Vulvar seborrheic dermatitis

　　1. Etiology

　　The etiology of the disease is not fully clear at present, but it is generally believed that the disease may be related to an increase in the activity of sebaceous glands, leading to an increase in the secretion of sebum or changes in its related chemical components, causing a disorder of the bacterial flora on the skin surface. Secondary microbial infections may occur: such as the excessive proliferation of Malassezia pachydermatis and Propionibacterium acnes, which can trigger an inflammatory response of the skin; an increase in sebaceous gland secretion, especially fungal infections, also plays a certain role in the occurrence and development of the disease. Genetic factors, changes in endocrine hormone levels, especially an increase in male hormone levels, neuroendocrine dysfunction, psychological factors, gastrointestinal dysfunction, vitamin B deficiency, dietary habits, and other factors are also related to the occurrence and development of the disease.

　　2. Pathogenesis

　　Histopathological examination shows focal hyperkeratosis, occasional neutrophils in the epidermis, mild thickening of the stratum spinosum, and visible edema in the prickle cells. There is mild lymphocytic infiltration around the dermal blood vessels. Experimental evidence shows that the IgG antibodies against microorganisms and the lymphocyte stimulation response induced by the extract of oval-shaped pityrosporum are lower in patients with seborrheic dermatitis than in normal people. These two factors promote the proliferation of these eosinophilic microorganisms and produce inflammatory reactions.

　　Patients with vulvar seborrheic dermatitis generally have skin in other areas of the body with excessive sebaceous, hairy, and sweaty areas simultaneously affected, such as the scalp, face, upper chest, interscapular area, armpits, umbilical fossa, perianal area, etc., so it is not difficult to diagnose. The rash is slightly different in different locations. The rash is oily-scaled yellow-red macules, symmetrically distributed, chronic, with varying degrees of itching.

　　The lesions are variable, more frequent during cold and humid weather, with the main symptoms being local skin itching. The vulva is mainly involved in the inguinal area, pubic area, perineal folds, between the buttocks, and the damage presents as clear boundary diffuse erythema or scabs, covered with greasy scales or yellow crusts, scattered or confluent. Due to friction, it is prone to erosion, secretion, fissuring, and shows eczematous changes. Chronic cases in the genital area may show psoriasiform damage (dark red scaly thick plaques). Patients with vulvar seborrheic dermatitis generally have skin with excessive sebaceous, hairy, and sweaty areas on other parts of the body, such as the scalp, face, upper chest, interscapular area, armpits, umbilical fossa, perianal area, etc., so it is not difficult to diagnose. The rash is slightly different in different locations.

　　Common in adults and newborns, with an incidence rate of 1% to 3% in the general population, 3% to 5% in young people, and up to 32% to 83% in patients with acquired immunodeficiency syndrome.

　　1. Prognosis:Prone to recurrence.

　　2. Health care:Pay attention to a regular lifestyle, regulate diet, eat less fatty, sugary, and spicy foods, eat more vegetables, avoid excessive mental stress, and ensure adequate sleep.

　　The diagnosis of vulvar seborrheic dermatitis, in addition to clinical manifestations, also requires necessary auxiliary examinations. The following are the examinations:

      1. Microbiological examination of secretions.

　　2. Histopathological examination.

　　Vulvar seborrheic dermatitis is a common allergic skin disease in women, often caused by unclean skin, with the vulva showing diffuse erythema, multifocal skin damage without clear boundaries, severe itching, and recurrent episodes. Allergic constitution is the main cause of the disease.

　　If patients with vulvar seborrheic dermatitis can understand what is good for patients with vulvar eczema, it can not only prevent the occurrence of eczema but also be beneficial to the treatment and recovery of eczema.

　　1. Celery:It contains abundant fiber, vitamin B2, and vitamin C, as well as a large amount of minerals and trace elements, which have the effects of removing dampness, promoting diuresis, etc., and can effectively prevent the recurrence of eczema.

　　2. Bitter melon:It contains quinine, which has the effects of clearing heat and detoxifying, removing dampness and stopping itching, and can be used to treat heat toxicity, boils, carbuncles, eczema, and other diseases.

　　3. Spinach:Spinach contains carotene, vitamin B:, vitamin C, and calcium, phosphorus, iron, protein, and fiber, etc. Spinach also has the effect of detoxifying and removing dampness, so spinach juice can be applied externally to treat eczema.

　　4. Tomato:It contains abundant vitamin A, vitamin B1, vitamin B2, vitamin C, niacin, vitamin E, as well as malic acid, citric acid, calcium, phosphorus, iron, and tomatine, etc. It has the effects of moistening the throat, stopping cough, promoting digestion, cooling the blood, calming the liver, clearing heat, etc.

　　The malic acid in tomatoes has a protective effect on vitamin C, so it can effectively supplement vitamin C; tomatine has antibacterial and anti-inflammatory effects, and can reduce vascular permeability, so topical tomato juice can have an antipruritic and astringent effect in the treatment of eczema.

　　Firstly, precautions before the treatment of vulvar seborrheic dermatitis

　　Prevention: Pay attention to a regular lifestyle, adequate sleep. Eat less fat and spicy刺激性 food, eat more vegetables. Avoid hot water and soap stimulation, avoid scratching locally, in order to prevent further hypersecretion of sebum and exacerbate the condition.

