Meneux E, Paniel B J, Pouget F, Revuz J, Roujeau J C, Wolkenstein P
Department of Gynecology, Centre Hôpitalier Intercommunal, Creteil, France.
J Reprod Med. 1997 Mar;42(3):153-6.
To evaluate the incidence of vulvar lesions during the acute and healing periods in toxic epidermal necrolysis (TEN), to describe the clinical aspects and functional consequences, and to evaluate surgical treatment.
During the acute period in 40 patients, cutaneous and mucous lesions were described on the day of hospitalization and daily thereafter. To evaluate the healing period, a questionnaire was sent to the same 40 patients to obtain information on symptomatology after the acute period, anatomic modifications, and the quality of sexual and other genital activity.
During the acute period, genital lesions were present in 28 of the 40 patients studied (70%). In 24/28 (89%) the lesions were vulvar only, and in 3/28 (11%) they were vulvovaginal. In one case vaginal involvement could not be proven because the patient was a virgin. During the healing period, sequelae occurred in 5 of the 40 patients (12.5%): four cases were known since the patients had visited the Department of Gynecology because of secondary effects, and one case was detected by the questionnaire. The symptoms occurred during hospitalization in 1 case, at the end of the second month in 2, at the 12th month in 1 and unknown in 1. The site was the vulva in all five cases and was the vulva and vagina in three. Again, the virgin could not be examined. The average interval between secondary effects and the original gynecologic visit was 7 months (3-12). The sequelae were treated surgically in two of the five affected patients: on the vulva, nymphoplasty, posthectomy and median perineotomy; in the vagina, sharp and blunt dissection, with use of a soft mold. The first patient had a recurrence six months after surgery, and the second had no recurrence but has been unable to engage in intercourse.
From our study of the involvement of the vulva and vagina during TEN and the sequelae, it is clear that detection from the questionnaire was insufficient. Some women can have synechiae without functional sequelae, and others can have minor involvement with important psychological repercussions. A prospective study with systematic examination of the vulvovaginal area and systematic follow-up for at least one year is needed. For therapy, a lubricant gel (perhaps topical steroids) could be useful. Placing a soft mold in the vagina as soon as possible, though difficult, and keeping it there until complete healing occurs can lead to infection. It is not clear that use of a mold would promote healing or be tolerated. Intercourse immediately after the acute period would be helpful but probably would not be welcome to the patients. However useful, a prospective survey would be difficult because it would entail many years of study.
评估中毒性表皮坏死松解症（TEN）急性期和愈合期外阴病变的发生率，描述其临床特征及功能影响，并评估手术治疗效果。
在40例患者的急性期，于住院当日及之后每日记录皮肤和黏膜病变情况。为评估愈合期，向这40例患者发放问卷，以获取急性期后症状、解剖结构改变以及性和其他生殖器官活动质量等方面的信息。
急性期，40例研究患者中有28例（70%）出现生殖器病变。其中24/28例（89%）仅为外阴病变，3/28例（11%）为外阴阴道病变。有1例因患者为处女，无法证实阴道受累情况。愈合期，40例患者中有5例（12.5%）出现后遗症：4例因继发效应曾就诊于妇科而被知晓，1例通过问卷发现。症状出现时间：住院期间1例，第二个月末2例，第12个月末1例，另1例时间不明。所有5例病变部位均为外阴，其中3例累及外阴和阴道。同样，该处女患者无法接受检查。继发效应与最初妇科就诊的平均间隔时间为7个月（3 - 12个月）。5例受累患者中有2例接受了手术治疗：外阴病变行小阴唇成形术、切除术后及会阴正中切开术；阴道病变行锐性和钝性分离，并使用软模具。第1例患者术后6个月复发，第2例未复发，但无法进行性交。
通过我们对TEN期间外阴和阴道受累情况及后遗症的研究可知，问卷调查发现问题并不充分。一些女性可能有粘连但无功能后遗症，而另一些女性虽病变轻微却有重要的心理影响。需要进行一项前瞻性研究，对外阴阴道区域进行系统检查并至少随访一年。对于治疗，润滑凝胶（可能还有局部类固醇）可能有用。尽快在阴道内放置软模具虽困难，但保持至完全愈合可导致感染。尚不清楚使用模具是否有助于愈合或患者能否耐受。急性期后立即进行性交可能有益，但患者可能并不欢迎。然而，尽管前瞻性调查有用，但因其需要多年研究，实施起来会很困难。
