenic effects, contraceptive measures should be taken during medication.

　　6. Griseofulvin: There are reports of successful treatment with oral griseofulvin, with a dosage of 250mg, 2 times a day, but it only has significant efficacy for erosive genitourinary diseases.

　　7. Dapsone: 50-100mg/d, was used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, and complete blood count should be monitored during medication.

　　8. Cyclosporin: For skin and mucosal diseases, the local use of cyclosporin is a safe and effective method, but it is expensive. Pe-lisse et al. used an oral or injectable formulation at an initial dose of 100mg, 4 times a day, for the affected skin. If multiple skin and mucosal sites are involved, then 100mg for the vulva, 100mg inserted vaginally, and 100mg held in the mouth can be used. Once controlled, symptoms will subside. In patients who are weak or have severe pain and the above methods cannot control, oral cyclosporin can be used. Renal function should be monitored during the medication process as it may increase the risk of late-stage lymphoma. The dose is 1mg/(kg/d) (can increase by 0.5mg/(kg/d) every 2-4 weeks, with a maximum dose of 3-5mg/(kg/d)).

　　9. Systemic antimetabolites: Cyclophosphamide, azathioprine.

　　10. Sedative-hypnotics: Recently found to have good efficacy for oral erosive lichen planus. However, there are no reports on the treatment of vulvar lichen planus.

　　Any treatment plan mentioned above is prone to recurrence if not adhered to.

　　II. Surgical Treatment

　　Surgical treatment can only be performed after the acute disease is controlled, otherwise, scars will re-form quickly. After surgery, the vagina needs to be dilated daily with a dilator to maintain a certain width and depth, and close follow-up is required.