Kraurosis treatment drugs. The female problem is lichen sclerosus (kraurosis). Traditional methods of treatment
Treatment of kraurosis of the vulva is complex includes elements pathogenetic therapy and local impact on the pathological process. First of all, treatment of concomitant extragenital and gynecological diseases (candidiasis, trichomoniasis, bacterial processes) is carried out. Important It has local treatment. When treating kraurosis, the vulva is wiped with olive oil or peach oil(or an emulsion of these oils), water treatments not recommended. If there are signs of an inflammatory process, corticosteroid ointments (hydrocortisone, prednisolone, fluorocort, Sinalar, etc.) are effective. When treating kraurosis of the vulva, emulsions containing antibacterial drugs and estrogens (add 1 ml of 0.1% to 20 ml of emulsion oil solution estradiol dipropionate or 1 ml of folliculin oil solution).
When treating kraurosis of the vulva, ointments and creams are used, containing androgens. Recommended biogenic stimulants(aloe extract, FBS, etc.), which have a general strengthening effect. In case of severe ovarian hypofunction, estrogens are prescribed, preferably estriol, which causes proliferative processes in the lower section reproductive tract (important for atrophy!), without having the same effect in the endometrium and mammary glands. Estriol is used 0.5 mg (1 tablet) 2 times a day for 2-3 weeks. followed by a break of 7-10 days. Conduct 3-4 such courses. In the absence of estriol, microdoses of microfollin can be used under the control of cytological and laboratory tests.
When treating kraurosis of the vulva, psychotherapy is used, especially with severe itching and severe emotional disturbances(depression, sleep disturbance, etc.). According to indications, suggestive therapy is prescribed. Recommended sedatives(preparations of bromine, valerian, motherwort, etc.), if necessary, prescribe tranquilizers, antihistamines (diphenhydramine, pipolfen, etc.), vitamins A and C, phonophoresis of hydrocortisone in the vulva, inguinal and perianal areas (trophic, vasotropic, analgesic effects ).
When treating kraurosis of the vulva, diet is important: exclude coffee, spicy foods, alcoholic drinks, as well as smoking. If you are obese, limit intake food products increased caloric content while maintaining a balanced diet ingredients.
In recent years, with the introduction of gynecological practice laser therapy very encouraging results have emerged treatment of itching, kraurosis and leukoplakia of the vulva. Under the influence of a helium-neon laser, blood supply to tissues improves, glycogen content decreases, and the proliferative potential of the epidermis decreases. Patients noted improvement already at the 5th-7th procedure, when, as a rule, the painful itching decreased. During one-year follow-up, a rare occurrence of relapses requiring repeated irradiations was noted. Besides local effect, there is a significant improvement mental status and normalization of bioelectrical parameters of cortical neurodynamics. Undoubtedly, the use of laser therapy opens up great therapeutic opportunities in the treatment of such long-term, persistent degenerative processes as leukoplakia, kraurosis and itching of the external genitalia.
– a chronic progressive atrophic process of the skin and mucous membrane of the vulva, associated with involutive changes in the external genitalia. Kraurosis of the vulva is accompanied by paresthesia, dryness, itching of the mucous membrane; atrophic and sclerotic changes in the labia minora, clitoris, labia majora; dyspareunia, vulvitis, vaginal stenosis. Kraurosis is diagnosed during an external examination, vulvoscopy, and biopsy of vulvar tissue. Treatment of vulvar kraurosis includes local and general hormonal therapy, physiotherapy, vitamin therapy, and, if indicated, vulvectomy.
Forecast and prevention of vulvar kraurosis
Treatment for kraurosis of the vulva is ineffective and full recovery impossible to achieve. Malignant transformation of vulvar kraurosis can be observed with long-term non-healing erosions, cracks, when combined with dysplasia and leukoplakia.
Kraurosis of the vulva requires constant monitoring by a gynecologist and treatment. Equally important are an individually selected diet, lack of stress, intimate hygiene, right choice underwear. To reduce the risk of cancer, patients with vulvar kraurosis need to undergo vulvoscopy once every six months, and in case of suspicious results, cytological and histological examinations.
Kraurosis of the vulva is a pathological process, a precancerous condition that affects the external genitalia and is accompanied by progressive atrophy, sclerosis of the mucous membrane and dermis of the vulva. Quite often this pathology occurs simultaneously with leukoplakia. The disease is usually diagnosed in women over 45. The disease often occurs in young women who have undergone surgery on the genital organs.
The appearance of pathology is caused by an atypical reaction upper layers skin on the influence of various external and internal factors. Another fairly common cause of the disease is a chronic inflammatory process. Kraurosis can also develop due to non-compliance with personal hygiene rules, central nervous system disorders, chemical burns and injuries. Many patients seek salvation in the treatment of kraurosis folk remedies, but not everything is so simple.
Therapy for the pathological process must be immediate and comprehensive. Along with the reception medications: antihistamines, sedatives, antibacterial, immunostimulating, anti-inflammatory, hormonal, you can use natural folk remedies used at home.
Folk remedies will help eliminate symptoms and speedy deliverance from kraurosis. However, despite the healing properties of medications, taking them without the knowledge of a specialist is strictly prohibited.
Recipes for oral administration
External home remedies
1. Mix dried chamomile with calendula flowers, celandine and string. You need to take a spoonful of all ingredients. Cut the herbs and brew 50 grams of boiled water - three liters. The product should sit for a while. After half an hour, strain and use for sitz baths.
Carry out the procedure three times a week. The infusion should be warm. The therapeutic course is one month. Baths will help eliminate symptoms and speed up recovery.
3. Take fresh parsley, grind it to a pasty consistency, combine with raw egg white and a pinch of salt. Stir the mixture and place on a linen napkin. Treat the affected areas with the prepared mixture. Keep the product refrigerated
4. Douching will also help in healing. Brew dried finely chopped veronica (herb) in the amount of 30 g with just boiled water - half a liter. After the composition has infused, use it for daily douching. The duration of the course is half a month, then a week break and repetition of treatment.
