Acutal ulcer N76.6

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 20.08.2021

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Synonym(s)

acutal ulcer; acute vulvar ulcer; Lip protection genital ulceration

History
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Lip contactor, 1913

Definition
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Acutely occurring ulcerations in the genital area of younger women of unknown etiology.

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Classification
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Diagnostic Criteria:

Major criteria (both must be met):

Acute onset
Exclusion of other causes

Minor criteria (at least 2 pieces)

Vestibule or labia minora affected
Virgo or last GV more than 3 months ago
General flu symptoms
Systemic infection in the last 2-4 weeks

Etiopathogenesis
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Triggers discussed are viral infections (in 30% evidence of an acute EBV infection), mixed bacterial infections, poor hygiene. Occurrence in underlying diseases such as Behçet 's disease or atypical pneumonia has also been described.

Manifestation
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Especially with younger women, also with infants and toddlers.

Clinical features
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Chronic form: Recurrent ulcerations of varying size, slowly healing, especially in the region of the vaginal introitus and the labia majora.
Gangrenous form: Rapidly growing, scab-covered, painful, possibly perforating, scarring healing ulcerations on the labia minora. Acute onset, fever, regional swelling of lymph nodes.
Miliary form: small ulcerations on the border of the greater labia, on the perineum and the lesser labia.
Histology: lymphocytic vasculitis

Differential diagnosis
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Ulcus molle; M. Behçet; hand-foot-mouth disease; herpes simplex.

General therapy
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Physical rest and bed rest.

External therapy
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For small ulcerations, external antiseptic or antibiotic therapy is sufficient. Sitting baths with disinfecting additives such as quinolinol (e.g. Chinosol 1:1000, R042 ), potassium permanganate (light pink) are helpful. In addition, brushing with disinfectant solutions such as Polyvidon-Iodine Solution R203 and ointment dressings with Polyvidon-Iodine Ointment (e.g. Braunovidone-Iodine) should be used. In case of accompanying intertrigo, brushing with drying aqueous disinfectant solutions (e.g. 0.5% methylrosanilinium chloride solution [gentian violet]) is indicated.

Internal therapy
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In the case of extensive ulcerations and severe clinical progressions, antibiotic administration after antibiogram, possibly also short-term in combination with systemic glucocorticoids such as prednisolone equivalent (e.g. Solu Decortin H) 40-60 mg/day in decreasing doses.

Literature
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Chen W et al. (2019) Lipschütz genital ulcer revisited: is juvenile gangrenous vasculitis of the scrotum the male counterpart? Journal of the European Academy of Dermatology and Venereology 33.9: 1660-1666.
Korting GW et al (1979) Ulcus vulvae acutum with cold agglutinin-positive, mycoplasma-related atypical pneumonia. Dermatologist 30: 550-552
Lipschütz B (1913) On a peculiar form of ulceration of the female genitalia (ulcus vulvae acutum). Arch Dermatol Syphilis (Vienna) 114: 363-395
Lipschütz B (1918) On vulvae acutum. Wiener klin Wochenschr 31: 461-464
Pelletier F et al (2003) Lipschutz genital ulceration: a rare manifestation of paratyphoid fever. Eur J Dermatol 13: 297-298
Torok L et al (2000) Ulcus vulvae acutum. Cutis 65: 387-389