女阴慢性单纯性苔藓108例临床分析

Clinical Analysis on 108 Cases of Vulvar Lichen Simplex Chronicus

目的探讨中国女性外阴慢性单纯性苔藓的致病因素和临床表现,并分析其诊治策略。方法分析北京医院皮肤科外阴门诊中女阴慢性单纯性苔藓患者的临床资料。结果 108例患者平均年龄(49.60±14.02)岁,平均病程(63.71±9.65)个月。62.96%的患者存在理化刺激或神经、精神和睡眠方面的致病因素;99.07%的患者伴中重度瘙痒;49.07%的患者出现色素减少性损害;35.19%的患者合并其他部位皮炎湿疹;39.81%的患者有过敏性疾病家族史;16.67%的患者有外阴疾病家族史。阳性致敏原为硫酸镍、芳香混合物和卡巴混合物,多与发病无关。首诊于妇科门诊的患者约70%曾诊断为硬化性苔藓。局部应用糖皮质激素短期有效率达50%以上,维持治疗的患者随访6个月复发率为0。结论部分女阴慢性单纯性苔藓患者可发现某些致病因素;近半数患者的损害中伴有色素减少,故易误诊为硬化性苔藓;治疗首选局部应用糖皮质激素。

Objective To investigate triggering factors and clinical manifestations of vulval lichen simplex chronicus(VLSC)among Chinese females and to discuss its strategy on diagnosis and treatment.Methods The medical records of patients with VLSC in Vulvar Clinic of Department of Dermatology in Beijing Hospital were collected and analyzed.Results The average age of 108 patients was(49.60±14.02)years,with the average duration for(63.71±9.65)months.62.96% of the enrolled patients had the triggering factors including physical or chemical stimulation or nervous or psychological and sleeping problems before developing this condition;99.07% complained of moderate to severe pruritus;nearly half(49.07%)the patients presented with hypopigmentation.35.19% suffered from dermatitis and eczema at other anatomical sites apart from the vulva.The family members of 39.81% patients experienced varying allergic disorders and 16.67% had a family history of vulvar diseases.The detected allergens including nickel sulphate,fragrance mix and carba mix were hardly related to VLSC.About 70% of the patients firstly visiting gynecological clinics had ever been diagnosed with lichen sclerosus.The patients with short-term topical corticosteroids received above 50% remission of the symptoms and signs,and none of the patients with maintaining therapy relapsed during 6 months' follow-up.Conclusion A large number of the VLSC patients in the study clearly claim some triggers before this illness.Nearly half the lesions show hypopigmentation,which result in frequent misdiagnosis as lichen sclerosus in gynecological clinics.Topical steroid medications are the first choice of treatment.