Obstetrics & Gynecology

Skip Navigation LinksHome > February 2009 - Volume 113 - Issue 2, Part 2 > Vulvovaginal Pellagra and Lichen Sclerosus Complicating Carc...

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Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e318191bb51
Case Reports

Vulvovaginal Pellagra and Lichen Sclerosus Complicating Carcinoid Syndrome

Reichman, Orna MD; Sobel, Jack D. MD

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Abstract

BACKGROUND: Pellagra is a rare clinical syndrome caused by niacin deficiency, and although most commonly nutritional in origin, may be secondary to carcinoid syndrome.

CASE: A premenopausal nulliparous woman with metastatic carcinoid tumor developed isolated vulvovaginal manifestations characterized by well-demarcated symmetrical vulvar erythema, mild scaling, ulcerations, and dyspareunia. Tryptophan levels were low. Treatment with nicotinamide resulted in dramatic improvement; however, after 2 years of effective treatment, she developed lichen sclerosus.

CONCLUSION: Patients with carcinoid tumor presenting chronic vulvar lesions should be evaluated for pellagra. Subsequent development of lichen sclerosus at the site of vulvar dermatosis may be a feature of the “Koebner phenomenon,” which describes appearance of lichen sclerosus in scarred areas or sites prone to friction.

© 2009 by The American College of Obstetricians and Gynecologists.

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