VULVO-VAGINAL SEQUELAE IN TOXIC EPIDERMAL NECROLYSIS

OBJECTIVE: To evaluate the incidence of vulvar lesions during the acut e and healing periods in toxic epidermal necrolysis (TEN), to describe the clinical aspects and functional consequences, and to evaluate sur gical treatment. STUDY DESIGN: During the acute period in 40 patients, cutaneous and mucous lesions were described on the day of hospitaliza tion and daily thereafter. To evaluate the healing period, a questionn aire was sent to the same 40 patients to obtain information on symptom atology after the acute period, anatomic modifications, and the qualit y of sexual and other genital activity. RESULTS: During the acute peri od, genital lesions were present in 28 of the 40 patients studied (70% ). In 24/28 (89%) the lesions were vulvar only, and in 3/28 (11%) they were vulvovaginal. In one case vaginal involvement could not be prove n because the patient was a virgin. During the healing period, sequela e occurred in 5 of the 40 patients (12.5%): four cases were known sinc e the patients had visited the Department of Gynecology because of sec ondary effects, and one case was detected by the questionnaire. The sy mptoms occurred during hospitalization in 1 case, at the end of the se cond month in 2, at the 12th month in 1 and unknown in 1. The site was the vulva in all five cases and was the vulva and vagina in three. Ag ain, the virgin could not be examined. The average interval between se condary effects and the original gynecologic visit was 7 months (3-12) . The sequelae were treated surgically in two of the five affected pat ients: on the vulva, nymphoplasty, posthectomy and median perineotomy; in the vagina, sharp and blunt dissection, with use of a soft mold. T he first patient had a recurrence six months after surgery, and the se cond had no recurrence but has been unable to engage in intercourse. C ONCLUSION: From our study of the involvement of the vulva and vagina d uring TEN and the sequelae, it is clear that detection from the questi onnaire was insufficient. Some women can have synechiae without func t ional sequelae, and others can have minor involvement with important p sychological repercussions. A prospective study with systematic examin ation of the vulvovaginal area and systematic follow-up for at least o ne year is needed. For therapy, a lubricant gel (perhaps topical stero ids) could be useful. Placing a soft mold in the vagina as soon as pos sible, though difficult, and keeping it there until complete healing o ccurs can lead to infection. It is not clear that use of a mold would promote healing or be tolerated. Intercourse immediately after the acu te period would be helpful but probably would not be welcome to the pa tients. However useful, a prospective survey would be difficult becaus e it would entail many years of study.