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Lipschutz Ulcer

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Lipschutz Ulcer

  • See Also
  1. Genital Ulcer
  • Epidemiology
  1. Incidence: Uncommon to rare
  2. Gender: Young women and girls
  • Pathophysiology
  1. Rare, non-sexually transmitted Genital Ulcer
  2. Hypersensitivity Reaction to Viral Infection triggers (e.g. EBC, Covid19)
    1. Immune complement deposition at dermal blood vessels
    2. Results in focal thrombosis and secondary tissue necrosis with ulceration
  • Symptoms
  1. Dysuria
  2. Vulvar Pain
  • Signs
  1. Large (>1 cm) vulvar ulcerations
    1. Deep ulcerations with red or violet boundaries
    2. Base is necrotic with a gray or gray black eschar
  2. Distribution
    1. Bilateral vulvar ulcerations are known as "kissing lesions" and are pathognomonic for Lipschutz Ulcer
  • Diagnosis
  • Proposed Criteria
  1. Major Criteria (both required)
    1. Acute vulvar ulcer (1 or more)
    2. Other Genital Ulcer causes are excluded
  2. Minor Criteria (at least 2 present)
    1. Ulcer located at the vestibule or labia minora
    2. No sexual intercourse within the last 3 months (or ever)
    3. Influenza-like illness symptoms
    4. Systemic infection within 2 to 4 weeks before Genital Ulcer onset
  3. References
    1. Sadoghi (2020) J Eur Acad Dermatol Venereal 34(7): 1432-9 [PubMed]
  • Differential Diagnosis
  1. See Genital Ulcer
  • Management
  1. Topical Anesthetics (e.g. Lidocaine ointment prn)
  2. Oral Analgesics (e.g. Acetaminophen, Ibuprofen)
  3. Corticosteroids (for moderate to severe refractory symptoms)
    1. Topical high potency Corticosteroid (e.g. clobetasol, Fluocinonide ointment)
  • References
  1. Uddin (2024) Crit Dec Emerg Med 38(1): 16-8
  2. Moise (2018) Facts Views Vis Obgyn 10(1):55-7 +PMID: 30510669 [PubMed]