Fischer G, Spurrett B, Fischer A
Royal Alexandra Hospital for Children, Sydney, Australia.
Br J Obstet Gynaecol. 1995 Oct;102(10):773-9. doi: 10.1111/j.1471-0528.1995.tb10841.x.
To determine the causes and management of chronic vulval symptoms and to compare the findings in patients first presenting to a gynaecologist with those in patients first presenting to a dermatologist.
A prospective study of 144 patients, approximately half each being referred to a gynaecologist and a dermatologist. Diagnosis was based on clinical history, vulvoscopy, vulval biopsy and bacteriology. Biopsies were examined by a histopathologist experienced in dermatopathology and gynaecological pathology.
The two patient groups were similar in both range and frequency of conditions. The commonest cause of chronic vulval symptoms was dermatitis, which was found in 64% of our patients. Dermatitis occurred alone in 55% and was found in association with histological evidence of human papilloma virus (HPV) in a further 9%. These patients responded to simple dermatological methods, mainly topical corticosteroids. Histopathological evidence of HPV was encountered in only 23% of our patients, and of these 36% also demonstrated dermatitis on biopsy. Most responded to topical corticosteroids. Another 7% had lichen sclerosus, and all responded to potent topical corticosteroid. The remaining 15% demonstrated a range of diagnoses, including psoriasis, dysaesthetic vulvodynia, vulval intraepithelial neoplasia (VIN) and chronic candidiasis. The majority of patients had a corticosteroid responsive dermatosis rather than a gynaecological condition.
The majority of patients with a chronically symptomatic vulva who present to either a gynaecologist or a dermatologist have a dermatological condition that responds to simple dermatological treatments. We believe that the presence or absence of the human papilloma virus is not relevant to most patients with a chronically symptomatic vulva and treatments should not be aimed at eradicating this virus. Histopathologists and gynaecologists who have focused on gynaecological disorders have often missed simple dermatological conditions that are easily treatable.
确定慢性外阴症状的病因及处理方法，并比较首次就诊于妇科医生的患者与首次就诊于皮肤科医生的患者的检查结果。
对144例患者进行前瞻性研究，每组约72例，分别转诊至妇科医生和皮肤科医生处。诊断基于临床病史、外阴镜检查、外阴活检及细菌学检查。活检由一位在皮肤病理学和妇科病理学方面经验丰富的组织病理学家进行检查。
两组患者的病情范围和频率相似。慢性外阴症状最常见的病因是皮炎，在64%的患者中发现。皮炎单独出现的占55%，另有9%的患者同时伴有人类乳头瘤病毒（HPV）的组织学证据。这些患者对简单的皮肤科治疗方法有反应，主要是外用糖皮质激素。仅23%的患者有HPV的组织病理学证据，其中36%的患者活检时也显示有皮炎。大多数患者对外用糖皮质激素有反应。另有7%的患者有硬化性苔藓，所有患者对强效外用糖皮质激素均有反应。其余15%的患者有一系列诊断结果，包括银屑病、感觉异常性外阴痛、外阴上皮内瘤变（VIN）和慢性念珠菌病。大多数患者患的是对糖皮质激素有反应的皮肤病，而非妇科疾病。
就诊于妇科医生或皮肤科医生的大多数有慢性症状的外阴患者所患的是皮肤病，对简单的皮肤科治疗有反应。我们认为，对于大多数有慢性症状的外阴患者，人乳头瘤病毒的有无并无关联，治疗不应旨在根除该病毒。专注于妇科疾病的组织病理学家和妇科医生常常忽略了易于治疗的简单皮肤病。
