Ulcerative Lesions of the Vulva: Root Causes, Noticeable Signs, and Therapeutic Options
Acute vulvar ulcers are a common concern that can affect millions of people worldwide. These breaks in the skin around the vagina or mucous membranes of the vulva can stem from a diverse range of causes, including infectious, inflammatory, and autoimmune factors.
Infectious causes are often linked to Sexually Transmitted Infections (STIs), with herpes simplex virus (HSV), particularly HSV-1 and HSV-2, being a leading cause. Other STIs associated with vulvar ulcers include chancroid, syphilis, chlamydia, gonorrhea, human papillomavirus (HPV), and HIV. Emerging infections, such as Mpox, which has emerged as a rare cause of genital ulceration since the 2022 outbreak, must also be considered.
Non-infectious causes can be reactive or autoimmune in nature. Lipschütz ulcers, typically seen in sexually inactive adolescents, are reactive, non-infectious ulcers often associated with systemic viral or bacterial infections. Autoimmune and inflammatory conditions, such as Crohn’s disease, Behçet’s disease, and lichen planus, can also lead to vulvar ulcers.
Proper diagnosis often requires a systematic clinical approach, including a detailed history, physical examination, laboratory studies, and sometimes biopsy. Treatment for vulvar ulcers depends on the cause. Mild ulcers may resolve with time, proper hygiene, and care, while more severe ulcers may require medical attention, antibiotics, antiviral pills or shots, steroids, or topical corticosteroids.
HSV, for instance, is treated with antivirals such as acyclovir, valacyclovir, and famciclovir for primary and recurrent episodes. Syphilis is treated with intramuscular penicillin G, while chancroid can be treated with azithromycin or ceftriaxone. Supportive care is often the treatment for reactive ulcers, such as Lipschütz ulcers, as lesions typically resolve spontaneously.
For autoimmune and inflammatory conditions, treatment varies. Behçet’s disease, for example, is treated with colchicine, corticosteroids, immunosuppressants, and biologics. Lichen planus is treated with topical or intralesional corticosteroids and calcineurin inhibitors, while systemic immunomodulators may be used in severe cases. Crohn’s disease and granulomatosis with polyangiitis (GPA) are treated with systemic corticosteroids, immunomodulators, biologics, or rituximab in severe cases.
Early recognition and tailored treatment are essential to alleviate symptoms and prevent complications. Persistent or atypical ulcers warrant biopsy to exclude malignancy or specific inflammatory conditions. With proper care and treatment, the impact of vulvar ulcers can be significantly reduced.
Diabetes, a chronic health-and-wellness condition, can lead to certain types of ulcers, particularly on the feet, due to poor circulation and nerve damage.
COPD, or Chronic Obstructive Pulmonary Disease, is not directly linked to ulcers, but it often co-exists with other health conditions, such as leg ulcers, in some individuals.
Multiple sclerosis, a degenerative disease affecting the central nervous system, doesn't usually cause ulcers, but it might lead to dry mouth or dry eyes as a result of salivary or lacrimal gland dysfunction.
Ulcerative colitis, an inflammatory bowel disease, causes ulcers in the lining of the colon and rectum, leading to symptoms like abdominal pain, diarrhea, and weight loss.
Macular degeneration, a vision-threatening eye condition, doesn't cause ulcers, but it can lead to blank spots or distorted vision in the center of the visual field.
Depression, a common mental health disorder, is not typically associated with ulcers, but it can co-exist with other health conditions, such as skin conditions like psoriasis or dermatitis.
Skin ulcers can also be a symptom of less common diseases like HIV, hepatitis, and AQ, especially in the advanced stages of these diseases.
Late-stage HIV can cause a range of skin problems, including Kaposi's sarcoma, a type of skin cancer that causes ulcers. Hepatitis C can lead to skin changes, including dry, scaly patches, but not necessarily ulcers. AQ, or Asian Quadriplegic Critical Illness Syndrome, can cause various complications, including skin ulcers.
Alzheimer's disease, a neurodegenerative disorder, does not directly cause ulcers, but poor oral hygiene, a common problem in Alzheimer's patients, can lead to mouth ulcers.
Multiple sclerosis can cause sexual dysfunction, but not necessarily ulcers in the genital area. However, genital ulcers can be a symptom of STIs like syphilis and herpes, both of which can be associated with MS.
Migraines, a common type of headache, are not associated with ulcers. However, certain medications used to treat migraines, such as topiramate, can cause skin reactions, including a rash or dermatitis.
Type 1 and Type 2 diabetes can both lead to skin problems, including dry, itchy skin, fungal infections, and non-healing wounds or ulcers.
Science continues to research and develop predictive models for various diseases, including those causing ulcers, to aid in early diagnosis and effective treatment. For instance, research is ongoing to develop predictive models for Crohn's disease, a inflammatory bowel disease causing ulcers in the gut. With better understanding and targeted treatment, the impact of these diseases on our health-and-wellness, skin-care, sexual-health, and women's health can be significantly reduced.
