Lipschütz ulcer, ''ulcus vulvae acutum'' or reactive non-sexually related acute genital ulcers ( en, acute ulceration of the vulva) is a rare disease characterized by painful

genital ulcer A genital ulcer is an open sore located on the genital area, which includes the vulva, penis, perianal region, or anus. Genital ulcers are most commonly caused by infectious agents (fungal infections, secondary bacterial infections, or sexually t ...

s, fever, and lymphadenopathy, occurring most commonly, but not exclusively, in adolescents and young women. Previously, it was described as being more common in virgins. It is not a

sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral ...

, and is often misdiagnosed, Retrieved on 2009-12-04. sometimes as a symptom of

Behçet's disease Behçet's disease (BD) is a type of inflammatory disorder which affects multiple parts of the body. The most common symptoms include painful sores on the mucous membranes of the mouth and other parts of the body, inflammation of parts of the ey ...

. Lipschütz ulcer is named after Benjamin Lipschütz, who first described it in 1912. The cause is still unknown, although it has been associated with several infectious causes, including

paratyphoid fever Paratyphoid fever, also known simply as paratyphoid, is a bacterial infection caused by one of the three types of ''Salmonella enterica''. Symptoms usually begin 6–30 days after exposure and are the same as those of typhoid fever. Often, a grad ...

, cytomegalovirus, ''Mycoplasma pneumoniae'' and

Epstein–Barr virus The Epstein–Barr virus (EBV), formally called ''Human gammaherpesvirus 4'', is one of the nine known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. EBV is a double-stranded DNA virus. It is b ...

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 minora (Latin for 'smaller lips', singular: ''labium minus'', 'smaller lip'), also known as the inner labia, inner lips, vaginal lips or nymphae are two flaps of skin on either side of the human vaginal opening in the vulva, situated b ...

. The

labia majora The labia majora (singular: ''labium majus'') are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum. Together with the labia minora they form the labia of the vulva. The labia majo ...

may be affected, as may the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

and

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra c ...

. 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 The polymerase chain reaction (PCR) is a method widely used to rapidly make millions to billions of copies (complete or partial) of a specific DNA sample, allowing scientists to take a very small sample of DNA and amplify it (or a part of it) ...

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/

astringent An astringent (sometimes called adstringent) is a chemical that shrinks or constricts body tissues. The word derives from the Latin ''adstringere'', which means "to bind fast". Calamine lotion, witch hazel, and yerba mansa, a Californian pla ...

s such as

potassium permanganate Potassium permanganate is an inorganic compound with the chemical formula KMnO4. It is a purplish-black crystalline salt, that dissolves in water as K+ and , an intensely pink to purple solution. Potassium permanganate is widely used in the c ...

(in sitz baths), is commonly used. In severe cases, a combination of systemic

glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every verteb ...

s and

broad-spectrum antibiotic A broad-spectrum antibiotic is an antibiotic that acts on the two major bacterial groups, Gram-positive and Gram-negative, or any antibiotic that acts against a wide range of disease-causing bacteria. These medications are used when a bacterial ...

s has been recommended.

Epidemiology

The disorder typically appears among young girls and adolescents but cases in children as young as 17 months have been reported.

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 ''Lactobacillus acidophilus'' (New Latin 'acid-loving milk-bacillus') is a rod-shaped, Gram-positive, homofermentative, anaerobic microbe first isolated from infant feces in the year 1900. The species is most commonly found in humans, specifically ...

'').

References

External links

{{DEFAULTSORT:Lipschutz Ulcer Gynaecologic disorders Virus-related cutaneous conditions Rare diseases