5. Fill a spoonful of copper sulfate with just boiled water - a liter. Wait for the solution to settle. Dilute the finished solution with boiling water in a ratio of 200 ml of water per 400 ml of product. Next, the composition is poured into a capacious container, for example, a basin. Take baths for at least half an hour for 30 days.
6. Excellent results can be achieved using freshly squeezed aloe juice. When taken orally, the product helps eliminate inflammation and accelerate regenerative processes in tissues.
To prepare the medicine, fresh leaves of the plant are taken (it is important that it is more than three years old) and crushed. Next, the container is placed in the refrigerator for 15 days.
7. Dilute 10 g of soda in a liter of boiled water, stir. Add tar soap here - a small piece. After the solution has cooled, use it for baths.
Treatment of kraurosis is a long and labor-intensive process. The sooner you go to the hospital, the greater the chance of cure. If you do not want to harm yourself, under no circumstances take any medication without consulting a doctor. Moreover, do not abuse drugs from the public and try not to exceed the dosages indicated in the recipes.
Those who have entered menopause. The disease manifests itself least often in people under 30 years of age. With kraurosis, atrophy of the epithelial layer of tissue of the external genital organs occurs, which leads to deformation, as well as subsequent disruption of their functions. Kraurosis develops as a result of external factors or existing diseases. Thus, among the causes of atrophy, disorders of the patient’s endocrine system are distinguished (hypofunction of the adrenal glands, ovaries or thyroid gland). Some researchers also link the disease to a disorder bioelectrical activity brain. Also common cause the appearance of a disease is the presence of an infectious or autoimmune process in organism. Sometimes kraurosis occurs due to chemical exposure of the external genitalia. Women who are susceptible to kraurosis may be obese.
Treatment
Kraurosis of the vulva is difficult to treat and can only be cured with correct positioning diagnosis and strict adherence to the doctor’s instructions. The emphasis in treatment is on eliminating itching, reducing inflammation, improving the properties of vulvar tissue and relieving emotional stress.
On initial stage may be assigned antihistamines(“Claritin”, “Tavegil”, “Diazolin”), which will help relieve itching and accompanying rashes. Also widely practiced by attending physicians sedatives(“Seduxen”, “Aminazine”), which can reduce discomfort from itching in the genitals. For the treatment of the kraurosis process itself, hormonal ointments containing estrogen (Premarin, Estriol) are prescribed. The use of progesterone and corticosteroid ointments is widely practiced. For the treatment of young patients, estrogen is not prescribed due to possible side effects.
Laser therapy, reflexology and balneotherapy are also used in treatment. Radiotherapy and photodynamic therapy are often used in treatment. Prescribing vitamins (A, B, E, C, PP) and taking medications to improve immunity are also indicated. If treatment is ineffective, technologies such as laser, cryodestruction of tissue and denervation of the vulva are used. Superficial excision of the vulva can also be performed if such indications exist.
Self-cure of the disease is not possible. To prevent kraurosis, you should make regular (at least once a year) visits to the gynecologist. If you have any initial suspicions of the disease, you should also immediately consult a doctor.
In front and behind, the labia majora are connected to each other through the anterior and, respectively, posterior commissures. The anterior commissure is slightly wider than the posterior one. The functions of the labia majora include maintaining the constancy of the internal environment of the vagina and protecting its mucous membrane from drying out.
Labia minora
The labia minora are small thin soft tissue flaps located deeper than the labia majora. Their size is small and they are usually not visible under the closed labia majora. However, quite often there are cases of significant variation in the size and shape of the labia minora, and these variations are regarded as the norm. Internal sides The labia minora are adjacent to each other. The slit-like space between them is called the vestibule of the vagina. The vagina itself, the short and wide urethra, as well as the ducts of the paraurethral, Bartholin and numerous single ducts open into the cavity of the vestibule. sebaceous glands. The above glands secrete a secretion that reduces the force of friction during sexual intercourse and reduces the degree of trauma to the vaginal mucosa. Outside of sexual intercourse, these glands maintain an optimal level of moisture in the vaginal mucosa.The anterior ends of the labia minora form two legs - lateral ( external) and medial ( internal). The lateral crura join above the clitoris to form the foreskin. The medial crura join beneath the clitoris to form its frenulum. The posterior ends of the labia minora, connecting with each other, form a less pronounced frenulum of the labia minora. The basis of the labia minora is connective tissue with a large number of elastic fibers. The outside of the labia minora is covered with thin, well-innervated skin. Unlike the skin of the labia majora, there are no hair follicles here, and the number of pigment cells is small, which is why these integuments have a red color.
Clitoris
The clitoris is a female erectile organ because it develops from the same embryonic tissues as the penis in men. The clitoris consists of a body and a glans. The body, in turn, consists of two cavernous bodies, separated by a connective tissue septum. Externally, the corpora cavernosa are surrounded by dense, inextensible fibrous fascia, which gives the clitoris characteristic shape during his erection. At the free, more narrowed end of the clitoris there is its head, covered by the foreskin. The foreskin and frenulum of the clitoris pass into the lateral and medial legs of the labia minora, respectively. At the base of the clitoris, the corpora cavernosa diverge to form two stalks that attach to the lower rami of the pubic bones.Hymen
The hymen is a thin sheet of mucous tissue that limits the entrance to the vagina. The shape of this anatomical formation may differ, however prerequisite is the presence of a hole or several holes in it. If these holes are absent, which is observed with their congenital fusion, then with the onset of menstruation bloody issues will not stand out. Instead, they will accumulate in the vagina and fester until they cause sepsis or break out. Meet rare cases congenital absence of the hymen. In addition, it can be destroyed in childhood if the child is washed too thoroughly, as is observed in some African tribes.Causes and pathogenesis of kraurosis ( lichen sclerosis)
The reasons for the development of vulvar kraurosis are currently unknown. Nevertheless, theories are regularly put forward in defense of the infectious, allergic, hormonal, autoimmune and other nature of the disease. Unfortunately, none of these theories is yet able to explain all the manifestations of this pathology. Pathogenesis of vulvar kraurosis ( lichen sclerosis) has been studied somewhat better. Its knowledge is necessary to understand the essence of the disease, as well as to identify links that can be influenced and improve its clinical picture.
