The impact of the latest classification system of benign vulvar diseases on the management of women with chronic vulvar pruritus.

摘要

BACKGROUND: The management of women with chronic benign vulvar dermatoses has been one of the most difficult and challenging aspects of women's healthcare for a long time. AIM: Our aim was to compare the ability to approach the specific diagnosis of nonneoplastic and noninfectious vulva diseases, between the new classification system and the old classification system. METHODS: One hundred women with chronic vulvar pruritus were included in the study. After detailed examination of the vulva, all visible lesions were biopsied, with normal skin included. All specimens was sent for dermatopathology and examined simultaneously under a binocular microscope by two pathologists. Specific diagnosis if possible and histopathological findings were classified according to both the 1987 and 2006 International Society for the Study of Vulvar Diseases (ISSVD) classifications. The ratios that were able to be approached on the specific diagnosis, with the aid the two classification systems, were compared. RESULTS: Specific clinical diagnosis by both pathological and after using clinicopathological correlation was possible in 69 out of 91 patients (75.8%) according to the 1987 ISSVD classification, and in 81 out of 91 patients (89.0%) according to the ISSVD 2006 classification system. The difference in the clinical diagnosis ratios between the two classification systems was statistically significant ( P < 0.05). In a subgroup of women without specific diagnosis at the time of pathological examination, clinical diagnosis was made in 28 out of 50 women (56%) after using the clinicopathological correlation according to the ISSVD 1987 classification, whereas, specific diagnosis was made in 39 out of 49 (79.6%) women after using the clinicopathological correlation according to the ISSVD 2006 classification. The difference was statistically significant in terms of the ratio of the ability to achieve a specific diagnosis (P < 0.01). CONCLUSION: ISSVD 2006 classification of nonneoplastic and noninfectious vulvar disease is more useful than the former classification, in terms of approaching the specific diagnosis of vulvar dermatoses.