Acute vulvar ulcer

　　1. Causes of the disease

　　The etiology has not been fully clarified; some have suspected viral infection, but it has not been confirmed. Lipschutz believes that the disease is an independent disease with certain clinical characteristics. The secretions of the affected area contain Gram-positive, large bacilli, which are considered to be the pathogenic bacteria of the disease. Some authors have raised objections to this view, arguing that the ulcer itself lacks sufficient characteristics to confirm it as an independent disease. The large bacilli are very similar to lactobacilli, and it is believed that they may belong to the lactobacillus group, which is non-pathogenic to humans and exists in the genital area of most women. A decrease in systemic or local resistance, such as anemia, malnutrition, endocrine disorders, and others, plays a certain role in the occurrence and development of the disease. Some acute infectious diseases such as typhoid, measles, chickenpox, influenza, and others can also trigger the occurrence of the disease. Some people also believe that the disease is a manifestation of Behcet's syndrome, genital herpes, and erythema nodosum.

　　2, Pathogenesis

　　Reduced systemic or local resistance, such as anemia, malnutrition, endocrine disorders, and other factors play a certain role in the occurrence and development of the disease. Some acute infectious diseases such as typhoid fever, measles, chickenpox, influenza, and so on can also trigger the occurrence of the disease.

　　Acute vulvar ulcer often has systemic symptoms, with a rapid onset and a tendency to recur, resembling soft chancre clinically. The symptoms of gangrene type are more severe, often with high fever, rapid development, often causing significant tissue defects, and severe pain. It is common in patients with poor overall nutrition, or those with diabetes, low immune function, and other conditions. Often accompanied by reduced systemic or local resistance, such as anemia, malnutrition, endocrine disorders, etc.

　　Mainly occurs in young women, with mild to severe prodromal symptoms before onset. Patients feel unwell, tired, fever, increased leukorrhea, followed by vulvar burning and itching, and quickly form ulcers. According to the clinical characteristics of the ulcers, they can be divided into three types:

　　1, Gangrene type:Commonly invades the inner side of the labia minora, mostly symmetrical, with a few ulcers, large and deep, with obvious redness and swelling, irregular edges, and a large amount of pus or dirty yellowish black crust on the surface. After removal, the base is soft and uneven. This type of symptoms is more severe, often with high fever, rapid development, often causing significant tissue defects, severe pain, and is common in patients with poor overall nutrition, or those with diabetes, low immune function, and other conditions.

　　2, Chancre type (venereal disease type):Commonly occurs on the inner side of the labia minora, also seen near the perineum and anus, with an appearance extremely similar to soft chancre, with a relatively slow course. The ulcers range in size from broad beans to finger nail size, round or elliptical, with varying depths, irregular edges, and fenestration. The texture is soft, with obvious inflammatory infiltration at the edges, and grayish white purulent secretions on the surface. They can be cured on one side while new ones appear, with a single occurrence or several concurrent occurrences, and severe pain is felt.

　　3, Granuloma type:The ulcers are small, numerous, ranging from the size of a needle head to that of a grain of rice, mostly round or irregular, with sizes often unchanged, rarely fused. The center of the ulcer is deeply sunken, with an inflammatory erythema around the margin, a small amount of pus on the surface, and a yellowish pus-like scab at the base. The自觉symptoms are mild.

　　Pay attention to diet and health care, strengthen nutrition, enhance physical fitness, and avoid infections of acute infectious diseases such as typhoid fever, measles, chickenpox, influenza, and so on. Avoid spicy foods and drinks such as chili, Sichuan peppercorns, raw scallions, raw garlic, and white wine, as well as seafood products such as fish and shrimp. If there are symptoms of vulvar discomfort, it is necessary to visit a gynecological department of a regular hospital in time, receive relevant examinations to make an accurate diagnosis, and receive standardized treatment in a timely manner to avoid delaying the disease.

　　Papanicolaou smear examination of vaginal cells:

　　1. The secretion from the ulcer site is smeared, Gram stained, and examined under a microscope to easily see large bacilli, and some patients have a low level of cell-mediated immune function.

　　The basic histopathological changes in all types are similar, with tissue defects at the ulcer site, reaching the dermis and subcutaneous tissue, with highly necrotic tissue in the defect area, and a large number of neutrophils, as well as a small number of plasma cells and lymphocytes infiltrating. The collagen fibers around the ulcer are disordered and irregular, and Gram-positive large bacilli can be seen between the necrotic tissue after Gram staining.

　　One, Dietary therapy for acute vulva ulcer

　　1. 500g of fresh olive, pounded, add 500g of water, slowly decoct until the soup turns green, and apply externally to treat acute skin conditions (such as superficial scrotal ulcers, acute vulva ulcer, eczema dermatitis, erythema).

　　2. Black beans 50g, 30g of Gancao, 30g of Chipi scallion, 60g of Huaitiao. Decoct the above herbs in water to make a concentrated decoction, and wash the affected area with it after it cools down. Twice a day. Detoxify, reduce swelling, and heal sores. Suitable for soft chancre, hard chancre. The symptoms include ulcers of varying sizes on the penile glans and inner foreskin, with pain or no pain, which can be solitary or multiple.

