Craurosis vulvae

Kraurosis vulvae is a pathology characterized by pronounced atrophic processes of the skin and mucous membranes of the vagina, which occurs as a result of external and internal factors. This problem mainly concerns women in the postmenopausal period, which is associated with the peculiarities of hormonal regulation, but it also occurs in young women. The possibility of an increased risk of developing oncopathology in women with kraurosis vulvae proves the need for early diagnosis and correction of this pathology.

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Epidemiology

The epidemiology of vulvar kraurosis is characterized by its predominant distribution among women in the menopause period, which is associated with etiological and pathogenetic factors. Among young women, this pathology occurs in no more than 5%, and of these women, more than 85% of cases are secondary kraurosis, i.e. post-traumatic or post-operative.

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Causes vulvar kraurosis

Speaking about the prevalence of this problem in women over 50, the reasons for the development of this pathology can be generalized. But if we are talking about women 30 years old, there are some features in the etiology and pathogenesis of the disease.

The exact cause of the development of vulvar kraurosis cannot be established even in women in individual cases, since there are often many of these causes.

One of the most common causes of kraurosis is hormonal disorders that concern not only female sex hormones, but also the general hormonal background under the influence of other endocrine glands. The pathogenesis of the development of such a process strongly depends on the regulation of hormonal balance. During menopause, kraurosis develops most often, since the level of estrogens, which play an important role in the female body, decreases. They ensure the division and differentiation of body cells, primarily skin and epithelium. This provides a woman with youth and a healthy fresh look. With a lack of estrogens, the division of vaginal skin cells is disrupted, which leads to a decrease in their number and normal function. At the same time, blood circulation in the pelvic area is also disrupted, ischemia occurs not only of the internal organs, but also of the skin - this further disrupts the differentiation of the endothelium. Thus, the changes intensify and gradually skin atrophy occurs, the amount of endothelium decreases, which leads to secondary processes in the form of cracks and dysplasia in such cells. Therefore, kraurosis is initially only a superficial process with skin atrophy, but later on, disturbances in the mitotic activity of such cells occur, and dysplasia develops, which is dangerous in terms of a precancerous condition.

But there may be a number of other factors that may cause such changes. As for the hormonal background, the direct cause is also diseases of other endocrine glands. Such pathologies include adrenal cortex insufficiency, which also disrupts the blood circulation of the vulva, and innervation, and cell division due to a lack of catecholamines. Another cause is hypothyroidism in women. This is a pathology in which the level of thyroid hormones of the thyroid gland decreases, which also regulate the process of tissue regeneration and cell growth. In this case, the lack of such hormones leads to inhibition of active mitosis and atrophy occurs with subsequent replacement by connective tissue. Insufficiency of ovarian function can also cause the development of atrophy of the mucous membrane of the vulva.

Such causes can be called endogenous general causes that can be inherent in every woman. But there are some local causes of the development of vulvar kraurosis, which include chronic inflammatory diseases of the internal and external genital organs, chronic foci of infection of the ovary or uterus, frequent surgical interventions on the uterus, as well as burns of the mucous membrane of chemical etiology. If there are primary foci of infection or viruses in the vaginal area, this only increases the effect of etiological factors that contribute to the development of dysplastic disorders and atrophy.

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Risk factors

Considering all possible causes of kraurosis, it is necessary to identify the main risk factors for this pathology in order to limit the group of women who require more careful monitoring. Risk factors for the development of this pathology include:

1. women with concomitant hypothyroidism;
2. women suffering from obesity – in this case, there is a violation of the regulation of hormonal levels at the level of target cells;
3. active hepatitis or cirrhosis of the liver at a young age - this disrupts the metabolism of many hormones and their regulation, which occurs mainly in the liver;
4. women with frequent vaginitis, colpitis or chronic adnexitis are a springboard for the action of other etiological factors;
5. women with disorders of the neurovegetative system - this is closely related to the hormonal regulation of body functions, as well as to local blood circulation (psychosomatic disorders);
6. women with pathological menopause and its various manifestations.

These risk factors must be taken into account not only to identify sick patients, but first and foremost, for the purpose of primary prevention of the development of vulvar kraurosis.

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Symptoms vulvar kraurosis

The clinical picture of the disease depends on the stage at which the disease is detected and at which treatment begins. Often the symptoms are not so pronounced that a woman would contact a doctor with this problem, but this is only at the initial stages, and later the symptoms are expressed to a greater extent.

The stages of vulvar kraurosis are sequential and, if left untreated, the changes become more severe.

