A Systematic Review Of The External Treatment Of Vulvar White Lesions With Traditional Chinese Medicine

Objective:Literature review:White lesions of vulva is a group of diseases that vulva skin and mucous tissue denaturation and pigment changes are caused by nutrients disturbance. These diseases most commonly occurring during the prepubertal and perimenopausal years. The pathogenesis of white lesions of vulva is still not clear. It is believed that inheritance, autoimmunization and internal secretion give rise to vulva changes in vessels and nerves, which causes skin and mucous depigmentation accompanied with pruritus, ulceration, atrophy, vaginal orifice shrinkage, dyspareunia, etc. There are three types of white lesions of vulva including hyperplasia type, atrophic type and mixed type. The risk of developing malignancy exists. The main treatment includes medicine, operation, phototherapy and so on. This literature review summarize the knowing of white lesions of vulva.To evaluate the efficacy and safety of topical applied traditional Chinese medicine compared with other interventions in treatment of white lesions of vulva.Methods:Literature searches were comprehensively performed on several databases, including Cochrane Library, Medline, Springer, China National Knowledge Infrastructure (CNKI), Wanfang database and VIP database. Randomized controlled trials (RCTs) that met the standard were included. Risk and bias of the included literature were assessed referred to the Cochrane Collaboration. Data analysis was performed by RevMan5.3 provided by Cochrane Collaboration.Results:A total of 23 RCTs were included. Due to the exist of clinical heterogeneity, 17 RCTs were for meta-analysis, others for qualitative analysis.10 of 23 RCTs record adverse reaction,5 have clinical homogeneous for meta-analysis, others for qualitative analysis.11 of 23 RCTs mention follow-up,4 have clinical homogeneous for meta-analysis, others for qualitative analysis. The meta-analysis shows:The efficacy of traditional Chinese medicine is higher than topical western medicine [RR 1.33,95%CI(1.21,1.46), p<0.00001]; ② The efficacy of traditional Chinese medicine topical application is same as phototherapy [RR 0.93,95%CI(0.82,1.06), p=0.29];③The efficacy of traditional Chinese medicine associated with other interventions is higher than only the same intervention [RR 1.17, 95%CI(1.10,1.24), p<0.00001];④ The efficacy of traditional Chinese medicine associated with other interventions is higher than water washing before the same intervention [RR 1.46, 95%CI(1.20,1.78), p=0.0002];⑤ The safety of traditional Chinese medicine associated with phototherapy is higher than phototherapy only [RR 0.38,95%CI(0.16,0.95), p=0.04]; ⑥ The safety of traditional Chinese medicine is same as topical western medicine [RR 0.66, 95%CI(0.13,3.37), p=0.62];⑦ The recurrence of traditional Chinese medicine is lower than other treatments [RR 0.15,95%CI(0.08,0.27), p<0.00001];⑧ The recurrence of traditional Chinese medicine associated with phototherapy is same as phototherapy only [RR 0.24, 95%CI(0.04,1.35), p=0.10].Conclusion:Traditional Chinese medicine topical application is more efficacy than topical western medicine and less recurrence. Traditional Chinese medicine associated with phototherapy is more efficacy and safety than phototherapy only. Thus, Traditional Chinese medicine associated with phototherapy is recommended as a preferred intervention for white lesions of vulva.