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Prognosis and Treatment of Desquamative Inflammatory Vaginitis

Sobel, Jack D. MD; Reichman, Orna MD; Misra, Dawn MHS, PhD; Yoo, Wonsuk PhD

doi: 10.1097/AOG.0b013e3182117c9e
Original Research

OBJECTIVE: Desquamative inflammatory vaginitis is a clinical syndrome frequently unrecognized, characterized by vaginal rash and purulent discharge. We describe patient outcomes and treatment at follow-up in a case series of 98 women diagnosed with this syndrome.

METHODS: We performed a chart review of 130 patients diagnosed with desquamative inflammatory vaginitis between 1996 and 2007 in a referral university-based vaginitis clinic. Clinical findings, laboratory findings, and treatment were documented during the first 12 months and at 2 and 4 years.

RESULTS: Of the 98 patients reviewed, 97 were white; mean age was 48.6 years (plus or minus 10.2 years), and 50% were postmenopausal. All patients were symptomatic with vaginal inflammation and 72% had vestibular findings. Treatment with topical 2% clindamycin (54%) or 10% hydrocortisone (46%) dramatically relieved symptoms within 3 weeks (median) in 86% of patients. Treatment was discontinued (median 8 weeks) in 53 patients experiencing clinical remission accompanied by normal wet mount appearance; however, 17 (32%) relapsed within 6 weeks. At 1 year, cure was achieved in 25 patients (26%), 57 (58%) were asymptomatic but remained dependent on maintenance treatment, and 16 (16%) were partially controlled only. A favorable initial response to therapy was associated with positive clinical prognosis by 20 weeks of follow-up (P=.01).

CONCLUSION: Desquamative inflammatory vaginitis is a chronic inflammatory process involving both vagina and vestibule, occurring almost exclusively in white women, that responds well to topical anti-inflammatory therapy, although long-term maintenance therapy frequently is required.

LEVEL OF EVIDENCE: III

Desquamative inflammatory vaginitis is a chronic inflammatory process involving both vagina and vestibule, occurring almost exclusively in white women, that responds well to topical anti-inflammatory therapy.

From the Division of Infectious Diseases, Department of Medicine, and the Department of Family Medicine, Wayne State University School of Medicine, Detroit, Michigan.

See related articles on pages 828, 837, and 948.

Presented in part at the International Society for the Study of Vulvovaginal Disease Meeting, September 13–17, 2009, Edinburgh, Scotland.

Corresponding author: Jack D. Sobel, MD, Harper University Hospital, Division of Infectious Diseases, 3990 John R, Detroit, MI 48201; e-mail: jsobel@med.wayne.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.