CHAPIN — LYPSHYUTTSA the ACUTE ULCER of the VULVA (D. S. Chapin;
Century of Lipschtitz, Austrian dermatologist, 1878 — 1931; synonym: an ulcer of a vulva acute, an ulcer pseudo-venereal) — seldom found bacterial disease of female external genitals which is characterized by formation of purulent ulcers. It is more often observed at girls and young women.
The disease was described for the first time by Lip-shyutts in 1904, having called it «a pseudo-syphilitic ulcer». D. S. Chapin (1908) gave this disease the name «not venereal ulcers on generative organs at women». In 1912 Mr. Lipshyutts called it an acute ulcer of a vulva.
Causative agents of an acute ulcer of a vulva are gram-positive Bacillus crassus and a vaginal stick of Dederleyn, saprofitiruyushchy on a mucous membrane of a vagina at healthy women. During the weakening of protective forces of an organism, its allergization, after postponed inf. diseases (typhoid, measles, chicken pox, flu, etc.) these saprophytes gain pathogenic properties. Development of an acute ulcer of a vulva is result of the giperergiche-sky reaction of an organism to operation of the activator proceeding as Artyus's phenomenon (see Artyus a phenomenon).
In a zone of ulcers vasodilatation of a derma, the considerable perivascular infiltrate consisting preferential of polymorphonuclear leukocytes and lymphocytes, which is especially accurately expressed in deep layers of a derma with necrotic changes in its most superficial sites is noted. Sometimes there are miliary abscesses.
The disease in typical cases develops sharply, fervescence, a fever, weakness, an indisposition, a headache is observed. On a mucous membrane small, less often than big, vulvar lips there are multiple erethistic ulcers of various size with the subdug edges, the wrong outlines, a soft consistence. The bottom of ulcers equal, granular, is covered seroznognoyny separated. Limf, nodes are, as a rule, not increased. A recurrence of a disease is possible.
Meets also gangrenous, pseudo-venereal and miliary forms of a disease. The gangrenous (shankriformny) form proceeds hard. Body temperature increases to 40 °, thermalgias in external genitals, morbidity appear at an urination. Ulcers on a mucous membrane of vulvar lips have 3 cm a diameter, are covered with necrotic masses, surrounding fabrics are sharply hyperemic and edematous. Regional limf, nodes are increased.
At a pseudo-vein, as a rule, it is not noted by a hairstyle to a form of a disease of temperature increase, the general condition of patients satisfactory. Ulcers are a little painful, their size about 3 mm in the diameter. They have the roundish or extended form, a clear boundary. Edges of ulcers slightly podryta, an inflammatory rim around them it is poorly expressed. Limf, nodes are not increased. Quite often there is recurrence of the Disease; scarring of ulcers on one sites and emergence new — on others is possible.
At a miliary form of a disease appear multiple small (about 1 mm in the diameter) ulcers with the narrow hardly expressed rim of a hyperemia insignificant purulent separated, at a touch they are poorly painful. Limf, nodes are not increased. The acute ulcer of a vulva can
sometimes be followed by emergence on skin of the rashes reminding a knotty erythema (see the Erythema knotty), and on a mucous membrane of an oral cavity — aft (see); in this case the disease has hron. current.
The diagnosis is established on the basis by a wedge, pictures, and also results of the bakterioskopichesky research separated ulcers, in Krom find the activator.
Differential diagnosis is carried out with a venereal ulcer (see), a hard ulcer (see Syphilis), a tubercular ulcer (see Tuberculosis extra pulmonary).
Treatment consists in carrying out an autohemotherapy, purpose of gamma-globulin, the hyposensibilizing means, polyvitamins. Outwardly recommend powders (Dermatolum, a xeroform, streptocide), and also corticosteroid ointments containing an antibiotic (Oxyzonum, Lo-kakorten-N, etc.), at considerable puffiness — lotions, e.g. 0,25% solution of potassium permanganate, 0,1%, water solution of Aethacridinum of a lactate (Rivanolum). At a gangrenous form of a disease antibiotics of a broad spectrum of activity are shown.
Forecast, as a rule, favorable; on site ulcers remain hems.
Prevention is directed to strengthening of protective forces of an organism (a hardening, physical culture, etc.), and also to observance of rules of personal hygiene.
Bibliography: Venereal diseases, under the editorship of O. K. Shaposhnikov, page 78, M., 1980;
M and sh to and l of l e y with about N of JI. H. Infectious and parasitic diseases of skin, M., 1960; Chapin D. S. Not venereal ulcers on sexual parts at women, Russian zhurn. kozhn. and veins. Bol., t. 15, No. 4, page 211, 1908; L i r s with h ii t z B. Ulcus vulve acutum, Handb. Haut-u. Geschl. - Kr., hrsg. v. J. Jadassohn, Bd 21, S. 392, B., 1927. B. G. Stoyanov.