Vulvar Leukoplakia

　　Vulvar leukoplakia presents with vulvar itching, dry skin, thickening and whitening, loss of elasticity, and even atrophy and ulceration, with pain and burning sensation. Clinical pathological examination shows atypical cell hyperplasia, which falls under the category of 'vulvar itching', 'vulvar pain', and 'vulvar ache' in traditional Chinese medicine. It is often due to downward invasion of damp-heat in the liver meridian affecting the vulva, or due to blood deficiency and liver hyperactivity, liver and kidney yin deficiency, or kidney yang deficiency, where the essence and blood cannot nourish the vulva.

　　It should be distinguished from diseases that can make the vulvar skin white, such as lichen sclerosis, chronic dermatitis, neurodermatitis, vulvar leukoplakia, lichen planus, diabetic vulvitis, vulvar papilloma, vitiligo, and vulvar cancer.

　　Vulvar leukoplakia can occur at any age, during all stages of a woman's life: childhood, adolescence, menopause, and old age. However, it is most common in women around the age of 50, with varying durations of the disease, with some lasting for decades. The predisposed areas are mainly between the clitoris, the inner groove of the labia minora, and the labia majora, sometimes occurring symmetrically in the vestibule, vagina, and urethral orifice, and the posterior commissure.

　　Vulvar itching is the prominent symptom felt by patients first, especially severe at night. The degree of itching is related to time, menstruation, climate, diet, environment, and mood. Itching usually occurs intermittently, and patients often scratch continuously due to severe itching. Scratching can cause multiple excoriations and swelling in the vaginal canal. Due to long-term itching, local ulcers, fissures, and secondary infections may occur. Therefore, patients often have local burning and pain, especially in sensitive areas such as the clitoris and labia minora.

　　Vulvar leukoplakia in the early stage shows hyperkeratosis and infiltration with fatty skin. The vulvar skin and mucosa appear with localized or diffuse white thickening resembling leather, with wrinkles or scales, and eczematous changes. The vulvar skin color is mostly purple-red or light red, but can also be gray-white, gray-blue, with clear boundaries and varying shapes and sizes of white keratotic plaques. Mixed malnutrition is present, with symptoms of both atrophy and hyperplasia, including significant vulvar atrophy, thickening of the prepuce of the clitoris, obvious keratosis, coarse texture of the labia majora, pigment reduction, and localized thickening and ulcers. The vulvar skin is rough and hypertrophic, with excoriations and sometimes fissures. Local pigment reduction is common, with the labia majora and labia minora becoming pale. There may be mild atrophy of the vulva, with severe cases showing atrophy and adhesion of the clitoris and labia majora, partial or complete disappearance of the labia minora, a tightened posterior commissure, a narrow vaginal orifice with loss of elasticity, and even affecting urination and sexual life.

　　The causes of lichen sclerosis of the vulva are related to changes in the internal environment, including endocrine disorders and the imbalance of liver, spleen, and kidney function, as well as the repeated infiltration of local vulvar inflammation. Therefore, do not overwork yourself, ensure a good sleep, adjust your emotions, and enhance your immunity. Vulvar and vaginal inflammation should be treated in a timely manner to eliminate the external factors that can cause lesions. If unfortunately, lichen sclerosis of the vulva is contracted, it is necessary to seek treatment in a regular specialized hospital in a timely manner to prevent the disease from developing to a severe degree, turning into cancer, and endangering life.

　　Traditional Chinese medicine believes that lichen sclerosis of the vulva is often due to insufficient liver, spleen, and kidney function and the imbalance of liver, spleen, and kidney function, as well as the disharmony of Qi and blood, obstruction of meridians, endocrine disorders, and malnutrition of the skin. Compared with Western medicine, Chinese herbal medicine has the characteristics of wide-spectrum effects, few side effects, and is suitable for long-term use. The treatment of lichen sclerosis of the vulva with traditional Chinese medicine has a history of over a thousand years, with rich experience, and is a trustworthy green therapy. As long as the treatment is persisted in and the treatment is correctly differentiated and treated, the majority of patients can achieve the effect of clinical cure.

　　1. Vulvar biopsy:It is one of the main examination methods, with accurate and reliable results, and the report can be issued in general within 20 minutes. What examination should be done for patients with lichen sclerosis of the vulva? Vulvar examination: Checking the condition of the vulvar lesions in patients, relying on the doctor's clinical experience to make a judgment.

　　2. Speculum examination:Using a speculum to deeply examine the vulva, checking the specific condition of the vulva and the affected area. What examination should be done for patients with lichen sclerosis of the vulva? Light examination: Using a light to illuminate the lesion area in a dark room, which is helpful for the judgment of lichen sclerosis of the vulva.