The first stage of kraurosis is characterized by initial changes in blood circulation and innervation of the mucous membrane, which is transient. At the same time, the first signs of the disease appear in the form of severe itching and burning in the vagina. As a rule, this is the first and only symptom in the initial stages. Itching may only occur during the day, it is provoked by physical activity or occurs after sexual intercourse. There is also a feeling of dryness of the mucous membrane, which requires the use of moisturizers. But such symptoms at the beginning of the disease are not constant, and the woman does not pay special attention to these signs.

The second stage develops when there are not only persistent changes in blood circulation, but also when initial changes in nerve endings and endothelial atrophy of a mosaic nature appear. Then cell division is also disrupted and cracks and erosions occur, which gives even more discomfort and forces you to seek help. In this case, the symptoms of burning and itching of the vagina intensify and bother you constantly. Vaginal dryness intensifies, which also causes another symptom - dyspareunia. In this case, the woman does not get pleasure from sexual intercourse and the process itself is disrupted - due to dryness and burning, painful sensations arise. This greatly affects the general psychological state of the woman and, against the background of concomitant hormonal disorders, a deficit in the regulation of nervous activity occurs. This is manifested by increased nervousness, bad mood, sleep disturbance, nervous excitability, hyperestrogenism.

The third stage of kraurosis is the final stage in terms of profound changes not only in the vagina, but also in the surrounding tissues. In this case, the blood flow disorders are irreversible, the atrophy is diffuse and the proliferation of the endothelium and other cells is completely disrupted. This is accompanied by complete atrophy and sclerosis of the vaginal mucosa, which leads to a significant narrowing of the lumen of the vagina. This also has a significant impact on the mucous membrane of the urethra - urination becomes painful and burning, discomfort, and itching increase. Cracks and erosions of the mucosa can be accompanied by contact bleeding, which is difficult to treat. Swelling of the labia, their hyperemia and signs of inflammation in secondary infections are expressed, because there are entry points for various infectious agents. Signs of atrophy of the skin and its appendages also appear - loss of pubic hair, dry skin, peeling. All this has a significant impact not only on the severity of local symptoms, but also on the general condition of the woman.

Speaking about the symptoms of vulvar kraurosis, it is necessary to know that already at the initial manifestations of such changes it is necessary to consult a doctor for treatment, since this pathology is dangerous in terms of complications.

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Diagnostics vulvar kraurosis

The diagnosis of kraurosis should be made in a timely manner, before the onset of complications and possible malignancy, and all complex research methods should be carried out. For this purpose, a physical examination, instrumental and laboratory diagnostics are carried out.

Diagnostics begin with a thorough collection of the anamnesis of life and disease. It is necessary to find out the characteristics of the menstrual cycle, especially if the woman is in menopause, then it is necessary to determine how this period proceeds and the connection of complaints with the onset of menopause. As a rule, the symptoms of kraurosis develop gradually, which must be clarified from the woman with a detailed description of all complaints. Next, it is necessary to examine the woman on the chair. A simple vaginal examination of a woman in mirrors is very informative, since many symptoms are visually determined and the stage of the disease can be judged by the degree of their severity. During the examination, you can see pronounced dryness of the vaginal mucosa, cracks and superficial erosions, which can make it difficult to insert a mirror. You can also see hyperemia of the labia, edema, a whitish tint of the mucosa and areas of atrophy or even sclerosis. For a more informative diagnosis, additional research methods are necessary. Since kraurosis is a precancerous condition, a biopsy is a mandatory stage of diagnosis. For this purpose, as well as for the purpose of differential diagnostics, instrumental diagnostics are performed using colposcopy. This is a research method that involves using a special device - a colposcope. This allows you to see the vaginal mucosa in magnification of several dozen times. In this case, you can visualize those changes that are not visible during a normal examination. Another advantage of this method is the possibility of a parallel biopsy. It can be performed with special forceps, which are at the end of the colposcope. The mucosal material is sent for histological examination to identify the degree of changes and exclude malignant transformation.

Smears for bacterial flora and the degree of cleanliness of the vagina are also a mandatory research method, since they allow to exclude bacterial inflammation or a specific infectious process.

The tests that are mandatory for kraurosis are HPV tests, which are associated with cervical cancer in women. Therefore, given the precancerous condition, this test allows us to study the risk of malignant transformation and determine the prognosis of the pathology. For this, a blood test is performed using a polymerase chain reaction and the determination of the virus antigen. A positive reaction allows us to more accurately determine the treatment tactics and use specific methods. If there is a suspicion of vulvar kraurosis in a woman of menopausal age, then a hormonal panel with a study of the level of the main hormones is required, since in complex treatment there may be a need to use replacement therapy.

