KRAUROSIS VULVAE

Breisky,¹ Heitzmann,² Janovski,³ Ohmann-Dumesnil,⁴ Baldy and
Williams,⁵ Ewald,⁶ Thibiérge,⁷ and others have called attention to the
rather rare, peculiar affection of the genitalia in women, characterized
by atrophic changes, shriveling, and contraction, with, as a rule, a more
or less intense pruritus. The parts usually involved are vestibulum,
labia minora, with the fourchet and præputium clitoridis, the inner
surface of the labia majora, extending to the posterior commissure, and
the immediately adjacent perineum. The folds are partly or completely
obliterated, and later the labia minora almost entirely disappear, their
site being indicated by a slight sulcus or furrow. The atrophic change
may involve the præputium clitoridis to such a degree as to leave no
recognizable trace. The posterior portion of the vulva also suffers to a
great extent, and here and in the other parts there is noted a tightening
or spanning of the tissues, with a tendency to some hardening. There
is generally some patchy thickening, which may be somewhat similar
to the plaques of leukoplakia buccalis. The contiguous and covering
integument is usually grayish or whitish, dry and often glossy, and

¹ Breisky, Zeitschr. für Heilkunde, 1885, p. 69 (12 cases; histologic cuts).

² C. Heitzmann, abs. Trans. Amer. Derm. Assoc. for 1888 (4 cases); never published
in full—abs. of the cases in Ohmann-Dumesnil‘s paper.

³ Janovski, Monatshefte, 1888, vol. vii, p. 951 (6 cases).

⁴ Ohmann-Dumesnil, ibid., 1890, vol. x, p. 294 (4 cases, with résumé of all other
published cases and others (unpublished) communicated to the author—in all a tabula­
tion of 35 cases).

⁵ Baldy and Williams, Amer. Jour. Med. Sci., 1899, vol. cxxviii, p. 528 (1 case,
with a review of literature).

⁶ Ewald, New Yorker med. Monatsschrift, 1901, p. 209.

The case described by R. F. Weir, New York Med. Jour., Mar., 1875, as “Ich-
thyosis of the Vulvæ,” seems also to be an example of this affection.

⁷ Thibiérge, Annales, 1908, p. 1 (report of cases and review), also refers to Jayle‘s
important paper, “Le kraurosis vulvæ,” Revue de gynécol. et de chirurg. abdom., 1906, p.
633.

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626

ATROPHIES

sometimes thickened. Breisky stated that there was no preceding or
accompanying inflammation or erythema, but in some instances pruritus.
Heitzmann‘s cases showed features of chronic eczema of patchy character,
these patches being slightly milky and psoriatic looking, and with con­
siderable tormenting itching. Baldy and Williams recognize the etio-
logic bearing of pruritus, which, in consequence of the scratching, leads
to inflammation, with the subsequent cicatricial tissue formation in the
corium and hypoderm, although admitting that there is still an unknown
factor to which the unusual changes are due.

In short, nothing definite can be said as to etiologic factors, except
that vaginal discharge and pruritus are the most common recognizable
antecedent and accompanying symptoms. It appears to bear no rela­
tion to coitus or pregnancy, as it is observed among both the unmarried
and married, the chaste and the prostitute. Both Jayle and Thibiérge
incline to the belief that the malady is chiefly met with in women whose
ovaries have been removed and in those whose ovaries have physiologic­
ally atrophied. Thibiérge considers it is to be looked upon as a locali­
zation of the atrophic process which characterizes the senile involutions
of the skin in general. The histologic examination, according to Breisky
(quoted by Janovski), shows atrophic changes in the upper part of the
corium, especially the papillary layer, which is found sclerosed, dull,
vitreous looking, and lightly streaked. The glandular structures are
almost completely gone and there is a small-celled infiltration at the
bottom of the papillæ.

Unfortunately, the malady is persistent, and in spite of treat­
ment usually continuous. The possibility of epitheliomatous devel­
opment, as in Weir‘s case, must be kept in mind. The vaginal dis­
charge, if present, should receive attention, as it serves to aggravate,
even if its removal does not cure. Heitzmann was the only hopeful
observer as regards the result of treatment; he states that he succeeded
in curing his patients by removing the thickened patches present in his
cases by the curet, and followed by continuous applications of from 0.5
to 2 per cent, of salicylic acid solution, alternating with pyrogallol
solution of the same strength. Owing to the tendency to recur, however,
the treatment must be repeated in some cases. Baldy and Williams
advise the total removal of the affected parts as a curative measure.

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