Vulvar Pseudo-squamous Hyperplasia

　　1. Etiology

　　The specific etiology is unknown and may be related to long-term stimulation of vulvar moisture or secretions.

　　2. Pathogenesis

　　The stratum spinosum of the vulvar epidermis hyperproliferates, the epidermal papillae extend downward, but as they extend downward, the cells decrease while the papillae become finer, the ends are rounded, the extension direction of the papillae is parallel, and there may be lymphocytes or a small amount of plasma cells infiltrating between the papillae. However, the arrangement of epithelial cells is orderly, and the size, polarity, morphology, and staining of the cells are normal.

　　May be accompanied by vulvar invasive cancer.

　　1. Age of Onset:

　　Vulvar invasive cancer accounts for about 4% of female reproductive tract malignant tumors, of which about 95% are squamous cell carcinomas, commonly seen in elderly women.

　　2. Site of Occurrence:

　　Tumors may occur at any part of the vulva, singly or multiply.

　　3. Clinical Manifestations:

　　Early stage: May be asymptomatic. Symptoms may include vulvar itching, erosion, ulceration, or mass. If accompanied by infection, there may be local exudation, bleeding, and pain.

　　Late stage: May be accompanied by urinary system symptoms or difficulty in defecation, as well as weight loss, etc.

　　4. Gross Examination:

　　The lesion may present as nodular, cauliflower-like, or erosive-ulcerative, with clear boundaries, irregular, and friable cancer tissue with hard base.

　　5. Pathological Examination:

　　Biopsy or local lesion resection should be performed for vulvar masses, long-standing vulvar white lesions, erosions or ulcers, and other suspicious lesions for pathological confirmation.

　　Commonly seen in middle-aged or post-menopausal elderly women, mainly manifested as vulvar itching. Due to repeated scratching, local skin may become thickened, hyperpigmented, or show lichenoid changes. The lesion may involve the large labia, clitoris, and posterior labial junction. The lesion may be solitary, focal, or multiple, and may融合. The disease may coexist with vulvar invasive cancer, with an approximately 2% malignancy rate.

　　One, Prognosis

　　A few cases may have canceration.

　　Two, Personal Hygiene

　　Keep the vulva clean, avoid wearing non-breathable synthetic panties, and do not use alkaline soaps with strong irritability to clean the vulva.

　　Three, Differential Diagnosis

　　Distinguish from vulvar intraepithelial neoplasia.

　　Four, Treatment

　　1, General treatment For those with severe symptoms and insomnia, sedatives can be added.

　　2, Drug treatment Local corticosteroids are used to control itching. Apply 1% to 2% hydrocortisone ointment 1 to 2 times a day, or 0.025% fluocinolone ointment, 3 times a day. Treatment is often effective, but symptoms may recur after discontinuation of medication, so long-term medication is needed.

　　3, Laser treatment uses CO2 laser treatment to destroy the nerve endings in the dermis to improve the symptoms of itching. CO2 laser treatment has the characteristics of small trauma, simple operation, and is easy to perform, but still has a long-term recurrence rate of 50%.

　　4, Surgical treatment is only suitable for those who have failed to respond to repeated drug therapy or have a possibility of malignancy. The preferred surgical method is simple vulvectomy. If the wound is large and it is estimated that postoperative scar formation can lead to postoperative sexual pain, skin grafting can be performed at the same time to reduce scar contracture. Since there is still a long-term recurrence rate (about 50%), regular follow-up should be carried out after surgery.

　　1, Tumor marker examination.

　　2, Pathological biopsy:Firstly, apply 1% toluidine blue to the vulvar lesion, dry it, and then use 1% acetic acid to decolorize it. Biopsy is performed in the non-decolorized area. Toluidine blue is a nuclear stain, and the non-decolorized area often indicates the presence of a裸核. If the pathological examination results suggest atypical hyperplasia or in situ carcinoma, it should be classified as vulvar intraepithelial neoplasia.

　　First, dietetic recipe for vulvar pseudo-epitheliomatous hyperplasia

　　1, Kelp and Mung Bean Porridge

　　Ingredients 30g of kelp, 30g of mung beans, appropriate amount of sugar, and 100g of glutinous rice.

　　Preparation method First, wash the kelp and cut it into pieces, soak the mung beans for half a day, wash the glutinous rice clean, and cook them into porridge. Add sugar for seasoning when it is about to be done.

　　Usage Take it twice a day in the morning and evening, and it is recommended to continue eating for 7 to 10 days.