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Differential diagnosis

Differential diagnostics of vulvar kraurosis should be carried out at the initial stages of the disease, when the symptoms are not specific. Differential diagnostics are especially important in young women, since this is a rare pathology for them. Therefore, it is necessary to carry out differential diagnostics with vulvitis, vulvovaginitis, vaginosis, neurodermatitis, lichen planus. With vulvitis vulvovaginitis there is also burning and itching of the vaginal area, there may be dryness of the mucous membrane, but this is a bacterial inflammation, so specific symptoms are white, green or yellow discharge. The main diagnostic sign of the pathology is the determination of a specific pathogen in a smear from the vagina. With kraurosis, the symptoms of dryness, burning, cracks are not accompanied by any discharge, but on the contrary, their amount decreases. Also, with primary kraurosis, there are no bacterial pathogens. Lichen planus is a dermatological pathology that primarily affects the skin of the genitals, and only secondarily the vagina. Therefore, with lichen, there may be redness and atrophy of the skin, and only then atrophy of the mucous membrane. In contrast, kraurosis is accompanied by atrophy of the mucous membrane, and the skin is affected already at the third stage of the disease.

This diagnostic program for vulvar kraurosis is the most complete and necessary for timely diagnosis and treatment.

Treatment vulvar kraurosis

Treatment of kraurosis is not very successful, which depends not only on timely diagnosis, but also on a comprehensive approach to such treatment. It is very important to use not only local symptomatic remedies, but also systemic pathogenetic ones. Therefore, first of all, treatment should begin with dietary recommendations, because the state of our cells directly depends on the energy material that we give to our body. Therefore, it is necessary to exclude spicy dishes, fried foods, as well as hot spices from the body - this will help reduce the severity of subjective symptoms of the disease. It is also necessary to exclude bad habits, because nicotine constricts blood vessels and further disrupts the trophism of the mucous membranes.

When talking about drug treatment, it is necessary to distinguish between systemic and local treatments. Among systemic treatments, it is necessary to use complex approaches to treatment using the following medications:

1. Estrogen replacement therapy, if kraurosis develops against the background of climacteric changes. In this case, estrogens restore the normal function of endothelial cells and relieve general symptoms of the disease.

Ovret is a hormonal drug, the active substance of which is norestrel from the gestagen group, which allows it to be used in the initial stages of treatment of kraurosis during climacteric changes. The method of administration of the drug is in tablets at the same time of day, preferably before meals. The dosage of the drug is one tablet per day throughout the entire time without breaks. Side effects are possible from the gastrointestinal tract in the form of stool disorders, nausea, a feeling of bitterness in the mouth. Fluid retention and headaches are possible, so the drug is not recommended for concomitant hypertension. Jaundice and uterine bleeding are also possible, which requires dose adjustment. Contraindications to taking the drug are pathology of the blood coagulation system, pathology of the coronary vessels and veins, diabetes, a history of cerebral hemorrhage or ischemic stroke. Precautions - in case of using antibiotics, the effectiveness of the drug is reduced, so it is necessary to dose the drugs correctly and take into account their interaction.

1. Antihistamines are used for the purpose of general desensitization, as well as reducing the severity of itching and a calming effect. For this purpose, first- or second-generation drugs are more recommended.

Diazolin is an antihistamine drug that has a pronounced effect on the symptoms of itching and burning in vaginal atrophy. The drug also has a sedative effect, which improves the general condition of the woman and normalizes sleep. The method of using the drug is one tablet per day at night. Treatment can be carried out for a week, when the symptoms are most pronounced. Side effects are possible in the form of apathy, drowsiness, irritation of the gastric mucosa and pain in the epigastrium. Nausea and pain in the liver are also possible. Precautions - do not use when driving a car or operating other vehicles, as the drug can cause a decrease in attention.

1. Antidepressants or anxiolytics - they are used for pronounced symptoms of vulvar kraurosis, which disrupts the general condition of the woman and affects the mental sphere. In complex treatment, they are mandatory in case of pronounced depression and mood suppression, as well as to improve sleep if the symptoms of kraurosis bother at night.

