One of the first published cases of Lipschütz ulcer
|Classification and external resources|
Lipschütz ulcer or ulcus vulvae acutum (English: acute ulceration of the vulva) is a rare disease characterized by painful genital ulcers, fever, and lymphadenopathy, occurring most commonly in adolescents and young women (particularly virgins). It is not a sexually transmitted disease, and is often misdiagnosed, sometimes as a symptom of Behçet's disease.
Lipschütz ulcer is named after Benjamin Lipschütz, who first described it in 1912. The etiology is still unknown, although it has been associated with several infectious causes, including paratyphoid fever, cytomegalovirus and Epstein-Barr virus infection
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. 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.
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 is symptomatic, and usually of little value; in most cases, the ulcer heals spontaneously within four to six weeks, 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.
The disorder typically appears among young girls and adolescents but cases in children as young as 17 months have been reported.
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).
- Lipschütz B (October 1912). "Über eine eigenartige Geschwürsform des weiblichen Genitales (Ulcus vulvae acutum)" (PDF). Arch Dermatol Res (in German) 114 (1): 363–96. doi:10.1007/BF01973166.
- Török L, Domján K, Faragó E (2000). "Ulcus vulvae acutum". Acta Dermatovenereologica Alpina, Pannonia et Adriatica 9 (1). ISSN 1581-2979.
- Kluger N, Garcia C, Guillot B (October 2009). "[Lipschütz acute genital ulcer]". J Gynecol Obstet Biol Reprod (Paris) (in French) 38 (6): 528–30. doi:10.1016/j.jgyn.2009.08.005. PMID 19744804.
- Lipschütz' ulcer at Who Named It? Retrieved on 2009-12-04.
- Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC, Landthaler M, ed. (2005). "Erkrankungen des weiblichen Genitales". Dermatologie und Venereologie (in German). Berlin: Springer. p. 1030. ISBN 978-3-540-40525-2.
- Burguete Archel E, Ruiz Goikoetxea M, Recari Elizalde E, Beristain Rementería X, Gómez Gómez L, Iceta Lizarraga A (May 2013). "Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein-Barr primoinfection". Eur. J. Pediatr. 172 (8): 1121–3. doi:10.1007/s00431-013-2013-8. PMID 23636284.
- Pelletier F, Aubin F, Puzenat E et al. (2003). "Lipschütz genital ulceration: a rare manifestation of paratyphoid fever". Eur J Dermatol 13 (3): 297–8. PMID 12804994.
- Martín JM, Godoy R, Calduch L, Villalon G, Jordá E (2008). "Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection". Pediatr Dermatol 25 (1): 113–5. doi:10.1111/j.1525-1470.2007.00597.x. PMID 18304169.
- Heller DS, Wallach RC (2007). Vulvar disease: a clinicopathological approach. Informa Healthcare. pp. 51–2. ISBN 0-8493-3793-3.