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--- med:desquamative_inflammatory_vaginitis [2012/11/06 14:00] – [증상 CLINICAL FINDINGS] 14.32.18.124
+++ med:desquamative_inflammatory_vaginitis [2016/07/10 09:50] (현재) – 바깥 편집 127.0.0.1
@@ 줄 1: / 줄 1: @@
+{{tag>의학 desquamative_inflammatory_vaginitis}}
+======박리성 염증성 질염 [Desquamative Inflammatory Vaginitis]======
+염증성 질염은 화농성의 질 분비물이 현저히 증가하고 질 상피세포가 탈락하는 증상이 나타나는 질염을 말한다. 정확한 발생 요인이나 원인균을 알 수 없는 상태이며, 단지 증상만으로 진단한다.
+Women who present because of a qualitative or quantitative alteration in vaginal discharge should be evaluated by clinical examination and appropriate laboratory tests, such as pH and microscopy. Bacterial vaginosis, vulvovaginal candidiasis, and trichomonas vaginitis are the most common causes of vaginal discharge in premenopausal women. When these conditions have been excluded, other causes of vaginal discharge must be considered in the differential diagnosis of women with vaginal complaints. (See "Evaluation of women with symptoms of vaginitis".)
+Desquamative inflammatory vaginitis is a rare chronic clinical syndrome of unknown etiology. Some investigators believe the disorder is due to altered vaginal flora (eg, Escherichia coli), and have termed it ‘aerobic vaginitis’, while others believe it is a sterile inflammatory vaginitis
+=====EPIDEMIOLOGY=====
+Desquamative inflammatory vaginitis occurs in both premenopausal and postmenopausal women. It is more common in perimenopausal women. It is seen in primarily in pre-menopausal women.
+=====병인 ETIOLOGY=====
+염증성 질염의 정확한 발생 원인은 알 수 없다. 단지 정상적으로 질 내에 살고 있는 유산균인 락토바실리(lactobacilli)가 없어지고, 연쇄구균(Streptococcus)등의 그람 양성 구균(Gram-positive cocci)이 크게 증식한 것이 발견된다.
+No consistent microbiologic pathogen has been identified except for the near absence of lactobacilli in almost all women [5]. The condition is thought to be inflammatory, rather than infectious.
+=====증상 CLINICAL FINDINGS=====
+전형적인 증상은 심한 화농성의 질 분비물과 함께 질 및 외음부 가려움증, 타는 듯한 느낌, 자극, 그리고 성교통 (성교 시에 나타나는 통증) 등이다.
+Desquamative inflammatory vaginitis is characterized by pain (dyspareunia, vaginal/introital pain, burning) with diffuse exudative vaginitis and epithelial cell exfoliation, resulting in profuse vaginal discharge (usually yellow but may be gray or green). In a large series of 98 patients diagnosed with desquamative inflammatory vaginitis (mean age 49.6 years), 70 to 90 percent had purulent vaginal discharge, dyspareunia, and vaginal inflammation
+It is seen in primarily in pre-menopausal women. Irritation, burning, soreness, rawness, pain with sexual activity, and sometimes vaginal discharge are the usual presenting complaints. The opening to the vagina and the inside of the vagina itself are usually red, and more severe cases exhibit redness of the entire mucous membranes of the vulva and mild swelling of the labia minora (inner lips). However, the more outside skin of the vulva looks fairly normal except for mild redness that is probably caused by contact with irritating vaginal secretions. These secretions are yellow, and often heavy.
+Under the microscope, vaginal secretions show many white blood cells (pus cells). Cells from the skin of the vagina also show signs of inflammation, and lactobacilli (the "good" bacteria) are usually absent.
+Vaginal biopsies are nonspecific but show inflammation. Routine and fungal vaginal cultures are negative. Occasionally, group B streptococcus is found, but treatment generally does not cure symptoms. These bacteria are presumably unimportant, and they are found normally in many women.
+진단은 주로 임상 증상을 관찰함으로써 이루어진다. 세균성 질염,칸디다성 질염 등 다른 질염이 아니면서 위와 같은 증세를 호소하고,진찰상 질벽 (vaginal wall)이 발적 (빨갛게 부어 오름)되어 있고 부분적으로 붉은 홍반성 점 (ecchymotic spot)이 관찰되며,자궁경부에도 역시 염증에 의한 특징적인 변화 (colpitis macularis)가 나타날 때 염증성 질염으로 진단할 수 있다.
+=====치료=====
+염증성 질염의 치료에는 항생제 클린다마이신(clindamycin) 2% 연고를 사용한다. 치료 후에도 약 30%에서 재발하며,이 경우 같은 항생제를 더 오랜 기간 사용해야 한다. 폐경기 여성에게서 재발하는 경우 여성 호르몬 치료를 시행하기도 한다
+  * 치료후 80%에서 효과.
+  *  1년뒤 25%만 완치..
+  *  나머지는 유지요법이 필요.
+An antibiotic such as **clindamycin cream** in the vagina at bedtime is a **treatment of choice**, __even though this is not an infection__. Clindamycin helps inflammation even when infection is not present; in fact, it is often used for acne, which also is not an infection. Cortisone creams and suppositories such as a hydrocortisone acetate suppository inserted every night can be used, as can specially compounded suppositories of combined clindamycin and hydrocortisone. If group B streptococcus is found on a vaginal culture, it will be treated just in case the strep is playing a role, which is unlikely. Patients receiving both antibiotics and a cortisone should certainly receive a weekly medicine, such as Diflucan by mouth, to prevent a yeast infection. These treatments often stops day in and day out irritation and burning, but pain with intercourse mayor may not persist.
+  * 출처: [[http://www.uptodate.com/contents/desquamative-inflammatory-vaginitis|desquamative-inflammatory-vaginitis (uptodate)]]
+  * [[http://www.ncbi.nlm.nih.gov/pubmed/21422855|Sobel JD et al. Prognosis and treatment of desquamative inflammatory vaginitis. Obstet Gynecol. 2011 Apr;117(4):850-5.]]
+  * [[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1194531/pdf/genitmed00046-0047.pdf|1990 review article]]
+  * [[http://www.medhelp.org/posts/Womens-Health/Inflammatory-Vaginitis/show/34007|진단받은 환자들의 문답(영어)]]
+  * [[http://www.libbyedwardsmd.com/documents/desquamative-inflammatory-vaginitis.htm|DIV by Libby Edwards, M.D. ]]
+  * [[http://www.skintherapyletter.com/2011/16.3/2.html|Overview of Treatment of Vulvovaginal Disease Lynette J. Margesson, MD, FRCPC ]]