　　3. Vaginal discharge examination:The examination items include pH value, cleanliness, ammonia test, and other 6 items. What examination should be done for patients with lichen sclerosis of the vulva? It is important to note that different physical conditions of patients can affect the accuracy of the examination. Pay attention to avoid lichen sclerosis of the vulva examination when there are these conditions. Avoid examination during vulvar suppurative infection and menstrual period.

　　Eating more vegetables and fruits rich in vitamins and fiber, avoiding spicy and刺激性 foods, can include more tomatoes, carrots, cabbage, winter melon, and other foods; at the same time, it is appropriate to strengthen nutrition by eating more soy milk, fish, and others, but it is important to avoid consuming too much sugar and fat, as the occurrence of these diseases is often related to sugar and fat metabolism.

　　1. Traditional Chinese medicine treatment

　　Traditional Chinese medicine treats this disease according to the different characteristics of the lesions and clinical symptoms, following the treatment principles of 'vulvar itching' and 'vulvar sore'. 'Vulvar itching' is accompanied by wind, and 'vulvar sore' is accompanied by dampness and heat retention. This disease often occurs in women during the childbearing and elderly periods, and is rare in young girls. Generally, it is divided into two types:

　　1. Hyperplastic nutrition deficiency: Symptoms include severe vulvar itching that is difficult to bear, accompanied by local pain after scratching, mainly affecting the labia majora and the interlabial groove, often symmetric, the skin in the area of the disease thickens like leather, with raised wrinkles, generally without atrophy and adhesion.

　　2. Sclerotic lichen nutrition: Symptoms include itching in the area of the skin damage, the skin or mucosa becomes white, thin, dry and prone to cracking, loses elasticity, and the clitoris often atrophies. In the late stage, there may be difficulty in sexual intercourse. When diagnosing, diabetes, candidiasis, and other causes of vulvar itching should be excluded. When there are obvious ulcers or hyperplasia, consider pathological examination to prevent the occurrence of malignancy.

　　In general, observe the body's physical condition, such as obesity, thinness, weakness, strength, and whether there are symptoms such as aversion to cold, hot flashes, alternating chills and fever, and cold limbs. Examine the tongue quality, differentiate the coating of the tongue, and wait for the pulse. Ask in detail: menstrual history, leucorrhea, pregnancy, childbirth, and whether there are any sisters with this disease. Locally, carefully observe whether there are cracks, atrophy, ulcers, nodules, adhesions, swelling, exudation, desquamation, and decreased elasticity in the lesion area. Whether the edge of the skin damage is neat and the boundary is clear. Observe the morphology of these rashes to differentiate them from cold and dampness, heat conglomeration, yang deficiency, phlegm and blood stasis, and the severity and urgency of the disease progression.

　　The 'Internal Classic' says that 'the kidney opens its orifices at the two yin organs' and 'the liver meridian connects with the genital organs'. The relationship between the white vulvar lesions and the liver and kidney meridians is the closest. 'The kidney stores essence' and 'the liver stores blood'. Deficiency of kidney essence and liver blood leads to the vulva losing its nourishment, and it is attacked by wind evil or dampness descending, which is the main etiology and pathogenesis of white vulvar lesions.

　　The white vulvar lesions, although occurring on the vulva, are actually due to liver depression, spleen deficiency, kidney deficiency, and disharmony of Chong and Ren channels. Cold and dampness, heat conglomeration, yang deficiency, and phlegm and blood stasis can induce this disease. The vulvar skin shows grayish-white thickening in patchy areas, severe itching, often leading to bleeding due to scratching, abundant leucorrhea with a yellow color, dry mouth and throat, hot flashes, irritability, yellow urine and hard stools, yellow greasy coating and red edge of the tongue, wiry and rapid pulse. According to the main clinical characteristics of this disease, it is considered to belong to the categories of 'vulvar itching', 'vulvar erosion', and 'vulvar sores' in traditional Chinese medicine. The pathogenesis is often due to insufficient Yin and blood in the liver and kidney, with blood deficiency in the vulva leading to wind and dryness, resulting in intolerable itching, or due to spleen deficiency, where Qi deficiency and blood deficiency cannot nourish the vulva, spleen deficiency can also produce dampness, flowing to the vulva, forming a mixed condition of deficiency and dampness retention, or due to internal damp-heat, heat蕴ing in the vulvar skin and muscles, leading to vulvar itching and rough skin; when the disease invades the collaterals, the flow of Qi and blood is not smooth, resulting in stagnation, and it combines with dampness and turbidity, showing changes such as lichenification, severe itching, and eczema-like changes, and it is difficult to heal for a long time. Clinical treatment should target the etiology and pathogenesis, either nourishing the liver and kidney, nourishing blood and stopping itching with wind-relieving herbs; or clearing heat, detoxifying, and promoting diuresis; or activating blood circulation to remove blood stasis and drive away wind; strengthening the spleen to remove dampness and kill parasites. Internal and external treatment, attacking and reinforcing at the same time, is the key to achieving clinical efficacy.