The initial link in the mechanism of this disease is the influence of one of causal factors, as a result of which there is a deterioration in the microcirculation of the soft tissues of the vulva. Deterioration of microcirculation leads to chronic hypoxia ( lack of oxygen) of these tissues, due to which the processes of catabolism ( destruction) in this area prevail over the processes of anabolism ( construction, formation of new structures). As a result of the above processes, a large number of cellular breakdown products accumulate in the tissues that limit the woman’s birth canal, which have a toxic effect on the body. To remove these cell products immune system migrate to places of their greatest concentration and absorb them. Thus, a small cell infiltrate is formed in the upper layers of the skin.
Subsequently, cells of the immune system release inflammatory mediators and lytic enzymes into the intercellular space. Inflammatory mediators such as histamine, serotonin and bradykinin lead to swelling of the upper layers of the dermis, while lytic enzymes ( elastase, collagenase) destroy connective tissue, elastic and even nerve fibers. Disorganization connective tissue and destruction nerve fibers leads to a decrease in the tone of the arterioles supplying these tissues and a decrease in their lumen. This, in turn, further worsens the blood supply to the perineal tissues and increases the oxygen deficiency in them, closing the vicious circle of the disease.
Symptoms of kraurosis ( lichen sclerosis)
The clinical picture of lichen sclerosis depends mainly on the stage of the disease, the area of affected tissue, as well as concomitant pathology pelvic organs. Approximately 2% of women with vulvar kraurosis are asymptomatic. Its highest incidence is observed among older women in menopause. Among women childbearing age The peak incidence occurs at the age of 35 years. The literature describes even isolated cases of the development of vulvar kraurosis in children, including those under 3 years of age. Symptoms of kraurosis ( lichen sclerosis) depending on the stage of the disease
| Disease stage | Symptom | Description of the symptom |
| initial stage | Paresthesia | Paresthesia is a feeling of "pins and needles" or slight tingling, which practically does not bother the patient and occurs long before signs of tissue atrophy. This symptom appears periodically, regardless of the time of day and type of activity. There may be point paresthesia or paresthesia that occurs immediately in a certain area of the vulva. |
| Itchy skin | A significant proportion of patients note the onset of the disease with skin itching, which manifests itself mainly at night. This itching is sporadic, that is, it migrates or occurs every time different areas vulva. The intensity of itching is low at first. It is believed that the severity this symptom corresponds to the intensity of element destruction processes intercellular space. In other words, the stronger the itching, the faster the disease progresses. | |
| Moderate stage clinical manifestations | Initial signs of skin atrophy | Among the initial signs of vulvar kraurosis are slight swelling, whitishness of the skin and thinning. These signs are usually noticeable in the area of the so-called “kraurotic triangle”. The base of this triangle is the transverse line separating the upper and middle third of the labia. The lateral sides of the triangle are the upper thirds of the labia majora, and the apex is the pubic symphysis. |
| Itchy skin | Skin itching has the same characteristics as before, but its intensity increases noticeably. As a result, some patients develop severe neuropsychiatric disorders. Antihistamines for this disease often have an insufficient and short-term effect. | |
| Dyspareunia | Dyspareunia is pain during sexual intercourse. After sexual intercourse, pain may persist for several hours. Normally, sexual intercourse should bring only pleasant sensations. | |
| Vulvodynia | Vulvodynia is pain in the vulva, characterized by a feeling of dryness, burning, tension and stiffness of the tissues. These sensations are present at rest and intensify with movements in the pelvic girdle. | |
| Terminal stage | Signs of terminal cutaneous atrophy | Thinning and thickening of the skin and mucous membranes progresses. Multiple subepithelial hemorrhages and telangiectasia are noted ( spider veins), giving previously white skin a variegated appearance. The affected area at this stage is not limited to the kraurotic triangle, but extends to the entire vulva, perianal area and inguinal-femoral folds. The clitoris and labia minora are so smooth that they are difficult to define. Atrophy of the labia majora is manifested by the disappearance of fatty tissue in them, which is why they practically do not rise above the surface of the skin. The vestibule of the vagina is greatly narrowed. |
| Itchy skin | Skin itching in the terminal stage of the disease, as a rule, is most intense, observed both at night and in the morning. daytime days, leading over time to nervous disorders, chronic fatigue syndrome, etc. | |
| Dyspareunia | Pain during sexual intercourse is much stronger than in the previous stage. This is due to more pronounced dryness of the external genitalia and narrowing of the vaginal opening. | |
| Vulvodynia | Vulvodynia also intensifies due to more pronounced processes of atrophy of the mucocutaneous membranes. | |
| Dysuria | Dysuria - urinary disturbance develops due to atrophy of the urethral epithelium. Due to atrophy of the urethra, a narrowing of its external opening occurs with loss of part of the mucous membrane lining its lumen. Such changes in the shape of the urethra, firstly, complicate the passage of urine, and, secondly, contribute to the occurrence of inflammatory diseases urinary tract. Thus, to the most frequent symptoms Dysuria with kraurosis refers to painful, difficult and frequent urination. | |
| Defecation disorders
(discharge feces ) | Impaired defecation develops when lichen sclerosis spreads to the perianal area. With this disease, a narrowing of the lumen of the anus occurs, often accompanied by cracks and prolapse of the mucous membrane. Thus, the process of passing feces in such patients is painful, lengthy, often accompanied by constipation and rectal bleeding. As a result, after some time the patient develops a fear of the act of bowel movement due to the unpleasant sensations accompanying this process. |
Diagnosis of kraurosis of the vulva ( lichen sclerosis)
Diagnosis of kraurosis ( lichen sclerosis) is based on the detection of the corresponding clinical picture, laboratory and instrumental studies. History data ( interviewing the patient) in this disease are considered uninformative due to the fact that no clear connection with any causative factors has been found. Which doctor should I contact if I suspect kraurosis of the vulva ( lichen sclerosis)?
