Treatment of desquamative inflammatory vaginitis with vitamin D: a case report

Desquamative inflammatory vaginitis (DIV) is a well-described but poorly understood vaginitis associated with yellow vaginal discharge and vulvovaginal pruritus, burning, and dyspareunia. Although etiologies of an inflammatory, infectious, and hormonal nature have been proposed, response to therapy has been inconsistent and complete resolution of symptoms has been disappointing. We propose that DIV is a mucous membrane manifestation of vitamin D deficiency that results in desquamation of the vaginal epithelium and discharge. Moreover, we suggest that the loss of this epithelium leads to altered vaginal pH levels, mucous membrane fragility, inflammation, and secondary infection. Because vitamin D is a known transcriptional activator, we suggest that vitamin D is necessary for the synthesis of specific vaginal structural proteins, such as cytokeratins. Vitamin D deficiency results in decreased amounts of these proteins, resulting in loss of epithelial structural integrity and desquamation. Correction of the vitamin D deficiency ultimately leads to regeneration of the vaginal epithelium and cessation of desquamation.