Diagnosis and Management of Vulvar Ulcers: Part II—Less Common Vulvar Ulcers

Abstract

types I and II, there are multiple other, less frequently encountered etiologies for such lesions that must also be considered. While serologic testing, cultures, and biopsies play an important role in the diagnosis of these lesions, a careful history and physical examination remain the most important factor in arriving at an accurate diagnosis. This second article in the series on vulvar ulcers reviews these rarer causes of vulvar ulcers. Behçet SyndromeBehçet syndrome is a complex vasculitis with diverse symptoms affecting many areas of the body. It is most frequently seen in young adults ages 20 to 40 years. There is a geographic propensity for Behçet disease in individuals from the Middle East, Turkey, and Eastern Asia. 1 The vasculitis that produces Behçet syndrome's multiorgan involvement affects vessels of all calibers: small, medium, and large. It most frequently manifests itself as recurrent, painful ulcers of the mouth and genitals surrounded by an erythematous rash (Figure 1). 2,3 In addition to involvement in other organ systems (skin, eye, This article is the second of 2 parts.Vulvar ulcers are frequently seen not only by gynecologists but also by pediatricians, family practitioners, and emergency department physicians. They present in girls and women of all ages as painful intact or unroofed blisters, often of abrupt onset. They can lead to such severe discomfort as to make urination impossible. Although the most common cause of such ulcers is herpes simplex virus (HSV)