If you suspect kraurosis of the vulva, first of all, you need to see a gynecologist. If necessary, this specialist refers the patient to additional laboratory and instrumental studies, based on the results of which a diagnosis is established and treatment is prescribed. If, during the research, signs of another disease are revealed, for example, oncological or venereological, then the gynecologist must give the patient a referral to the appropriate specialist - an oncologist or a dermatovenerologist, respectively.Laboratory diagnosis of vulvar kraurosis ( lichen sclerosis)
The main and most precise method Diagnosis of vulvar kraurosis is a histological examination of the most suspicious tissue samples. Sample collection may occur randomly ( blindly) from several areas of the vulva to increase the likelihood of detecting pathology, and specifically during vulvoscopy ( microscopic examination vulvar epithelium). Lichen sclerosis is characterized by swelling and small cell infiltration upper section dermis, flattening of the epithelium and a decrease in the number of melanocytes. In the connective tissue of the dermis, areas of destruction of collagen and elastin fibers are determined.Besides, histological method allows you to identify areas of hyperkeratosis, leukoplakia and cellular atypia, allowing you to timely diagnose precancerous diseases and malignant tumors of the vulva.
Another of the main tasks for kraurosis of the vulva is to exclude a papillomavirus infection similar in clinical picture. For this purpose, the patient’s blood is examined using the PCR method ( polymerase chain reaction) for the presence of human papillomavirus in it and determining its type. If one is detected, then the direction of treatment changes. If the virus is not detected, then they then resort to methods that directly determine the changes characteristic of lichen sclerosus, in particular vulvoscopy.
Instrumental diagnosis of vulvar kraurosis ( lichen sclerosis)
The main and practically the only instrumental method examination of the vulva is vulvoscopy - a method of microscopic examination of the vulva directly on the patient.There are two types of vulvoscopy - simple and extended. Simple vulvoscopy involves visual examination of the vulva under multiple magnification. The main objective of this method is to determine the thickness of the skin and mucous membranes and detect atypical blood vessels.
Advanced vulvoscopy involves the use of special substances ( acetic acid, toluidine blue, etc.) to determine areas of hyperkeratosis and malignant tissue degeneration. This method examination of the vulva is used primarily for differential diagnosis with malignant tumors vulva. The undeniable advantage of this method is the possibility of targeted biopsy taking ( piece) from the area of tissue affected by the disease for subsequent histological examination.
When is treatment for kraurosis necessary? lichen sclerosis)?
Treatment of kraurosis is indicated immediately after its diagnosis, since its main goal is to stop the progression of the disease. Thus, the sooner treatment begins, the more effective it will be. Surgical methods for treating kraurosis exist, but they are used in advanced cases of the disease, when narrowing of the urinary duct, anus, vestibule of the vagina, etc. develops. Treatment of kraurosis of the vulva ( lichen sclerosis)
Due to immediate cause, which causes the development of vulvar kraurosis, has not yet been found, prevention and targeted treatment of this disease is not possible. However, its pathogenesis is quite well studied and the influence on its components leads to a slowdown in the progression of the disease. Thus, in the treatment of lichen sclerosis ( kraurosa) strive to restore optimal blood circulation in the vulva area, eliminate inflammatory processes and the feeling of itching. Achieving these goals is mainly achieved through conservative drug treatment. A certain effect is achieved through the use of non-drug methods treatments such as physical therapy, acupuncture, laser therapy and photodynamic therapy. Talking about last method, it should be noted that its popularity has been steadily growing recently, due to a much more pronounced therapeutic effect than with other methods. Surgical treatment methods are applicable only in the terminal stage of the disease when narrowing of the urethral opening, adhesions in the vagina and rectum occur.
Non-drug ( physiotherapeutic) treatment of vulvar kraurosis ( lichen sclerosis).
Non-drug methods for treating vulvar kraurosis include ultraviolet irradiation, laser therapy, ultrasound therapy, acupuncture, etc. It is important to note that these methods are most effective with complex treatment.The main goal of physiotherapy for vulvar kraurosis is to suppress the inflammatory process and improve blood circulation in the vulva area.
It is extremely important to note that these types of physiotherapy are absolutely contraindicated in the presence of any malignant process in the body, due to the sharp acceleration of its progression. In addition, you should always listen to your feelings. If after several procedures the patient detects a deterioration in her condition, then she should, at a minimum, reduce the dose, review the procedure regimen, or cancel it completely.