　　Its effect is to clear heat and detoxify, and promote diuresis and heat excretion. It is suitable for vulvar itching.

　　2, Coix Seed and Red Date Porridge: 30g of coix seed, 10 dates, and 50g of rice.

　　Wash and cook into porridge for consumption. It has the effect of clearing heat, invigorating the spleen, and relieving itching.

　　3, Fo-ti, Mulberry, and Sesame Seed Porridge: 30g of fo-ti, 10g of mulberry fruit, 10g of black sesame, and 50g of rice.

　　Wash and cook into porridge for consumption. It has the effect of nourishing blood, moistening the Yin and relieving itching.

　　4, Steamed pork liver: 60g of pork liver, 30g of mare's tail.

　　Cut the pork liver and mare's tail into small pieces, mix well, place in a covered bowl, and steam in a steaming pot for 30 minutes. Take all at once. It has the effect of clearing heat and removing dampness.

　　Secondly, what should be eaten for vulvar pseudo-epitheliomatous hyperplasia that is good for the body

　　1, It is recommended to eat more foods that have the effect of preventing external genital tumor and leukoplakia, such as sesame seeds, almonds, wheat, barley, loofah, black-bone chicken, cuttlefish, green mamba, pork pancreas, chrysanthemum, umeboshi, peaches, lychees, purslane, chicken blood, eel, abalone, crabs, horseshoe crabs, sardines, clams, and turtle shells.

　　2, To relieve pain, it is recommended to eat horseshoe crab, red, lobsters, clams, sea cucumber, tiger fish, beetroot, mung beans, radish, and chicken blood.

　　3, To relieve itching, it is recommended to eat amaranth, cabbage, rapeseed, taro, kelp, nori, chicken blood, snake meat, and pangolin.

　　4, To enhance physical fitness and prevent metastasis, it is recommended to eat silver ear, black fungus, mushrooms, truffles, gizzards, sea cucumber, Job's tears, walnuts, crabs, monitor lizards, and needlefish.

　　Three. The best foods to avoid for vulvar parakeratotic hyperplasia

　　1. Avoid stimulants such as coffee.

　　2. Avoid spicy and irritating foods such as scallions, garlic, ginger, and cinnamon.

　　3. Avoid greasy, fried, moldy, and pickled foods.

　　4. Avoid promoting foods such as rooster and pork head meat.

　　5. Avoid seafood.

　　6. Avoid warm foods such as lamb, dog meat, chives, pepper, etc.

　　7. Avoid smoking and drinking.

　　One. Prevention:

　　1. Regular physical examination: Early prevention and treatment can improve survival rate, and regular physical examination and follow-up should be paid attention to.

　　2. Pay attention to personal hygiene, keep the vulva clean, avoid wearing non-breathable synthetic underwear, and do not use strong alkaline soaps with strong irritability to clean the vulva.

　　3. Strengthen physical fitness, improve immunity: Pay attention to the combination of work and rest, participate in more physical exercise, and eat more fresh fruits and vegetables rich in vitamins.

　　Two. Western Medical Treatment for Vulvar Parakeratotic Hyperplasia

　　1. General treatment:安抚患者，使之平静心情。For severe symptoms and insomnia, sedatives can be added.

　　2. Drug Treatment: Local corticosteroids can effectively control itching.

　　(1) Administration: 1% to 2% hydrocortisone ointment, 1 to 2 times/d, or 0.025% fluocinolone ointment.

　　(2) Dosage: 3 times/d.

　　(3) Precautions: The treatment is often effective, but symptoms may recur after discontinuation of medication, so long-term medication is required.

　　Three. Laser Treatment

　　1. Mechanism of Action: Using CO2 laser treatment to destroy the nerve endings in the dermal layer to improve the itching symptoms.

　　2. Advantages: CO2 laser treatment has the characteristics of small trauma, simple operation, and ease of use.

　　3. Disadvantages: There is still a 50% long-term recurrence rate.

　　Four. Surgical Treatment

　　1. Indications: Applicable only to those with repeated drug treatment failure or the possibility of malignancy.

　　2. Surgical Methods:It is advisable to perform simple vulvectomy. If the wound surface is large, it is estimated that scar formation after surgery may cause postoperative sexual pain, skin grafting can be performed at the same time to reduce scar contraction.

　　3. Disadvantages: Due to the same existence of long-term recurrence rate (about 50%), regular follow-up should be conducted after surgery.