　　3. Mung beans 60g, a small amount of tea leaves. Boil the mung beans until they are extremely soft, grind the tea leaves into powder, and pour them hot over an old toilet bowl, fumigate and wash to induce sweating.

　　Two What to eat for patients with acute vulva ulcer

　　Eat more fruits and vegetables rich in vitamins and proteins, which can help in the recovery of the disease. Traditional Chinese medicine believes that cool and balanced foods can be the first choice.

　　Three What not to eat for patients with acute vulva ulcer

　　Avoid spicy foods and drinks such as chili, Sichuan peppercorns, green onions, garlic, and white wine, as well as seafood products such as fish and shrimp, and should not be eaten at all.

　　Precautions before the treatment of acute vulva ulcer:

　　One, Yin deficiency

　　1. Treatment method: Nourish the liver and kidney, clear heat and detoxify.

　　2. Prescription: Modified Shenshuangshen Decoction: 15g of Beishashen, 10g of Maidong, 10g of Danggui, 10g of Shudizhi, 10g of Chenpi, 15g of Shouwu teng, 10g of Chuanduan, 15g of Nuzhenzi, 10g of Huanliancao, 10g of Kusen, 15g of Gongying. Decocted in water, take one dose per day, divided into two servings.

　　Two, External treatment methods

　　1. After taking a bath in water decocted with Shechuangzi and Ganshen, apply Bingpao powder externally. Alternatively, apply Yinxici Huanglian ointment externally, and later use Huanglian Ganru ointment.

　　2. For cases of corruption, first use Ku shen decoction for fumigation and washing, then apply Qing Babao and Qingdai ointment externally.

　　3. For cases of eschar separation and new tissue growth, apply Shengji powder and Qingdai ointment externally.

　　Three, Special prescriptions

　　1. Jushi Huanglian Paste: 10g of frankincense powder, 10g of indigo powder, 80g of Huanglian ointment. Function: Clear heat and detoxify, promote muscle growth and relieve pain. Treatment: Vulva ulcer.

　　2. Coptis and Myrrha Ointment; 10g of Coptis powder, 10g of Myrrha powder, 20g of Ganyan stone powder, 70g of Vaseline. Function: Detoxify and contract, relieve pain and promote muscle growth. Treatment: vulvar ulcer.

　　3. Ku shen Decoction: 60g of Ku shen, 30g of She Chuang Zi, 15g of Bai Ji, 30g of Yin Hua, 60g of Ju Hua, 15g of Huang Bai, 15g of Di Fu Zi, 9g of Da Gao Pu. Function: Expel wind and dampness, kill worms and relieve itching. Treatment: vulvar erosion. Usage: decocted with water, remove the dregs, and wash 2-3 times a day.

　　4. Qingbaba (experience formula): 30g of Flying Ganshi, 30g of Burnt Gypsum, 4.5g of Qingbai, 4.5g of Qingdai, all ground into fine powder and mixed evenly. Function: Promote pus and remove corruption; treat vulvar erosion. Usage: Spread the powder evenly over the affected area.

　　5. Qingdai Powder (experience formula): 60g of Qingdai, 120g of Gypsum, 120g of Talcum, 60g of Huang Bai, all ground into fine powder and mixed evenly. Function: Absorb moisture and relieve itching, clear heat and detoxify. Usage: Dry application or mixed with sesame oil and applied to the affected area, once a day. 6. Qingdai Ointment: 75g of Qingdai powder, 300g of Vaseline. First melt the Vaseline and cool it, then slowly add the powder, and it is ready to use. Apply externally to the affected area, once a day. Chinese medicine search Breakline Western treatment method for acute vulvar ulcer

　　Three, General Treatment

　　1. Rest in bed, pay attention to nutrition, keep the local area clean, relieve mental concerns, and encourage confidence in recovery.

　　2. Take a large dose of composite vitamin B complex, 2 tablets each time, 3 times a day; vitamin C, 0.2g each time, 3 times a day; inject penicillin, erythromycin, kanamycin, etc. Patients with gangrene need systemic use of corticosteroids and antibiotics (generally the first choice is penicillin), and gamma globulin may be injected if necessary. For severe ulcers, intravenous drip of penicillin or erythromycin, kanamycin, etc. can be used.

　　Four, Local Treatment

　　1. External application: sit in a bath with 1:6000 potassium permanganate solution for 20 minutes, then apply compound neomycin ointment. Or erythromycin ointment, tetracycline ointment, and the like.

　　2. After sitting in a bath, apply 5% silver nitrate to the wound surface, then apply compound silver nitrate ointment. Or first apply 5% carbonic acid solution to the ulcer surface, then sprinkle with iodophor powder, and finally apply a mild ointment (such as erythromycin ointment) to keep the wound surface.

　　3. Physical Method: Local helium-neon laser irradiation, once a day, for 10-15 minutes each time.