Cipralex is an antidepressant that is often used to treat climacteric changes in the mental sphere. This therapy is explained by the fact that often to relieve anxiety and fear it is necessary to take these drugs in combination with hormonal drugs. In case of vulvar kraurosis, the drug relieves increased excitability of the nervous system caused by the symptoms of the disease. This drug increases the number of molecules that are responsible for transmitting a nerve signal, and the number of excitatory mediators that relieve depression and fear increases. The drug is available in tablet form and the recommended initial dose is one tablet during meals. The dosage is 10 milligrams per day. Side effects of the drug can be expressed in the form of changes in the nervous system - dizziness, drowsiness, increased excitability, as well as lack of appetite, nausea, vomiting, diarrhea, increased sweating or dry mouth, palpitations and tremors of the limbs. The drug is contraindicated in cases of liver and kidney pathology, hypersensitivity to the components of the drug, and during simultaneous treatment with monoamine oxidase inhibitors.

1. Vitamin preparations should be used to improve trophism, improve the condition of the vascular wall, normalize nerve conduction, which helps to restore normal proliferative activity of cells in kraurosis. Multivitamins containing ascorbic acid, which affects the vascular wall, are recommended.

Supradin is a complex vitamin preparation recommended for pregnant women as a preventive and therapeutic vitamin remedy. Given its rich composition, the preparation replenishes not only vitamins, but also microelements, which allows it to be used as a vitamin preparation for the complex treatment of various pathologies. Due to the complex action of vitamin C and magnesium, the effect on the vascular wall and nerve endings is revealed simultaneously with the restoration of the normal level of electrolytes in the tissues. The drug is available in the pharmacological form of dragees and effervescent tablets. It is taken in a dose of one tablet once a day, dissolving in a small amount of water. Side effects are not detected if the dose is observed, changes in urine color are possible due to the composition of the drug. Contraindications to taking the drug are an increased level of any hormones, serious kidney and liver dysfunction. Precautions - do not combine with other vitamins.

1. Local means for restoring microflora and improving local immune function are also used to reduce the severity of symptoms. This is achieved through a moisturizing effect and by normalizing the function of endothelial cells.

Ginoflor is a drug from the group of combined probiotics and hormonal agents, the main active ingredient of which is lactobacilli and estriol. Due to this composition, the drug has a two-way effect - normalization of the vaginal microflora and increased proliferation of epithelial cells due to the local effect of estrogens. The drug is available in the form of vaginal tablets and the dosage is one tablet per day. Method of application - vaginally, you need to insert the suppository not too deeply into the vagina after all hygiene measures and without taking other local remedies. Side effects are rare, allergic reactions to the components of the drug are possible. Precautions - the tablets must be used for the entire course and that's it, long-term storage and an incomplete course reduces the effectiveness of the drug.

You can also use other local remedies based on antiseptic ointments with vitamins, oils, antihistamine components. Sea buckthorn suppositories, ointments with a testosterone base, as well as ointments with vitamins A, C, E have a good effect.

Surgical treatment of vulvar kraurosis can be used when conservative therapy is ineffective or as a combination therapy. Minimally invasive interventions are used only if there are histological examination results and there are no atypical cells. Then laser coagulation, cryodestruction or cauterization with liquid nitrogen of the affected areas of the mucosa, which are visible to the naked eye or with a colposcope, are used. This destroys the upper layer of atrophic cells, which improves blood circulation in the deep layers and their innervation, and thus increases the proliferative activity of other cells. In the case of the presence of atypical cells in histology, conservative therapy is not used, but vulvectomy is performed immediately.

Physiotherapeutic treatment of vulvar kraurosis can also be used as a local therapy, which is highly effective in combination with other methods. Laser therapy, iontophoresis and electrophoresis with glucocorticoids, as well as therapeutic mud are used. These methods can be used outside the period of exacerbation.

Traditional treatment of vulvar kraurosis

Traditional methods of treatment are aimed at reducing the severity of symptoms and are highly effective along with medications. Local lotions and baths are used, which help moisturize dry skin and have an antibacterial and protective effect. The main recipes of traditional medicine are as follows:

1. You need to make a sitz bath from calendula and celandine leaves. To do this, brew two bags of celandine grass and several stems with calendula leaves or flowers in a liter of water, leave until the solution becomes warm. Then you need to add a few drops of olive oil and take such a bath, sitting in it for at least ten minutes. After the procedure, you need to lubricate the vagina with a few drops of olive oil. Repeat the procedure for ten days.
2. Washing at night with a solution of egg and chamomile will help relieve itching and burning. To do this, first take chamomile leaves, pour boiled hot water over them and leave until the solution becomes slightly warm. After that, add the white of two eggs and perform evening hygiene procedures with this solution. The course of treatment is at least five days.
3. Sea buckthorn is recommended as an antibacterial and regenerating agent. To do this, take sea buckthorn oil, which can be purchased at a pharmacy in a jar, then make a gauze tampon, apply the oil to the tampon and insert it into the vagina for twenty minutes. This product has excellent moisturizing properties, which will relieve irritation and the symptoms will decrease.
4. A good remedy for treating kraurosis is considered to be the use of a solution of soap and kefir as a means for washing. To do this, you need to make a soap solution from laundry soap and add three teaspoons of kefir to it. You need to use it in the evening before going to bed for a week.