　　2. Traditional Chinese medicine differential diagnosis and summary

　　1. Nourish blood and expel wind, promote blood circulation and unblock the collaterals, clear heat and eliminate dampness, remove spots and stop itching;

　　2. Warm the kidney and assist Yang, promote blood circulation and stop itching;

　　3. Clear heat and relieve fire, nourish blood and moisten Yin;

　　4. Dredge the meridians, regulate Qi and blood, clear heat, eliminate dampness, and stop itching;

　　5. Nourish the liver and kidney, add essence and nourish blood;

　　6. Eliminate wind and kill insects, moisten and stop itching;

　　7. Dryness and itching, regulate Qi and blood;

　　8. Promote blood circulation, unblock the meridians, soften and disperse nodules.

　　3. The five characteristics of traditional Chinese medicine adjustment and balanced nutrition infiltration therapy

　　1. Targeted and strong effects, rich in various active factors and repair factors, as well as unique high-intensity penetration, can quickly penetrate into the body's pathological tissue, and the strong energy of the penetration site can instantly produce irreversible coagulative necrosis of the pathological tissue, while the surrounding tissues will not be damaged at all, without affecting future fertility, and not delaying study or work, creating an innovative clinical efficacy of 'only removing lesions without damaging tissues'.

　　3. Adhere to the classic theories of traditional Chinese medicine for thousands of years, combined with modern high technology, so that the patient's recovery is more in line with the characteristics of human physiology. This therapy does not have any adverse reactions or side effects! Thus, it has overcome the world's medical难题 of

　　4. Precise combination, exquisite formula, selected natural pure, high-activity ingredients, strong effects, and Chinese herbal medicine raw materials, after biological enzyme hydrolysis technology, purification and extraction, improve the utilization of drug effective ingredients, the medicinal value of some precious Chinese herbal medicine will be more effective, and the repair effect will be more obvious.

　　5. Treatment of both symptoms and root causes, eliminating surface symptoms while focusing on the treatment of the internal causes of vulvar leukoplakia. A safe, effective, and green comprehensive therapy of traditional Chinese medicine, reducing the occurrence of complications.

　　4. Western Medicine Treatment

　　Medication can include vitamin drugs. If the vulvar itching is severe and affects sleep, appropriate sedatives can be taken, and the local area can be treated with 1% hydrocortisone and 1-2% testosterone cream. This treatment can be maintained for 6-8 weeks, 3-4 times a day. It is very necessary to maintain the cleanliness and dryness of the vulva, not to wear tight underwear, not to wear poor permeability synthetic fiber underwear, and to eat less allergenic food while adhering to long-term treatment.

　　The medical community refers to the different degrees of whitening or rough atrophy of the vulvar skin and mucosa caused by various factors as vulvar leukoplakia. Its incidence of cancer is not high, generally only 2%, and can be considered as a precancerous lesion only when there is epithelial hyperplasia. People think that the name 'vulvar leukoplakia' is not ideal, so it is renamed chronic vulvar malnutrition, the etiology is unknown, and it is said to be related to the presence of a hormone in the dermis that can inhibit the division and growth of epidermal cells. This hormone can cause a imbalance between local connective tissue hyperplasia and metabolic stimulants.

　　The therapy for chronic dermatitis, atrophy, and leukoplakia of the vulva is basically the same. If there is severe itching at the lesion site, the vulva can be fumigated and washed with the decoction of the medicine, once or twice a day, then dried, and locally apply 2% compound propionate cream (this medicine can be prepared by the patient under the guidance of the doctor), gently rub it into the affected skin with the fingers. Vitamin A can be taken orally, 250,000 to 500,000 units per day, and 100 milligrams of vitamin B6 per day. The treatment methods for other diseases are the same as the treatment principles for this skin disease, such as adding 2% triamcinolone acetonide urea cream if there is thickening of the epidermis or there is already lichenoid change.

　　It should be noted during the treatment that after the condition improves and the itching stops, the medication should not be stopped immediately to prevent recurrence. The frequency of medication can be gradually reduced, such as every other day or twice a week. Do not eat spicy foods; prevent colds and all febrile diseases; avoid hot spring baths. If the condition does not improve or worsens after treatment, a repeat biopsy can be performed to determine whether there is atypical hyperplasia or cancer.

　　If there are severe symptoms such as severe vulvar atrophy, adhesion of the labia minora, and shrinkage of the vaginal fissure, which affect urination and sexual intercourse, appropriate surgical treatment can be performed simultaneously with conservative treatment. This disease does not affect pregnancy. If there is normal sexual life, like ordinary women, pregnancy is possible, and women with no obvious atrophy can also deliver vaginally naturally. For severe atrophy and shrinkage of the vaginal fissure that affect normal delivery, cesarean section can be performed.