Lipschütz ulcer
Encyclopedia
Lipschütz ulcer or ulcus vulvae acutum (acute ulceration of the vulva) is a rare disease characterized by painful genital ulcer
s, 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.
. 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.
s and anesthetics, as well as topical application of disinfectants/astringent
s such as potassium permanganate
(in sitz bath
s), is commonly used. In severe cases, a combination of systemic glucocorticoid
s and broad-spectrum antibiotic
s has been recommended.
).
Genital ulcer
A Genital ulcer is an ulcer located on the genital area, usually caused by a sexually transmitted disease such as genital herpes, syphilis, chancroid, or thrush. Some other signs of having genital ulcers include enlarged lymph nodes in the groin area, or vesicular lesions, which are small, elevated...
s, fever, and lymphadenopathy
Lymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
, occurring most commonly in adolescents and young women (particularly virgins
Virginity
Virginity refers to the state of a person who has never engaged in sexual intercourse. There are cultural and religious traditions which place special value and significance on this state, especially in the case of unmarried females, associated with notions of personal purity, honor and worth...
). It is not a sexually transmitted disease
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
, and is often misdiagnosed, sometimes as a symptom of Behçet's disease
Behçet's disease
Behçet's disease is a rare immune-mediated systemic vasculitis that often presents with mucous membrane ulceration and ocular involvements...
.
Lipschütz ulcer is named after Benjamin Lipschütz, who first described it in 1912. The etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
is still unknown, although it has been associated with several infectious causes, including paratyphoid fever
Paratyphoid fever
Paratyphoid fevers or Enteric fevers are a group of enteric illnesses caused by serotypic strains of the Salmonella genus of bacteria, S. Paratyphi....
, cytomegalovirus
Cytomegalovirus
Cytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
and Epstein-Barr virus
Epstein-Barr virus
The Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...
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 minoraLabia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
. The labia majora
Labia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
may be affected, as may the vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
and urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
. The ulcer develops very quickly, and is usually preceded by sudden onset of fever and malaise.
Treatment
Treatment is symptomatic, and usually of little value; in most cases, the ulcer heals spontaneously within four to six weeks, leaving scars. Topical analgesicAnalgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s and anesthetics, as well as topical application of disinfectants/astringent
Astringent
An astringent substance is a chemical compound that tends to shrink or constrict body tissues, usually locally after topical medicinal application. The word "astringent" derives from Latin adstringere, meaning "to bind fast"...
s such as potassium permanganate
Potassium permanganate
Potassium permanganate is an inorganic chemical compound with the formula KMnO4. It is a salt consisting of K+ and MnO4− ions. Formerly known as permanganate of potash or Condy's crystals, it is a strong oxidizing agent. It dissolves in water to give intensely purple solutions, the...
(in sitz bath
Sitz bath
A sitz bath is a bath in which a person sits in water up to the hips. It is used to relieve discomfort and pain in the lower part of the body, for example, due to hemorrhoids , anal fissures, rectal surgery, an episiotomy, uterine cramps, inflammatory bowel disease, and infections of the bladder,...
s), is commonly used. In severe cases, a combination of systemic glucocorticoid
Glucocorticoid
Glucocorticoids are a class of steroid hormones that bind to the glucocorticoid receptor , which is present in almost every vertebrate animal cell...
s and broad-spectrum antibiotic
Broad-spectrum antibiotic
The term broad-spectrum antibiotic refers to an antibiotic that acts against a wide range of disease-causing bacteria. A broad-spectrum antibiotic acts against both Gram-positive and Gram-negative bacteria, in contrast to a narrow-spectrum antibiotic, which is effective against specific families of...
s has been recommended.
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 acidophilusLactobacillus acidophilus
Lactobacillus acidophilus is a species in the genus Lactobacillus. L. acidophilus is a homofermentative species, fermenting sugars into lactic acid, which grows readily at rather low pH values and has an optimum growth temperature of 37 °C . L...
).