Vulvitis gangraenosa - Altmeyers Encyclopedia

Synonym(s)

vulvitis ulcerosa

Definition
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A clinical picture corresponding to balanitis gangraenosa in the area of the vulva. Mostly bacterially caused, severe infection, mostly with a disturbed immune system due to Gram-negative germs or anaerobes (see also Table 1).

External therapy
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Disinfecting sitz baths with polyvidon iodine solution(Betaisodona solution, R203 ) or potassium permanganate (light pink). If necessary, surgical intervention with necrectomy.

Internal therapy
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High-dose antibiotic therapy according to antibiogram. If pathogen is unknown, antibiotics such as imipenem/cilastatin, gentamicin, amoxicillin or metronidazole:

Imipenem/Cilastatin (e.g., Zienam): i.v. 0.5-1.0 g 3-4 times/day.
Gentamicin (e.g. Refobacin): 3-5 mg/kg bw/day i.m. or i.v. (30-60min short infusions) divided into 1-3 daily doses.
Amoxicillin (e.g., Amoxypen, Augmentan): 750 mg p.o. 3-4 times/day or 1(-2) g i.v. 4 times/day.
Metronidazole (e.g. Clont, Flagyl): 2-3 times/day 400 mg p.o. or 2-3 times/day 500 mg i.v.

Tables
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Inflammatory diseases of the vulva

Epidemiology/etiology	Symptomatology/disease patterns	Therapy
staphylococcus aureus	Folliculitis/furuncle/carbuncle: Painful lumps, fluctuation.	Local disinfecting measures (sitz baths with polyvidon iodine solution), topical antibiotic therapy with nebacetin/bactracin or fusidic acid (fucidine ointment), for the maturation of abscesses Ichtholan Special Ointment or Ichthoseptal, if necessary stab incision and drainage, wound irrigation, internal antibiotic therapy after antibiogram.
Staphylococci, streptococci	Bartholinitis: Painful swelling.	Local disinfectant measures (sitz baths with polyvidon iodine solution), topical antibiotic therapy with nebacetin/bactracin or fusidic acid (fucidine ointment), for the maturation of abscesses Ichtholan special ointment or Ichthoseptal, if necessary stab incision and drainage, wound irrigation, internal antibiotic therapy after antibiogram.
Corynebacterium minutissimum	Erythrasma: Red-brownish scaling flock of the groin and vulva, little discomfort.	Topical antibiotic treatment with ointments containing erythromycin (e.g. acne mycin ointment).
Bacterium crassus	Ulcus vulvae acutum: Painful, rapidly growing ulcers, especially in younger women.	Topical preparations are usually sufficient, e.g. fucidine ointment, nebacetin/bactracin ointment/cream. Additionally, disinfecting sitz baths (Betaisodona-Lsg., Kamillosan-Lsg.). For extended forms: internal antibiotic therapy after antibiogram, bed rest, antiphlogistic and analgesic therapy. In very severe cases: short-term systemic glucocorticoids.