Aphthous Ulcers (Acute Genital Ulceration, Lipschütz Ulcers, Non-Sexually Acquired Genital Ulceration, and Vulvar Aphthae)

Introduction

• Description: In general, vulvar ulcers are deep defects through the epidermis into the dermis that generally heal with scarring; they are deeper than erosions. They may be of infectious or noninfectious origin. Acute aphthous ulcers (acute genital ulceration, Lipschütz ulcers [named for Benjamin Lipschütz, who first described it in October, 1912], non-sexually acquired genital ulceration [NSAGU], and vulvar aphthae) are like the more common oral ulcers known as canker sores. These ulcers are the result of a localized vasculitis caused, in about one-third of cases, by various infections, most commonly Epstein-Barr virus, Mycoplasma pneumoniae, and viral respiratory infections (parvovirus, influenza, paramyxovirus). Other infections include tuberculosis, amebiasis, and leishmaniasis. There have even been reports of cases after COVID-19 infection and vaccination.

• Prevalence: Uncommon.

• Predominant Age: Most common in adolescent girls and young women, typically ages 8–25 years.

• Genetics: No genetic pattern. A family history of autoimmune disorders may be present.

Etiology and Pathogenesis

• Causes: Chronic or recurrent aphthous ulcers are often idiopathic.

• Risk Factors: Viral infection.

Signs and Symptoms

• Exquisitely painful ulcers appear quickly, evolving from a purpuric area that rapidly becomes necrotic, then ulcerating over 1–2 days.

• Normally shallow ulcers begin as pale yellow in color, generally turning gray as the condition develops.

• Flulike symptoms (fever, malaise, tonsillitis, lymphadenopathy) precede or accompany the ulcers.

• Multiple, bilateral ulcers are common.

Diagnostic Approach