The differential diagnosis must be made from herpes of the vulva. Both these forms further may be mistaken, in the stage of extensive ulceration, for syphilitic ulceration. Legendre has reported an interesting medico-legal case of the kind. The course of the disease evidently clears up the diagnosis.
Between eczema and herpes the diagnosis, in general, may be made in that in the first instance there is diffuse spreading, and in the latter an eruption in groups; in the former, further, the underlying tissues are more affected and infiltrated, while in the latter they are sound.
The prognosis, if the treatment be prompt and thorough, and if rub bing and scratching be not resorted to, is good. Still there are aggravated forms, especially on the mons veneris, which are difficult to treat. The most unpleasant symptom is the itching, which disturbs the patient both night and day. In the acute stage, during the burning and the swelling, the patients themselves ask for cold applications. The French physicians much prefer warm poultices. In general cold-water compresses relieve the symptoms best, but the water should be soft, rain water or boiled and filtered. To soften and remove the crusts, the different oils are of service, pure, with carbolic one part to eight, or else zinc oxide ointment made after Wilson's formula (oxide of zinc, tincture of henzoin, glycerine, lard, ol. amygdal. as 3 ii., gr. xxx.), or else Bell's calomel ointment (calomel 3 ii., lard 's: j.). Against the moisture the parts may be powdered with starch, or starch and sulphur. When the parts are less moist, liebra recommends the diachylon ointment, and similarly white precipitate oint ment, etc., are useful.
Where we wish to cauterize slightly, borax solution (1 to 12) or the zinc oxide with acetic acid (1 to 100) answer the purpose. The lime solu tions and soaps are useful for removing the crusts. Preparations of tar, according to lIebra, may give rise to itching and excessive moisture, so that they should be tried carefully. On harder surfaces, like the labia, they are not specially effective. Latterly iodoform has been recommended in case of eczema vulvve.
Herpes Vulvm. —This affection is characterized by the appearance of little vesicles, with clear contents in groups. We have already referred to
the differential diagnosis between eczema and herpes. • Corpulent women whose labia hang down deeply between the thighs, and where there is much secretion, are peculiarly liable to this affection. Possibly there is some causal connection between it and menstruation, since it is most likely to appear one to two days before the periods. There may be one or more groups of vesicles which burst and leave a superficial erosion. These remain till after menstruation and then disappear in a few days without leaving any trace. Pregnancy is a period when the disease is likely to appear owing to the tendency towards congestion. Vaginal discharge, unclean linen, rubbing and scratching by dirty drawers, immoderate coitus, such are other predisposing factors. A case of Legendre's would seem to prove that contact with blennorrheal discharge may give rise to herpes.
Herpes is accompanied by less redness and burning, in general, than acute eczema. The burning is found rather on the inner surface of the labia majors.
The course of the affection is typical. In about seven or eight days the vesicles disappear, dry up, or appear at another portion of the surface. Deep excoriations may form as the result of scratching and of rubbing. The appearance of the eruption worries those affected exceedingly. From syphilitic erosions and ulcerations herpes is differentiated by the border, which is not very round, by the intense itching, and by the deep red color instead of the coppery discoloration of syphilitic sores.
The treatment is to be directed in particular against the pruritus, lest the natural progress of the affection be disturbed. If the herpes is only present as one to two groups of vesicles, the simplest remedies are sufficient for cure—rest of the parts and frequent washing with warm or cold water. When painful ulceration is present, then our measures should be: rest in bed, warm baths prolonged for one hour, poultices, cold drinks, light diet. In case of vaginal catarrh lukewarm injections should be ordered. Thus in five to six days the patches will be healed.