Leukoplakia of vulva — what it is, causes and treatment
Leukoplakia of the vulva is a degeneration of the mucous membrane with keratinization of the superficial layers of the epithelium. This disease is found in about 6% of women and is a precancerous pathology. Leukoplakia is found not only in gynecology. These sections can be found on the mucosa of the oral cavity or respiratory tract.
The cause of the pathologies of the vaginal mucosa are frequent infections, hormonal disturbances, chemical exposure. To the occurrence of leukoplakia can lead to the uncontrolled use of drugs that possess local irritant effect, a long-existing cervical erosion. Additional factors provoking the development of the disease, identify diseases of the endocrine system (diabetes, thyroid disease), trauma, infection with human papillomavirus or herpes type 2. The increased production of estrogen can lead to hyperplasia of the mucous membrane of the vulva and the appearance of leukoplakia.
Depending on the morphological forms distinguish the following types of leukoplakia:
- verrucous (or warty);
Simple leukoplakia is characterized by the presence in the cervix of a transparent film, which is impossible to remove, as it adheres to the mucosa. During the inspection the abnormal cells are white in color, have irregular edges, the surface is dry and ribbed. On the surface of the formations you can see red dots. Complaints from patient no detected pathology when viewed on a chair at the gynecologist. If untreated, leukoplakia is transferred in the following form.
With verrucous leukoplakia of the mucous membrane of the vagina are formed by whitish plaques, towering above the mucous membrane, or the formation of uneven surface in the form of warts. This variant of the disease is more common than the simple form.
Hairy leukoplakia of the vulva occurs in disorders of the immune system, may occur in HIV infection. During the inspection shows a part of the vagina with small villi on the surface that looks like carpet.
Leukoplakia can affect all the mucous parts of the genital organs and urinary tract in women (labia, vulva, vagina, urethra and mucous membrane of the bladder, cervix). The disease is often asymptomatic and is found incidentally during preventive examination. When inflammation of the mucosa of the vulva and vagina appear discharge with an unpleasant odor, itching of the vagina or when urinating, which was forced to seek medical attention. In the erosive form spotting, intercourse becomes painful.
The examination begins with the inspection on the gynecological chair. Leukoplakia of the vulva is revealed when viewed on the mirrors, with visible rounded education in the mucosa of the vulva white. Depending on the forms of leukoplakia may be covered with fibers or wounded. In the study under a magnifying glass (colposcopy or vulvoscopy) we can clearly see the surface of education, to conduct a test of Schiller. The sample is based on the absence of staining of the pathological section of the vulva in the treatment of the vaginal mucosa with Lugol’s solution. Normal mucosa in the processing will be painted in brown color, while the area of leukoplakia will remain the same color.
It necessarily takes a swab from the vaginal flora, Cytology, bacteriological examination. In General, a smear from the vagina and cervix to evaluate the number of leukocytes detected pathogenic microorganisms that are visible under the microscope and do not require additional seeding environment (Trichomonas, gonorrhea, yeast).
Leukoplakia of the cervix is not cancer. Smear on Cytology allows to exclude neoplastic process.
In blood tests, as a rule, is not detected any changes. Inflammation may be a slight leukocytosis and increased erythrocyte sedimentation rate. In the menstrual cycle, you may have to donate blood to female hormones, thyroid hormones, make it ultrasound. If you suspect diabetes seems to blood sugar and glycated hemoglobin. Carefully collected medical history — whether it was previous injuries or medication.
Methods of treatment
Treatment of leukoplakia of the vulva includes the diet, physiotherapy, assignment of drugs locally and internally, according to the testimony surgical treatment. Before treatment, identify and address factors that contribute to the development of the disease. It is necessary to make correction of hormonal background of women, to appoint antidiabetic drugs, normalizing the function of thyroid, stop taking the medications, contributing to irritation.
