Desquamative inflammatory vaginitis (DIV) is not frequently discussed in the literature. Please describe the presenting symptoms, diagnosis, and treatment. Are there any predisposing factors? Can this condition be prevented?—TRISH NIGLIO, PA, Elysburg, Pa.
DIV is a relatively rare and poorly understood disorder. Patients complain of purulent discharge, pain and/or burning, and varying degrees of dyspareunia. Physical exam is relatively benign, although areas of erythema and increased secretions are possible. Microscopy of the discharge typically reveals increased numbers of polymorphonuclear cells, immature squamous epithelial cells, and increased vaginal pH. Specimens may also have an abundance of gram-positive cocci; group B streptococci are usually present, although their role in the disorder is unknown. Absence of lactobacilli is also characteristic. DIV has been postulated to be an atypical presentation of pemphigus vulgaris, lichen planus, or membranous pemphigoid. Diagnosis should only be made if other forms of infectious or atrophic vaginitis have been ruled out through examination, microscopy, culture, or biopsy, as indicated by physical findings. Treatment is empirical. Patients may respond to a course of topical clindamycin (2%) or topical corticosteroids; duration of treatment has not been standardized. Treatment with antimicrobials or estrogens has been ineffective. Prevention is difficult since the exact pathogenesis is controversial (Dermatol Ther. 2004;17:47-49).—Claire Babcock O’Connell, MPH, PA-C (146-3)