Vulvar leukoplakia

　　What causes vulvar leukoplakia?

　　The exact cause of vulvar leukoplakia is unknown.

　　Someone once exchanged the skin of vulvar lesions with normal skin on the patient's thigh and performed skin grafting. After a period of time, it was found that the grafted pathological skin turned normal, while the normal skin grafted to the vulva became pathological. Therefore, it is inferred that there may be a nutritional disorder of nerves and blood vessels in the deep connective tissue of the vulva, leading to the occurrence of skin lesions on the skin covering it. In recent years, it has been found that there is a kind of stimulant in the dermis that promotes the proliferation of local connective tissue and accelerates the epidermal metabolism at this place. In the epidermis, there is a protein hormone that can inhibit the division and growth of epidermal cells and acts only on the local epidermis, known as chalone. Under normal circumstances, both are in a balanced state. Chronic vulvar dystrophy is the result of the destruction of the balance between them. When the stimulant in the dermis is active and the chalone in the epidermis decreases, cells proliferate and grow in large numbers, resulting in thickening of the epidermis and manifesting as hyperplastic dystrophy. When there is an excessive production of chalone in the epidermis, the growth of the epidermis is suppressed, and it becomes thin, which is the atrophic lichenoid dystrophy. Through tritium (H) labeling thymine determination, it is shown that there is active protein synthesis in the epidermis of the above atrophic lichenoid type, and this synthesized protein may be chalone. The epidermal metabolism process is active and not atrophic. Therefore, some people have removed the word 'atrophy' from the previous name of 'sclerosing atrophic lichen' and changed it to 'sclerosing lichenoid type'. However, after a long time of lesion, inflammatory lesions cause the disappearance of elastic tissue in the dermis and fibrosis, leading to the atrophy of the clitoris and the labia minora.

       Vulvar leukoplakia can be accompanied by vulvar itching and other gynecological diseases. If not treated in time, it will affect the patient's daily life and pose a serious threat to the health of female patients in the long run. Therefore, do not delay the course of the disease.

　　The main symptom is an itchy vulva, with the duration of itching ranging from 2 to 3 months from onset to treatment, and sometimes lasting up to 20 years. The intensity of itching is not affected by season or day and night. If accompanied by trichomonal or candidal vaginitis, there will be more discharge, local burning sensation, pain, itching, and skin and mucosal damage or infection caused by local burning, pain, and itching. There is varying degrees of pigment reduction in the local skin and mucosa, often with edema, fissures, and scattered superficial ulcers.

　　1. Hyperplastic malnutrition

　　It usually occurs in women aged 30 to 60, with the main symptoms being severe vulvar itching, which worsens after scratching. The extent of the lesion varies, mainly affecting the labia majora, the interlabial sulcus, the prepuce of the clitoris, and the posterior commissure. It is often symmetrical, with thickened skin resembling leather, with wrinkles, scales, or eczema-like changes. The surface color is often dark red or pink, with clear white macules. Generally, there is no atrophy or adhesion.

　　2. Sclerosing leukoplakia type malnutrition

　　It can occur at any age, most commonly in women around 40 years old, with the main symptoms being itching in the lesion area, which is generally much less severe than hyperplastic lesions. In the late stage, there may be difficulties in sexual intercourse, and the lesions may involve the vulvar skin, mucosa, and perianal skin. In addition to the skin or mucosa becoming white, thin, dry, and prone to cracking, they also lose elasticity. The clitoris often atrophies and is adhered to the prepuce, the labia minora flatten and disappear, and in the late stage, the skin becomes thin and皱缩 like cigarette paper, the vaginal orifice becomes narrow and can only accommodate the tip of a finger.

　　Young girls with this disease often feel discomfort in the vulva and perianal area after urination or defecation, with the appearance of lock-like yellowish spots or white lesions in the vulva and perianal area. Generally, the lesions disappear spontaneously by the time puberty arrives.

　　3. Mixed-type malnutrition

　　It mainly manifests as the white area of the vulva is thin, or there are focal skin thickening or protuberances within the range.