The diet should exclude irritating foods such as coffee, strong tea, spicy seasonings and spices. These products will only intensify the itching and burning of the vulva, can cause erosion. The recommended intake of vegetables and fruits, dairy products and cereals.
The detection of the inflammatory process determine the causative agent. Cervical erosion often caused by human papilloma virus, or herpes, they are sensitive to the appointment of preparations of interferon and acyclovir. Upon detection of the fungi of the genus Candida prescribe fluconazole or other antifungal drugs. Streptococci and staphylococci require antibacterial therapy with antibiotics.
In addition to the assigned treatment local antiseptic and anti-inflammatory agents used in the form of suppositories, tampons, turundae, irrigations of the vagina. Antibacterial action have drugs sintomitsina, levomekol, chlorophyllin, chlorhexidine. If you identify specific flora, it is necessary to consult a venereologist.
With anti-inflammatory purpose, apply ointment elidel, baneuoqin, triderm and akriderm. In disorders of immunity, we recommend taking immunomodulatory drugs, multivitamin complexes.
Leukoplakia of the vulva and cervical erosion are frequently accompanied by menstrual irregularities, are treated together with the gynecologist-endocrinologist.
Before therapy take blood samples for progesterone, estradiol, follicle-stimulating and luteinizing hormones. If the detected changes, prescribed hormonal replacement therapy, the drug is selected individually for each woman. Locally accepted hormonal cream: estriol cream, progesterone cream, and others.
Radical cure leukoplakia will help the surgical removal of the affected area of the vulva. Modern gynecology uses for the treatment of leukoplakia cryotherapy, laser removal, diathermocoagulation, radio wave therapy, electrocoagulation, chemical degradation. Using these methods are treated well as erosion and leukoplakia of the cervix.
- Surgical diathermy — the removal of the site of leukoplakia with currents of high frequency. Until recently, it was the main method of treatment of leukoplakia.
- The chemical coagulation using drugs, cauterizing the affected cervical epithelium. This procedure is painless, can be performed in the gynecologist’s office and does not require significant patient preparation. Chemical reagent effect point to the site of the leukoplakia without affecting healthy tissue. This method of treatment can be applied in nulliparous women, since after it no scars are left.
- Painless modern treatment is laser photocoagulation. Before the procedure, the area of leukoplakia stained with iodine to determine the exact boundaries of coagulation. Procedure can be performed on an outpatient basis, it is also one of safe modern methods. During laser therapy does not occur contact with tissues and blood, so the risk of infection is minimal. Laser coagulation can be performed several times until complete removal of the damaged section.
- Cryosurgery is the removal of the foci of leukoplakia with liquid nitrogen. The procedure gives a positive result in more than 90% of cases. The result of this procedure, a high risk of scarring, so currently its use is limited.
- With extensive lesions possible a traditional surgical removal of the lesion using electrocautery. The site of leukoplakia was excised within healthy tissue. In this procedure, high risk of infection on the wound surface and the formation of scar tissue in the future, so this treatment method is now rarely used.
Treatment of folk remedies
Many women use decoctions of herbs for the treatment of leukoplakia. The greatest efficiency has St. John’s wort, calendula, chamomile and yarrow, decoctions of which wash the vulva and vulva daily at night. Possess the healing properties of tea tree oil and juniper. To traditional treatment methods include vaginal douching with a weak solution of vinegar (teaspoon to 500 ml water). It must be remembered that these methods are complementary in addition to traditional therapy.
Leukoplakia and pregnancy
Sometimes the pathology of the vulva detected only during pregnancy. Leukoplakia of vagina during pregnancy has no adverse effects on the fetus, however, if you change the hormonal level of a woman increases the risk of malignant transformation of medical education. That’s why doctors recommend preparing for pregnancy in advance and pass the required examination.
Modern gynecology offers a variety of methods of treatment of leukoplakia of the vulva. Begin treatment with medical methods, and only in the case of extensive destruction, the ineffectiveness of conservative therapy and the risk of degeneration of cells in malignant uses surgical methods.