Lipschütz ulcer

{{Infobox medical condition (new)

| name = Lipschütz ulcer

| synonyms =

| image = Lipschutz ulcer original image.jpg

| caption = One of the first published cases of Lipschütz ulcer

| pronounce =

| field =

| symptoms =

| complications =

| onset =

| duration =

| types =

| causes =

| risks =

| diagnosis =

| differential =

| prevention =

| treatment =

| medication =

| prognosis =

| frequency =

| deaths =

}}

Lipschütz ulcer, ulcus vulvae acutum or reactive non-sexually related acute genital ulcers ({{langx|en|acute ulceration of the vulva}}) is a rare disease characterized by painful genital ulcers, fever, and lymphadenopathy, occurring most commonly, but not exclusively, in adolescents and young women.{{Cite journal|last1=Vieira-Baptista|first1=Pedro|last2=Lima-Silva|first2=Joana|last3=Beires|first3=Jorge|last4=Martinez-de-Oliveira|first4=José|date=2016-03-01|title=Lipschütz ulcers: should we rethink this? An analysis of 33 cases|journal=European Journal of Obstetrics, Gynecology, and Reproductive Biology|volume=198|pages=149–152|doi=10.1016/j.ejogrb.2015.07.016|issn=1872-7654|pmid=26297242}} Previously, it was described as being more common in virgins.{{cite journal |vauthors=Török L, Domján K, Faragó E |title=Ulcus vulvae acutum |journal=Acta Dermatovenereologica Alpina, Pannonia et Adriatica |year=2000 |volume=9 |issue=1 |issn=1581-2979 |url=http://ibmi.mf.uni-lj.si/acta-apa/acta-apa-00-1/torok.html}} It is not a sexually transmitted infection, and is often misdiagnosed,{{cite journal |vauthors=Kluger N, Garcia C, Guillot B |title=[Lipschütz acute genital ulcer] |language=fr |journal=J Gynecol Obstet Biol Reprod (Paris) |volume=38 |issue=6 |pages=528–30 |date=October 2009 |pmid=19744804 |doi=10.1016/j.jgyn.2009.08.005}}{{WhoNamedIt|synd|2265|Lipschütz' ulcer}} Retrieved on 2009-12-04. sometimes as a symptom of Behçet's disease.{{cite book |chapter=Erkrankungen des weiblichen Genitales |year=2005 |title=Dermatologie und Venereologie |veditors=Braun-Falco O, Plewig G, Wolff HH, Burgdorf WH, Landthaler M |language=de |location=Berlin |publisher=Springer |pages=1030 |isbn=978-3-540-40525-2}}

Lipschütz ulcer is named after Benjamin Lipschütz, who first described it in 1912.{{cite journal |author=Lipschütz B |title=Über eine eigenartige Geschwürsform des weiblichen Genitales (Ulcus vulvae acutum) |language=de |journal=Arch Dermatol Res |volume=114 |issue=1 |pages=363–96 |date=October 1912 |doi=10.1007/BF01973166|s2cid=11890180 |url= https://scholar.archive.org/work/b6v6wnb2fzearlwbr4xq3gimle/access/ia_file/crossref-pre-1923-scholarly-works/10.1007%252Fbf01963479.zip/10.1007%252Fbf01973166.pdf }} The cause is still unknown, although it has been associated with several infectious causes, including paratyphoid fever, cytomegalovirus, Mycoplasma pneumoniae and Epstein–Barr virus infection{{cite journal |vauthors=Pelletier F, Aubin F, Puzenat E, etal |title=Lipschütz genital ulceration: a rare manifestation of paratyphoid fever |journal=Eur J Dermatol |volume=13 |issue=3 |pages=297–8 |year=2003 |pmid=12804994}}{{cite journal |vauthors=Martín JM, Godoy R, Calduch L, Villalon G, Jordá E |title=Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection |journal=Pediatr Dermatol |volume=25 |issue=1 |pages=113–5 |year=2008 |pmid=18304169 |doi=10.1111/j.1525-1470.2007.00597.x|s2cid=23743938 }}{{Cite journal|last1=Vieira-Baptista|first1=Pedro|last2=Machado|first2=Luísa|last3=Costa|first3=Ana Rosa|last4=Beires|first4=Jorge|last5=Martinez-de-Oliveira|first5=José|date=2013-07-01|title=Mycoplasma pneumoniae: a rare cause of vulvar ulcers or an undiagnosed one?|journal=Journal of Lower Genital Tract Disease|volume=17|issue=3|pages=330–334|doi=10.1097/LGT.0b013e3182710896|issn=1526-0976|pmid=23486069|s2cid=145823}}

Signs and symptoms

The most common presentation is a single large, deep ulcer (although several smaller ulcers may occur) in the internal surface of one or both labia minora.{{cite book |vauthors=Heller DS, Wallach RC |title=Vulvar disease: a clinicopathological approach |publisher=Informa Healthcare |year=2007 |pages=51–2 |isbn=978-0-8493-3793-2 |url=https://books.google.com/books?id=-u8ki9L4HL0C&pg=PT65}} The labia majora may be affected, as may the vagina and urethra. The ulcer develops very quickly, and is usually preceded by sudden onset of fever and malaise.

Diagnosis

The diagnosis is mainly clinical and centred in eliminating other more common causes for vulvar ulcers. Nevertheless, it has been proposed that Epstein-Barr detection using polymerase chain reaction for virus genome can help to reach sooner a diagnosis.

Treatment

Treatment is symptomatic, and usually of little value; in most cases, the ulcer heals spontaneously within four to six weeks, sometimes leaving scars. Topical analgesics and anesthetics, as well as topical application of disinfectants/astringents such as potassium permanganate (in sitz baths), is commonly used. In severe cases, a combination of systemic glucocorticoids and broad-spectrum antibiotics has been recommended.{{cn|date=May 2021}}

Epidemiology

The disorder typically appears among young girls and adolescents but cases in children as young as 17 months have been reported.{{cite journal |vauthors=Burguete Archel E, Ruiz Goikoetxea M, Recari Elizalde E, Beristain Rementería X, Gómez Gómez L, Iceta Lizarraga A |title=Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection |journal=Eur. J. Pediatr. |volume= 172|issue= 8|pages= 1121–3|date=May 2013 |pmid=23636284 |doi=10.1007/s00431-013-2013-8 |s2cid=189872655 |doi-access=free }}

History

The disease was first described in October 1912 by Galician-born Austrian dermatologist and microbiologist Benjamin Lipschütz, who published a series of four cases in girls aged 14 to 17. He initially ascribed the ulcer to infection with "Bacillus crassus" (Lactobacillus acidophilus).

See also

References

{{Reflist}}