Methods of physiotherapeutic treatment of vulvar kraurosis
| Physiotherapeutic method | Recommendations | Therapeutic effect |
| Ultraviolet irradiation | Irradiation is provided only to the external genital area daily or every other day. Start with one biodose, then add half a biodose for each session until three biodoses are reached. The course of treatment consists of 10 – 15 procedures. | Ultraviolet waves have a superficial anti-inflammatory effect and also stimulate recovery processes in irradiated tissues. |
| Ultrasound | Ultrasonic exposure is carried out on the vulva area with a sound intensity of 0.2 - 0.4 W/cm 2 in pulse mode. Procedures are carried out daily or every other day. The duration of the procedure is 3 - 4 minutes. The course of treatment includes 10 procedures. Combining ultrasound with application is encouraged. hormonal ointments and creams due to their deeper absorption and longer deposition. | Ultrasound causes slight fluctuations in the depth of the skin, beneficially affecting the tone of the underlying blood vessels and eliminating congestion. Improving tissue trophism leads to a slowdown in the breakdown of collagen and elastin fibers, slowing down the progression of kraurosis and even partially restoring damaged tissues. |
| Laser therapy | Laser therapy is carried out locally on the vulva area with relatively low-power radiation of 1 - 2 mW/cm 2 in pulsed mode. The duration of the procedure is 2 - 3 minutes. The course consists of 10 procedures performed daily. | Laser beams penetrate through keratin, being absorbed by red tissues, that is, primarily by blood vessels, red blood cells and muscle fibers. This, in turn, leads to an increase in vascular tone and tightening of the skin muscles. The above effects lead to a decrease stagnation in the tissues of the vulva. |
| Reflexology (acupuncture) | Impact on energy centers organism by irritating them with the finest sterile needles. The duration of the procedure may vary, as well as the frequency of sessions. The course of treatment consists of 15 - 20 procedures. With this type of physiotherapy, the qualifications and experience of the master are of utmost importance. | Impact on certain energy centers of the body leads to an increase in the metabolic rate in the tissues of the perineum. This, in turn, leads to a slowdown in the processes of connective tissue disorganization and stopping the progression of lichen sclerosus. |
Drug treatment of vulvar kraurosis ( lichen sclerosis)
Drug treatment for kraurosis of the vulva it is rightfully considered the main one due to its highest effectiveness. Predominantly local forms of medicines are used. Ointments and creams are applied 1 - 2 times a day to clean skin, lightly rubbing. Lotions are used less frequently due to the inconvenience of their use.Medicines used in the treatment of vulvar kraurosis
| Medicine | Dosage form | Dosage regimen | Therapeutic effect |
| Estriol (ovestine) | Vaginal cream 1 mg/g – 15g. | 1 - 2 times a day for a long time. | Slowing down the processes of vulvar atrophy. It is mainly prescribed if patients complain of vaginal dryness and pain during sexual intercourse. |
| Progesterone (Crinon) | Vaginal gel in bags with an applicator 90 mg. | 2 times a week for a long time. | Acceleration of metabolism of the skin and mucous membranes of the vulva. Compared to estriol, it has a more pronounced antipruritic effect, but is less effective for dyspareunia ( pain during intercourse) due to vaginal dryness. |
| Testosterone (androgel) | Cream 10 mg/g – 75 mg. | 2 times a day for 2 - 3 weeks. | Acceleration of the process of growth and differentiation of collagen - the main protein of connective tissue. More pronounced antipruritic effect compared to estriol and progesterone. |
| Hydrocortisone (Locoid) | Ointment 1% - 10 g. | 2 - 3 times a day in courses of 15 - 30 days with breaks for 2 - 3 months. | Drugs of the glucocorticosteroid group have the most pronounced antipruritic effect that is possible. In addition, they slow down inflammatory processes in tissues, blocking their mechanisms at several points at once. However, with prolonged local use, skin atrophy develops, and therefore the duration of drug use should be limited. |
| Prednisolone | Ointment 0.5% - 15g. | ||
| Betamethasone (Acriderm) | Cream 0.064% - 15 g. | ||
| Triamcinolone (fluorocort) | Ointment 0.1% - 15g. |
The choice of a specific drug and method of its use is made exclusively by the doctor, taking into account individual characteristics patients and concomitant diseases.
Treatment of kraurosis of the vulva ( lichen sclerosis) laser
Laser therapy for vulvar kraurosis is one of the modern and promising methods of treating this disease. Its effectiveness is highest on early stages disease, while the connective tissue base of the vulva has not yet undergone serious changes.The treatment uses helium-neon lasers that can penetrate deep into the skin, affecting areas that are not subject to soft fabrics. When using a laser, it is possible to reduce the intensity of the inflammatory process, which most likely leads to changes in vulvar tissue characteristic of kraurosis. Along with the elimination of the inflammatory process, skin itching is significantly reduced. However, the laser does not affect the processes of restoration of destroyed connective tissue and elastic fibers, which explains its uselessness in the terminal stages of the disease.
The procedures do not require hospitalization and are performed on an outpatient basis. During the session, the entire area of the vulva is affected, with a more intense effect on the most externally changed tissues. The duration of one session may vary, but on average it ranges from 3 to 10 minutes. The course of treatment consists of 15 - 25 procedures performed daily. The result is considered positive when the severity of itching decreases and the number of telangiectasia decreases ( spider veins ) and small subcutaneous hemorrhages. The skin becomes cleaner and healthier looking. An undoubted advantage is the almost complete absence of side effects of this therapy. Nevertheless, positive results It is not always possible to achieve this, which should be kept in mind when choosing this treatment method.
There are a number of limitations of this method that should definitely be mentioned. The main contraindication is the presence of any malignant process in the body, especially in the vulva area. Even leukoplakia ( squamous cell hyperplasia) of the vulva, which is a precancerous condition, is a contraindication due to the acceleration of the rate of malignancy and, accordingly, the shortening of the patient’s life. It is for this reason that before starting treatment of vulvar kraurosis with a laser, you should conduct a vulvoscopy and histological examination of the most altered areas of tissue and make sure that the process is benign. Laser treatment is also contraindicated in patients who have undergone successful surgery for cancer of the perineum and pelvic organs.
Another limitation is the presence of one of infectious diseases genital area, especially in acute period. After its cure, confirmed laboratory and clinically, you can begin laser therapy. Thus, in addition to vulvoscopy and histological examination, in preparation for laser treatment of vulvar kraurosis, vaginal flora should be cultured.