　　Secondly, traditional Chinese medicine treatment methods for vulvar seborrheic dermatitis

　　1. Differential diagnosis and treatment:

　　① Damp-heat and wind excess type: Red skin lesions on the face and head, greasy scabs, exudation, very itchy, red tongue, yellow greasy fur, soft and rapid pulse. Treatment should be to cool blood and eliminate wind, clear heat and remove dampness. The prescription is Modified Qingre Xiaofeng Decoction (Raw Rehmannia, Angelica sinensis, Ligusticum chuanxiong, Saposhnikovia divaricata, Forsythia, Pulsatilla, Arctium lappa, Lonicera japonica, Peony, Anemarrhena asphodeloides, Gypsum fibrosum, Forsythia, Polygonum multiflorum, Licorice root).

　　② Blood deficiency and wind generation type: Slow onset, slightly red skin lesions, itching, desquamation, alopecia, dizziness, pale red tongue, thin and rapid pulse. Treatment should be to nourish blood and moisturize dryness, eliminate wind and stop itching. The prescription is Nourishing Blood and Eliminating Wind Decoction (Saposhnikovia divaricata, Saposhnikovia divaricata, Cicadae, Angelica sinensis, Polygonum multiflorum, Scutellaria baicalensis, Gardenia jasminoides, Fritillaria thunbergii, Alisma orientale, Radix Polygoni multiflori, Cortex Poria, Raw Rehmannia, Tribulus terrestris, Licorice root).

　　③ Blood dry type: Dry skin, scaly scales like bran, slight inflammation, itching, dry and lackluster hair, red tongue with thin white fur, deep and thin pulse. Treatment is to nourish yin and moisturize dryness, eliminate wind and stop itching. The prescription is modified Angelica decoction (Angelica sinensis, raw Rehmannia, Polygonum multiflorum, Stephania tetrandra, Tribulus terrestris, Radix Paeoniae Rubra, Peony, Flos Carthami, Sower of Centipeda, Forsythia, Pulsatilla, Ligusticum chuanxiong).

　　2. Chinese medicine monographs and prescriptions:

　　① Sophora flavescens injection: 2-4ml, once daily by intramuscular injection.

　　② 5% Angelica sinensis injection for acupoint injection: Select acupoints on the ear, such as adrenal gland, endocrine, shenmen, and subcortical area. Select 2 acupoints each time, inject 0.1-0.2ml of medication into each acupoint, once every other day. 10-20 times constitute 1 course of treatment.

　　3. Topical therapy:

　　① Coix lacryma-jobi 9.0g, Chrysanthemum morifolium 15.0g, Dictamnus dasycarpus 9.0g, decocted, filtered, and the drug solution is used to wash the hair while hot.

　　② Snake gall ointment, containing 0.5ml of snake venom, mixed with 500g of emulsion base, applied twice a day, externally.

　　③ Baixie Feng Tincture, containing 30g of Cnidium monnieri, 30g of Sophora flavescens, 15g of Ramie cortex, 6g of menthol, 1000ml of 75% ethanol, soaked for one week, filtered, and applied externally.

　　4. Acupuncture therapy:

　　Acupoints such as Hegu, Quchi, Baihui, Fengchi, Neiting, and Sanyinjiao, with moderate intensity stimulation, once a day.

　　Third, integrated traditional Chinese and Western medicine treatment

　　1. Oral traditional Chinese medicine, topical corticosteroid ointments, antibiotic preparations, and various sulfur preparations.

　　2. Oral antihistamines, topical traditional Chinese medicine, acupuncture, or other compound and single herb Chinese medicine washes, tinctures, and ointments.

　　Fourth, Western medicine treatment for seborrheic dermatitis of the vulvar skin

　　Medication:

　　1. General treatment:Vitamin B2, Vitamin B6, Vitamin B12, or a complex vitamin B can be taken internally. For those with significant itching, antihistamines can be used for treatment. When inflammation is significant and the range is large, antibiotics (such as doxycycline, tetracycline, erythromycin taken orally) plus a small amount of prednisone (prednisone) or tripterygium glycosides tablets can be used. For refractory cases, antifungal drugs (such as 0.22g ketoconazole tablets per day for 14 days, 0.1g itraconazole per day for 21 days) can be used, as well as small to moderate doses of prednisone (prednisone), isotretinoin, etc.

　　2. Local treatment:To reduce sebaceous and keratin desquamation. The treatment principle is to remove oil, kill bacteria, reduce inflammation, and relieve itching.

　　(1) When there is no erosion or exudation, a mixture of 5% sulfur ointment and corticosteroid ointment can be used, or flaxseed oil or coal tar paste can also be used. Due to the easy secondary fungal and bacterial infections in the vulvar and crease areas, a compound preparation containing hormones, antibiotics, and antifungal drugs can be used, such as triamcinolone/nystatin/neomycin (Picon cream), griseofulvin/sulfate neomycin/short-chain fatty acid/triamcinolone (compound Kangle) cream, etc.

　　(2) For those with erosion and exudation, 3% boric acid or 1:5000 potassium permanganate solution can be used for wet dressing, and the above cream or paste can be used for treatment when exudation decreases.

　　(3) For those with fungal infections, 2% ketoconazole cream or ointment can be applied locally several times a day.