II. Epidemiology
- Incidence: Uncommon to rare
- Gender: Young women and girls
III. Pathophysiology
- Rare, non-sexually transmitted Genital Ulcer
-
Hypersensitivity Reaction to Viral Infection triggers (e.g. EBC, Covid19)
- Immune complement deposition at dermal blood vessels
- Results in focal thrombosis and secondary tissue necrosis with ulceration
IV. Symptoms
V. Signs
- Large (>1 cm) vulvar ulcerations
- Deep ulcerations with red or violet boundaries
- Base is necrotic with a gray or gray black eschar
- Distribution
- Bilateral vulvar ulcerations are known as "kissing lesions" and are pathognomonic for Lipschutz Ulcer
VI. Diagnosis: Proposed Criteria
- Major Criteria (both required)
- Acute vulvar ulcer (1 or more)
- Other Genital Ulcer causes are excluded
- Minor Criteria (at least 2 present)
- Ulcer located at the vestibule or labia minora
- No sexual intercourse within the last 3 months (or ever)
- Influenza-like illness symptoms
- Systemic infection within 2 to 4 weeks before Genital Ulcer onset
- References
VII. Differential Diagnosis
- See Genital Ulcer
VIII. Management
- Topical Anesthetics (e.g. Lidocaine ointment prn)
- Oral Analgesics (e.g. Acetaminophen, Ibuprofen)
-
Corticosteroids (for moderate to severe refractory symptoms)
- Topical high potency Corticosteroid (e.g. clobetasol, Fluocinonide ointment)
IX. References
- Uddin (2024) Crit Dec Emerg Med 38(1): 16-8
- Moise (2018) Facts Views Vis Obgyn 10(1):55-7 +PMID: 30510669 [PubMed]