In conclusion, it should be recalled that kraurosis is a relatively little-studied disease. None of the currently proposed treatment methods is ideal, so to achieve best result It is recommended to use all methods in combination. You should not abandon drug treatments during laser treatment.
Photodynamic therapy of vulvar kraurosis ( lichen sclerosis)
Photodynamic therapy for vulvar kraurosis is a modern and highly effective treatment method. of this disease by combining drugs and laser radiation.The essence of the method is intravenous administration the patient receives a special substance that is actively absorbed by the connective tissue cells of the body. When a given substance is exposed to photons of a certain wavelength ( laser) it transforms into poison, destroying the cells in which it has accumulated. After two hours, this substance is independently excreted from the body in urine, without causing delayed side effects.
In contrast to simple laser therapy with a helium-neon laser, the photodynamic therapy method has much greater selectivity for pathologically altered tissues. In this case, the laser only affects unnecessary connective tissue cells, while the multilayer squamous epithelium the vulva remains unaffected. After a few weeks, the areas where there was previously connective tissue are filled with fully functional squamous epithelium. The functions of the vulva and its condition are restored to a much greater extent than with any other type of therapy.
It is somewhat premature to say that photodynamic therapy can completely relieve patients from kraurosis. This method is still young enough to make such conclusions. After several years ( in some cases less) connective tissue cells again begin to replace the healthy epithelium of the vulva. Thus, the disease does not disappear anywhere, but the photodynamic therapy method allows you to forget about its symptoms for a long time and lead a life that is fulfilling in all respects. Moreover, there is no data yet on the harm of repeated courses of photodynamic therapy, therefore, as symptoms of the disease reappear, the procedure can be performed again and the mucous membrane can be restored birth canal for some more time.
Surgical treatment of vulvar kraurosis ( lichen sclerosis)
Surgery kraurosis of the vulva can be called palliative, since its goal is not to cure the patient, but to reduce the severity of her suffering. Surgical interventions for kraurosis of the vulva, they are used in the terminal stages of the disease, when stenoses develop ( narrowing of the lumen) and prolapse of the vagina, urethra or rectum. Their goal in the vast majority of cases is to restore the patency of the above-mentioned channels and return the ability to normal physiological acts.Previously, various surgical techniques, aimed at improving the trophism of vulvar tissue through its denervation ( destruction of the nerves that connect to it), destruction of the vulva with its subsequent fusion, etc.
Unfortunately, none of the above methods have taken root due to much more serious complications than the disease itself. The most commonly practiced manipulations today include cryodestruction ( cooling liquid nitrogen ) and laser ablation. These methods do not require the use of a scalpel, and their effectiveness is acceptable.
Traditional methods of treating vulvar kraurosis ( lichen sclerosis) at home
To begin with, it should be noted that an objective assessment traditional methods Treatment in most cases does not exist due to the fact that it requires serious research on a large number of patients. Therefore, reliable information about the degree of effectiveness of one or another folk recipe extremely difficult to obtain.Nevertheless, healing properties medicinal plants have been known for a long time, which, together with knowledge about pathogenesis ( development) diseases allows you to select those that would theoretically have a positive effect.
So, with kraurosis of the vulva, you should choose medicinal plants with an anti-inflammatory effect and from them prepare decoctions, extracts, ointments, compresses and others dosage forms. A striking example of a plant with a pronounced anti-inflammatory effect is field chamomile, namely its flowers. In its absence, you can successfully use St. John's wort, calendula, thyme, etc.
Substances and plants with irritating properties are also used, but with great caution due to the risk of burning the delicate tissues of the vulva. Representatives of this group include radishes, horseradish, mustard, ethanol and etc.
The dosage should be calculated experimentally yourself, since even in serious collections of traditional medicine the amount of any substance is indicated approximately. It is recommended not to pursue a high concentration of the resulting solution or extract. On the contrary, it is better to use low-concentrated solutions, but more often. It is also not recommended to combine plants, since if their effect turns out to be negative, it will not be clear which of them exactly. Internally received products should not be used under any circumstances, only locally. Herbal compresses or ointments with an anti-inflammatory effect are applied for several hours ( no more than 4 - 5 hours). Irritants are placed on delicate skin vulva only in low concentrations on short term (no more than 10 - 15 minutes). The temperature of the substances should be room temperature, body temperature, or slightly higher than body temperature.
Finally, it should be recalled that the basic rule traditional medicine, like medicine in general, is “ do no harm" This means that trying any unknown recipes should be done with caution, and if side effects occur, you should immediately stop treatment and consult a specialist.
What is the difference between kraurosis ( lichen sclerosis) and leukoplakia ( squamous cell hyperplasia) vulva?
Kraurosis and leukoplakia of the vulva are various diseases, however, have a common origin. In its natural course, kraurosis can eventually turn into leukoplakia, but not vice versa. The main difference between these diseases is that leukoplakia is a precancerous disease, while vulvar kraurosis is not. Kraurosis is an atrophic disease of the skin and subcutaneous fatty tissue of the vulva. Clinically, it is manifested by progressive thinning of the skin, fragility of blood vessels, destruction of elastic and connective tissue fibers. As a result of the above changes, visually the skin becomes somewhat swollen, shiny, pale with numerous pinpoint and small-focal subcutaneous hemorrhages. Destruction of elastic and connective tissue fibers of the skin and subcutaneous tissue leads to the destruction of the skin framework, resulting in its tightening. Clinically, this is manifested by a narrowing of the lumen of the urethra, the vestibule of the vagina and anus, the disappearance of hair on the genitals, and a decrease in their pigmentation. The external genitalia are greatly flattened. The mucous glands stop functioning, which causes dryness of the mucous membranes of the genital organs. Severe itching is observed in almost all cases of vulvar kraurosis. Thus, kraurosis is a truly degenerative disease.
