Patient's question:
One side of the external genitalia has leukoplakia for three years. It itches particularly after menstruation. After fumigation and washing, applying 39% Prickly Heat Ointment alleviates the symptoms, but it recurs after the next menstrual period. Currently, there is mild tinea-like lesions. I am asking gynecological experts for advice on how to treat it.Doctor's answer:
Benign keratotic lesions of the vulvar area are referred to as leukoplakia. Long-standing leukoplakia can further progress to vulvar dystrophy. The etiology is unclear and may be related to systemic factors, such as diabetes or endocrine disorders. Local environmental conditions of the vulva, such as moisture and heat, can induce vulvar dystrophy.Histopathology shows proliferative lesions of the mucosal epithelium or epidermis. Under normal conditions, vulvar mucosa lacks a granular layer and stratum corneum. However, when leukoplakia or vulvar dystrophy occurs, the granular layer becomes keratinized. If it arises at the skin-mucosa transition of the labia majora, there is significant hyperkeratosis, with thickening of the granular layer and hyperplasia of the prickle cell layer. Approximately 80% of lesions are benign leukoplakia, with no dysplastic squamous cells observed in the prickle cell layer. Generally, there are no dysplastic cells in the epidermis, and the subepidermal area shows chronic inflammatory cell infiltration.
In contrast, vulvar dystrophy may exhibit early dysplasia, where some prickle cells show atypia, with irregular nuclear size and cell size, and disorganized arrangement of prickle cells. Dysplastic cells are present in the superficial epidermis, referred to as malignant dysplastic cells. The dermis shows varying degrees of inflammatory cell infiltration, and the superficial dermal collagen fibers do not undergo homogenization or degeneration.