　　How to prevent vulvar leukoplakia:

　　1. Pay attention to menstrual hygiene and change menstrual pads frequently during menstruation.

　　2. Keep the vulva clean and dry, do not use hot water to wash, and do not use soap to wipe.

　　3. Underwear should be loose, breathable, and preferably made of cotton.

　　4. Avoid alcohol and spicy foods, and do not eat seafood and other foods that are easily allergenic.

　　5. Avoid misuse and overuse of medication, avoid scratching and local friction.

　　6. If there are any local breaks or infections, they can be soaked in a 1:5000 potassium permanganate solution (add a small amount of potassium permanganate powder to warm water to turn it light red, do not make it too concentrated) for 20-30 minutes, twice a day.

　　7. Check for mold or trichomoniasis during medical examination. If present, both partners should be treated simultaneously, and do not use 'itch relief water' for self-treatment.

　　8. Patients with long-standing illness should have a blood glucose test.

　　Perform more biopsies and send them for pathological examination to determine the nature of the lesion, exclude early cancer, and perform biopsies at sites with fissures, ulcers, protuberances, nodules, or roughness. To ensure proper sampling, apply 1% toluidine blue (toluidine blue) to the lesion area first, wait until it dries, and then wipe it off with 1% acetic acid solution. Any areas that do not fade indicate the presence of bare nuclei, suggesting biopsy at these sites, where there is a higher possibility of atypical hyperplasia or even cancer. If the area of local damage is too extensive, treat it for several days first, wait until most of the skin lesions have healed, and then choose the biopsy site to improve the accuracy of diagnosis.

　　First, what foods should be avoided for vulvar leukoplakia?

　　1. Avoid smoking, alcohol, and spicy刺激性 foods.

　　2. Avoid greasy, fried, moldy, and salted foods.

　　3. Avoid foods that generate heat, such as rooster and goose.

　　4. Avoid seafood and irritant, sensitizing foods when itching is severe.

　　5. Avoid warm and hot foods such as mutton, chive, ginger, pepper, cassia, etc. for ulcers and bleeding.

　　2. What foods are suitable for vulvar leukoplakia?

　　1. Eat more foods with anti-vulvar tumor and leukoplakia effects, such as sesame, almond, wheat, barley, loofah, black chicken, cuttlefish, green snake, pork pancreas, chrysanthemum, black plum, peach, lychee, horse radish, chicken blood, eel, abalone, crab, horseshoe crab, sardine, clam, tortoise shell.

　　2. For pain, eat horseshoe crab, red, lobster, scallops, sea cucumber, tiger fish, beetroot, mung bean, radish, chicken blood.

　　3. For itching, eat amaranth, cabbage, turnip, kudzu, kelp, purple kelp, chicken blood, snake meat, pangolin.

　　4. To enhance physical fitness and prevent metastasis, eat silver ear, black fungus, mushroom, monkey head fungus, chicken gizzard, sea cucumber, Job's tears, walnut, crab, lizard, needlefish.

　　How to treat vulvar leukoplakia:

　　1. Eliminate the etiology

　　For those with diabetes, trichomonal or candidal vaginitis, and others, treatment should be carried out, less spicy food should be eaten, the vulva should be kept clean, avoid soap scrubbing, scratching, and using irritant drugs. Multiple vitamins and tranquilizers, desensitizers can be taken.

　　2. Local medication

　　The purpose is to stop itching, inflammation, moisturize the skin, and improve local nutrition.

　　1External washing medicine:

　　Chinese herbal medicine ku shen yin chen washing agent or other Chinese herbal decoction steam bath.

　　2. For atrophic types:

　　Apply 1% to 2% testosterone propionate fish liver oil ointment (100 to 200mg of testosterone propionate, added to 10 to 20g of 20% fish liver oil ointment) externally, 3 to 4 times a day, for 2 to 3 months, which can thicken and soften the skin, and loosen adhesions.

　　3. For hyperplastic and mixed types:

　　Dexamethasone, hydrocortisone ointment, and for mixed types, external application of testosterone propionate fish liver oil ointment is also required.

　　3. Acupuncture and acupoint injection can be tried.

　　4. Laser Treatment

　　Laser treatment for hypertrophic lichenoid atrophic dermatitis has the effect of stopping itching, promoting healing of ulcerated surfaces, and improving local blood circulation.

　　5. Surgical Treatment

　　For moderate to severe atypical hyperplasia, or for ulcers and fissures that do not heal after non-surgical treatment, consider simple vulvectomy.