Leukoplakia, like kraurosis, develops due to deterioration of the local blood circulation of the vulva. The second name of this disease, squamous cell hyperplasia of the vulva, more accurately reflects its essence. Instead of thinning the epithelium, it thickens and exfoliates due to the acceleration of the rate of cell division in the basal layer of the epidermis. As a result, white and dense islands of hyperkeratosis appear on the skin and mucous membranes of the genital organs. There is no tightening of the skin and narrowing of the lumen of the urethra, vestibule of the vagina and anus. Itching is observed much less frequently than with kraurosis, which is why squamous hyperkeratosis occurs in most patients long time remains undiagnosed. Unfortunately, quite often this becomes the cause of malignant degeneration of the above skin changes into aggressive squamous cell carcinoma.
An experienced gynecologist, relying only on clinical changes in the skin and mucous membranes of the vulva, will be able to distinguish kraurosis from leukoplakia ( squamous hyperkeratosis). However, such diagnoses require clarification, for which part of the suspicious epithelium is examined histologically. Based on the results of the study, a conclusion is issued, on the basis of which subsequent treatment tactics are determined. With kraurosis in the biopsy specimen ( area of tissue being examined) small cell infiltration, a decrease in the number of melanocytes, thinning of the epithelium, atrophy are determined hair follicles, atrophy of the sebaceous and mucous glands, as well as disorganization of connective tissue and elastic fibers. In squamous hyperkeratosis, areas of thickened and stratified epithelium are found. Cytological examination may reveal cells with varying levels of atypia ( malignancy).
Treatment of kraurosis is conservative with medication. Predominantly anti-inflammatory, antihistamine, and also agents that improve microcirculation are used. In the last few years, photodynamic therapy has been gaining popularity. Surgical treatment is used extremely rarely, only for severe narrowing of the vestibule of the vagina, urethra and anus. Leukoplakia, on the contrary, is initially treated surgical methods in connection with high probability malignancy. The goal of treatment is to eliminate the precancerous disease before it becomes malignant. In some cases, additional courses of chemotherapy and radiation therapy may be prescribed.
The prognosis of kraurosis is considered favorable, despite the fact that the disease brings serious inconvenience to women and significantly reduces their quality of life. The prognosis of leukoplakia is somewhat worse, due to the serious likelihood of malignancy. In connection with the above, all women over 35 years of age are strongly recommended to visit a gynecologist at least once a year.
Which ointments are most effective for kraurosis ( lichen sclerosis)?
There is no clear answer to this question due to the fact that kraurosis is a disease with an unknown cause. All existing medicines act on certain parts of the putative mechanism of disease development. The effectiveness of these remedies may vary depending on the individual characteristics of each organism. However, through numerous observations, a recommended sequence for the use of medicinal substances has been developed. The basis for the treatment of kraurosis are topical agents, that is, ointments, creams and compresses. One of the advantages of this treatment is the creation high concentrations the drug directly into diseased tissues. Penetration of drugs into the blood during local application is minimal, which practically eliminates the risks of systemic side effects, and given that most ointments and creams for the treatment of kraurosis contain hormones as an active ingredient, their side effects could be quite serious.
Conventionally, ointments for the treatment of kraurosis are divided into first- and second-line drugs.
First line drugs
According to most experts, the first-line drugs for kraurosis are ointments and creams based on female sex hormones. The choice of a specific drug depends on the totality of the patient’s concomitant complaints.
For complaints of dryness and pain in the vagina, especially during sexual intercourse, medications containing the female sex hormone estriol are recommended. Its effect is to restore microcirculation of the vulva and stimulate its mucous glands. The drug also has a weak antipruritic effect. One of the most common commercial names this drug in the post-Soviet space is Ovestin, produced in the form of a vaginal cream with a concentration of the active substance of 1 mg/g in a metal tube of 15 g. The effect of the drug develops after several days of use and lasts exactly as long as it is used. The cream should be applied 1-2 times a day daily. If side effects occur, such as the appearance of hives or increased skin itching, you should immediately stop taking Ovestin and consult a doctor to select a more suitable drug.
Another first-line drug for the treatment of kraurosis is kraynon. This drug is available in the form of sachets with applicators containing vaginal gel weighing 90 mg. Active ingredient is progesterone, the concentration of which in the gel is 8%. The drug should be used less frequently - once every 3-4 days, that is, approximately 2 times a week, which is much more convenient than when using Ovestin. This frequency of administration is explained by the fact that the active substance binds to the epithelium of the vulva and has an effect over a longer period of time. This drug should be used by patients whose main complaint is itching. At atrophic changes skin and mucous glands, this drug is less effective. The duration of treatment, as in the previous case, is not limited. If side effects occur, the drug should be stopped immediately.
Second line drugs
One of the second-line drugs in the treatment of kraurosis is androgel, the active substance of which is testosterone at a concentration of 10 mg/g. The effect of this drug is to restore connective tissue and elastin fibers in the affected area, which significantly slows down the course of the disease. In addition, the antipruritic effect of testosterone is much stronger than that of female sex hormones, and therefore it is prescribed only after first-line drugs have proven ineffective. The ointment is applied to the vulva 2 times a day for 2 - 3 weeks. Longer use of the drug is not recommended due to the increased risk of side effects. Repeated courses of the drug are allowed only after several months.
Finally, the main second-line drugs in the treatment of kraurosis are glucocorticosteroid ointments. These include hydrocortisone ( locoid), prednisolone, betamethasone ( acriderm) and triamcinolone ( fluorocort). The advantage of this group of ointments is the rapid and complex effect. The antipruritic effect of these drugs is the most powerful, since it occurs through several mechanisms at once. In addition, glucocorticosteroid ointments are extremely effective in eliminating the inflammatory process. Such ointments should be applied 2-3 times a day for no more than one month. More long-term use is fraught with the development of more pronounced skin atrophy. A repeated course of treatment is carried out no earlier than after 2 - 3 months.
