Estrogen Treatment of Acetic Acid Burns to the Vagina, Cervix, and Perineum

Abstract

In colposcopic evaluation of the cervix, acetic acid of 3 to 5% is commonly used for identification of preneoplastic and neoplastic cells. Acetic acid is a known caustic substance and has the potential to cause irritation and chemical burns when there is sufficient concentration or duration of contact. The authors present a unique case of a woman who inadvertently received undiluted acetic acid during a routine colposcopy, resulting in significant chemical burns of the vagina, cervix, and perineum. Her burns were treated with topical estrogen cream of 1 g twice daily applied directly to the wounds. The burn wounds were fully healed within 8 weeks without complication or additional treatment. At 6 months after the injury, the patient was allowed to engage in sexual activity, and vaginal dilation and pelvic floor therapy were initiated. At 12 months postinjury, her only symptomatic scarring at the left vaginal wall continues to improve. Thus, topical estrogen treatment of 1 g applied twice daily should be continued until burn scar maturation is complete and treatment improvement plateaus in cases of burns to the vagina, cervix, and perineum. This case is further clinical evidence of estrogen's positive effect on wound healing and its potential role in burn treatment.

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

“…83,85 Topical estrogen has been shown to promote healing in other vulvar dermatoses and burns and should be considered as adjuvant therapy. [90][91][92][93][94] Urinary catheters are recommended to decrease pain with urination, prevent urinary obstruction, and monitor fluid balance. 11,80 They should be removed as soon as complete healing occurs and the patient passes a voiding trial.…”

Vulvovaginal involvement in Stevens‐Johnson syndrome and toxic epidermal necrolysis: management and techniques used to reduce gynecologic sequelae

“…[14][15][16] Although vaginal estrogen supplementation is best studied for postmenopausal atrophic vaginitis, it also has been described for the treatment of vaginal chemical burns with continued healing with supplementation for 12 months after iatrogenic injury. 17 Data would suggest the mechanism of action of topical estrogen on vaginal epithelium is similar in all age groups. Muhleisen et al in Maturitas 2016 reviewed the histologic and microbiome characteristics of vaginal epithelium across the lifespan.…”

“…Estrogen has a positive effect on vaginal wound healing by inducing epithelial proliferation, increasing epithelial cellular maturation, decreasing wound tissue elastase activity, decreasing elastase degradation of fibronectin, and increasing neutrophil phagocytosis 14–16 . Although vaginal estrogen supplementation is best studied for postmenopausal atrophic vaginitis, it also has been described for the treatment of vaginal chemical burns with continued healing with supplementation for 12 months after iatrogenic injury 17 …”