Medicinal herbs are also widely used in the treatment of this pathology, which has a positive effect both locally and systemically.

1. Red brush is a plant that helps stimulate the function of vaginal endothelial cells and their proliferation, has an anti-inflammatory effect and prevents the development of secondary bacterial infections against the background of cracks in the mucous membrane. For a medicinal infusion, take three tablespoons of the herb, pour boiling water over it and simmer for another five minutes, cover this infusion and leave for three hours. It should be taken warm five times a day, two tablespoons at a time. The course of treatment is one month.
2. Parsley has a tropism for vaginal tissue and helps reduce itching and dryness by improving blood circulation. Parsley infusion also has a calming effect. To prepare the medicine, take parsley leaves, pour alcohol over them and leave for at least three days. Take this solution one teaspoon in the morning and evening for two weeks.
3. A very good local treatment is celandine. Five tablespoons of celandine herb are poured with a liter of hot boiled water, and then infused for ten minutes. The warm solution should be used for washing twice a day. It is better to prepare a fresh solution for each time, since celandine loses its healing properties when stored in the refrigerator.

Homeopathic remedies have a good effect in the case of pronounced kraurosis against the background of menopause, which is accompanied by an effect on the nervous system. For this, specific remedies are used, which are selected individually. The main groups of drugs that can be used in this case are the following:

1. Carbo vegetabilis is a homeopathic remedy that has a composition of organic agents and helps to normalize hormonal levels during menopause due to acoustic and magnetic resonance with the organs and systems of the body. The drug also reduces proliferative processes at the cellular level and improves cellular differentiation processes in kraurosis. The drug is used in the pharmacological form of homeopathic drops and is dosed three drops three times a day half an hour before meals or an hour after. The course of treatment with the drug is long - about two months. No side effects have been identified. Contraindications to taking Carbo vegetabilis are hypersensitivity to the components of the drug and taking it for men.
2. Sepia is a homeopathic remedy of inorganic origin. The drug has a regenerating effect, which has a good effect on the restoration of atrophic cells in kraurosis and age-related changes. The drug also improves local blood circulation and lymph flow, which increases the effectiveness of the drug in concomitant pelvic pain. The drug is available in the pharmacological form of homeopathic granules and drops, dosed three granules three times a day half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not drink water. Side effects are rare, but stool disorders, dyspeptic phenomena and allergic reactions may occur. Precautions - the drug cannot be used by women with an asthenic physique and depressive mood.
3. Strontiana is a plant that improves tissue trophism, reduces the severity of burning and vaginal dryness due to its softening properties. The drug is available in granules and its dosage is eight granules once a day. Side effects are rare, skin rash on the hands is possible. Precautions - the drug cannot be used in acute inflammatory processes in the pelvis.

These are the main non-drug agents that can be used in the treatment of kraurosis not only as local agents, but also as systemic drugs.

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Prevention

What is the danger of vulvar kraurosis? This question should be asked before any complications arise and at the stage of diagnostic measures, when adequate treatment can improve the prognosis. First of all, kraurosis is dangerous due to the development of endometrial cancer or cervical cancer. This is the most terrible complication that should be feared, since kraurosis can be considered a precancerous process. Other complications that can arise with this pathology are secondary and are caused by atrophy of the mucous membrane, which entails cracks, erosions and deeper lesions with the addition of a secondary bacterial infection. The consequence of improper treatment of kraurosis or the absence of any measures to treat this pathology can be the progression of changes with the development of sclerosis and narrowing of the vagina, secondary changes in the urethra. Therefore, it is very important not only to consult a doctor in time, but also the correct complex treatment.

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Forecast

The prognosis for recovery from vulvar kraurosis is relatively positive, and the prognosis for further progression is favorable in the case of adequate treatment measures. In this pathology, the decisive place in preventing malignancy of this process belongs to secondary prevention, which provides for timely treatment, not only medication, but also surgical if indicated.

Kraurosis vulvae is a pathology that is more common in women in the climacteric period, when changes occur at the level of vaginal cells with their atrophy and subsequent sclerosis. This process develops over some time, so it is important to seek help from a doctor at the first stage. After all, the risk of malignancy of kraurosis is very high, and timely treatment can prevent the development of complications.

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