Is it possible to permanently cure kraurosis ( lichen sclerosis)?
Unfortunately, a definitive cure for vulvar kraurosis is impossible, since the cause of this disease is currently unknown. However, today there is a treatment that can significantly restore the normal epithelium of the vulva and reduce the symptoms of kraurosis. Kraurosis differs, for example, from pneumonia or influenza virus in that the cause, causing development This disease has not been identified to date; therefore, it cannot be eradicated. Most scientists tend to consider kraurosis a metabolic or degenerative disease, which is characterized by the presence of a large number of causative factors. If there are many reasons, then it is not possible to influence all of them.
However, the mechanism of development of the disease has already been studied quite thoroughly. This knowledge allowed us to develop effective methods pathogenetic treatment. In particular, improving microcirculation in the vulva and blocking immune processes slows down the progression of lichen sclerosus. The effectiveness of sex hormones allows us to conclude that in the pathogenesis of the disease there is an element of their deficiency, replenishing which it is possible to slow down the processes of atrophy of the skin and mucous membranes of the genital organs.
Recently, laser treatment methods for kraurosis have become very popular, in particular the photodynamic therapy method. Its advantage is the selective destruction of connective tissue in the vulvar area, while preserving the normal squamous epithelium. After a few weeks, a fully functional squamous epithelium of the vulva appears in place of the destroyed connective tissue. This method allows you to get rid of all signs of the disease for a long time and restore your former health. However, due to the fact that the causes of the disease are not eradicated, over time it begins to appear again. In this case, another course of photodynamic therapy will delay the symptoms of the disease for several more years.
Science does not stand still, and in the near future the discovery of new ways to treat previously incurable diseases is expected. Great hopes are placed on methods genetic engineering, which make it possible to protect the unborn child from metabolic, autoimmune and genetic diseases even at the stage of pregnancy planning. It is quite possible that a method for preventing vulvar kraurosis will also be found.
Is there kraurosis ( lichen sclerosis) in men?
Such a disease as penile kraurosis exists, but its incidence among the population is extremely low. In addition, this disease has practically nothing in common with kraurosis of the vulva in women, except external changes. Exactly according to external signs This disease was given the name kraurosis, which translated from Greek means wrinkling. The main difference between kraurosis of the penis and kraurosis of the vulva is its secondary nature. In other words, its development is associated with numerous previous injuries, infections or surgical operations on the foreskin and the head of the penis, while kraurosis of the vulva is more likely independent disease, not a complication. In favor this opinion is evidenced by the fact that kraurosis of the penis is almost always asymptomatic, while in kraurosis of the vulva it is present in 98% of cases severe itching. However, it should be noted that some authors admit the development of this disease in men without previous traumatic causes, that is, primarily.
Changes occurring in the tissues of the penis develop very slowly, so men often do not attach importance to them, attributing everything to natural changes reproductive organ when aging. The main reason for visiting a doctor is urinary retention due to phimosis ( narrowing of the foreskin).
Treatment this state depends on the stage at which it was diagnosed. In the early stages, creams and ointments based on sex hormones are used ( Ovestin, Kraynon, Androgel), as well as based on glucocorticosteroids ( lokoid, prednisolone, acriderm, fluorocort, etc.). Physiotherapy and laser therapy are also used. On late stages When urethral stenosis develops, they resort to surgical treatment. Depending on the severity of the stenosis and the likelihood of successful penile plastic surgery, one or another method of restoring the outflow of urine is used.
The prognosis for kraurosis of the penis is positive. However, in some cases, this disease transforms into cancer of the glans penis or cancer of the foreskin, and therefore such patients are strongly recommended to be under the supervision of a urologist.
Do you need special nutrition for kraurosis of the vulva ( lichen sclerosis)?
There is no definite answer to this question, but most doctors believe that proper nutrition for kraurosis of the vulva, at a minimum, will not hurt. As with most diseases, a diet for kraurosis involves avoiding spicy, salty, fatty, fried food. It is recommended to reduce or completely eliminate foods such as coffee, chocolate, sweets, baked goods, etc.
Coffee and chocolate, for example, irritate the nervous system. Sweets consist mainly of easily digestible carbohydrates, which are suitable only for a sharp increase in blood glucose levels. The body cannot build anything from them except fat deposits.
Should be consumed daily dairy products (kefir, fermented baked milk, sour cream). Milk is recommended only if it does not cause stomach upset, and not daily and in small quantities. Meat products should be on the table at least twice a week, but no more than four times. Eating meat every day is harmful. Dietary types of meat should be used preferentially. Fish can be consumed 3-4 times a week as it is a rich source of protein, phosphorus, vitamins A, D and E. It is preferable to cook fish fresh rather than buy canned fish.
Every day in the morning it is recommended to drink a glass of freshly squeezed juice, and it is especially welcome if it is prepared from a mixture of vegetables and fruits. A favorable combination is apple and pumpkin, apple and red beets, pear and carrots. In addition to juice, you should consume a small amount of salad or separate vegetables/fruits at each meal. Sunflower or olive oil should be used as a salad dressing. It is extremely rich in unbranched fatty acids, from which elements are subsequently formed cell walls. Another source of these substances is butter. Margarine, on the other hand, contains only branched fatty acids, which are useful only for breakdown to produce energy, so, in principle, it is not recommended for consumption.
Regarding the frequency of meals, it should be added that you need to eat 5-6 times a day. This regimen does not necessarily lead to weight gain. On the contrary, if you eat in small portions without overeating, then after a while the body will independently reach its optimal weight.
Thus, by eating right, women with kraurosis supply the body with everything necessary substances to successfully combat the disease. Of course, relying on diet alone is not enough to alleviate the condition, but in combination with modern treatment The diet has a healing, restorative effect.
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